A BREAST-FED 4-month-old infant was well until 10 weeks of age, when a rash developed on his right cheek. The rash did not respond to topical steroids or systemic antibiotics, and it spread to his entire face and scalp, as well as to his extremities and patchy areas of the trunk and groin. Decreased weight gain was noted in the last month. There was no history of diarrhea.
On physical examination, the infant appeared well and interactive. Multiple, erythematous, thin, scaly papules and plaques were present on his face, predominantly in the perioral and periorbital areas (Figure 1). Similar lesions were present on the scalp, trunk, and extremities. His genital and gluteal regions revealed markedly erythematous, scaly, eroded plaques (Figure 2).
Laboratory tests performed the results of which were normal included a complete blood cell count; sweat chloride, antinuclear, anti-Ro, and anti-La antibodies; and serum electrolyte levels. The alkaline phosphatase level was low normal, 52 U/L (reference range, 47-191 U/L). Additional laboratory information: the serum zinc level was decreased to 4.0 µmol/L; reference range, 7.7 to 24.5 µmol/L. The maternal serum zinc level was 14.8 µmol/L.
Mancini AJ, Tunnessen WW. Picture of the Month. Arch Pediatr Adolesc Med. 1998;152(12):1239-1240. doi:10.1001/archpedi.152.12.1239