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April 1979

Zinc Deficiency, Pellagra, or Both?

Author Affiliations

San Francisco

Arch Dermatol. 1979;115(4):507. doi:10.1001/archderm.1979.04010040079028

To the Editor.—  In their article "Acrodermatitis and Acquired Zinc Deficiency" (Arch Dermatol 114:937-939, 1978), Drs Ecker and Schroeter report the cutaneous and CNS findings of an anorexic woman with a long-standing history of alcoholism. Specifically, the patient showed a reticulated, crusting, maculopapular rash on the distal aspects of the upper and lower extremities, thighs, chest, and shoulders. The oral mucosae were atrophic. Serum zinc concentration was below normal and the alkaline phosphatase level was 434 units/L (normal, 21 to 91 units/L). A skin biopsy specimen showed chronic dermatitis. The patient responded promptly to multivitamin and zinc sulfate therapy.On the surface, this description appears to be a clear-cut case of the recently popularized zinc deficiency syndrome with typical cutaneous, CNS, and gastrointestinal manifestations that respond, often dramatically, to zinc therapy. However, in addition to an acral distribution, one finds the eruption in this syndrome more characteristically periorally, paranasally, periocularly,