(BMJ)—A woman in her 50s, s/p L hemicolectomy for colon CA and on enteral feeding due to poor oral intake, developed a painful rash on her face and lumbosacral area. Exam: red lesions and erosions on face and low back; blisters on fingers; brittle hair. What’s the dx?
Candida dermatitis
Staphylococcal scalded skin syndrome
Seborrheic dermatitis
Acrodermatitis enteropathica
Epidermolysis bullosa
You are correct. Despite receiving zinc as a constituent of enteral nutrition, the patient’s plasma zinc levels were low, confirming a dx of acquired acrodermatitis enteropathica. Initially, seborrheic dermatitis and infected decubitus ulcer were considered as diagnoses, but the cutaneous sx worsened and the brittle hair and finger blisters suggested zinc deficiency. Consider acquired acrodermatitis enteropathica in patients who present with a combination of periorificial dermatitis and lumbosacral erosions and are malnourished, even when receiving enteral nutrition.

BMJ 2021;373:n1151