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+A 77-year-old woman with dysphagia presented with a two-week history of rash characterized by brown plaques with erythematous borders and overlying thick scales involving the face and a prior percutaneous endoscopic gastrostomy (PEG) tube site (Fig.1a, c).
+No oral or conjunctival involvement was present.
+She had been receiving parenteral nutrition for two months following removal of the PEG tube due to infection.
+Although the differential diagnosis included drug hypersensitivity, autoimmune disorders and nutritional deficiency, the rash appearance was most consistent with acrodermatitis enteropathica-like eruption secondary to zinc deficiency.
+Her serum zinc level was 12 mcg/dL (normal, 55–150 mcg/dL), and the rash resolved within one week of parenteral zinc supplementation (Fig.1b, d).
+Zinc is essential for protein synthesis and wound healing.
+Acrodermatitis enteropathica presents in infancy as a periorificial desquamative dermatitis, resulting from an autosomal recessive mutation that impairs zinc absorption. A similar syndrome may occur due to nutritional zinc deficiency, and has been reported in the setting of parenteral nutrition that fails to include zinc supplementation; a prompt response to supplementation helps to confirm the diagnosis.
+A recent national shortage of parenteral zinc in the United States likely contributed to this patient’s presentation.