Background Diaper rash is not an uncommon complaint in the newborn infant. The most common causes are irritant and candidal diaper dermatitis. However, other diagnoses need to be considered in the infant that does not respond to conventional therapy. We report a case of zinc deficiency presenting as a recalcitrant diaper rash in a 5 month-old female who was born at 24 weeks gestation age.
Case Our patient presented with a 5-week history of an erythematous rash that began in the perineum and progressed to involve the entire lower face with areas of excoriation and erythematous, crusted patches around the mouth and on the distal extremities. The rash did not show response to oral nystatin or topical lamisil. Because of persistence of the rash and an inter-current upper respiratory tract infection, the patient presented to our emergency department.The infant was admitted to hospital and started on intravenous cloxacillin for impetigo.The diagnosis of zinc deficiency was confirmed biochemically by a serum zinc level of 4 µmol/L (normal 11–18 µmol/L). The infant was started on oral zinc supplementation and the rash showed improvement by 48 hours. The infant was discharged home on oral zinc supplementation.
Discussion Zinc deficiency can be caused by congenital or acquired causes. The congenital form, also known as acrodermatitis enteropathica, is an autosomal recessive condition that leads to impaired zinc absorption. Acquired zinc deficiency is caused by a number causes including extensive burns, malabsorbtion syndromes, long term TPN, prematurity, drugs and renal tubular dysfunction. Our patient presented with classic acquired zinc deficiency secondary to prematurity. Premature infants are particularly susceptible to zinc deficiency because of diminished total body zinc stores, poor absorption of zinc in the first 2 months of life, increased zinc secretion by the intestine and increased zinc demands. This case illustrates how the common complaint of diaper dermatitis may be caused by rare causes such as zinc deficiency and that this diagnosis should be considered in patients with the classic perioral and perianal rash that does not respond to treatment for candidal or irritant diaper dermatitis.
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