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Cystic Fibrosis Manifesting With Acrodermatitis Enteropathica-like Eruption: Association With Essential Fatty Acid and Zinc Deficiencies

Cystic Fibrosis Manifesting With Acrodermatitis Enteropathica-like Eruption: Association With... Abstract • A refractory dermatitis resembling acrodermatitis enteropathica was the manifesting sign in a 5-month-old male infant with cystic fibrosis, preceding pulmonary and gastrointestinal tract symptoms by two months. The eruption was clearly nutritionally responsive. Biochemical evidence was shown for deficiencies of zinc, essential fatty acids, and protein. Altered prostaglandin metabolism was also demonstrated. (Arch Dermatol 1983;119:51-55) References 1. Report of the Committee for a Study for Evaluation of Testing for Cystic Fibrosis . J Pediatr 1976;88:711-750.Crossref 2. Haning RV, Kieliszik FX, Alberino SP, et al: A radioimmunoassay for 13,14-dihydra-15-keto prostaglandin F2 with chromatography and internal recovery standard . Prostaglandins 1976;13:455-477.Crossref 3. MacGee J, Allen KG: Preparation of methyl esters from the saponifiable fatty acids in small biological specimens for gasliquid-chromatographic analysis . J Chromatogr 1974;100:35-42.Crossref 4. Moynahan EJ: Acrodermatitis enteropathica: A lethal inherited human zinc-deficiency disorder . Lancet 1974;2:399-400.Crossref 5. Arakawa T, Tamura T, Igarashi Y, et al: Zinc deficiency in two infants during total parenteral alimentation for diarrhea . Am J Clin Nutr 1976;29:197-204. 6. Arlette JP, Johnston MM: Zinc deficiency dermatosis in premature infants receiving prolonged parenteral alimentation . J Am Acad Dermatol 1981;5:37-42.Crossref 7. Williams RB, Russell RM, Dutta SK, et al: Alcoholic pancreatitis: Patients at high risk of acute zinc deficiency . Am J Med 1979;66:889-893.Crossref 8. Ackerman AB: Histologic Diagnosis of Inflammatory Skin Diseases . Philadelphia, Lea & Febiger, 1978, p 274. 9. Casey CE, Walravens PA, Hambidge KM: Availability of zinc: Loading tests with human milk, cow's milk, and infant formulas . Pediatrics 1981;68:394-396. 10. Neldner KN, Hambidge KM: Zinc therapy of acrodermatitis enteropathica . N Engl J Med 1975;292:879-882.Crossref 11. Der Kaloustian VM, Musallam SS, Sanjad SA, et al: Oral treatment of acrodermatitis enteropathica with zinc sulfate . Am J Dis Child 1976;130:421-423. 12. Hambidge KM: Trace element , in Pediatric Nutrition Handbook . Evanston, Ill, American Academy of Pediatrics, 1979, p 41. 13. Chase PH, Long MA, Lavin MH: Cystic fibrosis and malnutrition . J Pediatr 1979;95:337-347.Crossref 14. Halstead JA, Smith JC Jr: Plasma zinc in health and disease . Lancet 1970;1:322-324.Crossref 15. Palin HD, Underwood BA, Denning CR: The effect of oral zinc supplementation on plasma levels of vitamin A and retinalbinding protein in cystic fibrosis . Pediatr Res 1976;10:358. 16. Jacob RA, Sandstead H, Salomons NW, et al: Zinc status and vitamin A transport in cystic fibrosis . Am J Clin Nutr 1978;31:638-644. 17. Moynahan EJ: Zinc deficiency and disturbance of mood and visual behavior . Lancet 1976;1:91.Crossref 18. Rook A, Wilkinson DS, Ebling FJG: Textbook of Dermatology . Oxford, England, Blackwell Scientific Publication, 1979, p 2092-2093. 19. Golden MHN, Golden BE, Jackson AA: Skin breakdown in kwashiorkor responds to zinc . Lancet 1980;1:1256.Crossref 20. Hansen RC, Lynch PJ, Morrow GM: Proteolytic deficiency causing acrodermatitis enteropathica . Clin Res 1976;24:168. 21. Hubbard VS, Dunn GD, D'Sant Agnese PA: Abnormal fatty-acid composition of plasma-lipids in cystic fibrosis: A primary or secondary defect? Lancet 1977;2:1302-1304.Crossref 22. Hansen AE, Wiese HF, Boelsche AR, et al: Role of linoleic acid in infant nutrition . Pediatrics 1963;31:171-192. 23. Ginsburg R, Robertson A, Michel B: Acrodermatitis enteropathica: Abnormalities of fat metabolism and integumental ultrastructures in infants . Arch Dermatol 1976;112:653-660.Crossref 24. Cash R, Berger CK: Acrodermatitis enteropathica: Defective metabolism of unsaturated fatty acid . J Pediatr 1969;74:717-729.Crossref 25. Kayden HJ, Cox RP: Evidence for normal metabolism and interconversions of unsaturation in acrodermatitis enteropathica . J Pediatr 1973;83:993-998.Crossref 26. Horrobin DF, Cunnane SC: Interactions between zinc, essential fatty acids and prostaglandins: Relevance to acrodermatitis enteropathica, total parenteral nutrition, the glucagonoma syndrome, diabetes, anorexia nervosa and sickle cell anemia . Med Hypotheses 1980;6:277-296.Crossref 27. Norton JA, Kahn CR, Schiebinger R, et al: Amino acid deficiency and the skin rash associated with glucagonoma . Ann Intern Med 1979;91:213-215.Crossref 28. Charles BM, Hosking G, Green A, et al: Biotin-responsive alocia and developmental regression . Lancet 1979;2:118-120.Crossref 29. Thoene J, Baker H, Yoshino M, et al: Biotin-responsive carboxylase deficiency associated with subnormal plasma and urinary biotin . N Engl J Med 1981;304:817-820.Crossref 30. Mock DM, DeLorimer AA, Liebman WM, et al: Biotin deficiency: An unusual complication of parenteral alimentation . N Engl J Med 1981;304:820-823.Crossref 31. Lemen RJ, Gates AJ, Mathe AA, et al: Relationships among digital clubbing, disease severity and serum prostaglandins F2a and E concentrations in cystic fibrosis patients . Am Rev Respir Dis 1978;117:639-646. 32. Lemen RJ, Revsin B, Corrigan JJ, et al: Abnormal prostaglandin (PG) metabolism and platelet function in cystic fibrosis (CF) patients , abstracted. Pediatr Res 1981;15:724.Crossref 33. Weissmann G, Smolen JE, Korchak H: Prostaglandins and inflammation: Receptor/cyclase coupling as an explanation of why PGEs and PGI2 inhibit functions of inflammatory cells , in Samuelsson B, Ramwell P, Paoletti P (eds): Advances in Prostaglandin and Thromboxane Research . New York, Raven Press, 1980, vol 8, pp 1637-1653. 34. Hornstra G, Haddeman E, Don JA: Some investigations into the role of prostacycline in thromboregulation . Thromb Res 1978;12:367-374.Crossref 35. Mathias MM, Dupont J: The relationship of dietary fats to prostaglandin biosynthesis . Lipids 1979;14:247-252.Crossref 36. VanDorp D: Recent developments in the biosynthesis and the analyses of prostaglandins . Ann NY Acad Sci 1971;180:181-199. 37. Tan WC, Privett OS: Studies on the synthesis of prostaglandins in the vesicular glands of essential fatty acid-deficient and hypophysectomized rats . Biochem Biophys Acta 1973;296:586-592.Crossref http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Dermatology American Medical Association

Cystic Fibrosis Manifesting With Acrodermatitis Enteropathica-like Eruption: Association With Essential Fatty Acid and Zinc Deficiencies

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Publisher
American Medical Association
Copyright
Copyright © 1983 American Medical Association. All Rights Reserved.
ISSN
0003-987X
eISSN
1538-3652
DOI
10.1001/archderm.1983.01650250055016
Publisher site
See Article on Publisher Site

Abstract

Abstract • A refractory dermatitis resembling acrodermatitis enteropathica was the manifesting sign in a 5-month-old male infant with cystic fibrosis, preceding pulmonary and gastrointestinal tract symptoms by two months. The eruption was clearly nutritionally responsive. Biochemical evidence was shown for deficiencies of zinc, essential fatty acids, and protein. Altered prostaglandin metabolism was also demonstrated. (Arch Dermatol 1983;119:51-55) References 1. Report of the Committee for a Study for Evaluation of Testing for Cystic Fibrosis . J Pediatr 1976;88:711-750.Crossref 2. Haning RV, Kieliszik FX, Alberino SP, et al: A radioimmunoassay for 13,14-dihydra-15-keto prostaglandin F2 with chromatography and internal recovery standard . Prostaglandins 1976;13:455-477.Crossref 3. MacGee J, Allen KG: Preparation of methyl esters from the saponifiable fatty acids in small biological specimens for gasliquid-chromatographic analysis . J Chromatogr 1974;100:35-42.Crossref 4. Moynahan EJ: Acrodermatitis enteropathica: A lethal inherited human zinc-deficiency disorder . Lancet 1974;2:399-400.Crossref 5. Arakawa T, Tamura T, Igarashi Y, et al: Zinc deficiency in two infants during total parenteral alimentation for diarrhea . Am J Clin Nutr 1976;29:197-204. 6. Arlette JP, Johnston MM: Zinc deficiency dermatosis in premature infants receiving prolonged parenteral alimentation . J Am Acad Dermatol 1981;5:37-42.Crossref 7. Williams RB, Russell RM, Dutta SK, et al: Alcoholic pancreatitis: Patients at high risk of acute zinc deficiency . Am J Med 1979;66:889-893.Crossref 8. Ackerman AB: Histologic Diagnosis of Inflammatory Skin Diseases . Philadelphia, Lea & Febiger, 1978, p 274. 9. Casey CE, Walravens PA, Hambidge KM: Availability of zinc: Loading tests with human milk, cow's milk, and infant formulas . Pediatrics 1981;68:394-396. 10. Neldner KN, Hambidge KM: Zinc therapy of acrodermatitis enteropathica . N Engl J Med 1975;292:879-882.Crossref 11. Der Kaloustian VM, Musallam SS, Sanjad SA, et al: Oral treatment of acrodermatitis enteropathica with zinc sulfate . Am J Dis Child 1976;130:421-423. 12. Hambidge KM: Trace element , in Pediatric Nutrition Handbook . Evanston, Ill, American Academy of Pediatrics, 1979, p 41. 13. Chase PH, Long MA, Lavin MH: Cystic fibrosis and malnutrition . J Pediatr 1979;95:337-347.Crossref 14. Halstead JA, Smith JC Jr: Plasma zinc in health and disease . Lancet 1970;1:322-324.Crossref 15. Palin HD, Underwood BA, Denning CR: The effect of oral zinc supplementation on plasma levels of vitamin A and retinalbinding protein in cystic fibrosis . Pediatr Res 1976;10:358. 16. Jacob RA, Sandstead H, Salomons NW, et al: Zinc status and vitamin A transport in cystic fibrosis . Am J Clin Nutr 1978;31:638-644. 17. Moynahan EJ: Zinc deficiency and disturbance of mood and visual behavior . Lancet 1976;1:91.Crossref 18. Rook A, Wilkinson DS, Ebling FJG: Textbook of Dermatology . Oxford, England, Blackwell Scientific Publication, 1979, p 2092-2093. 19. Golden MHN, Golden BE, Jackson AA: Skin breakdown in kwashiorkor responds to zinc . Lancet 1980;1:1256.Crossref 20. Hansen RC, Lynch PJ, Morrow GM: Proteolytic deficiency causing acrodermatitis enteropathica . Clin Res 1976;24:168. 21. Hubbard VS, Dunn GD, D'Sant Agnese PA: Abnormal fatty-acid composition of plasma-lipids in cystic fibrosis: A primary or secondary defect? Lancet 1977;2:1302-1304.Crossref 22. Hansen AE, Wiese HF, Boelsche AR, et al: Role of linoleic acid in infant nutrition . Pediatrics 1963;31:171-192. 23. Ginsburg R, Robertson A, Michel B: Acrodermatitis enteropathica: Abnormalities of fat metabolism and integumental ultrastructures in infants . Arch Dermatol 1976;112:653-660.Crossref 24. Cash R, Berger CK: Acrodermatitis enteropathica: Defective metabolism of unsaturated fatty acid . J Pediatr 1969;74:717-729.Crossref 25. Kayden HJ, Cox RP: Evidence for normal metabolism and interconversions of unsaturation in acrodermatitis enteropathica . J Pediatr 1973;83:993-998.Crossref 26. Horrobin DF, Cunnane SC: Interactions between zinc, essential fatty acids and prostaglandins: Relevance to acrodermatitis enteropathica, total parenteral nutrition, the glucagonoma syndrome, diabetes, anorexia nervosa and sickle cell anemia . Med Hypotheses 1980;6:277-296.Crossref 27. Norton JA, Kahn CR, Schiebinger R, et al: Amino acid deficiency and the skin rash associated with glucagonoma . Ann Intern Med 1979;91:213-215.Crossref 28. Charles BM, Hosking G, Green A, et al: Biotin-responsive alocia and developmental regression . Lancet 1979;2:118-120.Crossref 29. Thoene J, Baker H, Yoshino M, et al: Biotin-responsive carboxylase deficiency associated with subnormal plasma and urinary biotin . N Engl J Med 1981;304:817-820.Crossref 30. Mock DM, DeLorimer AA, Liebman WM, et al: Biotin deficiency: An unusual complication of parenteral alimentation . N Engl J Med 1981;304:820-823.Crossref 31. Lemen RJ, Gates AJ, Mathe AA, et al: Relationships among digital clubbing, disease severity and serum prostaglandins F2a and E concentrations in cystic fibrosis patients . Am Rev Respir Dis 1978;117:639-646. 32. Lemen RJ, Revsin B, Corrigan JJ, et al: Abnormal prostaglandin (PG) metabolism and platelet function in cystic fibrosis (CF) patients , abstracted. Pediatr Res 1981;15:724.Crossref 33. Weissmann G, Smolen JE, Korchak H: Prostaglandins and inflammation: Receptor/cyclase coupling as an explanation of why PGEs and PGI2 inhibit functions of inflammatory cells , in Samuelsson B, Ramwell P, Paoletti P (eds): Advances in Prostaglandin and Thromboxane Research . New York, Raven Press, 1980, vol 8, pp 1637-1653. 34. Hornstra G, Haddeman E, Don JA: Some investigations into the role of prostacycline in thromboregulation . Thromb Res 1978;12:367-374.Crossref 35. Mathias MM, Dupont J: The relationship of dietary fats to prostaglandin biosynthesis . Lipids 1979;14:247-252.Crossref 36. VanDorp D: Recent developments in the biosynthesis and the analyses of prostaglandins . Ann NY Acad Sci 1971;180:181-199. 37. Tan WC, Privett OS: Studies on the synthesis of prostaglandins in the vesicular glands of essential fatty acid-deficient and hypophysectomized rats . Biochem Biophys Acta 1973;296:586-592.Crossref

Journal

Archives of DermatologyAmerican Medical Association

Published: Jan 1, 1983

References