Acrodermatitis enteropathica: unveiling the zinc connection in skin and systemic health

Acrodermatitis enteropathica is a rare zinc deficiency disorder presenting in infancy with characteristic acral and periorificial dermatitis. A two-month-old infant was brought to the outpatient department with scrotal discoloration and perineal erythema of recent onset. There was no history of diarrhea or systemic illness. On examination, the lesion appeared as an edematous, erythematous discoloration involving the scrotum and adjacent perineal region, an atypical early presentation that may mimic common dermatological conditions. Laboratory evaluation revealed low serum zinc levels (48 μg/dL). Based on clinical findings and biochemical evidence, a provisional diagnosis of acrodermatitis enteropathica was made. Differential diagnoses considered included atopic dermatitis, seborrheic dermatitis, and biotinidase deficiency. The infant was treated with oral zinc supplementation (1-3 mg/kg/day of elemental zinc), resulting in rapid clinical improvement. After one month, serum zinc levels increased to 70 μg/dL, with resolution of skin lesions. The favorable response confirmed the diagnosis. This case emphasizes that isolated genital involvement can be an early manifestation of zinc deficiency, and timely recognition is essential to prevent progression and systemic complications.