Conditions · Vitamins and minerals
Zinc deficiency (acrodermatitis enteropathica) !
Lack of zinc causes dermatitis around the mouth, anus and hands, diarrhoea, hair loss, poor growth and infections.
Updated 2026-11-01
Structures involved
Tap one to see what it is and open it in 3D.
In biochemistry
Why it happens
- Severe acute malnutrition: marasmus and kwashiorkor
- What delays healing: infection, diabetes, nutrition, glucocorticoids, poor blood flow
What it is
An insufficient zinc state, acquired (diet, losses or malabsorption) or inherited (acrodermatitis enteropathica, from mutations of the ZIP4 transporter). It presents with the triad of acral and periorificial dermatitis, diarrhoea and alopecia.
Who gets it
Acquired deficiency is common in low- and middle-income countries, where it contributes to stunting and deaths from diarrhoea and pneumonia; in Colombia the national nutrition survey (ENSIN) has found it common in young children. Inherited acrodermatitis enteropathica is rare (about 1 in 500,000).
Causes
- Diet low in meat and high in phytates (unsoaked cereals and legumes)
- Chronic diarrhoea, Crohn disease, coeliac disease, bariatric surgery
- Alcoholism, cirrhosis, chronic kidney disease
- Zinc-free parenteral nutrition, extensive burns
- Acrodermatitis enteropathica: SLC39A4 (ZIP4) mutations, autosomal recessive
- Premature infants or breast milk low in zinc (transient form)
Risk factors
- Young children and pregnant women living in poverty
- Malnutrition
- Weaning (in the inherited form, when breast milk stops)
- Diabetes and sickle cell disease
Pathophysiology
Zinc is a cofactor of more than 300 enzymes and forms the zinc fingers of transcription factors. Its lack slows division of fast-turnover cells (skin, gut lining, T cells), hence dermatitis, diarrhoea and immune deficiency. Alkaline phosphatase falls, retinol-binding protein synthesis fails (night blindness), taste is disturbed and growth and sexual maturation are delayed. In the inherited form ZIP4 cannot carry zinc from the gut lumen into the enterocyte.
Classification
- Acquired (nutritional or from losses)
- Inherited acrodermatitis enteropathica (ZIP4 failure)
- Transient infant form from zinc-poor breast milk
Symptoms and signs
- Red, scaly or blistering dermatitis around the mouth, eyes, nose, anus and genitals, and on the hands and feet
- Loss of scalp hair, eyebrows and eyelashes
- Diarrhoea
- Irritability, poor appetite, impaired taste and smell
- Poor growth and delayed puberty; wounds that do not heal; repeated infections
- Paronychia and nail changes
Diagnosis
- Clinical
- Triad of periorificial and acral dermatitis, diarrhoea and alopecia; a quick response to zinc supports the diagnosis.
- Tests
- Low plasma zinc (fasting, interpreted with albumin and C-reactive protein); low alkaline phosphatase; SLC39A4 genetic testing in the inherited form.
- Imaging
- Not needed; skin biopsy shows pallor of the upper epidermis but is not specific.
Treatment
- Medical
- Oral zinc supplement; lifelong and at higher doses in acrodermatitis enteropathica
- Medical
- Zinc together with oral rehydration salts in children with acute diarrhoea
- Medical
- Treat the cause: malabsorption, chronic diarrhoea, alcoholism; add zinc to parenteral nutrition
- Lifestyle
- Diet with meat, shellfish, soaked legumes and whole grains
Complications
- Severe infections and sepsis
- Stunting (short stature)
- Hypogonadism
- Death in infants with untreated inherited disease
Prognosis
Excellent with zinc: skin and diarrhoea improve within days to weeks; the inherited form needs lifelong treatment.
Prevention
- Varied diets and fortified or biofortified foods
- Zinc in the management of childhood diarrhoea
- Zinc in parenteral nutrition
Test yourself
Think of the answer, then tap the question to see it.
What is the classic triad of acrodermatitis enteropathica?
Acral and periorificial dermatitis, diarrhoea and alopecia.
Which gene fails in the inherited form?
SLC39A4, encoding ZIP4, the transporter that carries zinc from the gut lumen into the enterocyte.
Why do symptoms of the inherited form often start at weaning?
Breast milk contains a ligand that aids zinc absorption; when it stops, the deficiency shows.
Which indirect lab clue suggests zinc deficiency?
Low alkaline phosphatase, because it is a zinc-dependent enzyme.
Why do phytates promote zinc deficiency?
They bind zinc in the gut and form complexes that cannot be absorbed.
Related conditions
- Vitamin A deficiency (night blindness and xerophthalmia)
- Acute (viral) gastroenteritis
- Coeliac disease
- Crohn disease
Educational information, not medical advice. For any symptom, see a health professional.
Sources: Zinc in diet: MedlinePlus Medical Encyclopedia (MedlinePlus, US National Library of Medicine, 2026); SLC39A4: Zinc transporter ZIP4 (human) (UniProt, 2026); Fact sheets - Malnutrition (World Health Organization, 2026); Textbook of Biochemistry for Medical Students, 6th ed. (Jaypee Brothers Medical Publishers (Vasudevan DM, Sreekumari S, Vaidyanathan K), 2011).
Spotted a mistake?We are always improving for the community. Tell us what is wrong and our team will review it.Report a mistake
Representative model, for educational purposes only.
