Three infants who have perioral and acral skin lesions

Zinc is an essential trace metal whose deficiency leads to growth retardation; an eczematous, vesiculobullous, and pustular rash over the perioral, perianal, and acral areas; alopecia; diarrhea; secondary bacterial and fungal infections; and neurologic, behavioral, and cognitive impairment. Zinc deficiency can result from a zinc-deficient diet, malabsorption (as in AE), a genetic disorder of intestinal zinc uptake, and increased losses. Oral zinc supplementation reverses most signs and symptoms of zinc deficiency, regardless of cause.