Med Clin (Barc).

2017;149(9):e49

www.elsevier.es/medicinaclinica

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Erosions and blisters in a premature infant with exclusive

breastfeeding夽
Erosiones y ampollas en un prematuro con lactancia materna exclusiva
Antonio Sahuquillo-Torralba a,∗ , Anaid Calle-Andrino a , Belén Ferrer-Lorente b ,
Montserrat Évole-Buselli a
a
Servicio de Dermatología, Hospital Universitari i Politècnic La Fe, Valencia, Spain
b
Servicio de Pediatría, Hospital Universitari i Politècnic La Fe, Valencia, Spain

Fig. 1. Fig. 2.

4-Month-old male who presents with a 5-day history of cutaneous lesions. As medical history of interest the patient was preterm
at 25 weeks and 5 days and had exclusive breastfeeding. Physical examination showed erythematous, erosive, scabby, peri-buccal, and
genital lesions, with vesicle-blister formation in the auricles and knuckles (Fig. 1). Given these cutaneous lesions, normally located in
periorificial and acral areas, the history of prematurity and exclusive breastfeeding, the diagnosis of acrodermatitis enteropathica due to
zinc intake deficiency was made. Laboratory tests showed zinc levels of 36 ␮g/dl (normal value 65–110 ␮g/dl), confirming the diagnosis.
After 1 month of treatment with oral zinc at doses of 1 mg/kg/day, the levels of zinc were back to normal and the lesions were resolved,
persisting some residual hyperpigmentation (Fig. 2). Once progressive feeding was started according to the age of the patient, no recurrence
was observed after withdrawal of zinc supplementation. The presence of periorificial and acral erosive-bullous lesions in preterm infants
with exclusive breastfeeding should lead us to think of a zinc deficiency due to deficient intake as the first diagnosis, requesting zinc and
alkaline phosphatase determinations together with early empiric treatment initiation to avoid neurological damage.

夽 Please cite this article as: Sahuquillo-Torralba A, Calle-Andrino A, Ferrer-Lorente B, Évole-Buselli M. Erosiones y ampollas en un prematuro con lactancia materna exclusiva.
Med Clin (Barc). 2017;149:e49.
∗ Corresponding author.
E-mail address: saucodos@gmail.com (A. Sahuquillo-Torralba).

2387-0206/© 2017 Published by Elsevier España, S.L.U.