Bullous acrodermatitis due to zinc deficiency during total parenteral nutrition: an ultrastructural study of the epidermal changes

Abstract

A 5 1/2-year-old girl with idiopathic intestinal pseudo-obstruction became severely depleted of zinc during total parenteral nutrition and developed a vesico-bullous rash on face, hands and feet such as is seen in acrodermatitis enteropathica. Light and electron microscopy of a bullous lesion on one foot revealed a pronounced extracellular edema with cyst and cleft formation in the deep part of the epidermis. A few acantholytic cells were seen. In the electron microscope degenerate keratinocytes showed multiple vacuoles in the dark cytoplasm and slender, finger-like protrusions. Desmosomes were few. The basal lamina was well-preserved forming deep invaginations, which may serve to distinguish the condition from other bullous diseases of the skin.