Zinc-Responsive Acral Hyperkeratosis as a Sequela of Acrodermatitis Enteropathica

A 6-year-old boy with a history of inadequately treated acrodermatitis enteropathica (AE) developed zinc-responsive acral hyperkeratosis (ZRAH), characterized by persistent hyperkeratotic lesions on acral sites. Despite normal zinc levels, the boy exhibited symptoms such as hyperkeratotic plaques, yellowish-brown brittle hair, and nail abnormalities. Treatment with oral zinc sulfate and a zinc-rich diet led to significant improvement within 6 weeks, with marked recovery after 6 months. This case highlights ZRAH as a potential sequela of untreated AE, emphasizing the importance of recognizing and treating this condition, which mimics other hyperkeratotic disorders but requires specific zinc supplementation. Further studies are needed to explore the correlation between AE and ZRAH.