Figure 1 Periorificial lesions on face in an extensive case. Figure 2 Lesions on buttocks. Marked margins, erosions, and brown crusts. One child presented with poliosis which underwent complete repigmentation after therapy with zinc supplement. high throughput screening All children were totally or partially breast fed. Some of them were referred late to our facility by other health facilities after they had received systemic
antibiotics without improvement with already widespread lesions. None of them had signs or symptoms of diarrhea, irritability, severe growth failure, or burns. Their general condition was good, except for that only child affected by moderate malnutrition. Whether they were of normal birth weight and gestational age remained unknown. However, none of them reported any history of prematurity. Moreover, since they were living in rural villages with scanty health facilities, they were not likely to be significantly preterm unless they had a history of admission to the referral hospital. Cutaneous manifestations were mostly moderate to severe and with ulceration or erosions (Table 1). Table 1 Mean features of the patients. All of them showed a good and prompt improvement after short course of oral zinc supplement (3mg/kg/day for 2-3 months). None of the
patients had relapse of the lesions after discontinuing the treatment. For this reason, our diagnosis was transient neonatal zinc deficiency (TNZD). Zinc levels in the patient’s and mother’s blood and in the mother’s milk could not be measured, and mutation
screening of the SLC30A2 gene could not be performed because of the lack of diagnostic facilities in this region of Ethiopia. However, all the mothers were in good general health and had no cutaneous manifestations. One patient had positive family history for the same disease (one brother). We are not able to demonstrate whether other brothers/sisters presented mild signs of the disease; these were not reported by the mothers. One patient presented with an unusual “facies” characterized by hypertelorism, prominent ears, and slightly small sized head, making us think of an associated chromosomal anomaly which was not possible to diagnose GSK-3 as there were no facilities for chromosome mapping. One patient also had polydactyly, a common congenital defect encountered in this region. One patient presented with associated scabies, which is also a highly prevalent disease in this region. 3. Discussion Transient neonatal zinc deficiency (TNZD) is mainly observed in breast-fed infants and does not reoccur after weaning . We think that the number of cases observed in Northern Ethiopia is very high as other reports in the literature are mostly single-case or two-case reports [2, 3, 6–12].