Brandt syndrome (BS) is also called acrodermatitis enteropathica (AE). It is a congenital disease that causes zinc deficiency due to malabsorption. Inherited in an autosomal recessive pattern, BS characteristically presents with dermatitis, diarrhea and hair loss.
Brandt syndrome (BS) is an autosomal recessive inborn error of metabolism that usually occurs in early childhood, particularly in children who have recently been weaned off breast milk, or a few weeks after birth in children who are not breast fed. Symptoms are primarily due to zinc deficiency, secondary to reduced absorption of zinc . Acquired deficiency of this mineral is seen in adulthood, and the signs are the same as those of BS   . Zinc deficiency can be caused by various factors, like restricted diet, gastrointestinal pathologies such as celiac disease, alcoholism, excessive intake of phytates, burns and renal disease  .
The clinical triad for BS is dermatitis, diarrhea, and alopecia, although few patients present in this way . Dermatitis characteristic of BS includes periorificial, around the mouth and eyes, and acral dermatitis, which affects the extremities. Skin lesions may be pustular, vesicular, erythematous and crusted. In addition, they have a clear demarcation and may resemble eczema or psoriasis. As the condition progresses, lesions may spread to other areas of the body such as the buttocks and thighs. Alopecia is noted in the hair as well as eyebrows and eyelashes. Other dermatological symptoms are dysmorphic nails and superimposed bacterial or fungal infection. The latter may make the correct diagnosis even more difficult to ascertain.
Involvement of mucosal surfaces may manifest in the form of blepharitis, conjunctivitis and inflamed gums and stomatitis . Furthermore, patients may also show changes in mood, photophobia, increased susceptibility to infection, mental dullness, a reduced sense of taste and anorexia. In infants, additional symptoms comprise of failure to thrive, growth retardation and irritability.
Diagnosis of BS incorporates clinical assessment as well as laboratory studies. In a patient suspected to have BS because of their clinical symptoms, serum zinc levels, which may be depleted, can be calculated. A value less than 50 micro-grams per deciliter implies BS . Measuring zinc in the hair and urine is also done, but this is not common . Serum alkaline phosphatase levels may be low. If it is in the normal range, however, this does not rule out BS. Further, the administration of zinc and an improvement in symptoms is used to confirm the diagnosis.
Genetic testing for the mutation in the solute carrier family 39 member 4 (SLC39A4) gene are not routinely available.
Light and electron microscopy may be utilized in the analysis of biopsy samples. A breast feeding infant's mother can have her breast milk screened for low zinc, as an inadequate concentration in breast milk may be the cause of zinc deficiency in an infant .
Histological examination of lesions yields findings such as neutrophils in the epidermal layer as well as abnormal keratinization of the epidermis, pallor, tissue necrosis and hyperplasia. However, such details may also be noticed in other nutritional diseases.