Individuals with zinc deficiency present with the following signs and symptoms [7] [8]:

• Delayed growth and development
• Fertility issues
• Diarrhea
• Unexplained weight loss
• Loss of appetite
• Development of several skin diseases, such as eczema, acne, alopecia, xerosis, and seborrheic dermatitis
• Delay in wound healing
• Onset of mouth ulcers, stomatittis, burning mouth syndrome and angular cheilitis
• Frequent susceptibility to respiratory infections due to poor immunity
• Delay in onset of puberty and decrease in circulating testosterone

• Anorexia

  We present a case of zinc deficiency secondary to starvation induced by anorexia nervosa. [ncbi.nlm.nih.gov]

  Although it is clear that zinc deficiency produces specific and profound anorexia in experimental animals, the connection between zinc deficiency and anorexia is less certain. [doi.org]

  Anorexia and zinc deficiency in humans. Although it is clear that zinc deficiency produces a specific and profound anorexia in experimental animals, the connection between zinc deficiency and human anorexia is less certain. [jn.nutrition.org]

• Weight Loss

  CASE REPORT: After undergoing vertical gastroplasty and jejunoileal bypass, a female patient presented marked weight loss and protein deficiency. [ncbi.nlm.nih.gov]

• Malnutrition

  Malnutrition, prematurity, total parenteral nutrition dependence, and burns increase the demand for zinc, whereas congenital malabsorption syndromes represent clinical situations where less zinc is supplied to the growing child. [ncbi.nlm.nih.gov]

  HarvestPlus program seeks to reduce micronutrient malnutrition among the poor by breeding staple food crops that are rich in micronutrients through a process called biofortification. [harvestzinc.org]

  Expanded and updated chapters on international nutrition, including protein energy malnutrition and community nutrition. [books.google.com]

• Short Stature

  Deficiency of zinc is associated with short stature, anemia, increased pigmentation of skin (hyperpigmentation), enlarged liver and spleen (hepatosplenomegaly), impaired gonadal function (hypogonadism), impaired wound healing, and immune deficiency. [medicinenet.com]

  Complications can include motor delays, skeletal deformities, and chronic growth problems that can result in short stature, seizures, and dental defects. [adoptionnutrition.org]

  Signs of a Zinc Deficiency Common clinical symptoms of zinc deficiency are: short stature immune dysfunction hypogonadism skin disorders cognitive impairments anorexia Adequate intake of dietary zinc does not always equal adequate absorption. [mensahmedical.com]

  With zinc being required in the production of reproductive hormones, a deficiency can cause low birth weight, short stature, delayed testicular development, undescended testicles and generally poor mental and physical development in children. [growyouthful.com]

• Delayed Growth and Development

  Individuals with zinc deficiency present with the following signs and symptoms: Delayed growth and development Fertility issues Diarrhea Unexplained weight loss Loss of appetite Development of several skin diseases, such as eczema, acne, alopecia, xerosis [symptoma.com]

  development Delayed sexual maturation Skin lesions: These are commonly seen in association with conditions such as acrodermatitis enteropathica. [dovemed.com]

• Anosmia

  Anosmia after intranasal zinc gluconate use. Am J Rhinol 2004;18:137-41. [ PubMed abstract ] Alexander TH, Davidson TM. Intranasal zinc and anosmia: the zinc-induced anosmia syndrome. Laryngoscope 2006;116:217-20. [ PubMed abstract ] U.S. [ods.od.nih.gov]

  It has been noted that some people with anorexia nervosa lose the sense of taste, this links with zinc deficiency as it is known that some people with zinc deficiency have a poor sense of taste (ageusia) and smell (anosmia). [healthstatus.com]

  There have been reports of anosmia with intranasal zinc preparations. [ 17, 18 ] Gastrointestinal effects, including abdominal pain, dyspepsia, nausea, vomiting, diarrhoea, gastric irritation, and gastritis. [ 9 ] This is more likely when supplements [patient.info]

• Vomiting

  4 adverse effects 2 or 3 diarrhoea diarrhoea 2 or 3 2 or 3 adverse effects 5 — 1 and 4 diarrhoea morbidity 1 and 4 1 and 4 — 6 — vomiting morbidity 4 or 5 vomiting vomiting — 7 — adverse effects MORBIDITY 3 and 6 adverse effects adverse effects — 8 — [doi.org]

  No fever, weight loss, diarrhea, vomiting, abdominal pain, chronic cough, dyspnea, change in appetite, change in bowel habit, or urinary symptoms were noted. [ncbi.nlm.nih.gov]

  […] loss Decreased appetite When to see a doctor See your doctor if you have a persistent, burning, aching or gnawing pain in your upper abdomen, especially if you've also been experiencing nausea, vomiting and diarrhea. [mayoclinic.org]

  Excessive intake can be toxic, causing nausea, vomiting, headache, and abdominal pain. Continued intake of zinc in excess quantities can lead to organ failure and can even be fatal. © Newsmax. All rights reserved. [newsmax.com]

• Nausea

  Nausea iStock/monkeybusinessimages While nausea may be a symptom of a zinc deficiency, it may also be a sign of an overdose as well. Overdoses would most likely occur from a zinc supplementation, Dr. Hadjiev says. [rd.com]

  Lozenges containing at least 75 mg have been the most widely studied but their use needs to be balanced against side-effects of nausea and bad taste. [patient.info]

  […] loss Decreased appetite When to see a doctor See your doctor if you have a persistent, burning, aching or gnawing pain in your upper abdomen, especially if you've also been experiencing nausea, vomiting and diarrhea. [mayoclinic.org]

  […] drainage) Neuralgia in arms and legs (A) Tingling hands (B6) Numbness or cramps in arms and legs (B6) Carpal tunnel syndrome (B6) Anaemia (B6) Reactions to monosodium glutamate (Chinese restaurant syndrome) (B6) Hypoglycaemia (B6) Water retention (B6) Nausea [adhd-support.org.uk]

• Failure to Thrive

  Links: acrodermatitis enteropathica diarrhoea alopecia failure to thrive taste disturbance [gpnotebook.co.uk]

  In addition, he manifested a failure to thrive and irritability. The diagnosis was confirmed by reduced serum levels of zinc (2.3 mumol/l) and alkaline phosphatase (45 U/l). [ncbi.nlm.nih.gov]

  […] to thrive Infections and allergic illness in offspring (e.g. diarrhoea, eczema) Childhood and Adolescence "Growing pains" in muscles and joints (Cu) Hyperactivity (Cu) Autism School phobia Eating dirt and strange substances (pica) Behavioural problems [adhd-support.org.uk]

  Hair loss, nail dystrophy, failure to thrive and severe diarrhoea are also features. Atrophy of the brain cortex can lead to irritability and emotional disturbances. Secondary bacterial and fungal infections may also occur. [patient.info]

• Intestinal Disease

  Because zinc is primarily absorbed in the small intestines, diseases that affect them can increase the risk for loss. These conditions commonly include, infection, diarrhea, and IBS. [glutenfreesociety.org]

• Dysgeusia

  The serum Cu/Zn ratio was positively correlated with the both the SRT and the awareness of dysgeusia. The serum Zn concentration was not correlated with the SRT or the awareness of dysgeusia in univariate analyses. [ncbi.nlm.nih.gov]

  J Clin Psychiatry 55, 309 – 311. 25 Heckmann, SM, Hujoel, P, Habiger, S, Friess, W, Wichmann, M, Heckmann, JG & Hummel, T ( 2005 ) Zinc gluconate in the treatment of dysgeusia – a randomized clinical trial. [doi.org]

• Night Blindness

  In children or adults, manifestations also include alopecia, impaired immunity, anorexia, dermatitis, night blindness, anemia, lethargy, and impaired wound healing. [merckmanuals.com]

  […] fingernails Dandruff Decreased appetite Diarrhea Dry skin, prone to rashes Eye irritation or infections Failing Eyesight Anemia Hair Loss Hyperactive Infertility Insomnia Loss of sense of smell and/or taste Memory Impairment Nail cuticle inflammation Night [vitamins.lovetoknow.com]

  Night blindness can be another symptom. 7. Psychological disorders : Zinc deficiency could play a major role in depression. 8. Acne or rashes : People who have zinc deficiency can face various skin problems like rashes and acne. [food.ndtv.com]

• Visual Impairment

  [interaction with the 'normal' people' is a strange nexus] He also describes some of the practical difficulties in processing information with a visual impairement. Richard Patterson (Governor of New York is visually impaired. [indymedia.ie]

• Skin Lesion

  We report two cases of premature infants, breast-fed only, who showed skin lesions resembling acrodermatitis enteropathica. [ncbi.nlm.nih.gov]

• Alopecia

  Links: acrodermatitis enteropathica diarrhoea alopecia failure to thrive taste disturbance [gpnotebook.co.uk]

  The administration of zinc for zinc deficiency-related alopecia may recover appropriate activities of metalloenzymes, hedgehog signaling, and immunomodulation, all of which are required for normal control of hair growth cycle. [ncbi.nlm.nih.gov]

• Eczema

  Studies on Zinc Deficiency and Eczema Zinc Levels in Eczema A 2009 study published in the Turkish Journal of Dermatology investigated the serum levels of trace metals in patients with hand eczema. [progressivehealth.com]

  The infants were both initially misdiagnosed as having eczema and infection. [ncbi.nlm.nih.gov]

  Zinc is commonly taken as a supplement to help with skin conditions such as acne or eczema. The basis of zinc therapy lies in the fact that the mineral is necessary for normal cell division, tissue repair and renewal. [diagnose-me.com]

  […] of thighs (glossy skin) (A) Small bumps in skin of side and back of upper arm (A) Acne (A) Boils (A) Warts (A) Mouth ulcers (A) Sore tongue and mouth (B6) Cracks around mouth and split lips (B6) Leg ulcers (together with poor circulation) Dermatitis Eczema [adhd-support.org.uk]

  Symptoms of Zinc Deficiency Behavioral and sleep disturbances Delayed wound healing Diarrhea Joint pain Dandruff Eczema Skin rashes Growth retardation Hair loss Hyperactivity Increased allergic sensitivity Inflammatory bowel disease Loss of appetite Mild [adoptionnutrition.org]

• Delayed Wound Healing

  Clinical manifestations include growth retardation and male hypogonadism in adolescence, rough skin, poor appetite, mental lethargy, delayed wound healing, cell-mediated immune dysfunctions, and abnormal neurosensory changes. [ncbi.nlm.nih.gov]

  Symptoms of Zinc Deficiency Behavioral and sleep disturbances Delayed wound healing Diarrhea Joint pain Dandruff Eczema Skin rashes Growth retardation Hair loss Hyperactivity Increased allergic sensitivity Inflammatory bowel disease Loss of appetite Mild [adoptionnutrition.org]

  It is characterized by delayed wound healing and susceptibility to infection, growth detardation, fatigue, decreased alertness, a decrease in taste and odor sensitivity, poor appetite and delayed sexual maturity. [drugs.com]

  […] such as: frequent infections delayed wound healing reduced appetite decreased sense of taste and smell (sometimes also associated with low iron levels) poor skin condition white flecks on the nails A very severe zinc deficiency will lead to stunted growth [diagnose-me.com]

  You can have abdominal pain, loss of hair, loss of appetite, delayed wound healing,” Dr. Hadjiev says. “You can be depressed, you can have eczema or dermatitis, especially if it’s around the mouth or the anus.” [rd.com]

• Skin Rash

  Reported here is a patient who developed characteristic skin changes while he was receiving what was considered to be a balanced liquid enteral diet. The skin rash resolved with Zn supplementation. [ncbi.nlm.nih.gov]

  Deficiency can lead to a scaly red skin rash, especially around the mouth, on the hands, and in the groin. It can also lead to diarrhea, loss of appetite, and a risk for infections.” [todaysgeriatricmedicine.com]

  Symptoms of Zinc Deficiency Behavioral and sleep disturbances Delayed wound healing Diarrhea Joint pain Dandruff Eczema Skin rashes Growth retardation Hair loss Hyperactivity Increased allergic sensitivity Inflammatory bowel disease Loss of appetite Mild [adoptionnutrition.org]

  Acne or skin rashes: Some people with zinc deficiency also experience acne and skin rashes. Zinc is responsible for the formation and maintenance of oil glands, which can help decrease acne breakouts. [doctorshealthpress.com]

  Skin Cancer: Zinc supplementation can also lower the risk of skin cancer, however its direct association is uncertain. [thetruthaboutcancer.com]

• Mood Swings

  Zinc deficiency or imbalance with other minerals (especially iodine) is associated with hyperactivity, ADD and ADHD, anxiety, cognitive decline, depression, irritability, nervousness, emotional instability, memory problems, mood swings, bipolar disorder [growyouthful.com]

• Ataxia

  Neuropsychiatric signs include irritability, emotional instability, tremors, and occasional cerebellar ataxia. Weight loss, growth retardation, and male hypogonadism are also prominent clinical features. [doi.org]

  For example, low serum zinc levels have been reported in Autism Spectrum Disorders (ASD), Attention deficit hyperactivity disorder (ADHD), Mood Disorders, such as depression, Schizophrenia (SCZ), and Spinocerebellar ataxia type 2 ( Pfaender and Grabrucker [dx.doi.org]

• Apathy

  Mental Symptoms Anxiety Tension and nervousness (Cu) Insomnia (Cu, B6, A) Sleepiness (B6) Irritability (Cu, B6) Aggression (Cu) Depression (Cu, B6, A) Tearfulness (Cu) Reduced mental alertness Inability to concentrate (Cu, B6) Forgetfulness and amnesia Apathy [adhd-support.org.uk]

  Irritability, agitation, apathy, aggression, anhedonia, and self-injurious behavior are summarized by “behavioral abnormalities”. [dx.doi.org]

• Difficulty Concentrating

  Hadjiev notes nervousness and difficulties concentrating as additional symptoms. Here are the signs you might not be getting enough vitamin D. How to eat more zinc iStock/Marco_Piunti Some of the tastiest foods are also rich in zinc. [rd.com]

Measuring the plasma levels of zinc, forms the preliminary basis of diagnosis. In infants with acroderatitis enteropathica, the plasma levels are as low as < 50 mcg/dL. Biopsy of the skin or intestinal mucosa is not indicated in diagnosing zinc deficiency [9]. In addition to plasma zinc levels, other studies that provide useful insight for diagnosing zinc deficiency, include urinary excretion of zinc and metabolic balance studies, measuring activities of enzymes that are dependent on zinc, zinc tolerance test and copper:zinc ratio.

• Candida

  Candida albicans is one of the few fungal species of the normal human microbiome. [doi.org]

  Disease : Disease Economy: How the United States economy runs on "treating" chronic disease Deficiency : Get the Right Laboratory Test for Vitamin B12 Deficiency Problems : Antibiotics Cause Health Problems and Candida Overgrowth Cancer : Cancer is not [naturalnews.com]

  However, an excessive level of zinc may promote the growth of pathogens in your body, particularly fungi such as athlete's foot, candida, jock itch, nail fungus and thrush. [growyouthful.com]

  Lesions may develop secondary infection with Candida albicans or Staphylococcus aureus. Mucosal features include red glossy tongue, angular cheilitis and mouth ulcers. Wound healing is impaired. [dermnetnz.org]

• Colitis

  Exclusion criteria were pregnancy and lactation, systemic disease (ulcerative colitis, Crohn's disease, Behçet's disease), any current medication (topical or systemic), dental surgery during the previous month and deficiencies in iron, folic acid or vitamin [ncbi.nlm.nih.gov]

  McCallum and Bashashati A Treat to Target Update in Ulcerative Colitis: A Systematic Review Ungaro, et al. Gene-Environment Interactions and the Risk of Barrett’s Esophagus in Three US Cohorts Jovani, et al. [gi.org]

  Certain health conditions such as kidney disease and diabetes can affect zinc levels, while digestive disorders such as ulcerative colitis and Crohn’s disease can both decrease the amount of zinc the body absorbs. [bodyandsoul.com.au]

  Other health conditions are linked with zinc deficiency and zinc absorption issues, including diabetes, rheumatoid arthritis, hemodialysis, HIV/AIDS, sickle-cell anemia, chronic kidney disease, inflammatory bowel diseases such as ulcerative colitis and [doctorshealthpress.com]

In patients with acrodermatitis enteropathica, supplementation of zinc gluconate or zinc sulfate is given at the rate of 1–3 mg/kg/d orally. Through the intravenous route, about 300–1000 mcg/kg/d would be enough for reversal of symptoms. Improvement in symptoms is observed within a period of 5 to 10 days. This should be accompanied, by topical application of petrolatum and warm compresses on areas that are weeping. Such a kind of therapy would promote re-epithelialization. In such cases, lifelong therapy may be necessary [10].

In addition to zinc supplementation, underlying causes of zinc deficiency should also be promptly treated. Individuals are also asked to include food sources of zinc in their daily diet. Dietary sources of zinc include red meat, crab, oysters, pulses, nut, legumes, cheese, fortified breakfast cereals and wholegrain cereals. Including these food sources in the diet, would compensate for losses in zinc [11].

Zinc deficiency can be corrected with appropriate therapy, which includes zinc supplementation. The prognosis of the condition is very favorable, when individuals are given zinc supplementation, depending on their age and physiological status. A survival rate of 100% can be achieved with proper therapy, and treatment in infants with acrodermatitis enteropathica [6].

The acquired form of zinc deficiency is a common phenomenon. Whereas, the inherited form occurs as a result of inborn error in the zinc metabolism. This condition is referred to as acrodermatitis enteropathica. In addition, several other factors also contribute to zinc deficiency, which include improper intestinal absorption, insufficient dietary intake, increased loss and various factors that promote increased secretion of zinc from the body [2].

It has been estimated that newborns suffering from acrodermatitis enteropathica, as a result of zinc deficiency, die within the first few years [3]. Zinc deficiency can affect individuals at any age. Males, as well as females, are equally susceptible to contract such a type of nutritional deficiency.

Zinc deficiency that occurs as a result of improper dietary intake, accounts for 25% of the cases. It is thought to be the leading cause of mortality amongst the infant population. Statistics have revealed that zinc deficiency caused about 176,000 deaths due to diarrhea, and 406,000 deaths due to pneumonia [4].

Zinc is an essential mineral, which serves as an important element for various processes. About 60% of the total zinc content is found in the skeletal tissues, and the rest is found in the bone mass. Deficiency of the zinc also significantly produces loss in the epidermal Langerhans cells. In infants presenting with acrodermatitis enteropathica, a binding ligand goes missing, this significantly contributes to poor absorption of zinc from the breast milk. Genetic mutation in the mother, who is breastfeeding her child, is also known to contribute to development of acrodermatitis enteropathica. High concentration of phytates in certain food groups inhibits the absorption of zinc, favoring its deficiency to set in [5].

For preventing zinc deficiency from setting in, individuals are advised to follow the 5 strategies, which include:

• Agronomic biofortication, which consists of addition of zinc to the soil.
• Fortification, a method which involves addition of zinc to various food sources.
• Inclusion of zinc rich foods to daily diet.
• Oral zinc supplementation to high risk groups, such as children and pregnant and lactating mothers.
• Oral repletion using multivitamin or mineral supplements, which contain zinc sulfate or zinc gluconate.

Zinc is an essential mineral that is required for many body processes. It is necessary for the catalytic activity of approximately 100 enzymes. A daily intake of zinc is essential for maintenance of various processes; this is because, there is no mechanism by which the mineral can be stored in the body. Zinc is also important for immune response, and is also significantly associated with lymphocyte depletion, functioning of the phagocytes, and decreased production of interleukin [1].

• Definition: Zinc deficiency is characterized by a condition; wherein there are lower than normal levels of zinc. This essential trace mineral is important for several body processes, and its deficiency can call for onset of several debilitating conditions. Zinc deficiency is associated with increased incidence of diarrhea, malaria and pneumonia.
• Cause: Various factors contribute to the development of zinc deficiency. These include dietary deficiency, poor intestinal absorption, and increased utilization in conditions of pregnancy, infancy or periods of exercise. In addition to these factors, underlying chronic disease conditions also promote zinc deficiency to set in.
• Symptoms: Zinc deficiency severely affects the mouth, skin, eyes, immune system, cognitive functioning and sense of taste and smell. One of the most important clinical manifestations of zinc deficiency includes the onset of acrodermatitis enteropathica amongst the infants. Individuals with zinc deficiency also suffer from growth retardation, poor cognitive functioning, hair loss, mouth sores, ulcers, xerosis, dermatitis, stomatitis and burning mouth syndrome.
• Diagnosis: Measuring the plasma zinc levels helps in diagnosis of zinc deficiency. Along with evaluation of plasma levels of zinc, diagnostic methods would also include measuring the copper to zinc ratio, urinary excretion of zinc, metabolic balance studies, and measuring the activities of enzymes that are associated with zinc.
• Treatment: Oral zinc supplementation is the most important method to treat zinc deficiency. Intravenous zinc administration is given in severe cases to reverse the symptoms. The inclusion of zinc rich foods in the daily diet is yet another way to improve the zinc status of the affected individuals.

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2. Prasad AS. Zinc: an overview. Nutrition. Jan-Feb 1995;11(1 Suppl):93-9.
3. Wells BT, Winkelmann RD. Acrodermatitis enteropathica. Report of 6 cases. Arch Dermatol. Jul 1961;84:40-52.
4. Hambidge M, Krebs N. Zinc, diarrhea, and pneumonia. J Pediatr 1999; 135:661.
5. Bilinski DL, Ehrenkranz RA, Cooley-Jacobs J, et al. Symptomatic zinc deficiency in a breast-fed, premature infant. Arch Dermatol. Sep 1987;123(9):1221-4.
6. Neldner KH, Hambidge KM. Zinc therapy of acrodermatitis enteropathica. N Engl J Med 1975; 292:879.
7. Krebs NF. Update on zinc deficiency and excess in clinical pediatric practice. Ann Nutr Metab. 2013;62 Suppl 1:19-29.
8. American Academy of Pediatrics Committee on Nutrition. Trace Elements. In: Pediatric Nutrition, 7th, Kleinman RE, Greer FR. (Eds), American Academy of Pediatrics, Elk Grove Village, IL 2014. p.467.
9. Duggan C, MacLeod WB, Krebs NF, et al. Plasma zinc concentrations are depressed during the acute phase response in children with falciparum malaria. J Nutr 2005; 135:802.
10. Portnoy B, Molokhia M. Acrodermatitis enteropathica treated by zinc. Br J Dermatol. Dec 1974;91(6):701-3.
11. Veenemans J, Milligan P, Prentice AM, et al. Effect of supplementation with zinc and other micronutrients on malaria in Tanzanian children: a randomised trial. PLoS Med 2011; 8:e1001125.