Zinc salts in dermatology

Zinc salts in dermatology

Indications

• Acrodermatitis entropathica : 3 mg/kg/day of elemental zinc (50 mg elemental zinc per 220 mg zinc sulfate) lifelong.
• Acquired zinc deficiency : 0.5–1.0 mg/kg/day of elemental zinc for children and up to 15–30 mg elemental zinc per day for adults.
• Warts :10 mg/kg/day oral zinc sulphate for 2 months for recalcitrant warts to a maximum dose of 600 mg/day (side effects are common).
• Cutaneous leishmaniasis : Oral zinc sulphate in doses of 2.5, 5, and 10 mg/kg/day for 45 days.
• Acne vulgaris : zinc gluconate (200 mg/day).
• Rosacea : Oral zinc sulphate 100 mg thrice a day for 3 months.
• Hidradenitis suppurativa :Oral zinc gluconate 90 mg/day as maintenance therapy or in combination with other therapies.
• Behcet’s disease and oral aphthae : Oral zinc sulphate 100 mg/day or 300 mg/day PO for MC lesions.
• Recurrent aphthous stomatitis (RAS): Oral zinc sulfate 150 mg twice daily.
• Alopecia areata :5 mg/kg/day of oral zinc sulphate for 6 months.
• Uremic pruritus.
• Amicrobial pustulosis of the skin folds (oral zinc was effective in two cases).
• Wilson disease : zinc acetate has a role .
• Dissecting cellulitis: zinc sulphate, 135 mg three times a day.
• Necrolytic acral erythema : zinc sulfate 220 mg orally twice daily.

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Dosage

• 1–2 mg/kg daily of elemental zinc in three divided doses.
• Daily intakes of dietary zinc, according to the US RDA, are:
  • Infants and children up to 3 years: 2 – 3 mg (RDA).
  • Children 4 to 8 years: 5 mg (RDA).
  • Children 9 to 13 years: 8 mg (RDA).
  • Males 14 to 18 years: 11 mg (RDA).
  • Females 14 to 18 years: 9 mg (RDA).
  • Pregnant females 19 years and older: 11 mg (RDA).
  • Breastfeeding females: 12 -14 mg (RDA).
• Zinc sulfate injection: IV: Full term infants and children up to 5 years of age: 100 mcg zinc/kg/day.

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Baseline Monitoring

• Serum zinc level : normal reference range for zinc is 70–150 mcg/dl (10.7–22.9 µmol/l).
• Alkaline phosphatase.

Follow Up Monitoring

• Morning fasting specimen.
• Full blood count.
• Serum copper level.
• Stool examination for occult blood.

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Side effects

• Common
  • Stomach upset.
  • Nausea, vomiting.
  • Metallic taste in the mouth.
• Other
  • Dizziness, headache,drowsiness.
  • Increased sweating .
  • Loss of muscle coordination.
  • Alcohol intolerance.
  • Hallucinations.
  • Anemia.
• With high doses
  • lower HDL cholesterol and raise LDL.

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Contraindications

• Inadequate amount of copper.
• Hypersensitvity.

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Pregnancy &Lactation

• Zinc sulfate : pregnancy category C .
• Zinc gluconate has not been formally assigned to a pregnancy category by the FDA.
• Use with caution in pregnant and lactating women.
• Elemental zinc is known to be excreted into human milk and may lead to copper deficiency in the nursing infant.

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Precautions

• If zinc sulfate causes stomach irritation, zinc citrate should be tried.
• Zinc should be taken with water or juice.
• If zinc causes stomach upset, it can be taken with meals.
• Zinc should not be taken at the same time as iron or calcium supplements.
• Long-term use of zinc (including zinc in a multivitamin) should be accompanied by copper.
• For every 15 mg of zinc include 1 mg of copper.
• Zinc gluconate has a favorable safety profile and can be administered to pregnant women.

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Drug Info

• The normal plasma zinc level is 70–110 µg/dL and in serum 80–120 µg/dL
• The highest tissue concentration (>500 μg/g dry weight) being in the prostate, seminal fluid, uveal tissue, and skin.
• The skin contains nearly 6% of total body zinc.
• The continuous external supply of zinc is important for metabolic needs, growth, and tissue repair.
• Available forms of zinc supplementation include zinc sulfate, zinc acetate, zinc gluconate, and zinc propionate.
• Dosage must be based on the amount of elemental zinc present in the preparation, which varies between compounds.
• Animal foods like meat, eggs, fish, and oysters are rich in zinc.
• Zinc sulfate(220 mg) contains approximately 55 mg of elemental zinc.
• People who are zinc deficient tend to be more susceptible to a variety of infections.
• Zinc deficiency leads to increased susceptibility to opportunistic infections in people with AIDS.
• Zinc therapy should be monitored periodically with morning fasting specimen, full blood count, serum copper level, and stool examination for occult blood.

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