Acrodermatitis enteropathica Figure 13-3 shows a highly characteristic picture of the cutaneous changes of acrodermatitis enteropathica around the anus, the buttocks, and on the perineum. Note the psoriasiform appearance of this lesion and of those on the feet in Fig. 13-4. The full-blown picture of acrodermatitis enteropathica goes far beyond the typical changes of skin and hair. Affected children have severe diarrhea, growth retardation, and irritability. Without treatment, the disease follows a progressive course and may even be fatal. The child with suspected acrodermatitis enteropathica should be evaluated for a low zinc level or a low alkaline phosphatase level when zinc levels are normal or below normal. Treatment with dietary zinc supplementation leads to a dramatic resolution of all symptoms and, in some cases, must be maintained indefinitely.