Are Trace Element Levels Key to Understanding and Treating Common Skin Diseases?

🔍 Key Finding Serum zinc levels are often reduced in acne vulgaris, psoriasis, pemphigus vulgaris, atopic dermatitis, and seborrheic dermatitis, while copper and iron levels show more variable and conflicting changes depending on the specific disease and study. Further research is needed to clarify the roles of these trace elements in skin disease pathogenesis and their potential as diagnostic or therapeutic tools.

🔬 Methodology Overview

• Design: Narrative review.
• Data Sources: Published literature.
• Selection Criteria: Studies investigating the role of zinc, copper, and iron in psoriasis, pemphigus vulgaris, atopic dermatitis, acne vulgaris, and seborrheic dermatitis.
• Analysis Approach: Qualitative synthesis of findings from existing studies, highlighting agreements and discrepancies between studies.
• Scope: Concentrations of zinc, copper, and iron in various biological samples (serum, hair, skin, erythrocytes) and their correlation with disease presence, severity, and duration. Includes discussion of potential use of these trace elements as diagnostic or prognostic markers. Briefly mentions medical ultrasonography as a future research direction.

📊 Results

• Psoriasis: Serum zinc levels are often reported as lower in individuals with psoriasis, sometimes correlating with disease severity and type, though some studies find no difference compared to healthy individuals. Serum copper is often found to be elevated, potentially correlating with disease severity according to some studies, while others report no difference. Iron levels are lower in the epidermis and higher in the dermis of those with psoriasis, and serum iron is often lower.

• Pemphigus Vulgaris: Studies suggest lower serum zinc in patients. Serum copper levels are inconsistently reported, with some studies showing lower levels and others finding no difference compared to healthy individuals. One study found a negative correlation between copper levels and disease duration in men.

• Atopic Dermatitis: Serum zinc findings are conflicting, with some studies reporting lower levels in patients, particularly those with more severe disease, while others find no difference. Lower zinc is also observed in hair and erythrocytes. Serum copper levels are also inconsistently reported, with some studies showing higher, lower, or no difference compared to healthy controls. Higher copper is also seen in hair. Serum iron studies generally find no difference compared to healthy individuals.

• Acne Vulgaris: Serum zinc is frequently reported as lower in acne patients, and some studies show a correlation with disease severity and lesion type. Serum copper is mostly reported as lower in acne patients, with one study noting a decrease in copper with increasing acne severity. Some studies find no difference in copper levels. Serum iron shows no consistent difference compared to healthy individuals.

• Seborrheic Dermatitis: Serum zinc levels are inconsistently reported, with some studies showing lower levels in patients and others finding no difference. Hair zinc may be elevated. Serum copper is generally reported as higher in patients, and hair copper is also elevated. Serum iron is also reported as higher.

💡 Clinical Impact This review highlights the complex and often conflicting findings regarding the roles of zinc, copper, and iron in common skin diseases like psoriasis, pemphigus vulgaris, atopic dermatitis, acne vulgaris, and seborrheic dermatitis, suggesting that while measuring these trace elements may have future diagnostic or therapeutic potential, further research is needed to clarify their clinical utility and guide supplementation or dietary restrictions.

🤔 Limitations

• Conflicting reports on zinc and copper levels in psoriasis, atopic dermatitis, acne vulgaris, and seborrheic dermatitis.
• Limited data on urinary copper concentrations in psoriasis patients.
• Lack of clarity on the role of zinc in pemphigus vulgaris and its relationship to disease duration and activity.
• Inconsistent findings regarding the correlation between zinc levels and the severity of atopic dermatitis and acne vulgaris.
• Limited research on the long-term effects of zinc, copper, and iron supplementation or restriction in treating skin diseases.
• Scarcity of studies investigating the combined effects of zinc, copper, and iron interactions in skin disease pathogenesis.
• Need for further research to determine the optimal biological material (serum, hair, urine, etc.) for assessing trace element levels in different skin diseases.

✨ What It Means For You This research highlights the complex and often conflicting roles of zinc, copper, and iron in common skin conditions like psoriasis, eczema, and acne. While measuring these trace elements might offer diagnostic or disease severity clues, further research is needed before incorporating them into routine clinical practice. Doctors should be aware of these potential connections and consider dietary factors and potential supplementation or restrictions in conjunction with established treatments, but not rely on trace element levels for diagnosis or treatment decisions alone.

Reference Podgórska, A.; Kicman, A.; Naliwajko, S.; Wacewicz-Muczyńska, M.; Niczyporuk, M. Zinc, Copper, and Iron in Selected Skin Diseases. Int. J. Mol. Sci. 2024;25:3823. https://doi.org/10.3390/ijms25073823