Zinc is an essential electrolyte required for normal growth and development. Zinc supplementation has also shown to improve neutrophilic dermatoses such as sterile pustular disorders, due to the reduction of phagocytic function which modulates inflammatory proteins. However, there have been case reports of zinc supplementation resulting in hypocupraemia, due to competition of the divalent metal transporter in the gastrointestinal system that absorbs both zinc and copper. There are no existing guidelines recommending monitoring serum copper whilst supplementing with zinc in dermatology practice. Serum levels of both zinc and copper were taken on a cohort of dermatology patients on zinc supplementation. Results from 23 patients found that no patients displayed low serum copper due to zinc supplementation. The duration of supplementation ranged from 3 months to 20+ years. Zinc supplementation may cause hypocupraemia, but this was not demonstrated in a dermatology cohort, suggesting that frequent monitoring of copper may be unnecessary.

Delusional infestation (DI) is a psychocutaneous disorder marked by sensations of crawling and perceived fibers or foreign materials on the skin. Traditionally viewed as psychiatric, evidence now suggests a multifactorial pathogenesis involving dermatologic, neurologic, endocrine, psychosocial, and pharmacologic factors-most notably, striatal dopamine dysregulation. This review explores DI through a multidimensional lens, highlighting elevated striatal dopamine as a mechanism influenced by factors such as medication (e.g., amphetamines, dopamine agonists), iron deficiency, estrogen status, substance use, and psychosocial stressors. Radioligand neuroimaging supports aberrant striatal dopamine activity as central to pathogenesis. It is also possible that genetic predispositions may intersect with these factors, implicating polymorphisms in dopamine transporter/receptor genes and, iron regulation pathways. Central and peripheral nervous system dysfunction-seen in spinal cord injury, fibromyalgia, and neuropathic itch-may contribute, as can dermatologic conditions like prurigo nodularis that share inflammatory and sensory processing pathways with DI. We propose a model of DI that extends beyond psychiatric classification, emphasizing integrated care. Addressing nutritional deficiencies, medication effects, hormonal status, neuroinflammation, and social determinants may improve patient outcomes. Such a multidisciplinary approach targets underlying biological and environmental contributors.