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Kwashiorkor - Skin
Other Resources UpToDate PubMed

Kwashiorkor - Skin

Contributors: Craig N. Burkhart MD, Dean Morrell MD, Lowell A. Goldsmith MD, MPH, Nancy Esterly MD
Other Resources UpToDate PubMed

Synopsis

Kwashiorkor is a severe form of protein energy malnutrition (PEM) in which there is near normal caloric intake but insufficient protein consumption. Systemic findings include low serum protein levels, edema, growth failure, diarrhea and fatty infiltration of the liver. The characteristic skin eruption consists of hyperpigmented patches and plaques that desquamate, leaving behind a raw surface on peeling. The appearance has been described as "enamel paint" or "crazy paving." The dermatosis preferentially involves areas of the body subject to friction or pressure, including the flexures, groin, buttocks, and elbows, though it can be generalized when severe. Non-scarring diffuse alopecia is a common finding, as are alternating bands of light and dark hair color known as the "flag sign," which correspond with periods of adequate and inadequate protein consumption.

Although predominantly a disorder of developing countries, cases of kwashiorkor in the United States have been described in children in extreme poverty or with presumed food allergies on faddish or avoidance diets. Kwashiorkor usually presents in infancy or early childhood, typically soon after the child has been weaned off breast milk. The clinical findings of kwashiorkor must be distinguished from those of other nutritional deficiencies, and any underlying disease—malabsorption, immune deficiencies and infections—must be ruled out.

Related topic: malnutrition

Codes

ICD10CM:
E40 – Kwashiorkor

SNOMEDCT:
58262005 – Kwashiorkor

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Last Updated:04/06/2021
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Kwashiorkor - Skin
Kwashiorkor : Diarrhea, Desquamation, Erythroderma, Hypoalbuminemia, Irritability, Generalized edema
Clinical image of Kwashiorkor
Widespread thick scales with a "flaky paint" appearance on the arm and residual pink hypopigmentation in areas where desquamation has occurred.
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