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. Nonscarring 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, including malabsorption, immune deficiencies, and infections, must be ruled out.

Related topic: malnutrition