Dermatosis in children with oedematous malnutrition (Kwashiorkor): a review of the literature

Abstract

Children with oedematous malnutrition, known as kwashiorkor, may develop a characteristic skin lesion, named 'Dermatosis of Kwashiorkor' (DoK). Only a few studies have been concerned with this condition, and the reason for the development of DoK remains unexplained. This study review the existing studies concerning DoK, including its clinical manifestations, histopathology, suggested pathophysiology, current treatment and prognosis for children of the age of 6 months to 5 years. Standardized clinical studies are needed to further understand the implications of DoK. Such studies would suffer from the lack of consistency concerning the terminology and scoring of the lesions in DoK. We therefore stress the need for a standardized scoring of the degree of DoK. This would facilitate valid and comparable studies and the development of better treatment for this vulnerable group of patients.

Failure to Thrive in the Context of Carney Complex

“…Patient 11 also presented with severe dermatitis, which disrupted the microbial barrier of the skin and was probably the main reason for her sepsis and viremia. This particular skin presentation is not a known manifestation of CNC and may have been secondary to the malnutrition, as has been previously described [15], or it may be related to a compromise of the immune system due to CS and hypercortisolemia.…”

Characterization and scoring of skin changes in severe acute malnutrition in children between 6 months and 5 years of age

“…The ‘free radical hypothesis’ suggests an aetiological explanation to both skin changes and oedema . Apart from this theory, the present discussed aetiologies, are the role of essential fatty acids and the sulphur amino acids methionine and cysteine . Interventional studies on skin treatment in SAM has been sparse.…”

“…Standardization is the first and mandatory step towards well coordinated investigations on the missing aetiology, and a usefull tool in clinical trials when evaluating intervention. The aetiology of the skin changes is still unknown . The ‘free radical hypothesis’ suggests an aetiological explanation to both skin changes and oedema .…”

“…Ever since, skin changes have often been a focus in reports on patients with SAM. Despite this, the skin changes have never been described by dermatologists and to our knowledge a standardized terminology has not yet been developed . Consequently, the nature and global prevalence of these skin changes, is not easily assessed.…”

Management of severe acute malnutrition in low-income and middle-income countries

“…Kwashiorkor was originally described among children who were rapidly weaned onto low-protein complementary foods from breast milk, and thus the pathophysiology was thought to be primarily one of protein deficiency, but further experience has questioned this hypothesis 9 10. Children with kwashiorkor often have ‘flaky paint’ depigmentation of their skin, commonly leading to frank breakdown, which can serve as a portal of entry for infectious pathogens 11. The acute development of oedema among impoverished children in LMICs, even in children who have previously been growing well, is highly specific for kwashiorkor, although other diagnoses should of course still be kept under consideration, especially among those who do not recover as might be expected.…”