The Ultrastructure of Depigmented Skin in Kwashiorkor

Sims, Richard

doi:10.1111/j.1365-2133.1968.tb11952.x

Cited by 12 publications

(6 citation statements)

References 11 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Two articles describing histology reported atrophy of skin layers, but did not describe cutaneous immune cells [26]–[27]. Four articles described the “cutaneous inflammatory response”: They made small abrasions in the skin, and placed microscopy slides over the sites.…”

Section: Resultsmentioning

confidence: 99%

The Immune System in Children with Malnutrition—A Systematic Review

et al. 2014

View full text Add to dashboard Cite

BackgroundMalnourished children have increased risk of dying, with most deaths caused by infectious diseases. One mechanism behind this may be impaired immune function. However, this immune deficiency of malnutrition has not previously been systematically reviewed.ObjectivesTo review the scientific literature about immune function in children with malnutrition.MethodsA systematic literature search was done in PubMed, and additional articles identified in reference lists and by correspondence with experts in the field. The inclusion criteria were studies investigating immune parameters in children aged 1–60 months, in relation to malnutrition, defined as wasting, underweight, stunting, or oedematous malnutrition.ResultsThe literature search yielded 3402 articles, of which 245 met the inclusion criteria. Most were published between 1970 and 1990, and only 33 after 2003. Malnutrition is associated with impaired gut-barrier function, reduced exocrine secretion of protective substances, and low levels of plasma complement. Lymphatic tissue, particularly the thymus, undergoes atrophy, and delayed-type hypersensitivity responses are reduced. Levels of antibodies produced after vaccination are reduced in severely malnourished children, but intact in moderate malnutrition. Cytokine patterns are skewed towards a Th2-response. Other immune parameters seem intact or elevated: leukocyte and lymphocyte counts are unaffected, and levels of immunoglobulins, particularly immunoglobulin A, are high. The acute phase response appears intact, and sometimes present in the absence of clinical infection. Limitations to the studies include their observational and often cross-sectional design and frequent confounding by infections in the children studied.ConclusionThe immunological alterations associated with malnutrition in children may contribute to increased mortality. However, the underlying mechanisms are still inadequately understood, as well as why different types of malnutrition are associated with different immunological alterations. Better designed prospective studies are needed, based on current understanding of immunology and with state-of-the-art methods.

show abstract

Section: Resultsmentioning

confidence: 99%

The Immune System in Children with Malnutrition—A Systematic Review

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Compromise of the skin barrier is the most clinically evident defect in children with oedematous malnutrition, classically described as the 'peeling paint' dermatosis of kwashiorkor [13]. Histologically, this is characterized by atrophy and effacement of the skin layers, hyperkeratosis and a pronounced cutaneous inflammatory response [14][15][16], providing a potential portal of entry for pathogens. An extensive enteropathy has long been recognized in children with severe malnutrition, characterized by mucosal inflammatory infiltrate, villous atrophy and compromised intestinal barrier function [17].…”

Section: (A) Mucosal Barrier Dysfunctionmentioning

confidence: 99%

Malnutrition and vaccination in developing countries

Prendergast

2015

Phil. Trans. R. Soc. B

124

103

View full text Add to dashboard Cite

Malnutrition contributes to an estimated 45% of deaths among children under 5 years of age in developing countries, predominantly due to infections. Malnourished children therefore stand to benefit hugely from vaccination, but malnutrition has been described as the most common immunodeficiency globally, suggesting that they may not be able to respond effectively to vaccines. The immunology of malnutrition remains poorly characterized, but is associated with impairments in mucosal barrier integrity, and innate and adaptive immune dysfunction. Despite this, the majority of malnourished children can mount a protective immune response following vaccination, although the timing, quality and duration of responses may be impaired. This paper reviews the evidence for vaccine immunogenicity in malnourished children, discusses the importance of vaccination in prevention of malnutrition and highlights evidence gaps in our current knowledge.

show abstract

“…Although some authors have noted, that at least two different variations exist, the skin lesions in oedematous malnutrition, DoK, look consistent across the studies, with a characteristic development over time . Histopathological studies have found atrophy of the stratum granulosum and stratum spinosum …”

Section: Discussionmentioning

confidence: 86%

“…Three papers, describing histological investigations on DoK, were identified. Their observations are not completely consistent, but all found epidermal atrophy in stratum granulosum and stratum spinosum . The findings are summarized in Table .…”

Section: Histologymentioning

confidence: 88%

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

Heilskov

Rytter

Vestergaard

et al. 2014

Acad Dermatol Venereol

View full text Add to dashboard Cite

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.

show abstract

The Ultrastructure of Depigmented Skin in Kwashiorkor

Cited by 12 publications

References 11 publications

The Immune System in Children with Malnutrition—A Systematic Review

The Immune System in Children with Malnutrition—A Systematic Review

Malnutrition and vaccination in developing countries

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

Contact Info

Product

Resources

About