Dermatosis in a child with kwashiorkor secondary to food aversion

Kwashiorkor is a common affliction of children worldwide. It occurs less often in developed countries, but has been reported under a variety of circumstances, including poverty, neurologic disease, and malabsorption. Because of its rare occurrence in the United States and because the affected child has an edematous rather than wasted appearance, physicians often do not consider it as a diagnostic entity. This article describes a case of kwashiorkor in a child with food aversion that manifested as "flaky paint dermatitis." Our discussion will attempt to delineate underlying conditions that may predispose to kwashiorkor. In addition, biochemical and cellular etiologic factors that may be linked with classical and nonclassical skin findings of kwashiorkor are considered. Finally, we present a differential diagnosis for any child with a generalized eczematous or desquamative rash. Our aim is to increase the ability of health care providers to identify and treat children with kwashiorkor in a timely manner.