Kwashiorkor is the result of severe protein-energy malnutrition. The median age of onset is about 2 years.1 Protein-energy malnutrition, the most widespread nutritional deficiency disorder of mankind, is a group of related disorders.2 Kwashiorkor and marasmus represent extreme forms of protein-energy malnutrition and are common in children of Third World nations, but are rare in the United States. Marasmus differs from kwashiorkor in that there is an absence of edema and characteristic cutaneous findings. We describe a 5-month-old infant with the enamel paint sign that helped diagnose unsuspected kwashiorkor.
Buño IJ, Morelli JG, Weston WL. The Enamel Paint Sign in the Dermatologic Diagnosis of Early-Onset Kwashiorkor. Arch Dermatol. 1998;134(1):107-108. doi: