A 17-month-old girl was brought by her parents and grandparents for a further opinion regarding her 3-month history of an itching skin eruption, thinning of scalp hair with hair "falling out in clumps," swelling of her extremities, and lack of weight gain. One year earlier, her rate of growth slowed and reached progressively lower percentiles on a normal growth curve. Although she had started walking at 10 months of age, she stopped in the previous 3 months and was unsteady on her feet.
Kuhl J, Davis MDP, Kalaaji AN, Kamath PS, Hand JL, Peine CJ. Skin Signs as the Presenting Manifestation of Severe Nutritional DeficiencyReport of 2 Cases. Arch Dermatol. 2004;140(5):521-524. doi:10.1001/archderm.140.5.521