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Although uncommon, kwashiorkor continues to occur in developed nations. A recent case highlights the fact that such occurrences are typically the result of well-meaning dietary restriction in the setting of nutritional ignorance. Telltale skin and hair changes should prompt a thorough dietary history and appropriate dietary intervention.
A young boy presented with a 1-year history of progressive skin, hair, and nail changes after institution of a low-protein diet recommended by an outside physician as therapy for his nonketotic hyperglycinemia (NKH). Examination revealed generalized hypopigmentation with numerous erythematous and denuded patches over his trunk, arms, and legs. Desquamation in a flaking or “paint-chip” pattern was prominent on the upper and lower extremities (Figure 1). His abdomen was distended with dependent edema over the sacrum and extremities. His hair was pale yellow and brittle with patches of alopecia. Fingernails were thin and brittle with distal nail plate splitting.
Rogers AS, Shaughnessy KK, Davis LS. Dermatitis and Dangerous Diets: A Case of Kwashiorkor. JAMA Dermatol. 2014;150(8):910–911. doi:10.1001/jamadermatol.2013.10328
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