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Scaly Dermatitis and Edema in an Irritable Child

Educational Objective
Based on this clinical scenario and the accompanying image, understand how to arrive at a correct diagnosis.
1 Credit CME

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Article Information

Corresponding Author: Markus Boos, MD, PhD; Seattle Children’s Hospital, 4800 Sand Point Way NE, OC.9.833, Seattle, WA 98105 (markus.boos@seattlechildrens.org).

Published Online: January 7, 2021. doi:10.1001/jama.2020.10429

Conflict of Interest Disclosures: None reported.

Additional Information: We thank the patient’s mother for providing permission to share the patient’s information.

References
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Guidelines for the Inpatient Treatment of Severely Malnourished Children. World Health Organization. Published 2003. Accessed July 22, 2020. https://www.who.int/nutrition/publications/guide_inpatient_text.pdf
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Brewster  DR .  Critical appraisal of the management of severe malnutrition, 2: dietary management.   J Paediatr Child Health. 2006;42(10):575-582. doi:10.1111/j.1440-1754.2006.00932.xPubMedGoogle ScholarCrossref
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Henrique de S B Xavier  M , De Magalhães  E , Ferraz Oliveira  G , Keltke Magalhães  M , Prates de Almeida E Oliveira  C , Bragança Oliveira  N .  A child with kwashiorkor misdiagnosed as atopic dermatitis.   Dermatol Online J. 2017;23(5):23(5):13030/qt4dd7h96r.PubMedGoogle Scholar
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Grover  Z , Ee  LC .  Protein energy malnutrition.   Pediatr Clin North Am. 2009;56(5):1055-1068. doi:10.1016/j.pcl.2009.07.001PubMedGoogle ScholarCrossref
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Katz  KA , Mahlberg  MJ , Honig  PJ , Yan  AC .  Rice nightmare: kwashiorkor in 2 Philadelphia-area infants fed Rice Dream beverage  [published correction appears in J Am Acad Dermatol. 2005;53(3):496].  J Am Acad Dermatol. 2005;52(5)(suppl 1):S69-S72. doi:10.1016/j.jaad.2004.07.056PubMedGoogle ScholarCrossref
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Sandy  NS , Nogueira  RJN .  Nutritional treatment of a young infant with cystic fibrosis presenting with severe kwashiorkor dermatosis.   J Trop Pediatr. 2019;65(6):634-637. doi:10.1093/tropej/fmz008PubMedGoogle ScholarCrossref
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Tierney  EP , Sage  RJ , Shwayder  T .  Kwashiorkor from a severe dietary restriction in an 8-month infant in suburban Detroit, Michigan: case report and review of the literature.   Int J Dermatol. 2010;49(5):500-506. doi:10.1111/j.1365-4632.2010.04253.xPubMedGoogle ScholarCrossref
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Downie  ML , Gallibois  C , Parekh  RS , Noone  DG .  Nephrotic syndrome in infants and children: pathophysiology and management.   Paediatr Int Child Health. 2017;37(4):248-258. doi:10.1080/20469047.2017.1374003PubMedGoogle ScholarCrossref
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Brewster  DR .  Critical appraisal of the management of severe malnutrition, 3: complications.   J Paediatr Child Health. 2006;42(10):583-593. doi:10.1111/j.1440-1754.2006.00933.xPubMedGoogle ScholarCrossref
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