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| Fig. 40.1 Enamel paint dermatosis in a child with kwashiorkor. (Courtesy of William Weston, MD.) |
In black children, initial circumoral pallor progresses to diffuse depigmentation. In white children, there is diffuse blanching erythema that rapidly progresses to dusky nonblanching purple macules and papules. Classic findings include mosaic skin (dry, fine areas of desquamation with cracking along skin lines) and enamel paint dermatosis (Fig. 40-1), which evolves into large areas of erosion and desquamation. Hair in affected patients is sparse, thin, fragile, and depigmented. This hair depigmentation may produce the flag sign, which is alternating pigmented and depigmented bands seen along the hair shafts corresponding to periods of normal and inadequate nutrition.
Buno IJ, Morelli JG, Weston WL: The enamel paint sign in the dermatologic diagnosis of early-onset Kwashiorkor,
Arch Dermatol 134:107–108, 1998.
