This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (23)  • Contact me when this article is cited  Related Content  • Related article  • Similar articles in this journal  Topic Collections  • Nutritional and Metabolic Disorders  • Nutrition/ Malnutrition  • Hypersensitivity  • Alert me on articles by topic  Social Bookmarking   What's this?

Fad Diets, Perceived and True Milk Allergy, and Nutritional Ignorance

Theodore Liu, MD; Renée M. Howard, MD; Anthony J. Mancini, MD; William L. Weston, MD; Amy S. Paller, MD; Beth A. Drolet, MD; Nancy B. Esterly, MD; Moise L. Levy, MD; Lawrence Schachner, MD; Ilona J. Frieden, MD

Arch Dermatol. 2001;137:630-636.

Background  Kwashiorkor is the edematous form of protein-energy malnutrition. It is associated with extreme poverty in developing countries and with chronic malabsorptive conditions such as cystic fibrosis in developed countries. Rare cases of kwashiorkor in affluent countries unrelated to chronic illness have been reported. We present 12 cases of kwashiorkor unrelated to chronic illness seen over 9 years by pediatric dermatologists throughout the United States, and discuss common causative themes in this easily preventable condition.

Observations  Twelve children were diagnosed as having kwashiorkor in 7 tertiary referral centers throughout the United States. The diagnoses were based on the characteristic rash and the overall clinical presentation. The rash consisted of an erosive, crusting, desquamating dermatitis sometimes with classic "pasted-on" scale—the so-called flaky paint sign. Most cases were due to nutritional ignorance, perceived milk intolerance, or food faddism. Half of the cases were the result of a deliberate deviation to a protein-deficient diet because of a perceived intolerance of formula or milk. Financial and social stresses were a factor in only 2 cases, and in both cases social chaos was more of a factor than an absolute lack of financial resources. Misleading dietary histories and the presence of edema masking growth failure obscured the clinical picture in some cases.

Conclusions  Physicians should consider the diagnosis of kwashiorkor in children with perceived milk allergies resulting in frequent dietary manipulations, in children following fad or unorthodox diets, or in children living in homes with significant social chaos. The presence of edema and "flaky paint" dermatitis should prompt a careful dietary investigation.

From the Depts of Dermatology (Drs Liu, Howard, and Frieden) and Pediatrics (Dr Frieden), University of California, San Franscisco; the Division of Pediatric Dermatology, Children's Hospital, Oakland, Calif (Dr Howard); the Depts of Pediatrics and Dermatology, Northwestern University Medical School and Children's Memorial Hospital, Chicago, Ill (Drs Mancini and Paller); the Depts of Dermatology, University of Colorado Health Sciences Center, Denver (Dr Weston); the Depts of Dermatology (Drs Drolet and Esterly) and Pediatrics (Dr Esterly), Medical College of Wisconsin, Milwaukee; the Depts of Dermatology and Pediatrics, Baylor College of Medicine, Houston, Tex (Dr Levy); and the Depts of Pediatrics and Dermatology, University of Miami School of Medicine, Miami, Fla (Dr Schachner).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

RELATED ARTICLE

Archives of Dermatology Reader's Choice: Continuing Medical Education
Arch Dermatol. 2001;137(5):680-681.
FULL TEXT  

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Protein-Energy Malnutrition and Feeding Refusal Secondary to Food Allergies
Fortunato and Scheimann
CLIN PEDIATR 2008;47:496-499.
 

A Rash
Shah et al.
CLIN PEDIATR 2007;46:650-654.
 

Who should manage infants and young children with food induced symptoms?
Niggemann and Heine
Arch. Dis. Child. 2006;91:379-382.
FULL TEXT  

Cow's Milk Allergy: A Complex Disorder
Crittenden and Bennett
J. Am. Coll. Nutr. 2005;24:582S-591S.
ABSTRACT | FULL TEXT  

Atopic Dermatitis
Williams
NEJM 2005;352:2314-2324.
FULL TEXT  

Skin Signs as the Presenting Manifestation of Severe Nutritional Deficiency: Report of 2 Cases
Kuhl et al.
Arch Dermatol 2004;140:521-524.
FULL TEXT  

Commentary
Fischer
CLIN PEDIATR 2004;43:306-307.
 

Nutritional Management of Pediatric Food Hypersensitivity
Mofidi
Pediatrics 2003;111:1645-1653.
ABSTRACT | FULL TEXT  

Food Allergies' Effect on Nutrient Intake and Growth
Lester
AAP Grand Rounds 2003;9:31-31.
FULL TEXT  

Rice Dream Nondairy Beverages
Liu and Frieden
Arch Dermatol 2002;138:838-838.
FULL TEXT