Skip to main content

Defining and Assessing Skin Changes in Severe Acute Malnutrition (SAM)

  • Living reference work entry
  • First Online:
Book cover Handbook of Famine, Starvation, and Nutrient Deprivation

Abstract

Specific skin changes in severe acute malnutrition have been known since the earliest publication on the subject in 1933. They vary from mild dryness or pigmentary changes to severe and widespread erosions. A common standardized way to document the skin changes observed in severe acute malnutrition is still under development. Currently five specific skin changes, characteristic to severe acute malnutrition, have been identified in African children. There is no knowledge of the global prevalence, but most reports on severe skin affections are from sub-Saharan countries.

The etiology is still unknown and the recommendations on treatment are mostly based on expert opinion. Skin changes in severe acute malnutrition have proven to be a prognostic marker for the risk of death. The mortality rate for patients treated for severe acute malnutrition is persistently high and thus the skin is a target for new treatment approaches. The skin is easily accessible for administration of treatment and assessment and is potentially a good additional target to the existing treatment protocols.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Institutional subscriptions

Abbreviations

BSA:

Body surface area

SCORDoK:

Clinical score for SAM specific skin changes

EFAD:

Essential Fatty Acid Deficiency

HR:

Hazard ratio

MUAC:

Mid Upper Arm Circumference

F75 and F100:

Milk based therapeutic diets

SAM:

Severe acute malnutrition

References

  • Amadi B, Fagbemi AO, Kelly P, Mwiya M, Torrente F, Salvestrini C, Day R, Golden MH, Eklund EA, Freeze HH, Murch SH (2009) Reduced production of sulfated glycosaminoglycans occurs in Zambian children with kwashiorkor but not marasmus. Am J Clin Nutr 89:592–600

    Article  CAS  PubMed  Google Scholar 

  • Ashworth A (2005) Pocket book of hospital care for children: guidelines for the management of common illnesses with limited resources. World Health Organization, Geneva

    Google Scholar 

  • Ashworth A, Khanum S, Jackson A, Schofield C (2003) Guidelines for the inpatient treatment of severely malnourished children. World Health Organization, Geneva

    Google Scholar 

  • Becker K, Pons-Kühnemann J, Fechner A, Funk M, Gromer S, Gross H-J, Grünert A, Schirmer RH (2005) Effects of antioxidants on glutathione levels and clinical recovery from the malnutrition syndrome kwashiorkor -a pilot study. Redox Rep 10(4):215–226

    Article  CAS  PubMed  Google Scholar 

  • Bradfield RB (1972) A rapid tissue technique for the field assessment of protein-caloric malnutrition. Am J Clin Nutr 25(7):720–729

    CAS  PubMed  Google Scholar 

  • Bradfield RB, Bailey MA, Cordano A (1968) Hair-root changes in Andean Indian children during marasmic kwashiorkor. Lancet 30(2):1169–1170

    Article  Google Scholar 

  • Braun-Falco O, Plewig G, Wolff HH, Burgdorf WHC (2009) Dermatology, 3rd edn. Springer, Heidelberg

    Google Scholar 

  • Collins F, Sinclair A, Royle J, Coats D, Maynard A, Leonard R (1971) Plasma lipids in human linoleic acid deficiency. Nutr Metab 1971(13):150–167

    Article  Google Scholar 

  • Giovanni V, Bourdon C, Wang DX, Seshadri S, Senga E, Versloot CJ, Voskuijl W, Semba RD, Trehan I, Moaddel R, Ordiz MI, Zhang L, Parkinson J, Manary M, Bandsma RHJ (2016) Metabolomic changes in serum of children with different clinical diagnoses of malnutrition. J Nutr 146(12):2436–2444

    Article  PubMed  Google Scholar 

  • Golden BE, Golden MH (1979) Plasma zinc and the clinical features of malnutrition. Am J Clin Nutr 32(12):2490–2494

    CAS  PubMed  Google Scholar 

  • Golden M, Grellety Y (2012) Protocol -Integrated management of acute malnutrition version 6.6.2

    Google Scholar 

  • Golden MH, Golden BE, Jackson AA (1980) Skin breakdown in kwashiorkor responds to zinc. Lancet 1(8180):1256

    Article  CAS  PubMed  Google Scholar 

  • Ground KEU (1957) The dermatosis associated with kwashiorkor in Basutoland. Trans R Soc Trop Med Hyg 51(5):433–438

    Article  CAS  PubMed  Google Scholar 

  • Hegyi J, Schwartz RA, Hegyi (2004) Pellagra: dermatitis, dementia, and diarrhea. Int J Derm 43:1–5

    Google Scholar 

  • Heilskov S, Rytter MJH, Vestergaard C, Briend A, Babirekere E, Deleuran MS (2014) Dermatosis in children with oedematous malnutrition (kwashiorkor): a review of the literature. J Eur Acad Dermatol Venereol 28(8):995–1001

    Article  CAS  PubMed  Google Scholar 

  • Heilskov S, Vestergaard C, Babirekere E, Namusoke H, Rytter MJH, Deleuran MS (2015) Characterization and scoring of skin changes in severe acute malnutrition in children between 6 months and 5 years of age. J Eur Acad Dermatol Venereol 29(12):2463–2469

    Article  CAS  PubMed  Google Scholar 

  • Jahoor F (2012) Effects of decreased availability of sulfur amino acids in severe childhood undernutrition. Nutr Rev 70(3):176–187

    Article  PubMed  PubMed Central  Google Scholar 

  • Jahoor F, Badaloo A, Reid M, Forrester T (2008) Protein metabolism in severe childhood malnutrition. Ann Trop Paediatr 28(2):87–101

    Article  PubMed  Google Scholar 

  • Leichsenring M, Sütterlin N, Less S, Bäumann K, Anninos A, Becker K (1995) Polyunsaturated fatty acids in erythrocyte and plasma lipids of children with severe protein-energy malnutrition. Acta Paediatr 84(5):516–520

    Article  CAS  PubMed  Google Scholar 

  • Maltos AL, Portari GV, Moraes GV, Monteiro MCR, Vanucchi H, da Cunha DF (2015) Niacin metabolism and indoleamine 2,3-dioxygenase activation in malnourished patients with flaky paint dermatosis. Nutrition 31:890–892

    Article  CAS  PubMed  Google Scholar 

  • McLaren DS, Shirajian E, Loshkajian H, Shadarevian S (1969) Short-term prognosis in protein-calorie malnutrition. Am J Clin Nutr 22(7):863–870

    CAS  PubMed  Google Scholar 

  • Milner JA (1979) Assessment of the essentiality of methionine, threonine, tryptophan, histidine and isoleucine in immature dogs. J Nutr 109(8):1351–1357

    CAS  PubMed  Google Scholar 

  • Proksch E, Feingold KR, Man MQ, Elias PM (1991) Barrier function regulates epidermal DNA synthesis. J Clin Invest 87(5):1668–1673

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Rangam CM, Bhagwat AG, Gupta JC (1962) Cutaneous lesions in kwashiorkor. A histopathological and histochemical study. Indian J Med Res 50:184–190

    CAS  PubMed  Google Scholar 

  • Roediger WE (1995) New views on the pathogenesis of kwashiorkor: methionine and other amino acids. J Pediatr Gastroenterol Nutr 21(2):130–136

    Article  CAS  PubMed  Google Scholar 

  • Salam RA, Das JK, Darmstadt GL, Bhutta ZA (2013) Emollient therapy for preterm newborn infants – evidence from the developing world. BMC Public Health 13(Suppl3):S31

    Article  PubMed  PubMed Central  Google Scholar 

  • Sims RT (1968) The ultrastructure of depigmented skin in kwashiorkor. Br J Dermatol 80(12):822–832

    Article  CAS  PubMed  Google Scholar 

  • Stannus H (1935) Kwashiorkor. Lancet 2:1207

    Article  Google Scholar 

  • Thavaraj V, Sesikeran B (1989) Histopathological changes in skin of children with clinical protein energy malnutrition before and after recovery. J Trop Pediatr 35(3):105–108

    Article  CAS  PubMed  Google Scholar 

  • Trowell HC (1954) Clinical aspects of the treatment of kwashiorkor. Ann N Y Acad Sci 57(6):722–733

    Article  CAS  PubMed  Google Scholar 

  • Vasantha L (1969) Labile collagen content in the skin in kwashiorkor. Clin Chim Acta 26(2):277–280

    Article  CAS  PubMed  Google Scholar 

  • Vasantha L, Srikantia SG, Gopalan C (1970) Biochemical changes in the skin in kwashiorkor. Am J Clin Nutr 23(1):78–82

    CAS  PubMed  Google Scholar 

  • Waterlow JC, Tomkins A, Grantham-McGregor SM (2006) Protein-energy malnutrition. Smith-Gordon, New Barnet

    Google Scholar 

  • WHO (2013) Updates on the management of severe acute malnutrition in infants and children. World Health Organization, Geneva

    Google Scholar 

  • WHO, UNICEF (2009) WHO child growth standards and the identification of severe acute malnutrition in infants and children -a joint statement by the World Health Organization and the United Nations Children’s fund. World Health Organization, Geneva

    Google Scholar 

  • Williams CD (1933) A nutritional disease of childhood associated with a maize diet. Arch Dis Child 8(48):423–433

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  • Williams ML (1992) Ichthyosis: mechanisms of disease. Pediatr Derm 9(4):365–368

    Article  CAS  Google Scholar 

  • Wolff JA, Margolis S, Bujdoso-Wolff K, Matusick E, MacLean WC Jr (1984) Plasma and red blood cell fatty acid composition in children with protein-calorie malnutrition. Pediatr Res 18(2):162–167

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Sofine Heilskov .

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2017 Springer International Publishing AG

About this entry

Cite this entry

Heilskov, S., Vestergaard, C., Deleuran, M.S. (2017). Defining and Assessing Skin Changes in Severe Acute Malnutrition (SAM). In: Preedy, V., Patel, V. (eds) Handbook of Famine, Starvation, and Nutrient Deprivation. Springer, Cham. https://doi.org/10.1007/978-3-319-40007-5_12-1

Download citation

  • DOI: https://doi.org/10.1007/978-3-319-40007-5_12-1

  • Received:

  • Accepted:

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-319-40007-5

  • Online ISBN: 978-3-319-40007-5

  • eBook Packages: Springer Reference MedicineReference Module Medicine

Publish with us

Policies and ethics