Dermatosis of kwashiorkor:

· This is characterized by hypo- or hyper-pigmentation, shedding of skin in scales or sheets, and ulceration of the skin of the perineum, groin, limbs, behind the ears and armpits. There may be widespread weeping skin lesions that easily become infected. Spontaneous resolution occurs as nutrition improves. All children with this problem should receive systemic antibiotics.

· Atrophy of the skin in the perineum leads to severe napkin dermatitis, especially if the child has diarrhoea. The perineum should be left exposed to dry without napkins; if the perineum becomes colonized with candida, it should be treated with nystatin ointment or cream and the child should be given oral nystatin.

· In other affected areas, applying zinc and castor oil ointment, petroleum jelly or paraffin gauze dressings helps to relieve pain and prevent infection. The zinc supplement contained in the mineral mix is particularly important in these children, as they are usually severely deficient.