Dermatological changes in a prospective cohort of acutely ill, hospitalised Malawian children, stratified according to nutritional status

Deborah Van Den Brink*, Kelvin Mponda, Debbie Thompson, Colette Van Hees, Fletchter Ngong'a, Emma Segula, Emmie Mbale, Michael Boele Van Hensbroek, Robert H.J. Bandsma, Judd L. Walson, Daniella Brals, James Berkely, Wieger Voskuijl

*Corresponding author for this work

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Abstract

Rationale
Since the first documentation of skin changes in malnutrition in the early 18th century, various hair and skin changes have been reported in severely malnourished children globally. We aimed to describe the frequency and types of skin conditions in children admitted with acute illness to Queen Elizabeth Central Hospital, Blantyre, Malawi across a spectrum of nutritional status and validate an existing skin assessment tool.

Methods
Children between 1 week and 23 months of age with acute illness were enrolled and stratified by anthropometry. Standardised photographs were taken, and three dermatologists assessed skin changes and scored each child according to the SCORDoK tool.

Results
Among 103 children, median age of 12 months, 31 (30%) had severe wasting, 11 (11%) kwashiorkor (nutritional oedema), 20 (19%) had moderate wasting, 41 (40%) had no nutritional wasting and 18 (17%) a positive HIV antibody test. Six (5.8%) of the included patients died. 51 (50%) of children presented with at least one skin change. Pigmentary changes were the most common, observed in 35 (34%), with hair loss and bullae, erosions and desquamation the second most prevalent skin condition. Common diagnoses were congenital dermal melanocytosis, diaper dermatitis, eczema and postinflammatory hyperpigmentation. Severe skin changes like flaky paint dermatosis were rarely identified. Inter-rater variability calculations showed only fair agreement (overall Fleiss' kappa 0.25) while intrarater variability had a fair-moderate agreement (Cohen's kappa score of 0.47-0.58).

Discussion
Skin changes in hospitalised children with an acute illness and stratified according to nutritional status were not as prevalent as historically reported. Dermatological assessment by means of the SKORDoK tool using photographs is less reliable than expected.

Original languageEnglish
Article numbere002289
Number of pages8
JournalBMJ Paediatrics Open
Volume8
Issue number1
Early online date8 Jun 2024
DOIs
Publication statusE-pub ahead of print - 8 Jun 2024

Bibliographical note

Publisher Copyright:
© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY. Published by BMJ.

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