<s>[INST] context: Early signs of kwashiorkor present as general symptoms of malnutrition and include fatigue, irritability and lethargy. As protein deprivation continues the following abnormalities become apparent. Failure to thrive (failure to put on height and weight) Loss of muscle mass Generalised swelling (oedema) Large protuberant belly (pot belly) Fatty liver Failing immune system so prone to infections and increased severity of normally mild infections Skin and hair changes Cutaneous features of kwashiorkor Characteristic skin and hair changes occur in kwashiorkor and develop over a few days. Skin lesions are at first erythematousbefore turning purple and reddish-brown in colour with marked exfoliation (skin peeling and sloughing) Where the skin becomes dark and dry, it splits open when stretched to reveal pale areas between the cracks ("lacquered flaky paint", "crazy pavement dermatosis") Irregular or patchy discolouration of the skin caused by pigmentary changes Hair becomes dry and lustreless and may turn reddish yellow to white in colour. It becomes sparse and brittle and can be pulled out easily. Nail plates are thin and soft and may be fissured or ridged. [/INST] question: Which one of the following is not the characteristic feature of kwashiorkor ? | options: A: Hair and skin changes B: Muscle wasting C: Growth retardation D: Psychomotor changes | answer: B </s>