I remember a long debate about what caused the skin condition of this little boy, a few years back. Some people thought it was just dirt, or impetigo. I believe it very likely was pellagra, caused by a chronic niacin deficiency, which was especially prominent in populations such as this. It must have been extremely miserable! I had a severe rash on my forearms and hands, from ages 9-13, which looked similar. It was just from detergent allergy, and when my family got a dishwasher, it went away, but it was bad enough to make me sympathize with anyone with a severe rash. In addition to making life miserable, pellagra can actually cause death. I sure hope this little boy was able to get the nutrition he needed, to get rid of it.