Patient's skin looks dirty or at least splotchy (which could be acrocyanosis or petechiae). The really interesting part to me is what appears to be tissue damage on the edge of the ear by the lobe, maybe from sleeping on a hard/rough surface for an extended period of time since the body's self-healing functions slow drastically with malnutrition. Furthermore, it's difficult to tell, but the patient's hair also appears to be discolored/lighter towards the front hairline near the temple. White/lighter hair can be a symptom of malnutrition as well. Or it could be dirt with pretty clear implications if it's that option.
Looks like the patient's left hand with the pinky slightly bent forming the shadow at the top