eMedicine Specialties > Dermatology > Metabolic Diseases

Avitaminosis A: Differential Diagnoses & Workup

Author: Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Coauthor(s): Santiago A Centurion, MD, Staff Physician, Department of Dermatology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey; Cristina S Solis, RN, BSN, Consulting Staff, Department of Dermatology, UMDNJ-New Jersey Medical School; Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Contributor Information and Disclosures

Updated: Apr 29, 2008

Differential Diagnoses

Atrophia Maculosa Varioliformis Cutis
Lichen Simplex Chronicus
Keratosis Follicularis (Darier Disease)
Lichen Spinulosus
Keratosis Pilaris
Lichen Striatus
Kyrle Disease
Perforating Folliculitis
Lichen Nitidus
Pityriasis Rubra Pilaris
Lichen Planus
Prurigo Nodularis

Other Problems to Be Considered

Cholestatic hepatobiliary disease
Chronic cholestasis
Cystic fibrosis
Short-bowel syndrome
Biliary disease

Workup

Laboratory Studies

  • Diagnosis is usually based on a high index of suspicion in children who are malnourished or in patients with predisposing factors for its development.
  • Serum vitamin A levels: The biochemical definition of VAD is a plasma level of 35 µmol/dL or less. Several techniques are available, but high-pressure liquid chromatography is the most reliable. An important factor is that, with protein deficiency, serum vitamin A levels may be decreased despite good vitamin A intake and adequate vitamin A stores.
  • Total and holo retinol-binding protein (RBP) test: These tests (complex of vitamin A and RBP) for serum RBP tend to correlate with measures of serum vitamin A. These levels can also be decreased in the presence of protein deficiency.
  • Conjunctival impression cytology: This is a technique useful for detecting preclinical xerophthalmia. It is a noninvasive method of obtaining a specimen to assess the histologic appearance of the superficial conjunctival layers. Squamous metaplasia is evident by the presence of enlarged, irregular, and keratinized epithelial cells and the loss of goblet cells. Results are closely correlated with baseline serum vitamin A levels and with clinical improvement after treatment.

More on Avitaminosis A

Overview: Avitaminosis A
Differential Diagnoses & Workup: Avitaminosis A
Treatment & Medication: Avitaminosis A
Follow-up: Avitaminosis A
References
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References

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Further Reading

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Keywords

vitamin A deficiency, VAD, hypovitaminosis A, hyporetinemia, retinol, beta carotene, beta-carotene, keratomalacia, night blindness

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Contributor Information and Disclosures

Author

Robert A Schwartz, MD, MPH, Professor and Head of Dermatology, Professor of Medicine, Professor of Pediatrics, Professor of Pathology, Professor of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School
Robert A Schwartz, MD, MPH is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American College of Physicians, and Sigma Xi
Disclosure: Nothing to disclose.

Coauthor(s)

Santiago A Centurion, MD, Staff Physician, Department of Dermatology, New Jersey Medical School, University of Medicine and Dentistry of New Jersey
Santiago A Centurion, MD is a member of the following medical societies: American Academy of Dermatology, American Medical Association, and Sigma Xi
Disclosure: Nothing to disclose.

Cristina S Solis, RN, BSN, Consulting Staff, Department of Dermatology, UMDNJ-New Jersey Medical School
Disclosure: Nothing to disclose.

Pere Gascon, MD, PhD, Professor and Director, Division of Medical Oncology, Institute of Hematology and Medical Oncology, IDIBAPS, University of Barcelona Faculty of Medicine, Spain
Pere Gascon, MD, PhD is a member of the following medical societies: Alpha Omega Alpha, American College of Physicians, New York Academy of Medicine, New York Academy of Sciences, and Sigma Xi
Disclosure: Nothing to disclose.

Medical Editor

Shyam Verma, MBBS, DVD, FAAD, Adjunct Clinical Assistant Professor, Department of Dermatology, University of Virginia, State University of New York at Stonybrook, Penn State University
Shyam Verma, MBBS, DVD, FAAD is a member of the following medical societies: American Academy of Dermatology
Disclosure: Nothing to disclose.

Pharmacy Editor

David F Butler, MD, Professor of Dermatology, Texas A&M University College of Medicine; Director, Division of Dermatology, Scott and White Clinic; Director Dermatology Residency Training Program, Scott and White Clinic
David F Butler, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Dermatology, American Medical Association, American Society for Dermatologic Surgery, American Society for MOHS Surgery, Association of Military Dermatologists, and Phi Beta Kappa
Disclosure: 3M Pharmaceutical Grant/research funds Other; Graceway Pharmaceuticals Grant/research funds Other

Managing Editor

Jeffrey J Miller, MD, Associate Professor, Department of Dermatology, Penn State University, Milton S Hershey Medical Center
Disclosure: Nothing to disclose.

CME Editor

Joel M Gelfand, MD, MSCE, Medical Director, Clinical Studies Unit, Assistant Professor, Department of Dermatology, Associate Scholar, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania
Joel M Gelfand, MD, MSCE is a member of the following medical societies: Society for Investigative Dermatology
Disclosure: AMGEN Consulting fee Consulting; AMGEN Grant/research funds None; Genentech Consulting fee Consulting; Centocor Consulting fee Consulting; Centocor Grant/research funds None; Covance Consulting fee Consulting; Shire  Consulting

Chief Editor

William D James, MD, Paul R Gross Professor of Dermatology, University of Pennsylvania School of Medicine; Vice-Chair, Program Director, Department of Dermatology, University of Pennsylvania Health System
William D James, MD is a member of the following medical societies: American Academy of Dermatology and Society for Investigative Dermatology
Disclosure: elsevier Royalty Other; american college of physicians Honoraria Other

 
 
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