eMedicine Specialties > Dermatology > Metabolic Diseases

Avitaminosis A: Follow-up

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

Follow-up

Further Outpatient Care

  • Dietary modifications should include foods rich in vitamin A and periodic oral doses of vitamin A.

Deterrence/Prevention

  • Improving vitamin A status reduces childhood mortality and the risk of blindness. Prevention relies on the maintenance of adequate vitamin A stores either by increasing vitamin A intake in the diet or by periodically administering vitamin A. For prophylaxis, newborns should receive 50,000 IU of vitamin A, children younger than 1 year should receive 100,000 IU every 4-6 months, adults and children older than 1 year should receive 200,000 IU every 4-6 months, and pregnant or lactating women should receive 20,000 IU each week.
  • Public health programs studying the prevalence of VAD are investigating the most effective ways of distributing supplements, from linking them to immunization programs to fortifying common foods (ie, iodized salt). They also strive to promote nutritional education in an effort to increase consumption of red, orange, and leafy green vegetables by endemic populations.
  • VAD and child survival in sub-Saharan Africa were assessed by Aguayo and Baker in 2005.9 Effective and sustained control of VAD represents one of the most cost-effective and high-impact child-survival interventions in sub-Saharan Africa. The urgent solutions are known, effective, and affordable.

Complications

  • Acute gastroenteritis
  • Growth retardation
  • Infections
  • Vitamin A toxicity (secondary to treatment)

Prognosis

  • Early recognition and treatment is the key to preventing blindness due to secondary infections and/or ocular ulceration.

Patient Education

  • The promotion of community, school, and household gardens, especially the cultivation of foods rich in provitamin A activity, is currently one of the more common strategies to promote dietary change.
    • Nutritional education is often incorporated into gardening projects and is provided at health centers in conjunction with the distribution of vitamin A supplements.
    • Social marketing techniques are used to influence the acceptability of social action and to create programs that elicit desired behaviors. Behavioral changes perceived by the community as beneficial are the target for this approach. Social marketing requires the active involvement of community members and a mixture of communication strategies.

Miscellaneous

Medicolegal Pitfalls

  • Failure to recognize manifestations of VAD
  • Failure to perform a pregnancy test before starting treatment with high doses of vitamin A

Special Concerns

  • Pregnancy
    • Vitamin A is teratogenic, and treatment should not exceed the recommended dosage for pregnant women.
    • The American College of Obstetricians and Gynecologists has recommended that women who are pregnant or planning to become pregnant should not exceed a daily dose of 5000 IU of vitamin A.
    • The US Food and Drug Administration has recommended that vitamin A be taken by pregnant women in the form of beta-carotene, which is not considered toxic.
  • Anemia, iron status, and VAD among adolescent refugees in Kenya and Nepal
  • Combining vitamin A and zinc supplementation reduces the risk of clinical malaria episodes among children, and thus may play a role in malaria control for children in Africa.10
 


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

  1. Aguayo VM, Kahn S, Ismael C, Meershoek S. Vitamin A deficiency and child mortality in Mozambique. Public Health Nutr. Feb 2005;8(1):29-31. [Medline].

  2. Roncone DP. Xerophthalmia secondary to alcohol-induced malnutrition. Optometry. Mar 2006;77(3):124-33. [Medline].

  3. Woodruff BA, Blanck HM, Slutsker L, Cookson ST, Larson MK, Duffield A, et al. Anaemia, iron status and vitamin A deficiency among adolescent refugees in Kenya and Nepal. Public Health Nutr. Feb 2006;9(1):26-34. [Medline].

  4. Tielsch JM, Rahmathullah L, Katz J, Thulasiraj RD, Coles C, Sheeladevi S, et al. Maternal night blindness during pregnancy is associated with low birthweight, morbidity, and poor growth in South India. J Nutr. Apr 2008;138(4):787-92. [Medline].

  5. Barclay AJ, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed). Jan 31 1987;294(6567):294-6. [Medline].

  6. West CE. Vitamin A and measles. Nutr Rev. Feb 2000;58(2 Pt 2):S46-54. [Medline].

  7. Newton S, Owusu-Agyei S, Ampofo W, Zandoh C, Adjuik M, Adjei G, et al. Vitamin A Supplementation Enhances Infants' Immune Responses to Hepatitis B Vaccine but Does Not Affect Responses to Haemophilus influenzae Type b Vaccine. J Nutr. May 2007;137(5):1272-7. [Medline].

  8. Low JW, Arimond M, Osman N, Cunguara B, Zano F, Tschirley D. A Food-Based Approach Introducing Orange-Fleshed Sweet Potatoes Increased Vitamin A Intake and Serum Retinol Concentrations in Young Children in Rural Mozambique. J Nutr. May 2007;137(5):1320-1327. [Medline].

  9. Aguayo VM, Baker SK. Vitamin A deficiency and child survival in sub-Saharan Africa: a reappraisal of challenges and opportunities. Food Nutr Bull. Dec 2005;26(4):348-55. [Medline].

  10. Zeba AN, Sorgho H, Rouamba N, Zongo I, Rouamba J, Guiguemdé RT, et al. Major reduction of malaria morbidity with combined vitamin A and zinc supplementation in young children in Burkina Faso: a randomized double blind trial. Nutr J. Jan 31 2008;7:7. [Medline].

  11. Ag Bendech M, Malvy DJ, Chauliac M. [Vitamin A deficiency: epidemiological aspects and control methods]. Sante. Sep-Oct 1997;7(5):309-16. [Medline].

  12. Ahmed F. Vitamin A deficiency in Bangladesh: a review and recommendations for improvement. Public Health Nutr. Mar 1999;2(1):1-14. [Medline].

  13. Amedee-Manesme O, Mourey MS, Hanck A, Therasse J. Vitamin A relative dose response test: validation by intravenous injection in children with liver disease. Am J Clin Nutr. Aug 1987;46(2):286-9. [Medline].

  14. Anderson VP, Jack S, Monchy D, Hem N, Hok P, Bailey KB, et al. Co-existing micronutrient deficiencies among stunted Cambodian infants and toddlers. Asia Pac J Clin Nutr. 2008;17(1):72-9. [Medline].

  15. Asagba SO, Isamah GK, Ossai EK, Ekakitie AO. Effect of oral exposure to cadmium on the levels of vitamin A and lipid peroxidation in the eye. Bull Environ Contam Toxicol. Jan 2002;68(1):18-21. [Medline].

  16. Azaïs-Braesco V, Pascal G. Vitamin A in pregnancy: requirements and safety limits. Am J Clin Nutr. May 2000;71(5 Suppl):1325S-33S. [Medline].

  17. Beisel WR. Single nutrients and immunity. Am J Clin Nutr. Feb 1982;35(2 Suppl):417-68. [Medline].

  18. Bendech MA, Cusack G, Konate F, Toure A, Ba M, Baker SK. National Vitamin A Supplementation Coverage Survey among 6-59 Months Old Children in Guinea (West Africa). J Trop Pediatr. Apr 25 2007;[Medline].

  19. Caminha MD, Diniz AD, Falbo AR, Arruda IK, Serva VB, Albuquerque LL, et al. Serum Retinol Concentrations in Hospitalized Severe Protein-energy Malnourished Children. J Trop Pediatr. Apr 1 2008;[Medline].

  20. Chandra RK. Increased bacterial binding to respiratory epithelial cells in vitamin A deficiency. BMJ. Oct 1 1988;297(6652):834-5. [Medline].

  21. Chandra RK. Nutrition and immunity. Trop Geogr Med. Jul 1988;40(3):S46-51. [Medline].

  22. Cheung WM. Vitamin A and Retinoids: An Update of Biological Aspects and Clinical Applications, edited by M.A. Livrea, Wiley-VCH, 2000, 300 p. Biochimie. Oct 2001;83(10):987-8.

  23. Christian P, West KP Jr. Interactions between zinc and vitamin A: an update. Am J Clin Nutr. Aug 1998;68(2 Suppl):435S-441S. [Medline].

  24. Chugh R, Puri S. Affluent adolescent girls of Delhi: eating and weight concerns. Br J Nutr. Oct 2001;86(4):535-42. [Medline].

  25. Craft NE. Innovative approaches to vitamin A assessment. J Nutr. May 2001;131(5):1626S-30S. [Medline].

  26. Cusick SE, Tielsch JM, Ramsan M, Jape JK, Sazawal S, Black RE, et al. Short-term effects of vitamin A and antimalarial treatment on erythropoiesis in severely anemic Zanzibari preschool children. Am J Clin Nutr. Aug 2005;82(2):406-12. [Medline].

  27. de Pee S, West CE. Dietary carotenoids and their role in combating vitamin A deficiency: a review of the literature. Eur J Clin Nutr. Jul 1996;50 Suppl 3:S38-53. [Medline].

  28. Duggan C, Fawzi W. Micronutrients and child health: studies in international nutrition and HIV infection. Nutr Rev. Nov 2001;59(11):358-69. [Medline].

  29. Duggan MB, Milner RD. The maintenance energy requirement for children: an estimate based on a study of children with infection associated underfeeding. Am J Clin Nutr. Jun 1986;43(6):870-8. [Medline].

  30. Elefant E. [Vitamin A. Consequence of a deficiency, of excessive vitamin A, and value of systematic supplementation]. J Gynecol Obstet Biol Reprod (Paris). 1997;26(3 Suppl):95-9. [Medline].

  31. Figueiredo JF, Lorenzato MM, Silveira SA, Passos AD, Rodrigues Md, Galvao LC, et al. [Survival and infectious processes in pacients with AIDS: analysis based on initial serum vitamin A levels]. Rev Soc Bras Med Trop. Sep-Oct 2001;34(5):429-35. [Medline].

  32. Flores H, Campos F, Araujo RC, Underwood BA. Assessment of marginal vitamin A deficiency in Brazilian children using the relative dose response procedure. Am J Clin Nutr. Dec 1984;40(6):1281-9. [Medline].

  33. Gadomski AM, Kjolhede CL, Wittpenn J, Bulux J, Rosas AR, Forman MR. Conjunctival impression cytology (CIC) to detect subclinical vitamin A deficiency: comparison of CIC with biochemical assessments. Am J Clin Nutr. Mar 1989;49(3):495-500. [Medline].

  34. Gerster H. Vitamin A--functions, dietary requirements and safety in humans. Int J Vitam Nutr Res. 1997;67(2):71-90. [Medline].

  35. Gupta M, Jora R, Bhatia R, Pareek A. Keratomalacia in a neonate secondary to maternal vitamin A deficiency. Indian J Pediatr. Oct 2005;72(10):881-2. [Medline].

  36. Handelman GJ. The evolving role of carotenoids in human biochemistry. Nutrition. Oct 2001;17(10):818-22. [Medline].

  37. Harris EW, Loewenstein JI, Azar D. Vitamin A deficiency and its effects on the eye. Int Ophthalmol Clin. 1998;38(1):155-61. [Medline].

  38. Hu W, Tong S, Oldenburg B, Feng X. Serum vitamin A concentrations and growth in children and adolescents in Gansu Province, China. Asia Pac J Clin Nutr. 2001;10(1):63-6. [Medline].

  39. Kennedy CM, Kuhn L, Stein Z. Vitamin A and HIV infection: disease progression, mortality, and transmission. Nutr Rev. Oct 2000;58(10):291-303. [Medline].

  40. Kilic SS, Kezer EY, Ilcol YO, Yakut T, Aydin S, Ulus IH. Vitamin a deficiency in patients with common variable immunodeficiency. J Clin Immunol. May 2005;25(3):275-80. [Medline].

  41. Kjolhede CL, Gadomski AM, Wittpenn J, Bulux J, Rosas AR, Solomons NW, et al. Conjunctival impression cytology: feasibility of a field trial to detect subclinical vitamin A deficiency. Am J Clin Nutr. Mar 1989;49(3):490-4. [Medline].

  42. Leo MA, Lieber CS. Alcohol, vitamin A, and beta-carotene: adverse interactions, including hepatotoxicity and carcinogenicity. Am J Clin Nutr. Jun 1999;69(6):1071-85. [Medline].

  43. Looker AC, Johnson CL, Woteki CE, Yetley EA, Underwood BA. Ethnic and racial differences in serum vitamin A levels of children aged 4-11 years. Am J Clin Nutr. Feb 1988;47(2):247-52. [Medline].

  44. Lower GM Jr, Kanarek MS. Retinoids, urinary bladder carcinogenesis, and chemoprevention: a review and synthesis. Nutr Cancer. 1981;3(2):109-15. [Medline].

  45. Maden M. The role of retinoic acid in embryonic and post-embryonic development. Proc Nutr Soc. Feb 2000;59(1):65-73. [Medline].

  46. McCullough FS, Northrop-Clewes CA, Thurnham DI. The effect of vitamin A on epithelial integrity. Proc Nutr Soc. May 1999;58(2):289-93. [Medline].

  47. McDowell EM, Keenan KP, Huang M. Effects of vitamin A-deprivation on hamster tracheal epithelium. A quantitative morphologic study. Virchows Arch B Cell Pathol Incl Mol Pathol. 1984;45(2):197-219. [Medline].

  48. McDowell EM, Keenan KP, Huang M. Restoration of mucociliary tracheal epithelium following deprivation of vitamin A. A quantitative morphologic study. Virchows Arch B Cell Pathol Incl Mol Pathol. 1984;45(2):221-40. [Medline].

  49. McLaren DS. Vitamin A deficiency disorders. J Indian Med Assoc. Aug 1999;97(8):320-3. [Medline].

  50. Mejia LA, Arroyave G. The effect of vitamin A fortification of sugar on iron metabolism in preschool children in Guatemala. Am J Clin Nutr. Jul 1982;36(1):87-93. [Medline].

  51. Mertens TE, Cousens SN, Feachem RG. Evidence of a prolonged association between low birthweight and paediatric diarrhoea in Sri Lanka. Trans R Soc Trop Med Hyg. 1987;81(2):196. [Medline].

  52. Milton RC, Reddy V, Naidu AN. Mild vitamin A deficiency and childhood morbidity--an Indian experience. Am J Clin Nutr. Nov 1987;46(5):827-9. [Medline].

  53. Mora JO, Gueri M, Mora OL. Vitamin A deficiency in Latin America and the Caribbean: an overview. Rev Panam Salud Publica. Sep 1998;4(3):178-86. [Medline].

  54. Morriss-Kay GM, Ward SJ. Retinoids and mammalian development. Int Rev Cytol. 1999;188:73-131. [Medline].

  55. Muslimatun S, Schmidt MK, Schultink W, West CE, Hautvast JA, Gross R, et al. Weekly supplementation with iron and vitamin A during pregnancy increases hemoglobin concentration but decreases serum ferritin concentration in Indonesian pregnant women. J Nutr. Jan 2001;131(1):85-90. [Medline].

  56. Muslimatun S, Schmidt MK, West CE, Schultink W, Hautvast JG, Karyadi D. Weekly vitamin A and iron supplementation during pregnancy increases vitamin A concentration of breast milk but not iron status in Indonesian lactating women. J Nutr. Oct 2001;131(10):2664-9. [Medline].

  57. Nabakwe EC, Lichtenbelt WV, Ngare DK, Wierik M, Westerterp KR, Owino OC. Vitamin a deficiency and anaemia in young children living in a malaria endemic district of western Kenya. East Afr Med J. Jun 2005;82(6):300-6. [Medline].

  58. Natadisastra G, Wittpenn JR, West KP Jr, Muhilal, Sommer A. Impression cytology for detection of vitamin A deficiency. Arch Ophthalmol. Sep 1987;105(9):1224-8. [Medline].

  59. Nestel P, Trumbo P. The role of provitamin A carotenoids in the prevention and control of vitamin A deficiency. Arch Latinoam Nutr. Sep 1999;49(3 Suppl 1):26S-33S. [Medline].

  60. Niles RM. Vitamin A and cancer. Nutrition. Jul-Aug 2000;16(7-8):573-6. [Medline].

  61. Pal R, Sagar V. Antecedent risk factors of xerophthalmia among Indian rural preschool children. Eye Contact Lens. Mar 2008;34(2):106-8. [Medline].

  62. Petkovich PM. Retinoic acid metabolism. J Am Acad Dermatol. Nov 2001;45(5):S136-42. [Medline].

  63. Pilch SM. Analysis of vitamin A data from the health and nutrition examination surveys. J Nutr. Apr 1987;117(4):636-40. [Medline].

  64. Pinnock CB, Douglas RM, Badcock NR. Vitamin A status in children who are prone to respiratory tract infections. Aust Paediatr J. May 1986;22(2):95-9. [Medline].

  65. Raila J, Mathews U, Schweigert FJ. Plasma transport and tissue distribution of beta-carotene, vitamin A and retinol-binding protein in domestic cats. Comp Biochem Physiol A Mol Integr Physiol. Nov 2001;130(4):849-56. [Medline].

  66. Ramakrishna T. Vitamins and brain development. Physiol Res. 1999;48(3):175-87. [Medline].

  67. Rondo PH, Abbott R, Tomkins AM. Vitamin A and neonatal anthropometry. J Trop Pediatr. Oct 2001;47(5):307-10. [Medline].

  68. Ross AC, Stephensen CB. Vitamin A and retinoids in antiviral responses. FASEB J. Jul 1996;10(9):979-85. [Medline].

  69. Ross DA. Vitamin A and public health: challenges for the next decade. Proc Nutr Soc. Feb 1998;57(1):159-65. [Medline].

  70. Russell RM. The vitamin A spectrum: from deficiency to toxicity. Am J Clin Nutr. Apr 2000;71(4):878-84. [Medline].

  71. Samba C, Tchibindat F, Houze P, Gourmel B, Malvy D. Prevalence of infant Vitamin A deficiency and undernutrition in the Republic of Congo. Acta Trop. Mar 2006;97(3):270-83. [Medline].

  72. Seeliger M, Biesalski HK. [Vitamin A metabolism and retinal degeneration]. Ophthalmologe. Jun 2001;98(6):520-5. [Medline].

  73. Semba RD, Munasir Z, Akib A, Melikian G, Permaesih D, Muherdiyantiningsih, et al. Integration of vitamin A supplementation with the Expanded Programme on Immunization: lack of impact on morbidity or infant growth. Acta Paediatr. Oct 2001;90(10):1107-11. [Medline].

  74. Senior K. Vitamin A and its impact on human medicine. Lancet. Sep 29 2001;358(9287):1072. [Medline].

  75. Shenai JP, Kennedy KA, Chytil F, Stahlman MT. Clinical trial of vitamin A supplementation in infants susceptible to bronchopulmonary dysplasia. J Pediatr. Aug 1987;111(2):269-77. [Medline].

  76. Simms W, Ross PS. Vitamin A physiology and its application as a biomarker of contaminant-related toxicity in marine mammals: a review. Toxicol Ind Health. Sep 2001;16(7-8):291-302. [Medline].

  77. Smith J, Steinemann TL. Vitamin A deficiency and the eye. Int Ophthalmol Clin. 2000;40(4):83-91. [Medline].

  78. Solomons NW. Plant sources of vitamin A and human nutriture: how much is still too little?. Nutr Rev. Nov 1999;57(11):350-3. [Medline].

  79. Sommer A. Moving from science to public health programs: lessons from vitamin A. Am J Clin Nutr. Aug 1998;68(2 Suppl):513S-516S. [Medline].

  80. Sommer A. Xerophthalmia and vitamin A status. Prog Retin Eye Res. Jan 1998;17(1):9-31. [Medline].

  81. Sommer A, Katz J, Tarwotjo I. Increased risk of respiratory disease and diarrhea in children with preexisting mild vitamin A deficiency. Am J Clin Nutr. Nov 1984;40(5):1090-5. [Medline].

  82. Sommer A, Tarwotjo I, Katz J. Increased risk of xerophthalmia following diarrhea and respiratory disease. Am J Clin Nutr. May 1987;45(5):977-80. [Medline].

  83. Sommer A, West KP Jr. Impact of vitamin A on childhood mortality. Indian J Pediatr. Jul-Aug 1987;54(4):461-3. [Medline].

  84. Sorg O, Tran C, Saurat JH. Cutaneous vitamins A and E in the context of ultraviolet- or chemically-induced oxidative stress. Skin Pharmacol Appl Skin Physiol. Nov-Dec 2001;14(6):363-72. [Medline].

  85. Stephens D, Jackson PL, Gutierrez Y. Subclinical vitamin A deficiency: a potentially unrecognized problem in the United States. Pediatr Nurs. Sep-Oct 1996;22(5):377-89, 456. [Medline].

  86. Stephensen CB. Vitamin A, infection, and immune function. Annu Rev Nutr. 2001;21:167-92. [Medline].

  87. Stephenson LS, Latham MC, Ottesen EA. Global malnutrition. Parasitology. 2000;121 Suppl:S5-22. [Medline].

  88. Su GM, Sefton RM, Murray M. Down-regulation of rat hepatic microsomal cytochromes P-450 in microvesicular steatosis induced by orotic acid. J Pharmacol Exp Ther. Dec 1999;291(3):953-9. [Medline].

  89. Tamai H. [Vitamin A deficiency and neurological findings]. Ryoikibetsu Shokogun Shirizu. 2000;(29 Pt 4):102-3. [Medline].

  90. Tanumihardjo SA, Olson JA. A modified relative dose-response assay employing 3,4-didehydroretinol (vitamin A2) in rats. J Nutr. May 1988;118(5):598-603. [Medline].

  91. Underwood BA. From research to global reality: the micronutrient story. J Nutr. Feb 1998;128(2):145-51. [Medline].

  92. Underwood BA. Hypovitaminosis A: international programmatic issues. J Nutr. Aug 1994;124(8 Suppl):1467S-1472S. [Medline].

  93. Underwood BA. Methods for assessment of vitamin A status. J Nutr. Nov 1990;120 Suppl 11:1459-63. [Medline].

  94. Underwood BA. Perspectives from micronutrient malnutrition elimination/eradication programmes. Bull World Health Organ. 1998;76 Suppl 2:34-7. [Medline].

  95. Underwood BA. The role of vitamin A in child growth, development and survival. Adv Exp Med Biol. 352:201-8. [Medline].

  96. Underwood BA. The timing of high-dose vitamin A supplementation to children. Am J Public Health. Sep 1995;85(9):1200-1. [Medline].

  97. Underwood BA. Vitamin A deficiency. Bull World Health Organ. 1998;76 Suppl 2:124-5. [Medline].

  98. Underwood BA, Arthur P. The contribution of vitamin A to public health. FASEB J. Jul 1996;10(9):1040-8. [Medline].

  99. van den Berg H. Vitamin A intake and status. Eur J Clin Nutr. Jul 1996;50 Suppl 3:S7-12. [Medline].

  100. Villamor E, Fawzi WW. Vitamin A supplementation: implications for morbidity and mortality in children. J Infect Dis. Sep 2000;182 Suppl 1:S122-33. [Medline].

  101. West CE. Meeting requirements for vitamin A. Nutr Rev. Nov 2000;58(11):341-5. [Medline].

  102. Wittpenn JR, Tseng SC, Sommer A. Detection of early xerophthalmia by impression cytology. Arch Ophthalmol. Feb 1986;104(2):237-9. [Medline].

  103. Zile MH. Function of vitamin A in vertebrate embryonic development. J Nutr. Mar 2001;131(3):705-8. [Medline].

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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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