Dermatologic Manifestations of Vitamin A Deficiency Treatment & Management
- Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more...
A person with xerophthalmia requires immediate treatment if corneal destruction, blindness, and even death are to be avoided.
Oral administration of vitamin A 200,000 IU at presentation, the following day, and a third dose a week later is recommended. Children younger than 1 year should receive one half the standard dose, and infants younger than 6 months should receive a quarter of the standard dose.
Children with marasmus or kwashiorkor need further nutritional supplementation and monitoring with additional doses of vitamin A at monthly intervals until they are clinically improved.
Concurrent illness (eg, malaria, intestinal parasites, dehydration, tuberculosis) must be treated.
Pregnant women should not receive large doses of vitamin A because it may be teratogenic, but a daily dose of 10,000 IU over 2 weeks is safe.
In all cases, a diet rich in vitamin A should be advised.
Full-thickness keratomalacia is usually inoperable. The entire cornea is involved, and patients who are affected are too debilitated to undergo anesthesia.
Consultation with the following specialists may be helpful:
Common dietary sources of preformed vitamin A include liver, dairy products, and fish. Carrots are the major source of beta-carotene. Other contributors of beta-carotene are cantaloupe, broccoli, squash, peas, and spinach.
A food-based approach may be a desirable and sustainable complement to supplementation programs. A good example is the orange-fleshed sweet potato, which is rich in beta-carotene and has been well accepted by young children. Orange-fleshed sweet potatoes were found to increase vitamin A intake and serum retinol concentrations in young children in rural Mozambique. However, fried potatoes contain no vitamin A, and mentally challenged children consuming fried potatoes almost exclusively have been described with vitamin A deficiency.
Note the following possible complications:
- Acute gastroenteritis
- Growth retardation
- Vitamin A toxicity (secondary to treatment)
An association between pediatric pseudotumor cerebri and low serum vitamin A levels has been observed even when other manifestations of xerophthalmia are not evident.
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 vitamin A deficiency (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. 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.
Dietary modifications should include foods rich in vitamin A and periodic oral doses of vitamin A.
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