Dermatologic Manifestations of Vitamin A Deficiency Workup
- Author: Robert A Schwartz, MD, MPH; Chief Editor: William D James, MD more...
The diagnosis should be suspected in children who are malnourished or in patients with predisposing factors for its development. Note the following:
- Serum vitamin A levels: The biochemical definition of vitamin A deficiency (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.
Sorg O, Saurat JH. Topical Retinoids in Skin Ageing: A Focused Update with Reference to Sun-Induced Epidermal Vitamin A Deficiency. Dermatology. 2014 May 9. [Medline].
Brown CC, Noelle RJ. Seeing through the dark: New insights into the immune regulatory functions of vitamin A. Eur J Immunol. 2015 May. 45 (5):1287-95. [Medline].
Aguayo VM, Kahn S, Ismael C, Meershoek S. Vitamin A deficiency and child mortality in Mozambique. Public Health Nutr. 2005 Feb. 8(1):29-31. [Medline].
Roncone DP. Xerophthalmia secondary to alcohol-induced malnutrition. Optometry. 2006 Mar. 77(3):124-33. [Medline].
Venu M, Martin E, Saeian K, Gawrieh S. High prevalence of vitamin A and D deficiency in patients evaluated for liver transplantation. Liver Transpl. 2013 Mar 14. [Medline].
West KP Jr, Mehra S. Vitamin A intake and status in populations facing economic stress. J Nutr. 2010 Jan. 140(1):201S-7S. [Medline].
Bailey RL, West KP Jr, Black RE. The epidemiology of global micronutrient deficiencies. Ann Nutr Metab. 2015. 66 Suppl 2:22-33. [Medline].
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. 2006 Feb. 9(1):26-34. [Medline].
Khan MA, Gilbert C, Khan MD, Qureshi MB, Ahmad K. Incidence of blinding vitamin A deficiency in North West Frontier Province and its adjoining Federally Administered Tribal Areas, Pakistan. Ophthalmic Epidemiol. 2009 Jan-Feb. 16(1):2-7. [Medline].
Imdad A, Herzer K, Mayo-Wilson E, Yakoob MY, Bhutta ZA. Vitamin A supplementation for preventing morbidity and mortality in children from 6 months to 5 years of age. Cochrane Database Syst Rev. 2010. 12:CD008524. [Medline].
Kaufman DR, De Calisto J, Simmons NL, Cruz AN, Villablanca EJ, Mora JR, et al. Vitamin A deficiency impairs vaccine-elicited gastrointestinal immunity. J Immunol. 2011 Aug 15. 187(4):1877-83. [Medline]. [Full Text].
Jiang S, Wang CX, Lan L, Zhao D. Vitamin A deficiency aggravates iron deficiency by upregulating the expression of iron regulatory protein-2. Nutrition. 2012 Mar. 28(3):281-7. [Medline].
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. 2008 Apr. 138(4):787-92. [Medline].
Ocón J, Cabrejas C, Altemir J, Moros M. Phrynoderma: A Rare Dermatologic Complication of Bariatric Surgery. JPEN J Parenter Enteral Nutr. 2012 Jan 23. [Medline].
Garcovich S, Di Stefani A, Capizzi R, Massi G, Peris K. Occurrence of hidradenitis suppurativa and phrynoderma after bariatric surgery. J Eur Acad Dermatol Venereol. 2015 Apr 16. [Medline].
Wiseman EM, Bar-El Dadon S, Reifen R. The vicious cycle of vitamin A deficiency: A review. Crit Rev Food Sci Nutr. 2016 Apr 29. [Medline].
Barclay AJ, Foster A, Sommer A. Vitamin A supplements and mortality related to measles: a randomised clinical trial. Br Med J (Clin Res Ed). 1987 Jan 31. 294(6567):294-6. [Medline].
West CE. Vitamin A and measles. Nutr Rev. 2000 Feb. 58(2 Pt 2):S46-54. [Medline].
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. 2007 May. 137(5):1272-7. [Medline].
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. 2007 May. 137(5):1320-1327. [Medline].
Tanoue K, Matsui K, Takamasu T. Fried-Potato Diet Causes Vitamin A Deficiency in an Autistic Child. JPEN J Parenter Enteral Nutr. 2012 Feb 7. [Medline].
Dotan G, Goldstein M, Stolovitch C, Kesler A. Pediatric Pseudotumor Cerebri Associated With Low Serum Levels of Vitamin A. J Child Neurol. 2013 Jan 29. [Medline].
Aguayo VM, Baker SK. Vitamin A deficiency and child survival in sub-Saharan Africa: a reappraisal of challenges and opportunities. Food Nutr Bull. 2005 Dec. 26(4):348-55. [Medline].