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Vitamin A deficiency in Child
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Vitamin A deficiency in Child

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Contributors: Chris G. Adigun MD, David Dasher MD
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Synopsis

Phrynoderma is characterized by follicular hyperkeratosis. It is associated with various nutritional deficiencies, most notably vitamin A, but may be associated with deficiencies in vitamins A, B complex, C, or E. Even deficiencies in essential fatty acids have been implicated. However, the overall consensus in the literature is that general malnutrition is the strongest associated cause.

The term "phrynoderma," coined by Nicholls in 1933, comes from the description of "toad like," used to describe the appearance of undernourished laborers in Eastern Africa. Patients develop hyperkeratotic follicular papules, primarily on the extensor surfaces of the extremities. Other associated symptoms include cheilitis, glossitis, blepharitis, night blindness, diarrhea, muscle weakness and neuritis. Severe deficiency in vitamin A can lead to destructive eye problems, including xerosis conjunctiva, Bitot's spots (buildup of keratin debris located superficially in the conjunctiva; spots are oval, triangular, or irregular in shape), xerosis corneae, and keratomalacia.

This condition is more common in developing countries, where widespread starvation and malnourishment persist. Although rare, phrynoderma does occur in developed countries, typically as a result of an extremely calorie-restricted diet, malabsorption due to medical conditions, such as pancreatic insufficiency, or surgical interventions, such as gastric bypass surgery or colectomy. Infectious causes include chronic giardiasis. Other individuals at risk include those that are institutionalized or have a history of an eating disorder such as anorexia nervosa.

Codes

ICD10CM:
E50.8 – Other manifestations of vitamin A deficiency

SNOMEDCT:
238629004 – Phrynoderma

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 03/30/2017
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Vitamin A deficiency in Child
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Vitamin A deficiency : Dry skin, Extensor distribution, Follicular configuration, Night blindness, Widespread, Dry eyes, Scaly papules
Clinical image of Vitamin A deficiency
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