150 VITAMINS A AND CAROTENES 



color, and branny in texture as if strewn with coarse powder. There was no 

 evidence of sweating. Some patients showed chalky, opaque, and furrowed 

 nails, a few had numerous comedones on the face, neck, and chest. Body 

 temperature was frequently elevated and attributed to impaired heat- 

 regulating mechanisms of the integument; a similar phenomenon has been 

 noted in infants with keratomalacia^ , n . 20 g^j^^j ascribed to more deep- 

 seated metabolic disturbances.^" Pillat emphasized the widespread effects 

 upon the ectodermal leaf of the body, but made no microscopic study of the 

 skin; nor did he refer to follicular eruptions which were described two 

 years later by Frazier and Hu^* and have been generally accepted as spe- 

 cific manifestations of avitaminosis A. 



Frazier and Hu based their observations on 15 patients, of which 14 

 were soldiers, studied in the same hospital during the following year. They 

 further indicate^* that these were from a group of 209 soldiers with ocular 

 lesions which Pillat had examined, so that Pillat could not have been un- 

 aware of the follicular type of skin lesion. According to the history given 

 by the patients, the follicular lesions had usually preceded the onset of 

 keratomalacia, which was of 2 to 12 weeks' duration. Skin changes similar 

 to, but less severe than, those described by Pillat were noted in most of 

 these patients. Particular attention, however, was given to the papular 

 eruption to which they*'* applied the term ''follicular hyperkeratosis." Since 

 their observations have served as the standard of reference against which 

 subsequent findings have been compared, it seems appropriate to quote 

 their original description of the lesions -P 



Several weeks prior to the onset of the ocular symptoms, the skin became dry and 

 slightly rough. Subsequentl.y, spinous papules appeared at the sites of the hair 

 follicles, first involving the anterolateral aspect of the thighs and the posterolateral 

 aspect of the upper part of the forearms. The eruption gradually spread to the ex- 

 tensor surface of both upper and lower extremities, the shoulders and the lower part 

 of the abdomen, and to a less extent to the chest, back and buttocks. In some cases 

 the skin was darker than normal, turning a dull slate color. There was absence of 

 visible sweating, and the articular folds, which are usually moist, were dry and cov- 

 ered with closely adherent, delicate scales. The normal markings on the surface of 

 the skin were exaggerated in places, giving it a finely wrinkled appearance. 



The follicular papules varied in size according to the stage of development and the 

 degree of perifollicular infiltration. The largest were approximately 5 mm. in di- 

 ameter, hemispherical, rather firm and usually deeply i)igmented. The liyporpigmen- 

 tation extended in a narrow zone beyond the base of the lesion. Each papule held in 

 its apex a keratotic plug which in most instances projected above the surface of the 

 lesion as a hard spinous process, or was covered i\y a loosely adherent scale that 

 bridged the occluded follicular recess. When expressed, the plugs left gaping central 

 craters in the summits of the papules. The eruption was usually almndant and sym- 



" C. N. Frazier and C. K. Hu, Arch. Internal Med. 48, 507 (1931). 



34 C. N. Frazier and C. K. Hu, Arch. Dermatol, and Syphilol. 33, 825 (1936). 



