152 VITAMINS A AND CAROTENES 



of LoewenthaP'^ on prisoners in East Africa. Nieholls proposed the term 

 "phrynoderma," meaning like toad skin, for the papular eruption. Although 

 this term has been used chiefly by investigators in Africa and India, the 

 term "follicular hyperkeratosis" proposed by Frazier and Hu^"* is perhaps 

 more descriptive of the histopathologic lesion and more commonly used. 

 In the two studies mentioned above there was again the combination of 

 high incidence of ocular symptoms, diets very deficient in vitamin A, dry 

 and slate-grey skin, and follicular lesions which responded to cod liver oil 

 therapy (usually 1 oz. daily) more slowly than did the ocular symptoms. 



These early investigators were fully aware of the similarity between the 

 lesions ascribed to lack of vitamin A and those of other skin diseases in- 

 volving the pilosebaceous follicles. In addition to the therapeutic response 

 to cod liver oil, distribution of the lesions and infrequency of pustulation 

 seem to rule out acne vulgaris; the rarity of the papular lesions in post- 

 pubertal females, and in adolescent children, seemed incompatible with 

 keratosis pilaris; the incidence, and the lack of evidence of familial ten- 

 dency or of dyskeratotic changes histologically, seemed to exclude the 

 relatively rare condition of Darier's disease. As further evidence concerning 

 the specificity of the lesions, there was the demonstrated effectiveness of 

 halibut liver oil by Loewenthal in 2 patients, and by Frazier and Hu^'* in 

 1 patient, and of carotene injected intramuscularly in 1 patient by Frazier 

 and Li.^^ 



Further confirmation, based upon the macroscopic and microscopic char- 

 acter of the cutaneous lesions in adult subjects, and their response to vi- 

 tamin A therapy, is represented largely l)y the reports of Giblin^^ from 

 New Guinea (1 case), Radhakrishna Rao^"-'*! from Southern India, FasaP^ 

 from the Malay states, and Steffens et al}"^ (1 case) and Youmans and Cor- 

 lette^^ from this country. The recent report of NichoV^ based on a nutritional 

 survey in Nigeria in which careful attention was given to the macroscopic 

 features of the cutaneous lesions and their relation to other symptoms of 

 avitaminosis A, also provides strong evidence regarding the specdficity of 

 the lesions. In these confirmatory reports, varying degrees of ocular mani- 

 festations of vitamin A deficiency were common in the subjects examined, 



37 T.. J. A. Looweuthal, £/. African Med. J. 10, 58 (1933) ; Arch. Dermatol, and Si/philol. 

 28, 700 (1933). 



38 C. N. Frazier and H. C. Li, China Med. J. 54, 301 (1938). 



39 W. E. Giblin, Med. J. Australia 1, 202 (1936). 



"0 M. V. Radhakrisluia Rao, Indian J. Med. Research 24, 727 (1937). 



^' M. V. Radhakrishna Rao, Indian J. Med. Research 25, 39 (1937). 



« L. F. Steffens, II. L. Bair, and C. Sheard, Am. J. Ophthalmol. 23, 1325 (1940). 



" J. B. Youmans and M. B. Corlette, Am. J. Med. Sci. 195, 644 (1938). 



« B. M. Nichol, Brit. J. Nutrition 3, 25 (1949). 



