VIII. VITAMIN' A DEFICIENCY IN HUMAN BEINGS 155 



tively high incidence of the lesions in children of school age, often in associ- 

 ation with a low incidence of ocular symptoms referable to vitamin A 

 deficiency. XichoUs^'* observed tj'pical skin lesions in about one-fourth of 

 4380 children in Ceylon, and Loewenthal^' in about one-third of 952 chil- 

 dren examined in l^ganda, of which only 40 had ocular symptoms. The 

 general picture of a mild "goose-flesh" type of eruption in very young 

 children and small papules in older children, progressing to the more con- 

 spicuous follicular lesions in adults conforms to that observed in China. 

 Aykroyd and associates'^' '' observed a lower incidence in children in South 

 India and, largely on the basis of poor correlation between estimated dietary 

 intake and frequency of skin and ocular manifestations, felt that lack of 

 vitamin A was only one factor, and perhaps not the major one, in the 

 genesis of the follicular lesions. Yet, the histopathology of the lesions in 

 children and adults from the same local area, as described by Radhakrishna 

 Rao,'*"' *^ indicates a true axatamiriosis A. 



Fasal" reports finding follicular lesions in 2% of 1482 Malay, and 25.6% 

 of 657 Tamil, children. Although the incidence of Bitot's spots did not 

 parallel that of the skin lesions in the two groups, striking differences in 

 the dietary intake of vitamin A and the response of the lesions to red palm 

 oil and vitamin A concentrates strongly implicated lack of vitamin A. 

 Fasal states that the lesions closely resemble those of ichthyosis follicularis 

 and comments on their asj^mmetrical intensity in adults due to local pres- 

 sure and friction, such as resting of forearm on the thigh in weeding opera- 

 tions and carrying of infants on the hip. 



More recently, Ramalingaswami'- has reported a high incidence of Bitot's 

 spots, keratomalacia, severe diarrhea, dry inelastic skin, and follicular hy- 

 perkeratosis in children attending the nutrition clinic at Coonoor, South 

 India. The estimated dietary intake of vitamin A was 460 I.U., and plasma 

 vitamin A levels determined on 6 children with severe diarrhea ranged 

 from to 32 I.U. per 100 ml. Administration of a vitamin A concentrate 

 (72,000 I.U. of vitamin A dail}^ ga-ve dramatic control of the diarrhea in 

 about 48 hours and a more gradual improvement in the other manifestations 

 of the deficiency state. On the other hand, PaP^ reports on 70 cases of 

 avitaminosis A, mostly children 3 to 8 years of age, attending a medical 

 school Out-Patient Department in Calcutta; the majority showed ocular 

 manifestations ranging from night blindness to keratomalacia, yet only 4 

 ca.ses of follicular hypcrkeratosi.s were recognized. 



" L. Xicholls, Indian Med. Gaz. 69, 241 (1934); 70, 14 (1935); 70, 550 (1935). 

 ^9 L. J. A. Loewenthal, Ann. Trop. Med. Parasitol. 29, 349, 407 (1935). 

 50 W. R. Aykroyd and K. Rajagopal, Indian J. Med. Research 24, 419, (1936). 

 5' W. R. Aykroyd and B. G. Krishnan, Indian J. Med. Research 24, 707 (1937). 

 " V. Ramalingaswami, Indian J. Med. Sci. 2, 665 (1948), cited in Nutrition Revs. 3, 

 38 (1949). 



