160 VITAMINS A AND CAROTENES 



In 1941, Peck et al}^ reported the beneficial response of 4 patients with 

 Darier's disease to high vitamin A therapy. This was confirmed by others 

 prior to their later summary of experience with 10 patients, ^'^ and by sub- 

 sequent reports. ^^"^^ Although the response of patients has varied widely 

 and has been negative in some instances, the good responses do not seem 

 explicable on the basis of spontaneous remission. When considered as a 

 group, the majority of patients have shown low plasma levels of vitamin A, 

 associated with low carotene levels in some studies^" but not in others,'^'' 

 and with dark dysadaptation in some^^ but not in others. ^^ After vitamin A 

 therapy, blood levels have been restored to normal or somewhat above nor- 

 mal,^'' or have sometimes reached exceedingly high levels.^" The majority 

 of patients have shown striking improvement in the skin lesions, usually 

 after several months of therapy. With discontinuation of therapy, a ten- 

 dency for lesions to recur and for vitamin A blood levels to decrease below 

 normal has been noted." The findings referred to have much in common 

 with a hereditary hyperkeratosis in mice which is considerably modified by 

 high vitamin A therapy.^- It is postulated that a great excess of vitamin A 

 may overcome a metabolic defect in the ability of the liver or cutaneous 

 structures to utilize vitamin A," or may produce a state in which the rate 

 of absorption exceeds liver storage to the point where vitamin A reached 

 tissues from which it is excluded by disease.^" 



In pityriasis rubra pilaris (Devergie's disease), a rare and hereditary 

 disease of which a major characteristic is hyperkeratosis of hair follicles, 

 vitamin A blood levels are said to be within normal limits ;^^' ^'^ yet 100,000 

 to 200,000 I.U. of vitamin A daily causes pronounced involution of the 

 lesions. ^^ Somewhat the same observations have been made in other hj'per- 

 keratotic states such as keratosis palmaris et plantaris, ichthyosis and 

 pachyonychia,^^' ^® and local callosities.^'^ In a variety of skin diseases not 



"S. M. Peck, L. Chargin, and H. Sobotka, Arch. Dermatol, and Suphilol. 43, 223 



(1941). 

 "S. M. Peck, A. W. Glick, H. Sobotka, and L. Chargin, Arch. Dermatol, and 



Syphilol. 48, 17 (1943). 

 68 A. Caiieton and D. Steven, Arch. Dermatol, and Syphilol. 48, 143 (1943). 

 63 Z. A. Leitner and T. Moore, Brit. J. Dermatol. Syphilis 60, 41 (1948). 

 60 Z. A. Leitner, Brit. J. Nutrition 5, 130 (1951). 

 80'' Z. A. Leitner and T. Moore, Lancet I, 262 (1946). 



" A. Rostenberg and W. M. Siskind, Arch. Dermatol, and Si/philol. 61, 135 (1950). 

 82 F. C. Fraser, Can. J. Research 27, 179 (1949). 



" A. L. Weiner and A. A. Levin, Arch. Dermatol, and Suphilol. 48, 2SS (1943). 

 " Z. A. Leitner, Brit. J . Dermatol. Syphilis 59, 407 (1947). 

 66 A. D. Porter and H. IIal)er, Brit. J. Dermatol. Syphilis 62, 355 (1950). 

 66 A. D. Porter, Brit. J. Dermatol. Syphilis 63, 123 (1951). 

 6' J. V. Straumfjord, Northwest Med. 41, 7 (1942). 



