388 EIBOFLAVIN 



casein diet by Goldberger and Tanner."" A clear-cut separation between 

 these two deficiency states was not made until 1938, at which time both 

 nicotinic acid and riboflavin were available. Sebrell and Butler'^^- ^'^ studied 

 a group of patients on a diet low in riboflavin and nicotinic acid and showed 

 that the manifestations of pellagra sine pellagra were due to riboflavin de- 

 ficiency. 



1. Oral and Facial Lesions of Ariboplavinosis 



The changes observed by Sebrell and Butler"^""^ "consisted of lesions 

 on the lips, which began with a pallor of the mucosa in the angles of the 

 mouth. This pallor was soon followed by maceration; and within a few 

 days superficial linear fissures, usually bilateral, appeared exactly in the 

 corner of the mouth. These fissures showed very little inflammatory reac- 

 tion, remained moist, and became covered with a superficial yellow crust, 

 which could be scraped off without bleeding. In some instances these linear 

 fissures showed a tendency to extend onto the skin of the face but did not 

 extend into the mouth." 



In addition, there was a "scaly, slightly greasy, desquamative lesion on 

 a mildly erythematous base in the nasolabial folds, on the alae nasi, in the 

 vestibule of the nose and occasionally on the ears and around the eyelids, 

 especially at the inner and outer canthi." 



In the years subsequent to the above presentation there have been many 

 "confirmatory" reports stemming from clinical observations of "aribo- 

 flavinosis.""^'^-^ On the other hand, the failure of several groups to dupli- 

 cate Sebrell and Butler's results and the frequency of angular stomatitis 

 refractory to riboflavin therapy led to some skepticism regarding the syn- 



13 W. H. Sebrell and R. E. Butler, Public Health Repts. (U.S.) 53, 2282 (1938). 



" W. H. Sebrell and R. E. Butler, Public Health Repts. (U.S.) 54, 2121 (1939). 



1^ W. H. Sebrell, Human Riboflavin Deficiencj^, in Biological Action of the Vitamins, 



p. 73. University of Chicago Press, Chicago, 1942. 

 18 V. P. Sydenstricker, L. E. Geeslin, C. M. Templeton, and J. W. Weaver, /. Ain. 



Med. Assoc. 113, 1698 (1939). 

 " P. Manson-Bahr, Lancet II, 317, 356 (1940). 



18 R. W. Vilter, S. P. Vilter, and T. D. Spies, J. Am. Med. Assoc. 112, 420 (1939). 



19 J. W. Oden, L. H. Oden, Jr., and W. H. Sebrell, Public Health Repts. (U.S.) 54, 

 790 (1939). 



20 T. D. Spies, W. B. Bean, and W. F. Ashe, Ann. Internal Med. 12, 1830 (1939). 



21 T. D. Spies, R. W. Vilter, and W. F. Ashe, /. Am. Med. Assoc. 113, 931 (1939). 



22 N. Jolliffe, H. D. Fein, and L. A. Rosenblum, New Engl. J. Med. 221, 921 (1939). 



23 H. D. Kruse, V. P. Sydenstricker, W. H. Sebrell, and H. M. Clcckley, Public 

 Health Repts. (U.S.) 55, 157 (1940). 



24 V. P. Sydenstricker, W. H. Sebrell, H. M. Cleckley, and H. D. Kruse, ./. .4m. Med. 

 Assoc. 114, 2437 (1940). 



26 T. D. Spies, W. B. Bean, R. W. Vilter, and N. E. Huff, Am. J. Med. Sci. 200, 687 

 (1940). 



