Accompanying cases of acute hemorrhagic pancreatitis and eruptive xanthomas can also be seen.Įlevated serum transaminases may occur with oral retinoid usage. Both triglyceride and cholesterol levels have been found to be elevated in patients using bexarotene, isotretinoin, etretinate, and acitretin. Hypertriglyceridemia is the most common systemic effect of retinoids. Additionally, reversible renal dysfunction characterized by elevated creatinine was seen with etretinate but not isotretinoin. Hypothyroidism, reversible upon cessation of therapy, was seen in 40% of patients in Cutaneous T-cell lymphoma trials with bexarotene. Pseudotumor cerebri syndrome rarely has been noted secondary to vitamin A toxicity. Central nervous system effects include headache, nausea, and vomiting. Long-term consumption of high levels of dietary vitamin A may stimulate bone resorption and inhibit formation, contributing to osteoporosis and hip fractures. Bone effects include changes such as bone spurs, calcinosis, and bone resorption with resulting hypercalcemia. Telogen effluvium may be seen with higher doses.Ĭhronic retinoid toxicity can affect many organ systems.
Vitamin d video serial key skin#
Other cutaneous effects seen include overall skin dryness and pruritus, peeling of palms and soles, and fingertip fissuring. The putative mechanism is decreased sebum production, reduced epidermal thickness, and altered barrier function. Mucocutaneous effects include dry lips, cheilitis, and dry oral, ophthalmic, and nasal mucosa. Īcute retinoid toxicity has resulted in mucocutaneous and laboratory abnormalities. The mechanism is thought to be through a toxic effect on neural crest cells, possibly affecting the regulation of axial patterning in the embryo via the expression of the homeobox gene Hoxb-1.
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Isotretinoin is estimated to increase the risk of these malformations 25-fold. Teratogenic findings include craniofacial (cleft lip/palate), cardiac (transposition of the great vessels), thymic, and central nervous system (microcephaly, hydrocephalus) abnormalities. With regards to systemic retinoid usage, teratogenicity is the most worrisome adverse effect. Other adverse effects include transient hypopigmentation and hyperpigmentation, Koebnerization of psoriasis, allergic contact dermatitis, and ectropion. Topical retinoid application has not been proven to cause congenital disorders when used during pregnancy. The risk of teratogenicity from the use of topical retinoids is extremely low given that systemic absorption has been inconsequential in animal and human studies.
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Interestingly, the erythema may be mediated through a different mechanism. The peeling from topical retinoids is secondary to the hyper-proliferation of the epidermis mediated by retinoic acid receptor stimulation. Skin irritation in the form of peeling and erythema is the most common adverse effect from topical vitamin A use. In women taking over 10,000 IUs of preformed vitamin A per day from supplements, it is estimated that 1 of 57 babies is born with a secondary congenital disability.
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Įxcessive intake of preformed vitamin A, but not precursors, has been linked to teratogenicity in both human and animals studies. The current recommended dietary allowance of vitamin A is 800 retinol equivalents or 2700 international units (IU) for women. Many people in the United States take either isolated supplemental Vitamin A or other supplements that contain vitamin, A in addition to dietary intake. As a result, it is less likely to cause toxicity.
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Provitamin A (beta-carotene and other carotenoids), found in plants such as green leafy vegetables, sweet potatoes, and carrots, must be metabolized to vitamin A. A list of other foods containing Vitamin A includes milk, cheese, margarine, butter, eggs, chicken, chicken liver, beef, beef liver, processed meats, pizza, fish, and cold breakfast cereals. Pre-formed vitamin A is obtained from animal food sources, including dairy products and liver, and in most supplements. Oral vitamin A delivery comes in two forms: provitamin A (a prodrug that is metabolized to vitamin A) and preformed vitamin A. As noted above, vitamin A toxicity can occur from either topical or oral use.