Which physical findings are characteristic of chronic vitamin A toxicity?

Answer

Chronic vitamin A toxicity affects the skin, the mucous membranes, and the musculoskeletal and neurologic systems. Skin and mucous membrane effects include erythema, eczema, pruritus, dry and cracked skin, angular cheilitis, conjunctivitis, palmar and plantar peeling, and alopecia.

Musculoskeletal effects include pain and tenderness, particularly in the long bones of the upper and lower extremities, which may be exacerbated by exercise. Neurologic effects include blurred vision and frontal headache, which is often the first sign of toxicity.

In addition, studies suggest that elevated levels of vitamin A may cause increased bone resorption and promote the development of osteoporosis.^{[5, 44]}

Manifestations of chronic vitamin A toxicity also include the following:

Alopecia
Erythematous dermatitis
Skin desquamation
Brittle nails
Exanthema
Cheilitis
Conjunctivitis
Petechiae
Liver cirrhosis
Hepatosplenomegaly
Peripheral neuritis
Benign intracranial hypertension
Ataxia
Papilledema
Diplopia
Hyperostosis
Edema
Hepatic hydrothorax^[45]
Hepatomegaly
Ascites
Migratory arthritis
Craniotabes (in children)
Bulging fontanelle (in infants)
Epiphyseal capping and premature epiphyseal closure

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Author

Mark Rosenbloom, MD, MBA Chief Executive Officer and Editorial Director, PEPID, LLC; Founder and Chairman, The Unicorn Children's Foundation; Chief Medical Officer, LIFEFORCE Medical Institute

Mark Rosenbloom, MD, MBA is a member of the following medical societies: Alpha Omega Alpha, American Academy of Emergency Medicine, Royal Society of Medicine, American Academy of Anti-Aging Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Angela Gentili, MD Director of Geriatric Medicine Fellowship Program, Professor of Internal Medicine, Division of Geriatric Medicine, Virginia Commonwealth University Health System and McGuire Veterans Affairs Medical Center, Richmond, VA

Angela Gentili, MD is a member of the following medical societies: Virginia Geriatrics Society, American Geriatrics Society

Disclosure: Nothing to disclose.

Chief Editor

Michael A Miller, MD Clinical Professor of Emergency Medicine, Medical Toxicologist, Department of Emergency Medicine, Texas A&M Health Sciences Center; CHRISTUS Spohn Emergency Medicine Residency Program

Michael A Miller, MD is a member of the following medical societies: American College of Medical Toxicology

Disclosure: Nothing to disclose.

Acknowledgements

Robert A Adler, MD Chief of Endocrinology and Metabolism, McGuire Veterans Affairs Medical Center; Professor, Departments of Internal Medicine and Epidemiology and Community Health, Virginia Commonwealth University

Robert A Adler, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Federation for Medical Research, American Society for Bone and Mineral Research, and Endocrine Society

Disclosure: Eli Lilly Grant/research funds Independent contractor; Genentech Grant/research funds Independent contractor

Mohsen S Eledrisi, MD, FACP, FACE Consultant, Department of Internal Medicine, Division of Endocrinology and Metabolism, King Abdulaziz National Guard Medical Center, Saudi Arabia

Mohsen S Eledrisi, MD, FACP, FACE is a member of the following medical societies: American Association of Clinical Endocrinologists, American College of Physicians-American Society of Internal Medicine, American Diabetes Association, American Medical Association, and Endocrine Society