Vitamin A (retinol)

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Evidence

These uses have been tested in humans or animals. Safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Acne
Topical retinoids are considered among the best treatments for acne. Tretinoin (all- trans retinoic acid) Avita®, Renova®, Retin-A®, Retin-A Micro®) and derivatives of vitamin A, retinoids, and oral prescription medications, such as isotretinoin (Accutane®), are available for treatment. Isotretinoin may cause severe side effects, such as burning, erythema, and pruritus, and should be used only for severe resistant acne. Adapalene (Differin®), a naphthoic acid derivative and retinoid, is also effective and reported to have fewer side effects. Another retinoid, tazarotene (Tazorac®), has shown superior either tretinoin or adapalene. In general, supplementation with any retinoid (including tretinoin) must not be used in women who are pregnant, plan to become pregnant, or have a chance of being pregnant, due to a risk of severe birth defects. These medications should be prescribed and coordinated by a qualified licensed healthcare professional. Retinoids should not be used simultaneously, due to a risk of increased toxicity. 		A
Acute promyelocytic leukemia (treatment, all-trans retinoic acid)
The prescription drug all- trans retinoic acid (ATRA, Vesanoid®) is a vitamin A derivative that is an established treatment for acute promyelocytic leukemia that improves median survival in this disease. Treatment should be under strict medical supervision. Vitamin A supplements should not be used simultaneously with ATRA, due to a risk of increased toxicity. 		A
Anemia
Vitamin A deficiency has been shown to impair the mobilization of iron status, impair erythropoiesis, and increase susceptibility to infection. Vitamin A supplementation has been shown to raise hemoglobin levels and serum iron concentrations, particularly in children and pregnant women. It has also been shown to enhance the efficacy of iron supplementation in patients with vitamin A deficiency and iron deficiency anemia. 		A
Malaria (supportive agent)
Limited research suggests that vitamin A may reduce fever, morbidity, and parasite blood levels in patients with malaria ( Plasmodium falciparum infection). However, there is a lack of evidence suggesting that vitamin A is equivalent or superior to well-established drug therapies used for the prevention or treatment of malaria. Patients with malaria or those who are living or traveling in endemic areas should speak with a physician about appropriate measures. 		A
Measles (supportive agent)
Vitamin A should be administered to children diagnosed with measles in areas where vitamin A deficiency may be present. Measles is a viral disease that can lead to serious complications, such as diarrhea, pneumonia, and encephalitis. Supplementation with vitamin A in children with measles has been shown to be beneficial, by decreasing the length and impact of the disease. Side effects such as diarrhea, pneumonia, and death have been reduced with the use of vitamin A. Management of measles should be under strict medical supervision. 		A
Mortality reduction (childhood; all-cause)
Vitamin A is necessary for healthy growth and development, and recommended dietary allowances (RDAs) should be assured, particularly in children. Major causes of vitamin A deficiency in children are maternal vitamin A deficiency (thus low concentrations of vitamin A in breast milk), inadequate vitamin A intake upon weaning, and prevalent illness. Experts have maintained that in developing countries, diet alone is insufficient to main adequate vitamin A levels in children. Vitamin A is associated with a reduced risk of mortality in children. 		A
Retinitis pigmentosa
Retinitis pigmentosa is a genetic disorder that affects night vision. Early symptoms include night blindness and progressive loss of vision over time. Based on recent findings, vitamin A in the palmitate form has been recommended in patients with retinitis pigmentosa. 		A
Skin damage caused by the sun
Some studies suggest that topical tretinoin (all- trans retinoic acid, the acid form of vitamin A) may improve the appearance and integrity of photodamaged skin. Common adverse effects are skin pain and redness. 		A
Vitamin A deficiency
Vitamin A deficiency is generally rare in industrialized nations. In developing countries, diet alone may be insufficient to maintain adequate vitamin A levels, especially in children. Vitamin A supplementation can help prevent or treat vitamin A deficiency. 		A
Xerophthalmia (dry eye)
Prolonged vitamin A deficiency can lead to xerophthalmia (dry eye). It is most prevalent in rural, underdeveloped areas, such as India and Southeast Asia. Oral vitamin A is the treatment of choice for xerophthalmia caused by prolonged vitamin A deficiency, and it should be given immediately once the disorder is established. Bitot's spot, or the buildup of keratin debris in the conjunctiva, is a sign of xerophthalmia and may also be treated with vitamin A supplementation. 		A
Healing after photorefractive keratectomy (adjunct therapy)
Photorefractive keratectomy is a type of laser eye surgery used to correct nearsightedness. High-dose vitamin A supplementation in addition to vitamin E has been suggested to help improve ocular healing after surgery and to improve visual acuity, although additional evidence is necessary before a definitive conclusion can be reached. 		B
HIV (supportive treatment)
The role of vitamin A in the prevention, transmission, or treatment of HIV is controversial and not well established. A clear conclusion cannot be formed based on the available scientific research. 		B
Oral leukoplakia
Vitamin A may improve clinical resolution of oral leukoplakia (white patches or plaque in the mouth), although relapse is common. Further research is required. 		B
Age-related macular degeneration
Although this has not been well studied in humans, the use of vitamin A and carotenoids may be useful in the prevention of age-related macular degeneration. Further research is required. 		C
Asthma
Vitamin A intake is inversely associated with asthma risk and severity. A clear conclusion cannot be formed based on the available scientific research. 		C
Breast feeding (nipple pain)
Vitamin A and D ointment may be useful for sore and cracked nipples that occur during breastfeeding. However, available studies have not shown vitamin A or any other topical therapy to relieve the pain of breastfeeding. 		C
Bronchiolitis
Vitamin A is thought to be important in immune function. A clear conclusion cannot be formed on the effects of vitamin A on bronchiolitis (inflammation of the bronchioles) based on the available scientific research. 		C
Bronchopulmonary dysplasia in premature infants
Research results are not clear as to whether vitamin A is beneficial for bronchopulmonary dysplasia in premature infants (chronic lung condition). Further research is needed. 		C
Chemotherapy adverse effects
The effect of vitamin A supplementation on chemotherapy-related side effects, including nausea, vomiting, diarrhea, or mouth sores, is unclear. Also, it is unclear if vitamin A interacts with chemotherapy agents. Further research is needed. 		C
Colorectal cancer
Alpha-carotene and vitamin A may protect against recurrence of colorectal cancer in nonsmokers and nondrinkers or be indicative of compliance or another healthy lifestyle factor that reduces risk. Further research is needed before a conclusion can be drawn. 		C
Cystic fibrosis
Human research is lacking, and further research is needed in this field. 		C
Esophageal cancer
Higher intakes of beta-carotene and vitamin A were associated with reduced risk of esophageal adenocarcinoma. There is not sufficient evidence to form a clear conclusion at this time. 		C
Liver disease
There is insufficient evidence to support or refute the benefits or adverse effects of antioxidant supplements (including vitamin A) in patients with liver disease. 		C
Lung cancer
Vitamin A has been studied as a possible treatment for lung cancer, without evidence of benefits. The available evidence suggests that high-dose vitamin A and beta-carotene may actually increase the risk of adverse effects, especially among alcohol users and smokers. 		C
Miscarriage (prevention)
Poor nutrition is associated with an increased risk of miscarriage. However, excess intake of vitamin A has been reported to increase the risks of some birth defects. Vitamin A supplementation above the RDA is therefore not recommended in pregnancy. 		C
Mortality reduction
Adequate vitamin A (either through diet or supplementation) appears to have a major role in the prevention of morbidity and mortality. Further research is needed. 		C
Mortality reduction (maternal; maternal supplementation postpartum)
Maternal supplementation of vitamin A postpartum provides limited number of benefits to maternal health status. A clear conclusion cannot be formed based on the available scientific research. 		C
Mortality reduction (maternal; supplementation during pregnancy)
Vitamin A supplementation during pregnancy and lactation does not appear to reduce infant morbidity and mortality; however, it does appear to reduce maternal morbidity. A clear conclusion cannot be formed based on the available scientific research. 		C
Parasite infection (Ascaris reinfection)
After deworming, children supplemented with vitamin A may be less prone to Ascaris parasite reinfection. These benefits may be less in children with stunted growth. 		C
Prostate cancer (prevention)
It is unclear whether dietary vitamin A affects prostate cancer risk. Interventional studies are lacking. More research is needed in this area. 		C
Skin cancer
It is not clear if vitamin A or beta-carotene, taken by mouth or used on the skin with sunscreen, is beneficial in the prevention or treatment of skin cancers or wrinkles. 		C
Tuberculosis
There is insufficient evidence to assess vitamin A for tuberculosis. Further research is needed before a conclusion can be drawn 		C
Viral infection (Norovirus (NoV) infection)
Vitamin A supplementation has been suggested to help prevent NoV infection in children and reduce the symptoms associated with NoV infections. 		C
Weight loss
Daily vitamin A with calcium has been suggested for weight loss. In one study, an average loss of two pounds was reported after two years of supplementation in young women. 		C
Wound healing
In preliminary research, retinol palmitate significantly reduced rectal symptoms of radiation proctopathy, perhaps because of wound-healing effects. Further research is needed to confirm these results. 		C
Arthritis
The available evidence does not support the effectiveness of vitamin A (or combination products containing vitamin A) for the treatment of any form of arthritis. Further research is needed to confirm these results. 		D
Childhood growth promotion
Vitamin A is necessary for healthy growth and development, and recommended dietary allowances (RDA) should be assured, particularly in children. Overall, the available evidence has not shown significant changes in growth in children with respect to height and weight due to vitamin A. 		D
HIV (mother-to-child transmission)
Overall evidence does not support the use of vitamin A supplementation in HIV-infected pregnant women to reduce mother-to-child transmission of HIV. 		D
Infant mortality (maternal postpartum supplementation)
Overall, studies suggest a lack of effect of postnatal vitamin A supplementation on infant mortality. 		D
Infant mortality (maternal supplementation during pregnancy)
Overall, studies suggest a lack of effect of prenatal vitamin A supplementation on perinatal or neonatal infant mortality. 		D
Respiratory tract infections
Overall evidence is not sufficient to support the reduction of pneumonia incidence or mortality in children without measles. 		D
Cancer (gastrointestinal; prevention)
The overall evidence not only suggests that vitamin A does not reduce the rates of gastric cancer or precancerous gastric lesions but also links vitamin A supplementation with increased mortality. 		F

Key to grades
A Strong scientific evidence for this use
B Good scientific evidence for this use
C Unclear scientific evidence for this use
D Fair scientific evidence against this use (it may not work)
F Strong scientific evidence against this use (it likely does not work)

Grading rationale

Uses based on tradition or theory

The below uses are based on tradition or scientific theories. They often have not been thoroughly tested in humans, and safety and effectiveness have not always been proven. Some of these conditions are potentially serious, and should be evaluated by a qualified healthcare provider.

Aging, AIDS (adjunct), allergic rhinitis, autism, burns, cancer (treatment), candidiasis, cataracts, cervical cancer, chemical sensitivities (pollutant protection), chronic diseases (prevention), conjunctivitis, Crohn's disease, deafness, deficiency (protein), diabetes, diarrhea, dysentery (shigellosis), dysmenorrhea, eczema, epilepsy, fibrocystic breast disease, gastric ulcers, glaucoma, hay fever, headache (persistent), heart disease, hepatocellular carcinoma (chemoprevention), herpes (cold sores), hyperthyroidism, immune enhancement, increasing sperm count, infections (general, nose), kidney stones, lichen planus pigmentosus, menorrhagia (heavy menstruation), metabolic disorders (Hurler syndrome), mouth cancer, neurodegenerative diseases, nutritional supplement, pancreatic cancer, pancreatitis, periodontal disease, pityriasis rubra pilaris, premenstrual syndrome (PMS), psoriasis, respiratory disorders, sebaceous cysts, sinus infections, sinusitis, skin disorders (Darier's disease, ichthyosis), sleep (regulation), smell disorders, stroke, sunburn, tinnitus, tumors (neoplasms), ulcers (stress ulcers in severely ill hospitalized patients), urinary tract infection, vaginal atrophy, vaginal infections, vaginitis, vascular diseases (prevention), vision enhancement (nearsightedness, blurred vision), warts, yeast infection.

Dosing Related terms
NS_patient-vitamina Portions of this document last updated: Sept. 1, 2012

THIS EVIDENCE-BASED MONOGRAPH WAS PREPARED BY
THE NATURAL STANDARD RESEARCH COLLABORATION
(www.naturalstandard.com)

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