Treatment of Phrynoderma
Treat phrynoderma with intramuscular vitamin A (100,000 units every other day for 10 injections) or intramuscular vitamin B complex (2cc every other day for 10 injections), both combined with topical keratolytics (3% salicylic acid ointment twice daily). 1
Understanding the Condition
Phrynoderma is a distinctive follicular hyperkeratosis presenting as hyperkeratotic papules primarily on extensor surfaces of extremities, shoulders, and buttocks 2, 3. While historically attributed to vitamin A deficiency, it represents multifactorial malnutrition involving multiple nutrients rather than a single vitamin deficiency 2, 3. The condition affects predominantly young patients (mean age 10 years) with bilateral, symmetrical distribution in 71% of cases 3.
First-Line Treatment Approach
Parenteral Vitamin Therapy
Vitamin A regimen:
- Administer 100,000 units intramuscularly on alternate days for a total of 10 injections 1
- This produces good to excellent response (>50% improvement) in the majority of patients 1
Vitamin B complex regimen (equally effective alternative):
- Administer 2cc intramuscularly on alternate days for 10 injections 1
- Shows comparable efficacy to vitamin A with good to excellent response rates 1
Topical Adjunctive Therapy
- Apply 3% salicylic acid ointment twice daily to all affected areas 1
- This keratolytic agent accelerates clearance of hyperkeratotic lesions when combined with systemic therapy 1
Alternative Oral Therapies (Less Effective)
If parenteral therapy is not feasible, consider:
- Vitamin E 400mg once daily - produces only moderate to poor response (<50% improvement) 1
- Essential fatty acids (safflower oil) - 2 tablespoons twice daily with meals, also shows moderate to poor response 1
Important caveat: Oral therapies demonstrate significantly inferior outcomes compared to intramuscular vitamin A or B complex 1. Reserve these for patients refusing injections or when parenteral access is unavailable.
Evaluation for Underlying Causes
Before initiating treatment, evaluate for:
- Malabsorption syndromes: pancreatic insufficiency, inflammatory bowel disease, post-bariatric surgery states (especially biliopancreatic diversion) 4, 5
- Dietary inadequacy: particularly in settings of poverty or restrictive diets 2, 3
- Signs of specific vitamin deficiencies: night blindness (vitamin A), angular cheilitis or glossitis (B vitamins) 3, 4
Obtain baseline nutritional markers beyond just vitamin A levels, as phrynoderma reflects general malnutrition rather than isolated deficiency 2.
Expected Response and Monitoring
- Lesions typically begin improving within 2-3 weeks of appropriate therapy 1
- Good to excellent response (>50% improvement) occurs with vitamin A or B complex regimens 1
- Complete resolution may take 4-8 weeks 1
- Address underlying malnutrition and malabsorption to prevent recurrence 2, 4
Critical Pitfall to Avoid
Do not assume phrynoderma equals isolated vitamin A deficiency. Despite its historical association, multiple studies demonstrate that vitamin B complex therapy is equally effective, and many patients have normal vitamin A levels 2, 1. The condition represents broader malnutrition requiring comprehensive nutritional rehabilitation 2, 3.