Given the success of drugs to treat erectile dysfunction, such as sildenafil (Viagra), tadalafil (Cialis) and vardenafil (Levitra), drug companies have sought a comparable drug for women. Viagra has even been tried as a treatment for sexual dysfunction in women.
However, the Food and Drug Administration (FDA) has not approved this use of Viagra. Indeed, there are no FDA-approved drugs for treating sexual arousal problems in women. Yet 40 percent of women report having sexual concerns.
Female sexual response is complex. For most women, simply addressing difficulties with arousal may not get to the actual problem — which is often a lack of sexual desire. Many factors can influence a woman's sexual desire. For example:
Many women find that the stresses of daily life deplete their desire for sex.
Highs and lows in sexual desire may coincide with the beginning or end of a relationship or major life changes, such as pregnancy or menopause.
For some women, orgasm can be elusive — causing concerns or preoccupations that lead to a loss of interest in sex.
Desire is often connected to a woman's sense of intimacy with her partner, as well her past experiences. Over time, psychological troubles can contribute to biological problems and vice versa.
Some chronic conditions, such as diabetes or multiple sclerosis, can alter a woman's sexual-response cycle — causing changes in arousal or orgasmic response.
If you're experiencing changes or difficulties with sexual function, consult your doctor. In some cases, medications, hormones, creams, clitoral-stimulating products or other treatments may be helpful. These products don't work for everyone, however. Your doctor may also recommend consulting a sex therapist.
Vitamin A is a vitamin. It can be found in many fruits, vegetables, eggs, whole milk, butter, fortified margarine, meat, and oily saltwater fish. It can also be made in a laboratory.
Vitamin A is used for treating vitamin A deficiency. It is also used to reduce complications of diseases such as malaria, HIV, measles, and diarrhea in children with vitamin A deficiency.
Women use vitamin A for heavy menstrual periods, premenstrual syndrome (PMS), vaginal infections, yeast infections, “lumpy breasts” (fibrocystic breast disease), and to prevent breast cancer. Some women with HIV use vitamin A to decrease the risk of transmitting HIV to the baby during pregnancy, childbirth, or breast-feeding.
Some people use vitamin A for improving vision and treating eye disorders including age-related macular degeneration (AMD), glaucoma, and cataracts.
Vitamin A is also used for skin conditions including acne, eczema, psoriasis, cold sores, wounds, burns, sunburn, keratosis follicularis (Darier’s disease), ichthyosis (noninflammatory skin scaling), lichen planus pigmentosus, and pityriasis rubra pilaris.
It is also used for gastrointestinal ulcers, Crohn’s disease, gum disease, diabetes, Hurler syndrome (mucopolysaccharidosis), sinus infections, hayfever, and urinary tract infections (UTIs).
Vitamin A is also used for shigellosis, diseases of the nervous system, nose infections, loss of sense of smell, asthma, persistent headaches, kidney stones, overactive thyroid, iron-poor blood (anemia), deafness, ringing in the ears, and precancerous mouth sores (leukoplakia).
Other uses include preventing and treating cancer, protecting the heart and cardiovascular system, slowing the aging process, and boosting the immune system.
How does it work? Vitamin A is required for the proper development and functioning of our eyes, skin, immune system, and many other parts of our bodies.
My partner is 57. I'm 52. We've been together for six years and we get on really well. Both of us had been unhappily married in the past, so we greatly value the good relationship we have now.
When we got together, we had a terrific sex life. I was amazed because I'd never enjoyed sex much with my ex-husband. But, unfortunately, a couple of years ago, my partner began to have problems with his erection.
This was a pretty miserable time, but eventually he went to the GP, who put him onViagra.
We have to pay for this – because my partner doesn't qualify for that kind of help on the NHS.
Now, when he takes the Viagra, he does get a stiff erection and we can have good sex. He is really relieved, because he'd been worried that our love life was at an end.
But I'm uncomfortable with him having to take pills. I suppose I feel that if he really desired me, he'd be able to make love without medication. I also hate the fact that sex can no longer be so spontaneous – as we have to decide if we're going to do it, and then he has to take the pill, and then we have to wait a good hour till it takes effect.
Am I being unreasonable? I just don't feel that this way of going on is natural.
Christine replies...
I can see why you might prefer a love life that wasn't dependent on medication.
In an ideal world, your man would be having as many effective erections as you and he both wanted.
But the truth is that he has been having problems for a while, and they're not likely to go away without treatment.
Your partner did the sensible thing and went to his doctor; he was prescribed Viagra, which is the most popular of the anti-impotence drugs.
Presumably, the doctor ruled out the various physical conditions – such asdiabetes– that might have caused his erection difficulties?
I knows it's tough luck that your man can no longer automatically become, and stay, stiff. But this happens to masses of men as they age; it's a fact of life.
You feel that what is happening is not 'natural'. But for thousands of years, the 'natural' consequence of your partner's condition would have meant that the two of you would no longer have been able to have satisfying intercourse.
Would that have been better? I don't think so.
It might help if you imagine what would have happened to your sex life had the two of you encountered these problems prior to 1998. That was when Viagra became available for treating erectile dysfunction or ED.
Believe me, losing potency is just about the worst thing that can happen to men. It really chips away at their self-esteem and they often feel useless and emasculated.
Of course, guys who can't get erections can still satisfy their women by means of oral or manual stimulation. But, nevertheless, many of them feel that they're not 'real men'.
On top of that, if a bloke can't get an erection he has little chance of achieving any real pleasure or relief for himself. All of these difficulties can have a very negative impact on the quality of a couple's relationship.
You say that you feel that if he really desired you, he would be able to have intercourse without the pills. This is not true. In actual fact, anti-impotence drugs have no impact on libido.
What they do is help men who want to have sex, to manage it. None of the drugs available for ED make men sexier, or raise their levels of desire.
I would say that many men become more enthusiastic about sex once they take Viagra, for the simple reason that they regain confidence in their own performance.
But none of the anti-impotence drugs magically make someone feel desire if there is no desire in the first place.
Most couples who are able to be intimate together and to have satisfying sex believe that their relationships are enhanced by this closeness.
And I hope that you can come to feel more comfortable about your partner's problem, and also about him taking medication to alleviate it.
You might want to consider going together to see the doctor to discuss the various other drugs available for ED.Cialis, for example, gives the man a longer window of opportunity than Viagra, which means that it goes on working for longer.
Some couples prefer it – because they feel it gives them back a greater degree of spontaneity
I think as my husband reaches again for his new toy. Tragically, it's not a Ferrari or the latest Mac laptop — it's his Penis 2.0—the new, pharmaceutically enhanced model. I married an older man, and lucky for us both, the only part on him that's given out is his knees. But since I was writing about erectile dysfunction (ED) drugs, I wanted him to help me out. Would he try one? The little blue pill enables older men to sexually respond like 18-year-olds. "Wouldn't that be interesting," I asked him, "journalistically speaking?" The 10 secrets of a lasting longterm relationship. John was skeptical. "What if I take this and things never work without the pill again?" he asked. I pointed out that the label of a leading brand, Viagra, does not list physical dependence as a side effect (although it does mention headaches and an upset stomach). True to promise, when John used Viagra, everything was perfectly fine. But to my chagrin, it was perfectly fine a lot. Don't miss these Health stories
EXCLUSIVE: Marcheline Bertrand, French actress and mother of Angelina Jolie, has died of cancer Splash News.
More women opting for preventive mastectomy - but should they be? Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring. Larry Page's damaged vocal cords: Treatment comes with trade-offs Report questioning salt guidelines riles heart experts CDC: 2012 was deadliest year for West Nile in US What stresses moms most? Themselves, survey says And therein lies a problem I wonder whether the makers of Viagra and its pharmaceutical cousins Levitra and Cialis foresaw. While men of a certain age are undoubtedly thrilled to have their sexual potency restored, maybe their wives' enthusiasm is a bit more subdued?
What at first glance seems an obvious win-win situation for both husbands and wives can have a raft of unintended consequences. Don't get me wrong: Viagra is a wonder drug. Since the early '90s, when researchers testing a new heart medication called Sildenafil discovered that it had a startling side effect in men, erectile dysfunction drugs have become more than a billion-dollar industry.
One study conducted by Express Scripts, a pharmacy benefit management company, found that nearly 20% of all American men over age 45 have tried them. And since, according to the National Institutes of Health, approximately 5 percent of 40-year-old men and from 15 to 25 percent of 65-year-old men experience ED (for reasons ranging from narrowing of the blood vessels with age to high blood pressure, diabetes, obesity, and neurological problems), these drugs have been a godsend to millions. ED drugs can also, indirectly, be lifesavers. Thirty-four to 70 percent of all men who take antidepressants experience sexual dysfunction as a side effect, and of those who have this problem, almost 90 percent stop taking the antidepressants so their sex lives can go back to normal. 40 Things you should know about sex before the age of 40. But ED drugs are so readily available, so much a jokey part of the cultural landscape, that few of us really know how they work and what the potential dangers are. This leads to misuse — not so much life-threatening as knuckleheaded.
Essentially, ED drugs work like this: What gives a man an erection is blood flow to the penis. The vessels dilate, and blood flows in. There is an enzyme that counteracts the dilation. ED drugs inhibit that enzyme, allowing dilation to occur more easily and last longer. They can also diminish a man's refractory time, meaning that after orgasm he can more quickly get an erection again. The one thing most people know about Viagra and its cohorts is that they are not supposed to be used by men who take nitroglycerin, a common medication for heart patients that also dilates the blood vessels. But ask around. That little piece of knowledge has translated into "Viagra is bad if you have a heart condition." Not so, says Arthur S. Agatston, MD, a cardiologist and associate professor of medicine at the University of Miami Miller School of Medicine and Prevention editorial advisory board member. In fact, Dr. Agatston says, because Viagra keeps the blood vessels from becoming "sticky" and helps blood flow through them smoothly, not just in the penis but throughout the body, in the future, many of us—women included—may end up taking some small amount of Viagra daily, the way we take baby aspirin, which has the same nonsticking effect on blood itself. So when a man takes Viagra, he has to avoid anything that dilates the blood vessels, not just nitroglycerides. Drinking, lying in the sun — both are problematic. Viagra won't give him a heart attack, but, taken with too much alcohol, it could make him pass out, Dr. Agatston says.
Perhaps more damaging than ignorance of the physical ramifications of ED drugs is ignorance of their potential interpersonal blowback. When not discussed frankly, Viagra can cause a lot of misunderstanding and hurt between couples. "There is something about a hard erection that is extremely important to a man's identity," says Steven Lamm, MD, an internist in New York City and author of The Hardness Factor. "And of course most couples would prefer that the man be able to have one. But there are some who may have adjusted to life without sex. Perhaps the woman doesn't really want it anymore, for one reason or another. And for those couples, the introduction of an ED drug can throw them seriously out of sync." That leads to what is perhaps the biggest complicating factor: the reality that a woman's postmenopause genital health can put her physically at odds with her partner's newfound, drug-assisted prowess. As women age, their hormonal balances change. Reduced estrogen levels often mean less sexual desire but also decreased vaginal elasticity and lubrication, and thus more potential for sex to be painful.
Menopause or Peri-menopause? 11 Truths about hot flashes, crazy mood swings, out-of-nowhere belly bloat, and more The problem can be especially daunting for older women who are widowed or divorced or just beginning to date after years of being alone or with one man. Certainly this was the case for Marjorie P., a 60-something woman who complained about the drugs on a 50+ Web site: "Men have been saved from their middle-age sexual issues by Viagra and Cialis. They can be thirty again, while I have to deal with the sexual issues of being my age. It's put the world on 'tilt.'" Andrea D., a twice-divorced physician from Santa Monica, CA, and an over-50 dater, put it more bluntly. "Viagra has been liberating for men, but unless a woman is taking hormone therapy, she may have vaginal dryness and really not be that interested in the kind of driving, pounding intercourse he's now capable of." There is also fallout from the erroneous belief that Viagra causes not just greater blood flow but also greater desire. The hormone testosterone is the driving force behind libido; a man with little or no testosterone will not have any desire to have sex, Viagra or no. Moreover, even with normal amounts of testosterone, "Viagra does not just instantly give a man an erection," says Abraham Morgentaler, MD, associate clinical professor of urology at Harvard Medical School and author of The Viagra Myth. "You have to be in a sexual situation, you need to have desire and intent, in order for the drug to work." Dr. Morgentaler tells the story of a patient who was very upset because Viagra didn't do the trick for him. "He said, 'Doc, I followed your directions exactly. I took the pill an hour in advance. Then I watched a baseball game on TV and waited.' The man's wife was in the other room, waiting too; neither of them realized that the drug would be effective only if they were together, doing what couples do." The misunderstandings cut all ways: Some women think ED drugs make men amorous and that their presence isn't required. "What a lot of women need to be turned on is the feeling that they're desired," adds Virginia A. Sadock, MD, director of the program in human sexuality at New York University Langone Medical Center. "So with Viagra, they think, Oh, it's not me he wants; it's the Viagra talking. In my practice, I spend a lot of time reassuring them that this isn't the case — and I tell men they must reassure the women too."
Another big issue for many women: ED drugs drastically shorten the interval between climaxing and achieving another erection. Men look at this differently than women do. For them, it's not a bug, it's a feature. And for the woman? Low libido? Conquer these 5 common sexual stumbling blocks "We want maybe twenty or thirty great minutes of sex," says Susan K., a mother of two in Connecticut. "We don't want an interminable two hours." Not to mention the fact that prolonged intercourse, particularly without sufficient lubrication, can do damage. It can lead to vaginal abrasions and even tearing and can expose a woman to risk of getting yeast infections and — particularly for a woman who is dating or divorced — to sexually transmitted diseases. There are, too, single women who worry that men with new-and-improved sexual abilities will be less likely to commit to marriage, and wives who worry that their husbands will be more apt to look outside the
Be careful what you wish for, I think as my husband reaches again for his new toy. Tragically, it's not a Ferrari or the latest Mac laptop — it's his Penis 2.0—the new, pharmaceutically enhanced model. I married an older man, and lucky for us both, the only part on him that's given out is his knees. But since I was writing about erectile dysfunction (ED) drugs, I wanted him to help me out. Would he try one? The little blue pill enables older men to sexually respond like 18-year-olds. "Wouldn't that be interesting," I asked him, "journalistically speaking?"
The 10 secrets of a lasting longterm relationship. John was skeptical. "What if I take this and things never work without the pill again?" he asked. I pointed out that the label of a leading brand, Viagra, does not list physical dependence as a side effect (although it does mention headaches and an upset stomach). True to promise, when John used Viagra, everything was perfectly fine. But to my chagrin, it was perfectly fine a lot. Don't miss these Health stories EXCLUSIVE: Marcheline Bertrand, French actress and mother of Angelina Jolie, has died of cancer Splash News More women opting for preventive mastectomy - but should they be? Rates of women who are opting for preventive mastectomies, such as Angeline Jolie, have increased by an estimated 50 percent in recent years, experts say. But many doctors are puzzled because the operation doesn't carry a 100 percent guarantee, it's major surgery -- and women have other options, from a once-a-day pill to careful monitoring. Larry Page's damaged vocal cords: Treatment comes with trade-offs Report questioning salt guidelines riles heart experts CDC: 2012 was deadliest year for West Nile in US What stresses moms most? Themselves, survey says And therein lies a problem I wonder whether the makers of Viagra and its pharmaceutical cousins Levitra and Cialis foresaw. While men of a certain age are undoubtedly thrilled to have their sexual potency restored, maybe their wives' enthusiasm is a bit more subdued?
What at first glance seems an obvious win-win situation for both husbands and wives can have a raft of unintended consequences. Don't get me wrong: Viagra is a wonder drug. Since the early '90s, when researchers testing a new heart medication called Sildenafil discovered that it had a startling side effect in men, erectile dysfunction drugs have become more than a billion-dollar industry. One study conducted by Express Scripts, a pharmacy benefit management company, found that nearly 20% of all American men over age 45 have tried them. And since, according to the National Institutes of Health, approximately 5 percent of 40-year-old men and from 15 to 25 percent of 65-year-old men experience ED (for reasons ranging from narrowing of the blood vessels with age to high blood pressure, diabetes, obesity, and neurological problems), these drugs have been a godsend to millions. ED drugs can also, indirectly, be lifesavers. Thirty-four to 70 percent of all men who take antidepressants experience sexual dysfunction as a side effect, and of those who have this problem, almost 90 percent stop taking the antidepressants so their sex lives can go back to normal. 40 Things you should know about sex before the age of 40. But ED drugs are so readily available, so much a jokey part of the cultural landscape, that few of us really know how they work and what the potential dangers are. This leads to misuse — not so much life-threatening as knuckleheaded.
Essentially, ED drugs work like this: What gives a man an erection is blood flow to the penis. The vessels dilate, and blood flows in. There is an enzyme that counteracts the dilation. ED drugs inhibit that enzyme, allowing dilation to occur more easily and last longer. They can also diminish a man's refractory time, meaning that after orgasm he can more quickly get an erection again. The one thing most people know about Viagra and its cohorts is that they are not supposed to be used by men who take nitroglycerin, a common medication for heart patients that also dilates the blood vessels. But ask around. That little piece of knowledge has translated into "Viagra is bad if you have a heart condition." Not so, says Arthur S. Agatston, MD, a cardiologist and associate professor of medicine at the University of Miami Miller School of Medicine and Prevention editorial advisory board member. In fact, Dr. Agatston says, because Viagra keeps the blood vessels from becoming "sticky" and helps blood flow through them smoothly, not just in the penis but throughout the body, in the future, many of us—women included—may end up taking some small amount of Viagra daily, the way we take baby aspirin, which has the same non sticking effect on blood itself.
So when a man takes Viagra, he has to avoid anything that dilates the blood vessels, not just nitroglycerides. Drinking, lying in the sun — both are problematic. Viagra won't give him a heart attack, but, taken with too much alcohol, it could make him pass out, Dr. Agatston says. Perhaps more damaging than ignorance of the physical ramifications of ED drugs is ignorance of their potential interpersonal blowback. When not discussed frankly, Viagra can cause a lot of misunderstanding and hurt between couples. "There is something about a hard erection that is extremely important to a man's identity," says Steven Lamm, MD, an internist in New York City and author of The Hardness Factor. "And of course most couples would prefer that the man be able to have one. But there are some who may have adjusted to life without sex. Perhaps the woman doesn't really want it anymore, for one reason or another. And for those couples, the introduction of an ED drug can throw them seriously out of sync." That leads to what is perhaps the biggest complicating factor: the reality that a woman's postmenopause genital health can put her physically at odds with her partner's newfound, drug-assisted prowess. As women age, their hormonal balances change. Reduced estrogen levels often mean less sexual desire but also decreased vaginal elasticity and lubrication, and thus more potential for sex to be painful. Menopause or Peri-menopause? 11 Truths about hot flashes, crazy mood swings, out-of-nowhere belly bloat, and more The problem can be especially daunting for older women who are widowed or divorced or just beginning to date after years of being alone or with one man. Certainly this was the case for Marjorie P., a 60-something woman who complained about the drugs on a 50+ Web site: "Men have been saved from their middle-age sexual issues by Viagra and Cialis. They can be thirty again, while I have to deal with the sexual issues of being my age. It's put the world on 'tilt.'" Andrea D., a twice-divorced physician from Santa Monica, CA, and an over-50 dater, put it more bluntly. "Viagra has been liberating for men, but unless a woman is taking hormone therapy, she may have vaginal dryness and really not be that interested in the kind of driving, pounding intercourse he's now capable of." There is also fallout from the erroneous belief that Viagra causes not just greater blood flow but also greater desire. The hormone testosterone is the driving force behind libido; a man with little or no testosterone will not have any desire to have sex, Viagra or no. Moreover, even with normal amounts of testosterone, "Viagra does not just instantly give a man an erection," says Abraham Morgentaler, MD, associate clinical professor of urology at Harvard Medical School and author of The Viagra Myth. "You have to be in a sexual situation, you need to have desire and intent, in order for the drug to work." Dr. Morgentaler tells the story of a patient who was very upset because Viagra didn't do the trick for him. "He said, 'Doc, I followed your directions exactly. I took the pill an hour in advance. Then I watched a baseball game on TV and waited.' The man's wife was in the other room, waiting too; neither of them realized that the drug would be effective only if they were together, doing what couples do." The misunderstandings cut all ways: Some women think ED drugs make men amorous and that their presence isn't required. "What a lot of women need to be turned on is the feeling that they're desired," adds Virginia A. Sadock, MD, director of the program in human sexuality at New York University Langone Medical Center. "So with Viagra, they think, Oh, it's not me he wants; it's the Viagra talking. In my practice, I spend a lot of time reassuring them that this isn't the case — and I tell men they must reassure the women too."
Another big issue for many women: ED drugs drastically shorten the interval between climaxing and achieving another erection. Men look at this differently than women do. For them, it's not a bug, it's a feature. And for the woman? Low libido? Conquer these 5 common sexual stumbling blocks "We want maybe twenty or thirty great minutes of sex," says Susan K., a mother of two in Connecticut. "We don't want an interminable two hours." Not to mention the fact that prolonged intercourse, particularly without sufficient lubrication, can do damage. It can lead to vaginal abrasions and even tearing and can expose a woman to risk of getting yeast infections and — particularly for a woman who is dating or divorced — to sexually transmitted diseases.
Steroids are important compounds used in medicine, but people often misunderstand what they are.
The term steroid and sterol simply refer to chemical molecules that share a common chemical ring structure. There are many steroids and sterols that are important in health and medicine. Some may be used as medications. Some steroids are called hormones. Hormones are chemicals that are made in the brain, kidneys, or sex organs. They carry a signal to other cells in the body to change the way that part of the body is working. Other steroids are not hormones and have a direct action on their own.
The adrenal glands in your body make several types of steroids. Each has a specific purpose. Steroids are also found in other animals, and in plants. For example, the drug digitalis comes from the foxglove plant. It was 1 of the first steroids used in medicine.
Your body makes these types of steroids:
Sex hormones. These are the male hormones, including testosterone, which together are called androgens, and the female hormones, including estradiol, a type of estrogen. Anabolic steroids are another name for androgens.
Corticosteroids. These hormones include cortisone and cortisol. They are thought to have a role in the immune system.
Mineralocorticoids. These hormones maintain the balance of sodium and potassium in the body and include aldosterone.
Bile salts or bile acid. These steroids are made in the liver. They don't function as hormones, but are necessary for digestion and absorption of fats.
Sterols. The most commonly known of these is cholesterol. Other sterols help your body to make vitamin D from sunlight and to build cell walls.
Commercially produced corticosteroids are steroids that reduce inflammation. They include hydrocortisone, prednisone, dexamethasone, triamcinolone, budesonide, betamethasone, fluticasone, and flunisolide. The FDA has approved more than 100 corticosteroids for patient use. They are used in pills, ointments, inhalers, and by injection to treat diseases that cause inflammation, including multiple sclerosis, lupus, rheumatoid arthritis, and other autoimmune diseases. They also are used to treat many skin conditions, and leukemia and other cancers.
Corticosteroids are very important in the treatment of asthma and COPD. They help to reduce inflammation in the lungs' airways. A health care provider can prescribe them in various forms. Most people use the inhaled form because it has fewer side effects.
Rarely people experience side effects, like thrush after using inhaled steroids. But, cleansing the mouth with water after use can reduce this oral yeast infection. When taken over a long period of time, oral corticosteroids also can have side effects, like weight gain, ulcers, high blood glucose and cataracts. But, when taking the recommended dosage under a health care provider's supervision, they are considered safe.
Anabolic steroids are male hormones like testosterone or commercially produced chemicals identical to male hormones. When produced naturally by the body, they increase muscle mass and direct proteins to make muscle. As men age, their testosterone production may decrease resulting in mood changes or loss of bone density. Testosterone is sometimes prescribed to treat low testosterone levels. Anabolic steroids are also commonly taken and abused by athletes to boost athletic performance and build muscle mass. Some teenagers abuse them, too.
Taking doses of anabolic steroids beyond the body's normal level increases the risk for prostate cancer, stroke, and heart attack. People who take unnecessary doses of anabolic steroids may display violent behavior and drastic mood swings. They may also suffer from depression. Unfortunately, they can cause lasting damage, according to the National Institute on Drug Abuse.
This 24-page publication provides information about many aspects of credit card fraud and offers tips for recognizing fraud and preventing it. The guide also covers how to check your credit card billing statement, where to report credit card fraud and what to do when fraud strikes. A list of helpful resources is included.
How does credit card fraud occur? Credit card fraud happens when consumers give their credit card number to unfamiliar individuals, when cards are lost or stolen, when mail is diverted from the intended recipient and taken by criminals, or when employees of a business copy the cards or card numbers of a cardholder.
What is an unauthorized charge on my credit card? credit card image An unauthorized charge is a purchase on your credit card that you did not make or permit anyone else to make. When your card is lost or stolen, the person who finds it or steals it may use it to make purchases. Criminals can use the card by forging your name, or order goods and services by phone or on the Internet.
My brother stole my credit card and personal identification number (PIN) and took out a cash advance using the card. Can I still dispute the transaction? Yes, if you did not allow your brother to use your card. You may have to sign a sworn statement that your brother took the card and PIN without your permission.
What is a counterfeit credit card? Counterfeit credit cards are fakes that have real account information stolen from victims. Often, the victims still have their real cards, so they don't know a crime has occurred. The cards appear legitimate, with issuers' logos and encoded magnetic strips. Criminals use stolen account information to create counterfeit cards or to charge items over the phone or the Internet. Counterfeit cards often are used just a few times and abandoned before the victim becomes aware and reports their misuse.
Identity theft What is identity theft? Identity theft, or ID theft, is the fraudulent use of an individual's personal information—such as Social Security number or date of birth—to commit financial fraud.
What happens to victims of identity theft? Identity thieves harm and inconvenience victims by using their names and other personal information to open new credit accounts or access existing credit and bank accounts, and by placing fraudulent charges on these accounts. Victims of identity theft have to dispute these charges as fraudulent, and locate and close down all bogus accounts opened in their names.
Are victims of ID theft held liable for the losses? No. But while victims of identity theft are not held liable for the losses, it may take years for victims to clean up the financial and credit problems caused by the crime.
Skimming, phishing and online fraud What is credit card "skimming"? Credit card skimming refers to thieves making an illegal copy of a credit card or a bank card using a device that reads and duplicates the information from the original card. Dishonest business employees use small machines called "skimmers" to read numbers and other information from credit cards and capture and resell it to criminals, who create counterfeit cards or charge items over the phone or the Internet.
What is "phishing"? Phishing is a crime that starts with deceptive e-mails being sent to consumers. These messages are made to look as if they come from the person's bank, in an effort to get the intended victim to reveal personal information, such as bank account numbers and online passwords. Phishing has become a widespread practice of criminals, who have succeeded in stealing personal information from many people. The crime succeeds because the e-mails look legitimate, with realistic bank logos and web site addresses (URLs) that are very similar to the bank URLs.
What could happen if I respond to a phishing e-mail? Account holders who respond to such e-mail messages are directed to a fake web site where they are asked to type in account numbers, passwords and other personal banking or credit card information. Then, in a matter of hours, the criminals can drain your bank accounts, using your passwords to authorize the electronic transfer of funds to accounts they control.
How can I tell the difference between a scammer's e-mail and a legitimate attempt by my bank to contact me? Banks don't use e-mail communications to ask for personal information because e-mail is not secure. Hit the delete button and never respond to such an e-mail. Don't respond to e-mails—or phone calls—asking you to provide your credit card numbers, Social Security number or your mother's maiden name. Even when you have a legitimate request, banks ask that you never send detailed account information in an e-mail. This is because criminals might intercept your e-mails. When you wish to address an issue that requires personal account information, visit your bank in person, use its secure web site, place a phone call or write a letter.
How can I protect the bank and credit card accounts I access online? Change your user name and password several times per year. Never use variations of your name, children's names, birth date, address, etc., that might be guessed by criminals. Examine your bank's web site home page and log-in screens carefully. If the look of the site changes, contact the bank by phone before logging in to ask if they have made site changes and to let them know you have concerns.
What is a credit card "security code" and what purpose does it serve? Many credit cards have a special numerical code used by many merchants to verify that the card is in your possession when you make purchases by phone or on the Internet. These 3- or 4-digit numbers are found at the top right corner of the card or on the back, following the credit card number, near the space where you sign the card. If your card number and expiration date were stolen, but not the card itself, the thief would not have access to this security code.
What should I do when I receive a new credit card? As a protection, most card issuers now suggest that you call from your home phone to activate a new card before you use it. Sign the back of the card as soon as you receive it. Some people suggest writing "ask for ID" in the signature space. This is not a good idea. Many credit card issuers have advised merchants not to let purchases go through if the cardholder hasn't signed the card.
Protecting yourself How can I prepare myself in case my card is lost or stolen? Record all your account numbers and company contact information and keep this list in a safe and secure place. Do not keep it in your wallet or purse.
How can I protect myself against unauthorized charges? Keep copies of your vouchers and ATM receipts, so that you can check them against your billing statements. Notify your card issuer immediately if you suspect unauthorized use or fraudulent use of your card.
How can I avoid becoming a victim of credit card fraud? It might not be possible to guarantee that you won't become a victim of fraud, but you can take these steps to cut down on your chances:
Safeguard your wallet or purse at all times. Never leave your purse or wallet unattended in public. Never carry all your cards—only the one or two that you might need. Carry your credit cards separately from your wallet in a credit card case or in another compartment in your purse. If your credit card is lost or stolen, call your credit card issuers immediately. What is mail fraud and how can I avoid it? Mail fraud is the illegal use of the postal service to commit a crime, such as the theft of mail. To avoid mail fraud:
Notify the post office immediately if you change your address. Make sure your mailbox is secure and always locked. Never leave outgoing bill payments in your mailbox or apartment building lobby. Instead drop them off at the post office or postal service mailboxes. Call your credit card and banking companies to change your billing address when you move. Always put your return address on the envelope. Shred before discarding all unwanted credit card solicitations. Be aware of when your credit card and other bills are due to arrive each month, and call the companies if you fail to receive them. What is "zero liability" on a credit card? Credit card payments processed by Visa, MasterCard, American Express and Discover are subject to a “zero liability” policy—a guarantee that you will not be held responsible for any fraudulent charges.
What are some ways I can protect my credit card when I use it online? Payment card networks, such as Visa, MasterCard and American Express, offer services to help you avoid fraud, such as special verification passwords. Make sure you are using a secure merchant site by dealing only with well-known reputable stores and checking that your browser is in the secure mode before making a purchase. (Look for a padlock or other security symbol in the lower right corner of your browser window.) Avoid websites that offer "free access" if you provide your credit card number. If you give them the number, your card is likely to be charged by the company you give it to, and maybe by companies unknown to you as well.
I bank online—is there anything I can do to protect my personal information? If you bank online, don't use your Internet browser to automatically fill in your user name and password when you log in to bank or credit card sites, or to any merchant site that keeps your card number on file. Anyone using your computer would be able to sign on automatically and access your accounts. You can deactivate this function in your Internet browser's "preferences" menu under "security."
How can I make sure that my personal identification number (PIN) is safe? With your PIN number and your card, a thief can make cash advance withdrawals from your account at an ATM machine. Keep your PIN secure by following these tips: credit cards image
Never write down your PIN—memorize it. Never give your PIN to anyone. Don't write your PIN number on your credit card. Don't write your credit card number on a post card or on the outside of an envelope you are going to mail. Don't keep your PIN number in the same place as your credit card or ATM card. How can I protect my credit cards? Never provide your credit card number or other personal information on the phone, unless you are able to verify that you are speaking with your financial institution or a merchant you trust. When you lend your card, you are responsible for all charges. You will not be protected against unauthorized use if someone to whom you knowingly and willingly gave the card, including family and friends, makes the charges. Don't give your account number to anyone who calls you on the phone.
How can I protect myself from credit card skimming or any other attempt to steal my credit card number? Watch closely as store and restaurant employees handle your card to make sure they are not copying or skimming your credit card number. The devices used for skimming are sometimes disguised as cell phones. After you make a purchase and your card is handed back to you, make sure it is your card and not a dummy card or another person's card.
I plan to take a trip and to use my credit card while I am away. Should I notify my credit card company? If you are going to be traveling and plan to use your card away from home, notify your credit card company. This may prevent your account from being flagged for possible fraud and any inconvenience you might suffer if your issuer blocks your account.
We are going to renovate our bathroom and pay for the materials with our credit card. Should we let our credit card company know about our plans? If you are going to make any unusually large purchases, notify your card company so that your account is not flagged for possible fraud. For instance, if you are renovating your home and plan to purchase materials, fixtures or appliances, let your issuer know in advance.
Why should I care about fraud when my credit card company has to pay for it, not me? Consumers are not financially responsible for unauthorized charges if they behave responsibly and report lost or stolen cards, but credit card companies experience losses of close to $50 billion dollars per year because of credit card fraud. These costs "trickle down" in the form of higher interest rates and fees that are paid for by all consumers.
What are credit card companies doing to fight fraud? Most credit card companies have developed the technology to help identify fraudulent activity and they will act quickly to stop misuse once they discover it. Your card company may contact you because it notices an especially large purchase or a charge made in a town that is not near your home or in another country. Occasionally, your card may be blocked or suspended until you call the company back. To avoid any inconvenience, notify your card company if you plan to be out of town or to make any large purchases.
Your billing statement Is there any way that I can monitor my credit card between statements? Yes. If you have Internet access, consider enrolling at the bank's web site so you can access your credit card account online. You can monitor your account online for unauthorized charges between statements.
Why is it important to review my credit card statement when it arrives? To protect yourself against unauthorized credit card charges, report fraud as soon as you become aware of it. Review credit card statements the day you receive them and report any questionable charges to your card issuer immediately.
What should I do if my credit card statement does not arrive? If one of your credit card bills is late, call the card issuer right away. A missing statement may indicate that your statement has been stolen. Call your issuer if you don't receive your statement at the usual time. (You are responsible for paying your bills on time even when you didn't receive the statement.)
What should I do with old statements after I have paid them? Store old statements and receipts in a secure place and shred them before you discard them.
What will happen if I move and forget to change my mailing address with my credit card company? If you don’t update your address, you may not receive the billing statement in time to avoid a late payment charge. Make sure to update your records with your credit card company when you move. Many merchants verify your address and ZIP code to make sure they match the bank's records.
I got a phone call from someone selling "credit card loss protection insurance." Is this a good thing to buy? No. Be wary of credit card protection offers. This type of insurance is unnecessary because federal law limits your credit card fraud liability. But scam artists try to sell $200-$300 credit card insurance by falsely claiming that cardholders face significant financial risk if their cards are misused. According to recent Federal Trade Commission estimates, 3.3 million consumers have purchased unnecessary insurance to prevent unauthorized use of their credit cards. To make sure you are fully protected against unauthorized use, report missing cards right away, before they are used. This way you are not responsible for any fraudulent charges. If a thief uses your card before you report it missing, the most you will owe under federal law for unauthorized charges is $50. If your card has a zero liability policy, you will owe nothing.
Should I pay for a service that will notify all my card issuers if my cards are lost or stolen? Save money by doing it yourself. Keep credit card account numbers and toll-free numbers in a separate place from your credit cards so that you can easily find the information when you need it.
Reporting credit card fraud What should I do when my card is lost or stolen? If you lose your credit cards or realize that they have been lost or stolen, call the issuers immediately. Most credit card companies have 24-hour customer service lines to deal with emergencies. Ask your issuer if it recommends that you follow up with a letter, and if so, ask what information you need to include in the letter. Report the loss of your card as soon you can. If someone has used your card without your permission, your maximum liability under federal law is $50 per card.
What law protects my credit history from being damaged if I am a victim of identity theft or credit card fraud? The federal Fair Credit Reporting Act (FCRA) gives you the right to get a free credit report if you are the victim of identify theft. It also gives you the right to place a fraud alert in your file. Many states have their own consumer reporting laws that may give you additional rights. Contact your state or local consumer protection agency or your state attorney general for more information. You can find these agencies in the government pages of the phone book.
What law protects me from unauthorized charges made by a credit card thief? Regulation Z, which implements the Fair Credit Billing Act and the Truth in Lending Act, protects you against unauthorized purchases. To be fully protected, report the problem to the credit card issuer, preferably in writing. Include your name and account number and an explanation of why you believe the charge is incorrect. Include a copy of your billing statement with the questionable charge highlighted. Send your letter to the address designated by the creditor for handling billing errors or claims of unauthorized use. Do not send it in the same envelope with your payment. You must pay the portion of your bill that is not in dispute.
What is a credit card "billing error"? Under federal law, a billing error is defined as:
A credit card charge for something you did not agree to buy. A purchase made by a person who is not authorized to use your account. A charge that is not properly identified, that is for a different amount than the actual purchase, or that was charged more than once. A charge for something that was not delivered or not accepted by you when delivered. A mathematical error on your billing statement. A failure to properly credit a payment or other credit to your account. A failure to mail the bill to your current address, provided you told the creditor about any address change at least 20 days before the end of the billing period. Any charge which you cannot identify without more information. What is my liability for charges made without my permission by someone who found or stole my credit card? You’ll owe nothing if you report the lost card before unauthorized charges are made. When unauthorized purchases or cash advances were made, federal law restricts your liability to $50 per card. However, if you card has a “zero liability” policy, you will not be liable for fraudulent charges.
When I checked my account online, I saw a charge I didn't make on my credit card. What should I do? With online access, you can monitor posted transactions on a daily basis. This can help you monitor your account for fraud. If you look at your account online and see a charge that you didn't make, contact your credit card company immediately. Notify the company even if the card is still in your possession. You may be told that you must wait because you can't dispute "unbilled activity" until it shows up on a monthly statement. Tell the company that this is more than just a dispute—you suspect fraud.
When fraud strikes I looked for my credit card and found it was missing. What should I do? Call the card issuer immediately if your card is lost or stolen. Follow up your phone call with a letter to the card issuer. The letter should contain your card number, the date the card was discovered missing, and the date you reported the loss. Once you report the lost card, you are not responsible for any unauthorized charges.
A credit card that I don't use very often was stolen. I don't know when it was taken, but when I contacted the bank, it said that charges had been made on the card recently. Will I have to pay for the unauthorized charges? When you are late in reporting a lost or stolen credit card, or do not become aware of unauthorized use until you receive a billing statement, your liability is limited to $50 per card by federal law. Federal law allows the issuer to ask you to pay up to $50. However, many card issuers have “zero liability” policies—this means that cardholders aren’t liable for unauthorized charges.
What is a fraud affidavit? If you report that a charge is fraudulent, you may be asked by your card issuer to sign an affidavit that you did not make the purchases in question. An affidavit is a written statement you sign under oath, swearing that the contents are true to the best of your knowledge. Sign, date and return the fraud affidavit promptly.
Helpful resources How can I get a free annual copy of my credit report? A new law has given consumers the right to request a free copy of their credit report from each of the three major national credit reporting agencies. You can get your free credit reports on the Internet at www.annualcreditreport.com. To request your free reports by phone, call 877-322-8228. Your reports will be mailed to you.
Can I request my free credit reports by mail? credit card imageYes, but you must use a special form that you can download from the site mentioned above. Mail the completed form to:
Annual Credit Report Request Service P.O. Box 105281 Atlanta, GA 30348-5281 Why should I check my credit report? Checking your credit report at least once a year may help prevent identity theft and gives you a chance to make sure that all items and credit accounts listed in the report are accurate.
What is "Verified by Visa"? When you enroll in the "Verified by Visa" program you can protect your Visa card online with a personal password. Visit the Visa web site (www.visa.com) for more information.
Which federal agencies can help me with credit card fraud? The Federal Trade Commission (FTC) (www.consumer.ftc.gov) offers free publications on credit cards, billing rights and how to avoid credit card fraud.
The federal agencies that regulate banks are also responsible for helping consumers deal with bank and credit card fraud.
Different agencies regulate different types of banks:
National banks (the word "National" or the initials N.A. appear in or after the bank's name) and federal branches of foreign banks are regulated by the Office of the Comptroller of the Currency (OCC), Customer Assistance Group, 1301 McKinney Street, Suite 3450, Houston, TX 77010; fax: 713-336-4301. (Your letter or fax should provide the bank's full name and address.) Federal Reserve System member banks are regulated by the Federal Reserve Board, Division of Consumer & Community Affairs, Washington, DC 20551; 202-452-3693; www.federalreserve.gov. Savings associations and federally chartered savings banks whose names have the word "Federal" or the initials F.S.B. are regulated by the Office of Thrift Supervision, Consumer Complaints, Washington, DC 20552; 800-842-6929; www.ots.treas.gov. Federal credit unions are regulated by the National Credit Union Administration, 1775 Duke Street, Alexandria, VA 22314; 703-519-4600. www.ncua.gov. State-chartered banks that are not members of the Federal Reserve System are regulated by the Federal Deposit Insurance Corporation, Consumer Response Center, 2345 Grand Ave., Suite 100 Kansas City, MO 64108;877-275-3342; www.fdic.gov. As a credit card fraud victim, how can I protect my credit? By monitoring your credit report on a regular basis, you can check for fraudulent accounts and inaccurate information. (See the beginning of this section.) As a credit card fraud victim, you have the option to place a fraud alert on your credit report. Fraud alerts will ensure that creditors contact you before any new accounts are opened in your name or when changes are made to your existing accounts.
Payday loans are often used by people who are in a financial bind and looking for temporary relief until their next paycheck, like many government workers who were furloughed due to the government shutdown this week. In most instances, this option is exercised if no other immediate resources, such as credit cards or funds from a savings account, are available.
Because lenders do not typically run a credit check during the application process, the process of requesting a payday loan does not have an effect on your credit score. Instead, they inquire about your current employment status and source of income. Lenders also mandate that you submit a post-dated check to cover the amount of the loan once funds from your employer are disbursed into your account on payday.
How Payday Loans Can Affect Your Credit Score
In the event that the post-dated check you provided to the payday lender does not clear the bank and you default on the loan, your credit score could take a hit, unless you have another source of funds available (or arrange a payment plan or extension) to cover the balance. Defaulting on a loan often results in the debt being sold to a collection agency and reported to each of the three credit bureaus. Some lenders even go as far as filing lawsuits, which will also show up in the public records section of your credit report if the judge rules in their favor.
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If you have taken out a payday loan and realize prior to the due date that you will be unable to remit a timely payment in full, contact the lender immediately to request a payment plan or make other arrangements. Although this will add more interest and fees (which can make the loan even harder to pay off), it prevents the loan from going into default and damaging your credit score for the time being.
Other Alternatives
On the other hand, if you are considering taking out a payday loan, be sure to exhaust all other remedies available before moving forward. Payday loans are often accompanied by excessive finance charges and fees, which can get you deeper in debt if you repeatedly use them to bail out when financial emergencies arise.
Therefore, it is best to consider the following alternatives before turning to a payday loan:
Making cuts to the variable expenses in your budget to free up funds; Borrowing funds from friend or family member; Using a credit card that has a low interest rate; Negotiating due dates for other debt obligations with lenders; Taking a cash advance from your credit card if the fee is manageable; Overdrawing your account temporarily if protection is offered by your bank; Obtaining a small loan from your local credit union or financial institution. If none of these options work for you, be sure to only borrow as much as you can repay.
You should also work towards achieving financial stability so that you can rely on your emergency fund when unexpected problems arise.
Don’t Ignore Your Credit
You may find it difficult to face your credit while you’re having financial difficulties. However, it’s important as ever to stay aware of your credit during times like this so you can deal with any potential problems — including errors, collection accounts or signs of fraud — that can show up on your credit report. It’s also important to keep an eye on your credit score, which can indicate a problem with your credit.
You can obtain your credit reports and credit scores for free, so use those options whenever you can. You’re entitled to your free credit reports once a year through AnnualCreditReport.com, and there are free services and tools out there that allow you to monitor your credit scores (Credit.com’s Credit Report Card is one of them).
Vitamin A (retinol) is required for the formation of rhodopsin, a photoreceptor pigment in the retina. Vitamin A helps maintain epithelial tissues. Normally, the liver stores 80 to 90% of the body’s vitamin A. To use vitamin A, the body releases it into the circulation bound to prealbumin (transthyretin) and retinol-binding protein. β-Carotene and other provitamin carotenoids, contained in green leafy and yellow vegetables and deep- or bright-colored fruits, are converted to vitamin A. Carotenoids are absorbed better from vegetables when they are cooked or homogenized and served with some fat (eg, oils).
Retinol activity equivalents (RAE) were developed because provitamin A carotenoids have less vitamin A activity than preformed vitamin A; 1 µg retinol = 3.33 IU.
Synthetic vitamin analogs (retinoids) are being used increasingly in dermatology. The possible protective role of β-carotene, retinol, and retinoids against some epithelial cancers is under study. However, risk of certain cancers may be increased after β-carotene supplementation.
Vitamin A deficiency can result from inadequate intake, fat malabsorption, or liver disorders. Deficiency impairs immunity and hematopoiesis and causes rashes and typical ocular effects (eg, xerophthalmia, night blindness). Diagnosis is based on typical ocular findings and low vitamin A levels. Treatment consists of vitamin A given orally or, if symptoms are severe or malabsorption is the cause, parenterally.
Etiology
Primary vitamin A deficiency is usually caused by
Prolonged dietary deprivation
It is endemic in areas such as southern and eastern Asia, where rice, devoid of β-carotene, is the staple food. Xerophthalmia due to primary deficiency is a common cause of blindness among young children in developing countries.
Secondary vitamin A deficiency may be due to
Decreased bioavailability of provitamin A carotenoids
Interference with absorption or storage is likely in celiac disease, cystic fibrosis, pancreatic insufficiency, duodenal bypass, chronic diarrhea, bile duct obstruction, giardiasis, and cirrhosis. Vitamin A deficiency is common in prolonged protein-energy undernutrition not only because the diet is deficient but also because vitamin A storage and transport is defective.
In children with complicated measles, vitamin A can shorten the duration of the disorder and reduce the severity of symptoms and risk of death.
Symptoms and Signs
Impaired dark adaptation of the eyes, which can lead to night blindness, is an early symptom. Xerophthalmia (which is nearly pathognomonic) results from keratinization of the eyes. It involves drying (xerosis) and thickening of the conjunctivae and corneas. Superficial foamy patches composed of epithelial debris and secretions on the exposed bulbar conjunctiva (Bitot spots) develop. In advanced deficiency, the cornea becomes hazy and can develop erosions, which can lead to its destruction (keratomalacia).
Keratinization of the skin and of the mucous membranes in the respiratory, GI, and urinary tracts can occur. Drying, scaling, and follicular thickening of the skin and respiratory infections can result. Immunity is generally impaired.
The younger the patient, the more severe are the effects of vitamin A deficiency. Growth retardation and infections are common among children. Mortality rate can exceed 50% in children with severe vitamin A deficiency.
Diagnosis
Serum retinol levels, clinical evaluation, and response to vitamin A
Ocular findings suggest the diagnosis. Dark adaptation can be impaired in other disorders (eg, zinc deficiency, retinitis pigmentosa, severe refractive errors, cataracts, diabetic retinopathy). If dark adaptation is impaired, rod scotometry and electroretinography are done to determine whether vitamin A deficiency is the cause.
Serum levels of retinol are measured. Normal range is 28 to 86 μg/dL (1 to 3 µmol/L). However, levels decrease only after the deficiency is advanced because the liver contains large stores of vitamin A. Also, decreased levels may result from acute infection, which causes retinol-binding protein and transthyretin (also called prealbumin) levels to decrease transiently. A therapeutic trial of vitamin A may help confirm the diagnosis.
Prevention
The diet should include dark green leafy vegetables, deep- or bright-colored fruits (eg, papayas, oranges), carrots, and yellow vegetables (eg, squash, pumpkin). Vitamin A–fortified milk and cereals, liver, egg yolks, and fish liver oils are helpful. Carotenoids are absorbed better when consumed with some dietary fat. If milk allergy is suspected in infants, they should be given adequate vitamin A in formula feedings.
In developing countries, prophylactic supplements of vitamin A palmitate in oil 60,000 RAE (200,000 IU) po every 6 mo are advised for all children between 1 and 5 yr of age; infants < 6 mo can be given a one-time dose of 15,000 RAE (50,000 IU), and those aged 6 to 12 mo can be given a one-time dose of 30,000 RAE (100,000 IU).
Treatment
Vitamin A palmitate
Dietary deficiency is traditionally treated with vitamin A palmitate in oil 60,000 IU po once/day for 2 days, followed by 4500 IU po once/day. If vomiting or malabsorption is present or xerophthalmia is probable, a dose of 50,000 IU for infants < 6 mo, 100,000 IU for infants 6 to 12 mo, or 200,000 IU for children > 12 mo and adults should be given for 2 days, with a third dose at least 2 wk later. The same doses are recommended for infants and children with complicated measles. Infants born of HIV-positive mothers should receive 50,000 IU (15,000 RAE) within 48 h of birth. Prolonged daily administration of large doses, especially to infants, must be avoided because toxicity may result.
For pregnant or breastfeeding women, prophylactic or therapeutic doses should not exceed 10,000 IU (3000 RAE)/day to avoid possible damage to the fetus or infant.
Key Points
Vitamin A deficiency usually results from dietary deficiency, as occurs in areas where rice, devoid of β-carotene, is the staple food, but it may result from disorders that interfere with the absorption, storage, or transport of vitamin A.
Ocular findings include impaired night vision (early), conjunctival deposits, and keratomalacia.
In children with severe deficiency, growth is slowed and risk of infection is increased.
Diagnose based on ocular findings and serum retinol levels.
Treat with vitamin A palmitate.
Vitamin A Toxicity
Vitamin A toxicity can be acute (usually due to accidental ingestion by children) or chronic. Both types usually cause headache and increased intracranial pressure. Acute toxicity causes nausea and vomiting. Chronic toxicity causes changes in skin, hair, and nails; abnormal liver test results; and, in a fetus, birth defects. Diagnosis is usually clinical. Unless birth defects are present, adjusting the dose almost always leads to complete recovery.
Acute vitamin A toxicity in children may result from taking large doses (> 300,000 IU [> 100,000 RAE]), usually accidentally. In adults, acute toxicity has occurred when arctic explorers ingested polar bear or seal livers, which contain several million units of vitamin A.
Chronic toxicity in older children and adults usually develops after doses of > 30,000 RAE (> 100,000 IU)/day have been taken for months. Megavitamin therapy is a possible cause, as are massive daily doses (50,000 to 120,000 RAE [150,000 to 350,000 IU]) of vitamin A or its metabolites, which are sometimes given for nodular acne or other skin disorders. Adults who consume > 1500 RAE (> 4500 IU)/day of vitamin A may develop osteoporosis. Infants who are given excessive doses (6,000 to 20,000 RAE [18,000 to 60,000 IU]/day) of water-miscible vitamin A may develop toxicity within a few weeks. Birth defects occur in children of women receiving isotretinoin (which is related to vitamin A) for acne treatment during pregnancy.
Although carotene is converted to vitamin A in the body, excessive ingestion of carotene causes carotenemia, not vitamin A toxicity. Carotenemia is usually asymptomatic but may lead to carotenosis, in which the skin becomes yellow. When taken as a supplement, β-carotene has been associated with increased cancer risk; risk does not seem to increase when carotenoids are consumed in fruits and vegetables.
Symptoms and Signs
Although symptoms may vary, headache and rash usually develop during acute or chronic toxicity. Acute toxicity causes increased intracranial pressure. Drowsiness, irritability, abdominal pain, nausea, and vomiting are common. Sometimes the skin subsequently peels.
Early symptoms of chronic toxicity are sparsely distributed, coarse hair; alopecia of the eyebrows; dry, rough skin; dry eyes; and cracked lips. Later, severe headache, pseudotumor cerebri, and generalized weakness develop. Cortical hyperostosis of bone and arthralgia may occur, especially in children. Fractures may occur easily, especially in the elderly. In children, toxicity can cause pruritus, anorexia, and failure to thrive. Hepatomegaly and splenomegaly may occur.
In carotenosis, the skin (but not the sclera) becomes deep yellow, especially on the palms and soles.
Diagnosis
Clinical evaluation
Diagnosis is clinical. Blood vitamin levels correlate poorly with toxicity. However, if clinical diagnosis is equivocal, laboratory testing may help. In vitamin A toxicity, fasting serum retinol levels may increase from normal (28 to 86 μg/dL [1 to 3 µmol/L]) to > 100 μg/dL (> 3.49 µmol/L), sometimes to > 2000 μg/dL (> 69.8 µmol/L). Hypercalcemia is common.
Differentiating vitamin A toxicity from other disorders may be difficult. Carotenosis may also occur in severe hypothyroidism and anorexia nervosa, possibly because carotene is converted to vitamin A more slowly.
Prognosis
Complete recovery usually occurs if vitamin A ingestion stops. Symptoms and signs of chronic toxicity usually disappear within 1 to 4 wk. However, birth defects in the fetus of a mother who has taken megadoses of vitamin A are not reversible.
Treatment
Vitamin A is stopped.
Key Points
Vitamin A toxicity can be caused by ingesting high doses of vitamin A—acutely (usually accidentally by children) or chronically (eg, as megavitamin therapy or treatment for skin disorders).
Chronic toxicity causes rash, increased intracranial pressure, sparse and coarse hair, dry and rough skin, and arthralgia; risk of fractures is increased, especially in the elderly.
Diagnose based on clinical findings.
When vitamin A is stopped, symptoms (except birth defects) usually resolve within 1 to 4 wk.
