30 Aug Vitamin D and Skin diseases
Vitamin D and Skin diseases
· The association of vitamin D and skin is wide where skin at one end acting as a target organ for active vitamin D synthesis and vitamin D controlling multiple functions in skin keratinocyte proliferation, differentiation, barrier mechanism and an immune-modulator (DD, 2012). Various immunological cells such as monocytes, T and B-lymphocytes and Langerhans cells express both vitamin D receptor and 25-hydroxy-vitamin D-1α-hydroxylase (Van Etten E, 2003) implicating a vital role of vitamin D in control and regulation of immune mechanisms. Apart from the structural and functional aspects, which Vitamin D has in skin, its role in skin pathology is also crucial. We review few important dermatological conditions and vitamin D as a therapeutic option.
· Psoriasis- Role of vitamin D in psoriasis pathology is well established. The US Food and Drug Administration (USFDA) have approved topical calcitriol with its minimal effects on serum calcium for the treatment of psoriasis. It is now accepted that vitamin D analogs are effective and safe for the topical treatment of skin areas that are usually difficult to treat and that respond slowly (Grace K, 2010)
· Atopic dermatitis– Owing to Vitamin D’s immune suppressing response, ability to enhance antimicrobial peptide activity and promote integrity of the permeability barrier, Vitamin D supplementation provides a possible therapeutic intervention for atopic dermatitis. Vitamin D can inhibit the skin infections in AD by enhancing the expression of antimicrobial peptides like cathelicidins and defensins, activation of toll like receptors (Liu PT, 2006).
· Icthyosis-Disorders like ichthyosis caused by abnormal keratinization may be associated with an alteration in vitamin D metabolism leading to rickets and osteomalacia. The various factors leading to rickets in a patient with disorder of keratinization may include alterations in epidermal cholesterol metabolism, avoidance of sunlight to prevent sunburn, associated vitamin D deficiency rickets, or increased keratinocyte proliferation leading to poor penetration of skin by sunlight (Griffiths WA, 1998).
· Skin cancer- In vitro studies suggest that Vitamin D offers protection to keratinocytes from ultra Violet radiation (Langberg M, 2009) and we know that ultra violet radiations are a cause of non-melanoma cutaneous carcinomas (Lehmann B, 2004). Promotion of cell differentiation and apoptosis along with inhibition of cancer cell proliferation, inflammation and angiogenesis by calcitriol may explain the cancer protective benefits of vitamin D (Manson JE, 2011)
· Acne- A study evaluated the role of Vitamin D in patients with acne (S.K. Lim, 2016). It was found that patients with acne had low level of vitamin D than healthy controls and an inverse relationship was observed between vitamin D levels and severity, number of inflammatory acne lesions. The possible mechanism of Vitamin D’s effect in acne may be due to inhibition of Interleukins. The use of vitamin D in acne is currently a grade B recommendation with a IIb level of evidence.
· Thus maintaining a vitamin D serum concentration within normal levels is warranted in many dermatological disorders including atopic dermatitis, psoriasis, vitiligo, polymorphous light eruption, mycosis fungoides, alopecia areata, systemic lupus erythematosus, and melanoma patients.
Please always ensure to check with your Doctor / Healthcare / GP before starting with any new medication or therapy.
DD, B. (2012). Vitamin D and the skin: physiology and pathophysiology. Rev Endocr Metab Disord , 13:3-19.
Grace K, K. D. (2010). The rationale behind topical vitamin D analogues in the treatment of psoriasis. Where does topical calcitriol fit in? . J Clin Aesthet Dermatol , 3:46-53.
Griffiths WA, J. M. (1998). Disorders of keratinization. In: Wilkinson R, editor. Ebling Textbook of Dermatology. 6 th ed. Oxford: Blackwell Science, 1483-8.
Langberg M, R. C. (2009). Vitamin D protects keratinocytes from deleterious effects of ionizing radiation. Br J Dermatol , 160:151-61.
Lehmann B, Q. K. (2004). Vitamin D and skin: New aspects for dermatology. Exp Dermatol , 13(Suppl 4):11-5.
Liu PT, S. S. (2006). Toll-like receptor triggering of vitamin Demediated human antimicrobial response. Science , 311:1770-3.
Manson JE, M. S. (2011). Vitamin D and prevention of cancer- ready for prime time? . N Engl J Med , 364:1385-7.
S.K. Lim, J. H. (2016). Comparison of vitamin D levels in patients with and without acne: A case-control study combined with a randomized controlled trial. PloS One, e0161162.
Van Etten E, D. B. (2003). Analogs of 1α,25-dihydroxy vitamin D3 as pluripotent immunomodulators. J Cell Biochem , 88:223-6.