Vitamin D Deficiency
And
Skin Disorders
Skin not only synthesizes vitamin D, but also responds to vitamin D in maintaining its own health. Therefore, vitamin D deficiency may be putting us at risk for several skin disorders.
Vitamin D Deficiency And Psoriasis
Psoriasis is a chronic skin disorder, with periods of remissions and relapses. While there are various types of skin rashes, the most common is in the form of thickened skin plaques, which have scaly, silvery-white appearance. These plaques frequently appear on elbows and knees, although any part of the skin can be involved such as scalp, back and genitals. Sometimes, it can affect nails as well. Occasionally arthritis can develop which is called Psoriatic arthritis.
There is no cure for psoriasis at the present time. Often steroids are used to provide temporary symptomatic relief. Steroids have serious side-effects. Is there a better treatment and/or cure for psoriasis?
Psoriasis is an autoimmune disorder, in which immune cells mistakenly start to attack your skin cells. Vitamin D deficiency and stress play an important role in causing any autoimmune disorder, as I elaborated in Chapter 10. Therefore, I recommend vitamin D replacement and stress management in these patients.
In one study (1), published in 1988 in the journal of the American Academy of Dermatology, researchers found vitamin D as a skin cream to be an effective treatment for a majority of patients with psoriasis. This led to the development of a synthetic vitamin D analog called calcipotriene (brand name Dovonex, available as skin cream) which is now commonly used in the treatment of psoriasis.
Oral vitamin D supplementation is also effective for the treatment of psoriasis. According to the authors of a publication (2) from the University of California, Davis, USA, vitamin D deficiency is associated with the severity of psoriasis. Oral vitamin supplementation not only helps the psoriasis of the skin, but also helps with joint-involvement due to psoriasis.
Vitamin D Deficiency And Vitiligo
Low vitamin D is also associated with a skin condition known as vitiligo, (medically speaking, vitiligo vulgaris ), which is an autoimmune disorder. In this skin condition, your immune system attacks and kills your melanocytes (pigment forming cells) in the skin. This leads to a loss of skin pigmentation, which is often patchy in distribution. It can affect dark as well as fair skin. Vitiligo is often associated with other autoimmune disorders as well such as Graves’ disease, Hashimoto’s thyroiditis, and Myasthenia gravis.
An excellent study (3) was published in 2010 in the journal of the American Academy of Dermatology. In this study, investigators from the State University of New York (SUNY), Brooklyn, USA, measured 25 (OH) vitamin D level in 45 patients with vitiligo. They found that 25 (OH) Vitamin D level less than 30 ng/ml was associated with a high risk of developing vitiligo.
Vitamin D Deficiency, Ultraviolet (UV) Radiation And Skin Cancer Risk?
Over 1 million skin cancers occur annually in the USA. 80% are basal cell carcinoma, 16% are squamous cell carcinoma and 4% are melanomas. Traditional knowledge in dermatology links excessive sun exposure to skin cancer risk. Hence, the drumbeat to avoid sun exposure and use sunscreen whenever you are outdoors, which has contributed to an epidemic of vitamin D deficiency. There is strong evidence to link low vitamin D to cancers of the colon, breast and prostate.
Can low vitamin D also be associated with increased risk of skin cancer? This is a question of intense debate at this time. An interesting study (4) from the University of California in San Francisco, USA was published in Discovery Medicine . This study showed that lack of Vitamin D Receptor (VDR) in mice actually increased the risk of skin tumor formation upon exposure to UV radiation. The author hypothesized that Vitamin D and its receptor (VDR) acts as a tumor-suppressor agent in the skin upon exposure to UV radiation. In this way, vitamin D may actually prevent skin cancer.
Vitamin D Deficiency And Hair Loss?
There is mounting evidence to shed light on the importance of vitamin D and its receptor (VDR) in regulating the health of hair follicles. In an excellent study (5) from Cairo University in Egypt, investigators found vitamin D and ferritin levels to be much lower in females with hair loss than those without hair loss. Ferritin is a measure of your iron level. Interestingly, there was a direct correlation between the severity of hair loss and the severity of ferritin and vitamin D deficiency. In other words, the lower the level of vitamin D and ferritin, the more severe was the hair loss. They found that a 25 (OH) vitamin D level of less than 27 ng/ml, (which is equal to 67.9 nmol/L) was associated with excessive hair loss.
An interesting study (6) from the University of California in San Francisco, USA, found that the absence of Vitamin D Receptor (and hence, lack of vitamin D action) led to alopecia (hair loss) in mice. Hair loss developed by 3 months after birth and gradually led to nearly total hair loss by 8 months in these vitamin D deficient mice.
Can vitamin D treat alopecia in humans? An exciting case report (7) was published in the Annals of Dermatology in 2012, in which investigators from Chung-Ang University in Seoul, Korea successfully treated alopecia in a 7-year old boy, with calcipotriene (50 microgram/ml), a vitamin D analog. Calcipotriene (brand name Dovonex) was applied daily for 3 months. Complete hair re-growth took place in the affected area at 3 months. A punch biopsy was done before the treatment, which showed lack of Vitamin D Receptor (VDR) in hair follicles. A repeat punch biopsy at 3 months showed VDR expression in the hair follicles. There was no relapse of hair loss over the next 6 months. A great study!
Vitamin D Deficiency And Eczema
Eczema is an allergic disorder of the skin. It is also known as atopic dermatitis. It is a chronic skin condition, usually starts in childhood and may persist through adulthood. Patients experience recurring, itchy skin rashes. What causes eczema is not clearly known. Genetics plays a role. Precipitating factors include pollens, skin irritants, skin infections, dust mites, food allergies, and stress. Some patients also suffer from asthma and hay fever.
Vitamin D plays an important role in the normal functioning of the immune system. Vitamin D deficiency is well-known to be associated with other allergic disorders such as asthma. Can vitamin D deficiency play a role in eczema and can vitamin D supplementation be helpful in patients with eczema? An excellent study (8) was carried out in Mongolian children suffering from Eczema. This study involved researchers from Harvard School of Public Health, USA and Health Sciences University of Mongolia, Mongolia. Compared with placebo, vitamin D supplementation (1000 IU per day) for 1 month produced a clinically significant improvement in the severity of eczema.
Vitamin D Deficiency And Chronic Urticaria
Urticaria refers to hives on the skin. Typically, these are raised, reddish, itchy bumps on the skin. The causes of urticaria include stress, allergy to food, drugs, or other environmental agents, and autoimmune dysfunction.
For chronic urticaria, treatment typically consists of an antihistamine such as diphenhydramine (Benadryl), hydroxyzine (Atarax) loratadine (Claritin), cetirizine (Zyrtec), or desloratadine (Clarinex). These antihistamines block Histamine 1 (H1) receptors. Often patients also need drugs to block Histamine 2 (H2) receptors. These drugs include ranitidine (Zantac) and cimetidine (Tagamet). Many patients also need the addition of a 3rd drug, such as leukotriene receptor antagonist such as montelukast (Singulair). A number of patients also need short courses of oral steroids such as prednisone. Some even require more heavy duty immunosuppressive drugs.
Most cases of urticaria involve immune system. Vitamin D is intimately involved in the health of our immune system. Therefore, it is logical to think that vitamin D supplementation should have a role in the treatment of chronic urticaria. In an interesting study (9), researchers from the University of Nebraska, Omaha, USA, recruited 42 patients with chronic urticaria. They randomly divided these patient into two groups. One group received a small dose of vitamin D3 as 600 IU per day, while the other group received a high dose of vitamin D3 as 4,000 IU per day. All of the patients also received triple-drug therapy consisting of cetirizine, ranitidine, and montelukast. Triple-drug therapy decreased Urticaria-Symptom-Severity scores by 33% in the first week. There was an additional 40% decrease in the Urticaria-Symptom-Severity scores in the high, but not low, vitamin D3 treatment group by the end of 12 weeks. The authors concluded that the add-on therapy with high-dose vitamin D3 (4,000 IU/d) could be considered a safe and potentially beneficial agent in patients with chronic urticaria.
It is pretty clear that vitamin D is extremely important for the normal health of skin. Deficiency of vitamin D or lack of vitamin D receptor can lead to a wide range of skin abnormalities, including psoriasis, vitiligo, skin tumor formation, alopecia, eczema and urticaria. Therefore, instead of running away from vitamin D, it’s time to embrace it for a healthy skin.
References:
1. Smith EL, Pincus SH, Donovan L, Holick MF. A novel approach for the evaluation and treatment of psoriasis. J Am Acad Dermatol 1988;(19):516-519.
2. Kamangar F1 , Koo J, Heller M, Lee E, Bhutani T.Oral vitamin D, still a viable treatment option for psoriasis. J Dermatolog Treat . 2013 Aug;24(4):261-7.
3. Silverberg JI, Silverberg AI, Malka E, Silverberg NB. A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris. J Am Acad Dermatol . 2010 Jun;62(6):937-41
4. Bikle DD. The vitamin D receptor a tumor suppressor in skin. Discov Med . 2011 Jan;11(56):7-17.
5. Rasheed H, Mahgoub D, Hegazy R, El-Komy M, Abdel Hay R, Hamid MA, Hamdy E. Serum ferritin and vitamin d in female hair loss: do they play a role? Skin Pharmacol Physiol. 2013;26(2):101-7
6. Xie Z, Komuves L, Yu QC, Elalieh H, Ng DC, Leary C, Chang S, Crumrine D, Yoshizawa T, Kato S, Bikle DD. Lack of the vitamin D receptor is associated with reduced epidermal differentiation and hair follicle growth. J Invest Dermatol . 2002 Jan;118(1):11-6
7. Dong Ha Kim, M.D., Jin Woong Lee, M.D., In Su Kim, M.D., Sun Young Choi, M.D., Yun Young Lim, Ph.D., Hyeong Mi Kim, M.S., Beom Joon Kim, M.D., Ph.D. and Myeung Nam Kim, M.D., Ph.D. Successful Treatment of Alopecia Areata with Topical Calcipotriol. Ann Dermatol . 2012 August; 24(3): 341–344.
8. Camargo CA Jr1 , Ganmaa D2 , Sidbury R3 , Erdenedelger Kh4 , Radnaakhand N5 , Khandsuren B4 . Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. J Allergy Clin Immunol . 2014 Oct;134(4):831-835.
9. Rorie A1 , Goldner WS2 , Lyden E3 , Poole JA4 . Beneficial role for supplemental vitamin D3 treatment in chronic urticaria: a randomized study. Ann Allergy Asthma Immunol . 2014 Apr;112(4):376-82.