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The relevance of serum vitamin D in psoriasis: a review

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Abstract

Observational research has identified low serum levels of 25-hydroxyvitamin D (25[OH]D) in many non-skeletal diseases. Whether this is causal or due to underlying illness is unknown. Low serum 25[OH]D levels are also reported in the general population. Observational and experimental studies identify that vitamin D supplementation may be beneficial in reducing all-cause mortality in elderly women, as well as cancer mortality. Our aim was to review the literature to identify the relevance of serum 25[OH]D levels in psoriasis. Forty-five studies were included in our analysis. Most of these studies identified low serum 25[OH]D levels in psoriasis patients. Evidence of causality is lacking. Treatment with phototherapy leads to an increase in serum 25[OH]D. There is little evidence that the increase in 25[OH]D after phototherapy correlates with improved disease severity. Multiple studies report an improvement in psoriasis with vitamin D supplementation. These data are predominantly from small observational or non-randomised interventional studies. Randomised controlled trials to date have had small numbers and short follow-up periods. The optimal dose of supplementation is unknown and dosing is not standardised across different studies. The definition of vitamin D insufficiency varies across studies. Low serum 25[OH]D levels may be associated with comorbidities in psoriasis patients, including metabolic syndrome and cardiovascular risk. Evidence of causation is absent. Until further high-quality evidence is available, the relevance of low serum 25[OH]D levels in psoriasis patients is unknown, as is the benefit of supplementation on disease control. Supplementation in patients with low 25[OH]D is of benefit to those at risk of impaired bone health.

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Abbreviations

25[OH]D:

25-Hydroxyvitamin D

SLE:

Systemic lupus erythematosus

CV:

Cardiovascular

RA:

Rheumatoid arthritis

USA:

United States of America

IOM:

Institute of Medicine

RDA:

Recommended daily amount

24,25[OH]2D:

24,25-Dihydroxyvitamin D

1,25[OH]2D:

1,25-Dihydroxyvitamin D

BMI:

Body mass index

PASI:

Psoriasis area severity index

CRP:

C-reactive protein

TNF-α:

Tumour necrosis factor alpha

ESR:

Erythrocyte sedimentation rate

BSA:

Body surface area

LL-37:

Cathelicidin LL-37

IMA:

Ischaemia-modified albumin

hs-CRP:

High sensitivity C-reactive protein

T-reg:

Regulatory T cells

UVB:

Ultraviolet B

BB-UVB:

Broad-band UVB

PUVA:

Psoralen and ultraviolet A

NB-UVB:

Narrow-band UVB

AD:

Atopic dermatitis

HbA1c:

Haemoglobin A1c

LDL:

Low density lipoprotein

HDL:

High density lipoprotein

1α[OH]D3 :

1 Alpha hydroxyvitamin D3

1,25[OH]2D3 :

Calcitriol

RCT:

Randomised controlled trial

DBP:

Vitamin D binding protein

VDR:

Vitamin D receptor

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Authors and Affiliations

  1. Department of Dermatology, The Charles Centre, St Vincent’s University Hospital, Elm Park, Dublin 4, Ireland

    R. Hambly & B. Kirby

  2. University College Dublin School of Medicine and Medical Sciences, Dublin 4, Ireland

    B. Kirby

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Roisin Hambly has no disclosures. Brian Kirby has the following disclosures: Research Support/Principal Investigator: Abbvie, Pfizer, Merck Sharpe Dolme, Novartis. Consultant: Merck Sharpe Dolme, Pfizer, Jansen, Abbvie, Novartis, Celgene; Honoraria: Janssen, Pfizer, Abbott, Novartis, Celgene. Scientific Advisory Board: Pfizer, Abbvie, Novartis, Celgene, Janssen. We do not believe that any of the above associations are a conflict for this review.

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Hambly, R., Kirby, B. The relevance of serum vitamin D in psoriasis: a review. Arch Dermatol Res 309, 499–517 (2017). https://doi.org/10.1007/s00403-017-1751-2

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