Abstract
Vitamin D, sunshine and UVB phototherapy were first reported in the early 1900s to control psoriasis, cure rickets and cure tuberculosis (TB). Vitamin D also controlled asthma and rheumatoid arthritis with intakes ranging from 60,000 to 600,000 International Units (IU)/day. In the 1980s, interest in treating psoriasis with vitamin D rekindled. Since 1985 four different oral forms of vitamin D (D2, D3, 1-hydroxyvitaminD3 (1(OH)D3) and 1,25-dihydroxyvitaminD3 (calcitriol)) and several topical formulations have been reported safe and effective treatments for psoriasis—as has UVB phototherapy and sunshine. In this review we show that many pre-treatment serum 25(OH)D concentrations fall within the current range of normal, while many post-treatment concentrations fall outside the upper limit of this normal (100 ng/mL). Yet, psoriasis patients showed significant clinical improvement without complications using these treatments. Current estimates of vitamin D sufficiency appear to underestimate serum 25(OH)D concentrations required for optimal health in psoriasis patients, while concentrations associated with adverse events appear to be much higher than current estimates of safe serum 25(OH)D concentrations. Based on these observations, the therapeutic index for vitamin D needs to be reexamined in the treatment of psoriasis and other diseases strongly linked to vitamin D deficiency, including COVID-19 infections, which may also improve safely with sufficient vitamin D intake or UVB exposure.
Highlights
Neither of these two references mentions the use of oral vitamin D
A discussion of the implications of our findings in this review for the treatment of psoriasis and other diseases strongly linked to vitamin D deficiency using vitamin
The authors noted that “because phototherapy for psoriatic plaques produces changes in keratinocytes similar to those described for 1,25-(OH)2D3, this raises the possibility that one of the mechanisms of action of UVB may be through enhanced vitamin D metabolism”
Summary
The American Academy of Dermatology (AAD) and the National Psoriasis Foundation released two guidelines in 2019 outlining best practices for managing this inflammatory skin disease [10,11]. One guideline extensively reviews the use of the relatively newly developed biologic agents that target specific components of the inflammatory process causing psoriasis [10], and the other focuses on the management and treatment of psoriasis with awareness of and attention to comorbidities [11]. Neither of these two references mentions the use of oral vitamin D
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