Oral Vitamin D Therapy for Chronic Plaque-Psoriasis among Iraqi Patients, Efficacy, and Safety

Abstract

Background: Psoriasis is an immune-mediated disorder that results from a polygenic predisposition combined with environmental triggers. Any problem in the optimal function of the skin due to psoriasis may lead to a decrease in the ability of vitamin D3 cutaneous production. Up-to-date, the effective management of psoriasis built on sufficient nutritional consumption of vitamin D, while oral intake of vitamin D in psoriasis still not fulfilled clinical necessity, and its effect still controversial. Aim: The aim of the current study was to evaluate the safety and efficacy of oral vitamin D in the treatment of moderate to severe classical plaque psoriasis. Patients and methods: 76 patients enrolled in the study were allocated randomly into two groups. Group A (38 psoriasis patients) were given only topical potent corticosteroid (clobetasol propionate) therapy for 3 months’ duration, while group B (38 psoriasis patients) were taken topical potent corticosteroid (clobetasol propionate) in addition to oral vitamin D (50,000 IU weekly dose for 3 months’ duration). The severity of psoriasis was assessed monthly for the 3 months’ duration of the study based on photography and evaluation of psoriasis area severity index (PASI) score, and vitamin D serum level was also assessed. Results: There was no significant difference in mean age, basal metabolic rate (BMR), and gender between the two groups in the study. No significant difference between the mean of serum vitamin D of two groups, and also no statistical difference between PASI score of two groups. Regarding vitamin D serum level evaluation among patients in group A, it was 13.2 + 6.12 ng/mL at baseline, then after 3 months, its level was 13.6 + 3.82 ng/mL with non-significant differences between the two serum levels (improvement 3.03 + 6.21%, p = 0.62). Otherwise, serum vitamin D level among patients in group B was 13.5 + 4.16 ng/mL, then this level was significantly and constantly increased to reach 42.12 + 5.63 (improvement 212 + 47.82%, p = 0.0012), and this increment of vitamin D serum level was statistically significant inverse relationship with the improvement in PASI score (r = –0.4) throughout the 3 months’ period of study. There was a significant improvement in PASI score among patients who took in addition to the topical steroid oral vitamin D (p = 0.033). Conclusion: The oral vitamin D supplementation can be safe, effective, and cheap therapeutic modality to psoriasis patients. Other drugs used for treatment of psoriasis systemically are costly and widely side effects.