Reaction to chemical irritants is a common cause of dermatology consultation and a challenge for topical medication utility. Cholecalciferol (D3) mitigates inflammation from experimental sunburn in humans and chemical injury in mice. To investigate the clinical utility of D3 for chemical injury in humans, we conducted a double-blinded, placebo-controlled trial. 28 healthy subjects had 3x8mm2 of arm skin exposed to 0.0016% topical nitrogen mustard (NM) under occlusion. 2 weeks later, subjects were randomized to receive 200,000 IU oral D3 or placebo after repeat NM exposure on the other arm. By proteomic analysis of skin biopsies, placebo subjects have 22% more differentially expressed inflammatory proteins (DEP) than D3 subjects after 3 days and 650% after 6 weeks. PCA of RNAseq separates samples by exposure yet shows 2 intervention-independent subclusters in NM exposure 2. One shows a normal skin profile (NS) and the other shows immune memory cell enrichment, suggesting immune sensitization (S). S subjects show more inflammation than NS by skin erythema (p<0.01), edema (p=0.05), and histopathologic score (p<1e-4). S and NS D3 subjects express fewer DEPs than placebo at 3 days (S:41%;NS:82%) and 6 weeks (S:86%;NS:100%). Subgroup analysis of exposure 1 identifies early S-associated biomarkers. After exposure 2, NS subjects express no S markers if given D3 vs 75% if given placebo. Results identify biomarkers of sensitization that may have predictive clinical utility and demonstrate that oral D3 mitigates chemically-induced inflammation for up to 6-weeks. Thus, D3 may have preventative properties against chemical sensitization and serve as a low-risk treatment and prevention in those undergoing repetitive chemical exposure.
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