What is the relationship between vitamin D levels and psoriasis management?

From the Guidelines

Vitamin D plays a crucial role in psoriasis management, and maintaining adequate levels is essential for optimal treatment outcomes, with the most recent and highest quality study 1 suggesting that vitamin D analogues can be used in conjunction with phototherapy and topical corticosteroids to improve disease severity. The relationship between vitamin D levels and psoriasis management is complex, with many psoriasis patients having vitamin D deficiency, and supplementation may help reduce disease severity.

• Typical supplementation involves vitamin D3 (cholecalciferol) at 1000-4000 IU daily, with higher doses sometimes needed for severe deficiency under medical supervision.
• Vitamin D works by regulating immune function and keratinocyte proliferation, which are disrupted in psoriasis, and has anti-inflammatory properties that help normalize skin cell growth.
• Topical vitamin D analogs like calcipotriol (Dovonex) and calcitriol (Vectical) are FDA-approved treatments that can be applied directly to psoriatic plaques once or twice daily, with studies 1 showing their efficacy in treating mild to moderate psoriasis.
• The use of combination treatments with vitamin D analogues and potent topical corticosteroids is recommended for the treatment of psoriasis, as it can improve treatment outcomes and reduce disease severity, as shown in studies 1.
• However, oral vitamin D supplementation is not recommended for the treatment of psoriasis, as it does not directly improve disease activity at dosages that avoid hypercalcemia and calciuria, as stated in study 1. For best results, combine vitamin D optimization with standard psoriasis treatments, sun exposure (15-30 minutes several times weekly), and a diet rich in vitamin D sources like fatty fish, fortified dairy products, and egg yolks.
• Patients should aim for blood levels between 30-50 ng/mL (75-125 nmol/L) for optimal management, and treatment with calcipotriene foam for 8 weeks and calcipotriene plus betamethasone dipropionate gel for 4 to 12 weeks can be safe and effective for the treatment of mild to moderate scalp psoriasis, as shown in study 1.

From the FDA Drug Label

In humans, the natural supply of vitamin D depends mainly on exposure to the ultraviolet rays of the sun for conversion of 7-dehydrocholesterol to vitamin D3 (cholecalciferol) in the skin. Calcipotriene is a synthetic analog of vitamin D3 Clinical studies with radiolabelled calcipotriene ointment indicate that approximately 6% (± 3%, SD) of the applied dose of calcipotriene is absorbed systemically when the ointment is applied topically to psoriasis plaques or 5% (± 2. 6%, SD) when applied to normal skin, and much of the absorbed active is converted to inactive metabolites within 24 hours of application.

The relationship between vitamin D levels and psoriasis management involves the use of calcipotriene, a synthetic analog of vitamin D3, which is absorbed systemically when applied topically to psoriasis plaques. Key points include:

• Vitamin D is crucial for skin health, and its analogs like calcipotriene are used in managing psoriasis.
• The absorption rate of calcipotriene varies between psoriasis plaques and normal skin.
• The metabolism of calcipotriene follows a similar pathway to the natural vitamin D hormone, with primary metabolites being less potent than the parent compound 2.

From the Research

Vitamin D and Psoriasis Relationship

• The relationship between vitamin D levels and psoriasis management is complex and has been extensively studied 3, 4, 5, 6, 7.
• Research suggests that vitamin D plays a crucial role in the pathophysiology and treatment of psoriasis, with topical vitamin D analogs being used as a first-line treatment option 3.
• Studies have shown that low vitamin D status is associated with psoriasis, and vitamin D supplementation may be beneficial in reducing disease severity 4, 5, 7.

Vitamin D Deficiency in Psoriasis Patients

• Vitamin D deficiency is highly prevalent in patients with psoriasis, with studies reporting a prevalence of 57.8% to 82.2% 5, 7.
• Season and skin phototype are associated with vitamin D levels, with higher prevalence of deficiency in winter and in patients with certain skin phototypes 5.
• An inverse correlation between psoriasis area and severity index (PASI) and vitamin D levels has been established, suggesting that lower vitamin D levels are associated with more severe disease 5.

Effectiveness of Vitamin D Supplementation

• The effectiveness of oral vitamin D supplementation in lessening disease severity among patients with psoriasis is still controversial, with some studies showing a favorable effect and others finding no significant benefit 6.
• A systematic review and meta-analysis of randomized controlled trials found that vitamin D supplementation was effective in ameliorating PASI score after 6 months of intervention, but the results became non-significant after adjustment 6.
• More research is needed to determine the optimal dosage and duration of vitamin D supplementation for psoriasis management 6.