Vitamin D and Folliculitis: Evidence and Clinical Implications

Topical vitamin D analogs can cause folliculitis as a side effect when used for treatment of conditions like alopecia areata. 1

Evidence on Vitamin D and Folliculitis

The most recent study of topical vitamin D analogs (calcipotriol) for alopecia areata reported folliculitis as one of the side effects, along with skin irritation, pruritus, pigmentation, and scaling 1
Narang et al. assessed a twice-daily regimen of topical 0.005% calcipotriol for patients with patchy alopecia areata and specifically noted folliculitis as an adverse reaction 1
This suggests a direct causative relationship between topical vitamin D application and follicular inflammation 1

There is no direct evidence in the provided literature that oral vitamin D supplementation causes folliculitis 1
The research primarily focuses on vitamin D deficiency in relation to alopecia areata rather than vitamin D excess causing folliculitis 1
Multiple studies have actually shown lower serum vitamin D levels in patients with alopecia areata compared to controls 1

Vitamin D functions as a steroid hormone that enters cells via surface vitamin D receptors (VDR), complexes with retinoic acid X receptor, and affects gene expression 1
When applied topically in high concentrations (as with calcipotriol), vitamin D analogs may cause local irritation of the hair follicles, leading to folliculitis 1
Calcipotriol (a synthetic vitamin D analog) works by inhibiting T-cell proliferation and reducing inflammatory mediator production, but paradoxically can cause follicular inflammation in some patients 1

When prescribing topical vitamin D analogs like calcipotriol for conditions such as alopecia areata, warn patients about potential side effects including folliculitis 1
Monitor patients using topical vitamin D preparations for signs of follicular inflammation 1
There is no evidence suggesting that oral vitamin D supplementation at standard doses causes folliculitis 1
For patients who develop folliculitis while using topical vitamin D analogs, consider discontinuation of the medication 1

For patients with folliculitis, other treatment options include:
- Antibiotics for bacterial folliculitis 2
- Isotretinoin for gram-negative folliculitis 3
- Fusidic acid has shown efficacy in folliculitis decalvans 2
- Aminolevulinic acid photodynamic therapy for recalcitrant cases 4

The evidence specifically linking vitamin D to folliculitis is primarily limited to topical applications of vitamin D analogs 1
Other vitamins, such as vitamin B12, have been more clearly documented to cause acneiform eruptions 5
Folliculitis has multiple potential causes including bacterial infection, mechanical factors, and immune dysfunction 2
The relationship between vitamin D and skin inflammation is complex - vitamin D has both pro-inflammatory and anti-inflammatory effects depending on context and concentration 1