Oral and Topical Vitamin D, Sunshine, and UVB Phototherapy Safely Control Psoriasis in Patients with Normal Pretreatment Serum 25-hydroxyvitamin D Concentrations: A Literature Review and Discussion of Health Implications

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.

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Oral and Topical Vitamin D, Sunshine, and UVB Phototherapy Safely Control Psoriasis in Patients with Normal Pretreatment Serum 25-Hydroxyvitamin D Concentrations: A Literature Review and Discussion of Health Implications

Nutrients ◽

10.3390/nu13051511 ◽

2021 ◽

Vol 13 (5) ◽

pp. 1511

Author(s):

Patrick J. McCullough ◽

William P. McCullough ◽

Douglas Lehrer ◽

Jeffrey B. Travers ◽

Steven J. Repas

Keyword(s):

Vitamin D ◽

Therapeutic Index ◽

Hydroxyvitamin D ◽

Optimal Health ◽

Significant Clinical Improvement ◽

25 Hydroxyvitamin D ◽

Uvb Exposure ◽

Pre Treatment ◽

Sufficient Vitamin ◽

Uvb Phototherapy

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.

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Effect of smoking on the serum levels of 25-hydroxyvitamin D depends on the assay employed

Acta Endocrinologica ◽

10.1530/eje-10-0150e ◽

2010 ◽

Vol 163 (6) ◽

pp. 965 ◽

Cited By ~ 2

Author(s):

Guri Grimnes ◽

Bjørg Almaas ◽

Anne Elise Eggen ◽

Nina Emaus ◽

Yngve Figenschau ◽

...

Keyword(s):

Vitamin D ◽

Vitamin D3 ◽

Serum Levels ◽

Ultraviolet B ◽

Vitamin D2 ◽

Effect of Body Site and Surface on Vitamin D and 25-Hydroxyvitamin D Production after a Single Narrowband UVB Exposure

Journal of Investigative Dermatology ◽

10.1016/j.jid.2017.01.032 ◽

2017 ◽

Vol 137 (6) ◽

pp. 1391-1393 ◽

Cited By ~ 3

Author(s):

Florence Libon ◽

Justine Courtois ◽

Caroline Le Goff ◽

Pierre Lukas ◽

Neus Fabregat-Cabello ◽

...

Keyword(s):

Vitamin D ◽

Body Site ◽

Hydroxyvitamin D ◽

Narrowband Uvb ◽

25 Hydroxyvitamin D ◽

Uvb Exposure

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25-hydroxyvitamin D circulates in different fractions of calf plasma if the parent compound is vitamin D2or vitamin D3, respectively

Journal of Dairy Research ◽

10.1017/s0022029915000588 ◽

2015 ◽

Vol 83 (1) ◽

pp. 67-71 ◽

Cited By ~ 2

Author(s):

Lone Hymøller ◽

Søren K Jensen

Keyword(s):

Vitamin D ◽

Parent Compound ◽

The Body ◽

Vitamin D Metabolites ◽

Hydroxyvitamin D ◽

Efficient Route ◽

25 Hydroxyvitamin D ◽

Sufficient Vitamin ◽

Insight Into ◽

Endogenous Synthesis

Vitamin D has become one of the most discussed nutrients in human nutrition, which has led to an increased interest in milk as a vitamin D source. Problems related to fortifying milk with synthetic vitamin D can be avoided by securing a high content of natural vitamin D in the milk by supplying dairy cows with sufficient vitamin D. However, choosing the most efficient route and form of supplementation requires insight into how different vitamin D metabolites are transported in the body of cattle. There are two forms of vitamin D: vitamin D2(D2) and vitamin D3(D3). Vitamin D2originates from fungi on roughage. Vitamin D3originates either from endogenous synthesis in the skin or from feed supplements. Vitamin D2is chemically different from, and less physiologically active than, D3. Endogenous and dietary D3is chemically similar but dietary D3is toxic, whereas endogenous D3appears well regulated in the body.

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Assessment of 3-epi-25-hydroxyvitamin D levels during cholecalciferol supplementation in adults with chronic liver diseases

Applied Physiology Nutrition and Metabolism ◽

10.1139/apnm-2016-0196 ◽

2016 ◽

Vol 41 (12) ◽

pp. 1311-1317 ◽

Cited By ~ 1

Author(s):

Caroline S. Stokes ◽

Dietrich A. Volmer

Keyword(s):

Vitamin D ◽

Liver Diseases ◽

Chronic Liver ◽

Vitamin D Metabolites ◽

Chronic Liver Diseases ◽

Hydroxyvitamin D ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Cholecalciferol Supplementation ◽

Sufficient Vitamin

Recently, hepatic immaturity was cited as a possible reason for high levels of the C-3 epimer of 25-hydroxyvitamin (25(OH)D) in premature infants: however what role, if any, the liver plays in controlling epimer concentrations is unknown. This study assesses 3-epi-25-hydroxyvitamin D (3-epi-25(OH)D) levels during the course of cholecalciferol supplementation in adults with chronic liver diseases (CLD). Vitamin D metabolites were analyzed in 65 CLD patients with 25(OH)D <30 ng/mL who received 20 000 IU cholecalciferol/week for 6 months. The primary outcome assessed serum 25(OH)D and 3-epi-25(OH)D in response to supplementation. Corresponding values from 16 CLD patients with sufficient vitamin D levels receiving no supplementation were compared. The epimer was detected in all samples and at lower relative concentrations with lower vitamin D baseline status, i.e., severe vitamin D deficiency (<10 ng/mL) as compared with deficient (10–19.9 ng/mL), insufficient (20–29.9 ng/mL), or sufficient (≥30 ng/mL) vitamin D levels (2.4% vs. 4.8%, 5.2%, 5.8%, respectively; P < 0.001). Similar relative concentrations for 3-epi-25(OH)D, ranging from 4.3%–7.1% (absolute concentrations: 1.1–4.0 ng/mL; all P < 0.001), were obtained in response to cholecalciferol in all supplemented patients, regardless of inadequacy threshold. Epimer levels significantly decreased (P = 0.007) in unsupplemented patients, coinciding with decreasing serum 25(OH)D concentrations over time. No epimer differences between patients with (n = 17) or without (n = 48) cirrhosis were demonstrated. The 3-epi-25(OH)D was present in serum of all patients at comparable levels to those reported by others. Epimer levels increased linearly with increasing 25(OH)D levels after supplementation. However, no effect of cirrhosis on epimer concentrations was observed.

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Variations in 25-Hydroxyvitamin D in Countries from the Middle East and Europe: The Roles of UVB Exposure and Diet

Nutrients ◽

10.3390/nu11092065 ◽

2019 ◽

Vol 11 (9) ◽

pp. 2065 ◽

Cited By ~ 8

Author(s):

William B. Grant ◽

Hana M. A. Fakhoury ◽

Spyridon N. Karras ◽

Fatme Al Anouti ◽

Harjit P. Bhattoa

Keyword(s):

Vitamin D ◽

Middle East ◽

Middle Eastern ◽

Dietary Factors ◽

European Countries ◽

Hydroxyvitamin D ◽

Animal Fat ◽

Country Study ◽

25 Hydroxyvitamin D ◽

Uvb Exposure

Serum 25-hydroxyvitamin D (25(OH)D) has been largely associated with latitude and sunshine exposure across several regions. According to previous results, 25(OH)D concentrations are, on average, relatively low in countries with abundant sunshine, including those of the Middle East and North Africa region, as well as lower-latitude Europe. The standard explanation for this phenomenon is that people wear concealing clothing because of cultural and religious practices and that high temperatures in summer limit direct sun exposure. However, the role of diet in the development of profound hypovitaminosis D has not been adequately explored in those countries. To examine how diet affects vitamin D status in the Middle Eastern and European countries, a search was conducted for papers from that region reporting 25(OH)D concentrations. Papers were sought that reported summertime and wintertime 25(OH)D concentrations for healthy nonpregnant adults representative of the entire population. Data from 15 Middle Eastern and European countries were found through this search. Data for postmenopausal women from 19 European countries were also obtained. Dietary supply data for animal products containing vitamin D (animal fat, eggs, ocean fish, animal meat, and milk) were obtained from the Food and Agriculture Organization of the United Nations. Latitude and a solar UVB dose index also were obtained for each country. For the 15-country study, energy from dietary factors was highly correlated with latitude, making it difficult to separate the effects of UVB exposure and dietary factors. However, for the 19-country study, dietary factors were only weakly correlated with latitude. In that study, ocean fish was the most important single dietary factor affecting serum 25(OH)D concentration for postmenopausal women in various European countries, but animal fat and meat also contributed. Because this is an ecological study, further research is encouraged to evaluate and extend the findings.

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Vitamin D Status and Gastric Cancer: A Cross-Sectional Study in Koreans

Nutrients ◽

10.3390/nu12072004 ◽

2020 ◽

Vol 12 (7) ◽

pp. 2004

Author(s):

Jung Hyun Kwak ◽

Jean Kyung Paik

Keyword(s):

Gastric Cancer ◽

Vitamin D ◽

Cross Sectional Study ◽

Vitamin D Status ◽

Cross Sectional ◽

Hydroxyvitamin D ◽

Index Model ◽

Vitamin D Levels ◽

25 Hydroxyvitamin D ◽

Sufficient Vitamin

Sufficient vitamin D levels are associated with reduced Helicobacter pylori infections, which can cause gastric carcinogenesis. We examined associations between vitamin D concentrations and gastric cancer (GC) prevalence in a Korean population. We analyzed data of 33,119 adults using serum 25-hydroxyvitamin D (25(OH)D) concentrations as a biomarker of vitamin D status. Participants were classified with GC if previously diagnosed as such by a physician. After controlling for age, sex and body mass index (model A), odds ratio (OR) for GC was 0.81 (95% confidence interval [CI]: 0.70, 0.95), with a 5-ng/mL increment in total 25(OH)D concentrations. In fully adjusted models (model B), the OR for GC was 0.84 (95% CI: 0.72, 0.98), with a 5-ng/mL increment in total vitamin D. Following the classification of vitamin D concentrations into three categories or for GC in model A was 0.52 (95% CI: 0.30, 0.92) comparing between higher (≥20 ng/mL) and lower (<12 ng/mL) total 25(OH)D concentrations. In model B OR for GC was 0.57 (95% CI: 0.32, 1.00) comparing between higher and lower total 25(OH)D concentrations. Our results suggested that high vitamin D concentration was associated with lower ORs of GC in Korean adults.

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Depressed Serum 25-Hydroxyvitamin D Levels Increase Hospital Stay and Alter Glucose Homeostasis in First-ever Ischemic Stroke

Current Neurovascular Research ◽

10.2174/1567202616666190924161947 ◽

2019 ◽

Vol 16 (4) ◽

pp. 340-347

Author(s):

Yuge Wang ◽

Yanqiang Wang ◽

Bingjun Zhang ◽

Yinyao Lin ◽

Sha Tan ◽

...

Keyword(s):

Vitamin D ◽

Ischemic Stroke ◽

Hospital Stay ◽

Functional Outcome ◽

Vitamin D Deficiency ◽

Glucose Homeostasis ◽

Clinical Severity ◽

Hydroxyvitamin D ◽

25 Hydroxyvitamin D ◽

Deficiency Group

Background and Objective: Vitamin D deficiency is internationally recognized among the potentially modifiable risk factors for ischemic cardio-cerebrovascular diseases. However, the association between vitamin D deficiency and stroke morbidity or mortality remains insufficiently known. Our aim is to investigate their relevance to 25-hydroxyvitamin D [25(OH) D] levels and clinical severity and outcome after 3 months in first-ever ischemic stroke. Methods: Retrospective analysis of 356 consecutive patients in first-ever ischemic stroke between 2013 and 2015. Serum 25(OH) D levels were measured at baseline. Stroke severity was assessed at admission using the National Institutes of Health Stroke Scale (NIHSS) score. Functional outcome after 3 months of onset was evaluated using the modified Rankin scale (mRS). Results: Among the 356 enrolled patients, HbA1c was higher in insufficiency/deficiency group than that in the sufficiency group (6.3 ± 1.7 vs. 5.9 ± 1.1, p =0.015). The hospital stay was longer in insufficiency/deficiency group than that in the sufficiency group (11 (8-17) vs. 9.5 (7-13), p = 0.035). There was a significant inversed trend between serum 25(OH) D levels and hospital stay (OR 0.960, P = 0.031), using logistic regression. Conclusions: 25(OH)D levels are associated with glucose homeostasis, 25(OH) D contributes to increase the length of hospital stay. Low serum 25-OHD level is an independent predictor for hospital stay in first-ever ischemic stroke. Vitamin D deficiency did not predict functional outcome in the span of 3 months.

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