EFFECT OF ORAL VITAMIN D SUPPLEMENTATION ON PSORIASIS SEVERITY: DOES IT GENERATE SIGNIFICANT BENEFITS? EFECTO DE LA SUPLEMENTACIÓN ORAL CON VITAMINA D SOBRE LA GRAVEDAD DE LA PSORIASIS: ¿GENERA BENEFICIOS SIGNIFICATIVOS?

Juan Esteban  Ospina Gómez; Maria Camila  Forero Buelvas; Manuel Enrique Duarte Arias

doi:10.25176/RFMH.v23i4.5968

Authors

Juan Esteban Ospina Gómez Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
Maria Camila Forero Buelvas Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.
Manuel Enrique Duarte Arias Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.

DOI:

https://doi.org/10.25176/RFMH.v23i4.5968

Keywords:

Vitamin D, Psoriasis, Severity of Illness Index, Treatment Outcome

Abstract

Psoriasis is a chronic immune-mediated skin disease with a complex genetic and pathogenic basis, often leading to significant comorbidities and a reduced quality of life. Its prevalence varies globally and exhibits an increasing trend over time. Comorbidities such as psoriatic arthritis, cardiovascular diseases, and mental health issues further compound the burden of psoriasis. Treatment options range from topical therapies to systemic agents, with biologics playing a prominent role in recent years. However, the safety and efficacy of these treatments are continuously assessed through real-world data. Vitamin D has gained attention as a potential therapeutic target due to its role in immune regulation and skin barrier function. This review aims to evaluate the efficacy of oral vitamin D supplementation in ameliorating the severity of psoriasis. After bibliographic search, it was found that psoriasis is a multifaceted condition with significant global implications. Biologics have transformed its management, and oral vitamin D supplementation is a promising avenue for further exploration. A comprehensive, patient-centered approach that considers comorbidities and long-term outcomes is crucial for optimizing psoriasis care. Further research is needed to fully understand the role of vitamin D in psoriasis and its potential as a therapeutic intervention.

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Author Biographies

Juan Esteban Ospina Gómez, Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.

Médico general

Maria Camila Forero Buelvas, Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.

Médico general

Manuel Enrique Duarte Arias, Departmento de Medicina, Universidad Autónoma de Bucaramanga, Bucaramanga, Colombia.

Médico general

References

Kim N, Thrash B, Menter A. Comorbidities in psoriasis patients. Semin Cutan Med Surg. 2010 Mar;29(1):10-5. doi: 10.1016/j.sder.2010.01.002

Gelfand JM, Feldman SR, Stern RS, Thomas J, Rolstad T, Margolis DJ. Determinants of quality of life in patients with psoriasis: a study from the US population. J Am Acad Dermatol. 2004 Nov;51(5):704-8. doi: 10.1016/j.jaad.2004.04.014

Griffiths CEM, Armstrong AW, Gudjonsson JE, Barker JNWN. Psoriasis. Lancet. 2021 Apr 3;397(10281):1301-1315. doi: 10.1016/S0140-6736(20)32549-6.

Gudjonsson JE, Elder JT. Fitzpatrick’s Dermatology in General Medicine. 8th edition (eds Goldsmith, L. A. et al.). pp 197–231 (McGraw-Hill Education, 2012).

Michalek IM, Loring B, John SM. A systematic review of worldwide epidemiology of psoriasis. J Eur Acad Dermatol Venereol. 2017;31(2):205-212. doi:10.1111/jdv.13854

Rachakonda TD, Schupp CW, Armstrong AW. Psoriasis prevalence among adults in the United States. J Am Acad Dermatol. 2014;70(3):512-516. doi:10.1016/j.jaad.2013.11.013

World Health Organization. Global report on psoriasis [Internet]. [Consulted 1 Oct 2023]. Available in: https://www.who.int/publications-detail-redirect/9789241565189

Parisi R, Symmons DPM, Griffiths CEM, Ashcroft DM; Identification and Management of Psoriasis and Associated ComorbidiTy (IMPACT) project team. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. 2013;133(2):377-385. doi:10. 1038/jid.2012.339

Tsai TF, Wang TS, Hung ST, Tsai PI, Schenkel B, Zhang M, et al. Epidemiology and comorbidities of psoriasis patients in a national database in Taiwan. J Dermatol Sci. 2011 Jul;63(1):40-6. doi: 10.1016/j.jdermsci.2011.03.002

Griffiths CEM, Barker JN. Pathogenesis and clinical features of psoriasis. Lancet 2007; 370: 263–71. doi: 10.1016/S0140-6736(07)61128-3

Parisi R, Iskandar IYK, Kontopantelis E, Augustin M, Griffiths CEM, Ashcroft DM. National, regional, and worldwide epidemiology of psoriasis: systematic analysis and modelling study. BMJ 2020; 369: m1590. doi: 10.1136/bmj.m1590

Tollefson MM, Crowson CS, McEvoy MT, Maradit Kremers H. Incidence of psoriasis in children: a population-based study. J Am Acad Dermatol 2010; 62: 979–87. doi: 10.1016/j.jaad.2009.07.029

Wei JC-C, Shi L-H, Huang J-Y, Wu X-F, Wu R, Chiou J-Y. Epidemiology and medication pattern change of psoriatic diseases in Taiwan from 2000 to 2013: a nationwide, population-based cohort study. J Rheumatol 2018; 45: 385–92. doi: 10.3899/jrheum.170516

Icen M, Crowson CS, McEvoy MT, Dann FJ, Gabriel SE, Maradit Kremers H. Trends in incidence of adult-onset psoriasis over three decades: a population-based study. J Am Acad Dermatol. 2009 Mar;60(3):394-401. doi: 10.1016/j.jaad.2008.10.062

Singh S, Taylor C, Kornmehl H, Armstrong AW. Psoriasis and suicidality: A systematic review and meta-analysis. J Am Acad Dermatol. 2017 Sep;77(3):425-440.e2. doi: 10.1016/j.jaad.2017.05.019

Zachariae H, Zachariae R, Blomqvist K, Davidsson S, Molin L, Mørk C, et al. Quality of life and prevalence of arthritis reported by 5,795 members of the Nordic Psoriasis Associations. Data from the Nordic Quality of Life Study. Acta Derm Venereol. 2002;82(2):108-13. doi: 10.1080/00015550252948130

Gelfand JM, Gladman DD, Mease PJ, Smith N, Margolis DJ, Nijsten T, et al. Epidemiology of psoriatic arthritis in the population of the United States. J Am Acad Dermatol. 2005 Oct;53(4):573. doi: 10.1016/j.jaad.2005.03.046

Reich K, Krüger K, Mössner R, Augustin M. Epidemiology and clinical pattern of psoriatic arthritis in Germany: a prospective interdisciplinary epidemiological study of 1511 patients with plaque-type psoriasis. Br J Dermatol. 2009 May;160(5):1040-7. doi: 10.1111/j.1365-2133.2008.09023.x

Mease PJ, Gladman DD, Papp KA, Khraishi MM, Thaçi D, Behrens F, et al. Prevalence of rheumatologist-diagnosed psoriatic arthritis in patients with psoriasis in European/North American dermatology clinics. J Am Acad Dermatol. 2013 Nov;69(5):729-735. doi: 10.1016/j.jaad.2013.07.023

Gladman DD, Antoni C, Mease P, Clegg DO, Nash P. Psoriatic arthritis: epidemiology, clinical features, course, and outcome. Ann Rheum Dis. 2005 Mar;64 Suppl 2(Suppl 2):ii14-7. doi: 10.1136/ard.2004.032482

Yeung H, Takeshita J, Mehta NN, Kimmel SE, Ogdie A, Margolis DJ, et al. Psoriasis severity and the prevalence of major medical comorbidity: a population-based study. JAMA Dermatol. 2013 Oct;149(10):1173-9. doi: 10.1001/jamadermatol.2013.5015

Ahlehoff O, Skov L, Gislason G, Lindhardsen J, Kristensen SL, Iversen L, et al. Cardiovascular disease event rates in patients with severe psoriasis treated with systemic anti-inflammatory drugs: a Danish real-world cohort study. J Intern Med. 2013 Feb;273(2):197-204. doi: 10.1111/j.1365-2796.2012.02593.x

Gelfand JM, Neimann AL, Shin DB, Wang X, Margolis DJ, Troxel AB. Risk of myocardial infarction in patients with psoriasis. JAMA. 2006 Oct 11;296(14):1735-41. doi: 10.1001/jama.296.14.1735

Dalgard FJ, Gieler U, Tomas-Aragones L, Lien L, Poot F, Jemec GBE, et al. The psychological burden of skin diseases: a cross-sectional multicenter study among dermatological out-patients in 13 European countries. J Invest Dermatol. 2015 Apr;135(4):984-991. doi: 10.1038/jid.2014.530

Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med. 2014 Aug 1;4(8):a015354. doi: 10.1101/cshperspect.a015354

Nestle FO,Kaplan DH,Barker J. Mechanisms of disease: psoriasis. N Engl J Med. 2009;361(5):496- 509. doi:10.1109/APCCAS.2002.1114931

Gudjonsson JE, Elder JT. Psoriasis: epidemiology. Clin Dermatol. 2007 Nov-Dec;25(6):535-46. doi: 10.1016/j.clindermatol.2007.08.007

Mahil SK, Capon F, Barker JN. Genetics of psoriasis. Dermatol Clin. 2015 Jan;33(1):1-11. doi: 10.1016/j.det.2014.09.001

Tsoi LC, Stuart PE, Tian C, Gudjonsson JE, Das S, Zawistowski M, et al. Large scale meta-analysis characterizes genetic architecture for common psoriasis associated variants. Nat Commun. 2017 May 24;8:15382. doi: 10.1038/ncomms15382

Nair RP, Duffin KC, Helms C, Ding J, Stuart PE, Goldgar D, et al. Genome-wide scan reveals association of psoriasis with IL-23 and NF-kappaB pathways. Nat Genet. 2009 Feb;41(2):199-204. doi: 10.1038/ng.311

Strange A, Capon F, Spencer CC, Knight J, Weale ME, Allen MH, et al. A genome-wide association study identifies new psoriasis susceptibility loci and an interaction between HLA-C and ERAP1. Nat Genet. 2010 Nov;42(11):985-90. doi: 10.1038/ng.694

Harden JL, Krueger JG, Bowcock AM. The immunogenetics of Psoriasis: A comprehensive review. J Autoimmun. 2015 Nov;64:66-73. doi: 10.1016/j.jaut.2015.07.008

Liang Y, Sarkar MK, Tsoi LC, Gudjonsson JE. Psoriasis: a mixed autoimmune and autoinflammatory disease. Curr Opin Immunol. 2017 Dec;49:1-8. doi: 10.1016/j.coi.2017.07.007

Kumar S, Han J, Li T, Qureshi AA. Obesity, waist circumference, weight change and the risk of psoriasis in US women. J Eur Acad Dermatol Venereol 2013; 27: 1293–98. doi: 10.1111/jdv.12001

Armstrong AW, Read C. Pathophysiology, Clinical Presentation, and Treatment of Psoriasis: A Review. JAMA. 2020;323(19):1945–1960. doi:10.1001/jama.2020.4006)

Twelves S, Mostafa A, Dand N, Burri E, Farkas K, Wilson R, et al. Clinical and genetic differences between pustular psoriasis subtypes. J Allergy Clin Immunol. 2019 Mar;143(3):1021-1026. doi: 10.1016/j.jaci.2018.06.038

Elmets CA, Leonardi CL, Davis DMR, Gelfand JM, Lichten J, Mehta NN, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with awareness and attention to comorbidities. J Am Acad Dermatol. 2019 Apr;80(4):1073-1113. doi: 10.1016/j.jaad.2018.11.058

Greb JE, Goldminz AM, Elder JT, Lebwohl MG, Gladman DD, Wu JJ, et al. Psoriasis. Nat Rev Dis Primers. 2016 Nov 24;2:16082. doi: 10.1038/nrdp.2016.82.

Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis: section 6. Guidelines of care for the treatment of psoriasis and psoriatic arthritis: case-based presentations and evidence-based conclusions. J Am Acad Dermatol. 2011 Jul;65(1):137-74. doi: 10.1016/j.jaad.2010.11.055

Nast A, Gisondi P, Ormerod AD, Saiag P, Smith C, Spuls PI, et al. European S3-Guidelines on the systemic treatment of psoriasis vulgaris--Update 2015--Short version--EDF in cooperation with EADV and IPC. J Eur Acad Dermatol Venereol. 2015 Dec;29(12):2277-94. doi: 10.1111/jdv.13354

Amatore F, Villani AP, Tauber M, Viguier M, Guillot B, Psoriasis Research Group of the French Society of Dermatology. French guidelines on the use of systemic treatments for moderate-to-severe psoriasis in adults. J Eur Acad Dermatol Venereol 2019; 33: 464–83. DOI: 10.1111/jdv.15340

Menter A, Strober BE, Kaplan DH, Kivelevitch D, Prater EF, Stoff B, et al. Joint AAD-NPF guidelines of care for the management and treatment of psoriasis with biologics. J Am Acad Dermatol. 2019 Apr;80(4):1029-1072. doi: 10.1016/j.jaad.2018.11.057

Menter A, Korman NJ, Elmets CA, Feldman SR, Gelfand JM, Gordon KB, et al. Guidelines of care for the management of psoriasis and psoriatic arthritis. Section 3. Guidelines of care for the management and treatment of psoriasis with topical therapies. J Am Acad Dermatol. 2009 Apr;60(4):643-59. doi: 10.1016/j.jaad.2008.12.032

Rizova E, Corroller M. Topical calcitriol--studies on local tolerance and systemic safety. Br J Dermatol. 2001 Apr;144 Suppl 58:3-10. doi: 10.1046/j.1365-2133.2001.144s58003.x

Morita A. Current developments in phototherapy for psoriasis. J Dermatol 2018; 45: 287–92. DOI: 10.1111/1346-8138.14213

Kaushik SB, Lebwohl MG. Psoriasis: which therapy for which patient: psoriasis comorbidities and preferred systemic agents. J Am Acad Dermatol 2019; 80: 27–40. doi: 10.1016/j.jaad.2018.06.057

Saurat JH, Stingl G, Dubertret L, Papp K, Langley RG, Ortonne JP, et al. Efficacy and safety results from the randomized controlled comparative study of adalimumab vs. methotrexate vs. placebo in patients with psoriasis (CHAMPION). Br J Dermatol. 2008 Mar;158(3):558-66. doi: 10.1111/j.1365-2133.2007.08315.x

Augustin M, Spehr C, Radtke MA, Boehncke WH, Luger T, Mrowietz U, et al. German psoriasis registry PsoBest: objectives, methodology and baseline data. J Dtsch Dermatol Ges. 2014 Jan;12(1):48-57. doi: 10.1111/ddg.12233

Gonzalez-Cantero A, Carretero G, Rivera R, Ferrándiz C, Daudén E, de la Cueva P, et alp. Women with moderate-to-severe psoriasis in Spain (BIOBADADERM registry) show more than a 50% reduction in age-adjusted fertility rate when compared with the general population. Br J Dermatol. 2019 Nov;181(5):1085-1087. doi: 10.1111/bjd.18164

Burden AD, Warren RB, Kleyn CE, McElhone K, Smith CH, Reynolds NJ, et al. The British Association of Dermatologists' Biologic Interventions Register (BADBIR): design, methodology and objectives. Br J Dermatol. 2012 Mar;166(3):545-54. doi: 10.1111/j.1365-2133.2012.10835.x

Fletcher J, Bishop EL, Harrison SR, Swift A, Cooper SC, Dimeloe SK, et al. Autoimmune disease and interconnections with vitamin D. Endocr Connect. 2022 Mar 31;11(3):e210554. doi: 10.1530/EC-21-0554

Mattozzi C, Paolino G, Richetta AG, Calvieri S. Psoriasis, vitamin D and the importance of the cutaneous barrier's integrity: An update. J Dermatol. 2016 May;43(5):507-14. doi: 10.1111/1346-8138.13305

Navarro-Triviño FJ, Arias-Santiago S, Gilaberte-Calzada Y. Vitamin D and the Skin: A Review for Dermatologists. Actas Dermosifiliogr (Engl Ed). 2019 May;110(4):262-272. English, Spanish. doi: 10.1016/j.ad.2018.08.006

Ren Y, Liu J, Li W, Zheng H, Dai H, Qiu G, et al. Causal Associations between Vitamin D Levels and Psoriasis, Atopic Dermatitis, and Vitiligo: A Bidirectional Two-Sample Mendelian Randomization Analysis. Nutrients. 2022 Dec 11;14(24):5284. doi: 10.3390/nu14245284

Gamonal SBL, Gamonal ACC, Marques NCV, Brandão MAF, Raposo NRB. Is vitamin D status relevant to psoriasis and psoriatic arthritis? A retrospective cross-sectional study. Sao Paulo Med J. 2022 Sep 6;141(3):e2022216. doi: 10.1590/1516-3180.2022.0216.R1.01072022.

Barrea L, Savanelli MC, Di Somma C, Napolitano M, Megna M, Colao A, et al. Vitamin D and its role in psoriasis: An overview of the dermatologist and nutritionist. Rev Endocr Metab Disord. 2017 Jun;18(2):195-205. doi: 10.1007/s11154-017-9411-6

Mason A, Mason J, Cork M, Hancock H, Dooley G. Topical treatments for chronic plaque psoriasis: An abridged Cochrane Systematic Review. J Am Acad Dermatol 2013;69:799–807. doi: 10.1016/j.jaad.2013.06.027.

Megna M, Ferrillo M, Barrea L, Patruno C, Muscogiuri G, Savastano S, et al. Vitamin D and psoriasis: an update for dermatologists and nutritionists. Minerva Endocrinol. 2020 Jun;45(2):138-147. doi: 10.23736/S0391-1977.20.03190-9

Bhat GH, Guldin S, Khan MS, Yasir M, Prasad G. Vitamin D status in Psoriasis: impact and clinical correlations. BMC Nutr. 2022 Oct 19;8(1):115. doi: 10.1186/s40795-022-00610-y.

Perez A, Raab R, Chen TC, Turner A, Hollck MF. Safety and efficacy of oral calcitriol (1,25-dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol 1996;134:1070–8. doi: 10.1111/j.1365-2133.1996.tb07945.x.

Morimoto S, Yoshikawa K, Kozuka T, Kitano Y, Imanaka S, Fukuo K, et al. Treatment of psoriasis vulgaris by oral administration of 1 alpha-hydroxyvitamin D3--open-design study. Calcif Tissue Int 1986;39:209–12. doi: 10.1007/bf02555120

Disphanurat W, Viarasilpa W, Chakkavittumrong P, Pongcharoen P. The Clinical Effect of Oral Vitamin D2 Supplementation on Psoriasis: A Double-Blind, Randomized, Placebo-Controlled Study. Dermatol Res Pract 2019;2019:5237642. doi: 10.1155/2019/5237642.

Stanescu AMA, Simionescu AA, Diaconu CC. Oral Vitamin D Therapy in Patients with Psoriasis. Nutrients. 2021 Jan 6;13(1):163. doi: 10.3390/nu13010163.

Theodoridis X, Grammatikopoulou MG, Stamouli EM, Talimtzi P, Pagkalidou E, Zafiriou E, et al. Effectiveness of oral vitamin D supplementation in lessening disease severity among patients with psoriasis: A systematic review and meta-analysis of randomized controlled trials. Nutrition. 2021 Feb;82:111024. doi: 10.1016/j.nut.2020.111024.

Formisano E, Proietti E, Borgarelli C, Pisciotta L. Psoriasis and Vitamin D: A Systematic Review and Meta-Analysis. Nutrients. 2023 Jul 30;15(15):3387. doi: 10.3390/nu15153387.

Pitukweerakul S, Thavaraputta S, Prachuapthunyachart S, Karnchanasorn R. Hypovitaminosis D is Associated with Psoriasis: A Systematic Review and Meta-Analysis. Kans J Med. 2019 Nov 25;12(4):103-108