Original Research

Narrowband UVB Treatment Increases Serum 25-Hydroxyvitamin D Levels in Patients With Chronic Plaque Psoriasis

Cutis. 2017 June;99(6):431-435

References

Şavk E. Immunology of Photo(chemo)therapy. Turkderm. 2010;44(suppl 2):62-66.
Ferahbaş A. Phototherapy modalities and protocols. Turkderm. 2010;44(suppl 2):67-72.
Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop report. Br J Dermatol. 2004;151:283-297.
Norval M, Björn LO, de Gruijl FR. Is the action spectrum for the UV-induced production of previtamin D₃ in human skin correct? Photochem Photobiol Sci. 2010;9:11-17.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281.
McKenzie RL, Liley JB, Björn LO. UV radiation: balancing risks and benefits. Photochem Photobiol. 2009;85:88-98.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353-373.
May E, Asadullah K, Zügel U. Immunoregulation through 1,25-dihydroxyvitamin D₃ and its analogs. Curr Drug Targets Inflamm Allergy. 2004;3:377-393.
Reichrath J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol. 2007;16:618-625.
Fu LW, Vender R. Systemic role for vitamin D in the treatment of psoriasis and metabolic syndrome. Dermatol Res Pract. 2011;2011:276079.
Gisondi P, Rossini M, Di Cesare A, et al. Vitamin D status in patients with chronic plaque psoriasis. Br J Dermatol. 2012;166:505-510.
Orgaz-Molina J, Buendía-Eisman A, Arrabal-Polo MA, et al. Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study. J Am Acad Dermatol. 2012;67:931-938.
Osmancevic A, Landin-Wilhelmsen K, Larkö O, et al. UVB therapy increases 25 (OH) vitamin D syntheses in postmenopausal women with psoriasis. Photodermatol Photoimmunol Photomed. 2007;23:172-178.
Ryan C, Moran B, McKenna MJ, et al. The effect of narrowband UV-B treatment for psoriasis on vitamin D status during wintertime in Ireland. Arch Dermatol. 2010;146:836-842.
Vahavihu K, Ala-Houhala M, Peric M, et al. Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis. Br J Dermatol. 2010;163:321-328.
Lesiak A, Narbutt J, Pawlaczyk M, et al. Vitamin D serum level changes in psoriatic patients treated with narrowband ultraviolet B phototherapy are related to the season of the irradiation. Photodermatol Photoimmunol Photomed. 2011;27:304-310.
Osmancevic A, Landin-Wilhelmsen K, Larko O, et al.Vitamin D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed. 2009;25:119-123.
Romaní J, Caixàs A, Carrascosa JM, et al. Effect of narrowband ultraviolet B therapy on inflammatory markers and body fat composition in moderate to severe psoriasis. Br J Dermatol. 2012;166:1237-1244.
Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther. 2010;23:48-60.
Armas LA, Dowell S, Akhter M, et al. Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol. 2007;57:588-593.
Olds WJ, McKinley AR, Moore MR, et al. In vitro model of vitamin D₃ (cholecalciferol) synthesis by UV radiation: dose-response relationships. J Photochem Photobiol B. 2008;93:88-93.

Results

A total of 49 participants (30 [61.22%] males; 19 [38.78%] females) were included in the study. The mean age (SD) was 40.27 (14.62) years (range, 19–74 years). Three (6.12%) participants were Fitzpatrick skin type I, 15 (30.61%) were skin type II, and 31 (63.27%) were skin type III.

The baseline median PASI score for the 49 participants was 10.20 (7.85–13.65). Baseline serum 25(OH)D levels were noted to be deficient in 40 participants (81.63%) and inadequate in 9 participants (18.37%). The distribution of the serum 25(OH)D levels of the participants according to the season was evaluated with the Kruskal-Wallis test and no association was found between serum 25(OH)D levels and seasonal changes (P=.685). Comparison of 25(OH)D basal values with Fitzpatrick skin type revealed a statistically significant relationship between skin type and vitamin D level (P=.024). The basal serum 25(OH)D levels were significantly lower in Fitzpatrick skin type II versus skin type I (P=.039).

Thirty-two (65.31%) participants achieved PASI 75 by the end of treatment. The baseline median PASI score (25th-75th quartiles) for the 32 patients was 10.45 (8.20-13.83) and the posttreatment PASI score was 1.95 (1.20-3.55), a statistically significant decrease following treatment (P<.001)(Table 1). Mean (SD) baseline serum 25(OH)D levels were 14.14 (6.70) ng/mL and posttreatment levels were 46.42 (15.51) ng/mL in these participants, which demonstrated a statistically significant increase during NB-UVB treatment (P<.001). None of the participants reached the toxicity levels (>80 ng/mL) for serum 25(OH)D. There were no significant changes in serum calcium or phosphorus levels posttreatment (Table 1), but statistically significant decreases in serum ALP and PTH levels were noted (P=.001 and P=.019, respectively)(Table 1).

Participants who completed the study (n=32) received an average (SD) of 30.09 (7.53) sessions of NB-UVB treatment and the mean (SD) MED was 611.88 (240.14) mJ/cm². The mean (SD) maximum dose was 2090.09 (341.78) mJ/cm² (Table 2).

Posttreatment serum 25(OH)D levels were compared with the number of NB-UVB phototherapy sessions and the maximum dose values. We found that the posttreatment serum 25(OH)D levels correlated with the number of sessions (P=.031) but not with the maximum dose (P=.498).

Using regression analysis, we also evaluated the effect of the increase in vitamin D levels—posttreatment serum 25(OH)D level minus baseline serum 25(OH)D levels—on the decrease in PASI scores—baseline PASI score minus posttreatment PASI score—and found no effect of serum 25(OH)D level increase on PASI decrease (P=.530). There was no correlation between increased serum 25(OH)D levels and age, Fitzpatrick skin type, or baseline PASI score.

References

Şavk E. Immunology of Photo(chemo)therapy. Turkderm. 2010;44(suppl 2):62-66.
Ferahbaş A. Phototherapy modalities and protocols. Turkderm. 2010;44(suppl 2):67-72.
Ibbotson SH, Bilsland D, Cox NH, et al. An update and guidance on narrowband ultraviolet B phototherapy: a British Photodermatology Group Workshop report. Br J Dermatol. 2004;151:283-297.
Norval M, Björn LO, de Gruijl FR. Is the action spectrum for the UV-induced production of previtamin D₃ in human skin correct? Photochem Photobiol Sci. 2010;9:11-17.
Holick MF. Vitamin D deficiency. N Engl J Med. 2007;357:266-281.
McKenzie RL, Liley JB, Björn LO. UV radiation: balancing risks and benefits. Photochem Photobiol. 2009;85:88-98.
Holick MF. High prevalence of vitamin D inadequacy and implications for health. Mayo Clin Proc. 2006;81:353-373.
May E, Asadullah K, Zügel U. Immunoregulation through 1,25-dihydroxyvitamin D₃ and its analogs. Curr Drug Targets Inflamm Allergy. 2004;3:377-393.
Reichrath J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol. 2007;16:618-625.
Fu LW, Vender R. Systemic role for vitamin D in the treatment of psoriasis and metabolic syndrome. Dermatol Res Pract. 2011;2011:276079.
Gisondi P, Rossini M, Di Cesare A, et al. Vitamin D status in patients with chronic plaque psoriasis. Br J Dermatol. 2012;166:505-510.
Orgaz-Molina J, Buendía-Eisman A, Arrabal-Polo MA, et al. Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study. J Am Acad Dermatol. 2012;67:931-938.
Osmancevic A, Landin-Wilhelmsen K, Larkö O, et al. UVB therapy increases 25 (OH) vitamin D syntheses in postmenopausal women with psoriasis. Photodermatol Photoimmunol Photomed. 2007;23:172-178.
Ryan C, Moran B, McKenna MJ, et al. The effect of narrowband UV-B treatment for psoriasis on vitamin D status during wintertime in Ireland. Arch Dermatol. 2010;146:836-842.
Vahavihu K, Ala-Houhala M, Peric M, et al. Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis. Br J Dermatol. 2010;163:321-328.
Lesiak A, Narbutt J, Pawlaczyk M, et al. Vitamin D serum level changes in psoriatic patients treated with narrowband ultraviolet B phototherapy are related to the season of the irradiation. Photodermatol Photoimmunol Photomed. 2011;27:304-310.
Osmancevic A, Landin-Wilhelmsen K, Larko O, et al.Vitamin D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed. 2009;25:119-123.
Romaní J, Caixàs A, Carrascosa JM, et al. Effect of narrowband ultraviolet B therapy on inflammatory markers and body fat composition in moderate to severe psoriasis. Br J Dermatol. 2012;166:1237-1244.
Diehl JW, Chiu MW. Effects of ambient sunlight and photoprotection on vitamin D status. Dermatol Ther. 2010;23:48-60.
Armas LA, Dowell S, Akhter M, et al. Ultraviolet-B radiation increases serum 25-hydroxyvitamin D levels: the effect of UVB dose and skin color. J Am Acad Dermatol. 2007;57:588-593.
Olds WJ, McKinley AR, Moore MR, et al. In vitro model of vitamin D₃ (cholecalciferol) synthesis by UV radiation: dose-response relationships. J Photochem Photobiol B. 2008;93:88-93.

Narrowband UVB Treatment Increases Serum 25-Hydroxyvitamin D Levels in Patients With Chronic Plaque Psoriasis

References

Results

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