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

In the early 1900s, vitamin D, sunshine and ultraviolet B (UVB) phototherapy were first reported to control psoriasis, cure rickets and cure tuberculosis (TB). Vitamin D is also shown to control asthma and rheumatoid arthritis with intakes ranging from 60,000 to 6,00,000 International Units (IU)/day. The 1980s witnessed revived interest in treating psoriasis with vitamin D. 

Since 1985, four different oral forms of vitamin D (D2, D3, 1-hydroxyvitaminD3 and 1,25-dihydroxyvitaminD3 [Calcitriol]) and many topical formulations have been documented to be safe and effective for treating psoriasis; and same is the case with UVB phototherapy and sunshine. 

Interestingly, many pre-treatment serum 25-Hydroxyvitamin D [25(OH)D] concentrations are within the current range of normal, while many post-treatment concentrations exceed the upper limit of this normal (100 ng/mL). Still, psoriasis patients have shown significant clinical improvement without complications utilizing these treatments. Current estimates of vitamin D sufficiency seem to undervalue serum 25(OH)D concentrations needed for optimal health in psoriasis patients, while concentrations associated with adverse events emerge to be much higher than current estimates of safe serum 25(OH)D concentrations. Considering these observations, the therapeutic index for vitamin D must be reexamined in the treatment of psoriasis and other diseases strongly linked to vitamin D deficiency, including COVID-19 infections, which will help in managing them safely with sufficient vitamin D intake or UVB exposure.

Source: McCullough PJ, McCullough WP, Lehrer D, et al. 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. 2021;13(5):1511.