Original article
Deficiency of serum concentration of 25-hydroxyvitamin D in psoriatic patients: A case-control study

https://doi.org/10.1016/j.jaad.2012.01.040Get rights and content

Background

Some autoimmune conditions have been associated with reduced vitamin D levels, including systemic lupus erythematosus, rheumatoid arthritis, diabetes mellitus, and multiple sclerosis.

Objective

The main objective of this study was to analyze the 25-hydroxyvitamin D (OHD) status of patients with psoriasis in comparison with control subjects without this disease.

Methods

This case-control study included 86 patients (43 with psoriasis and 43 age- and sex-matched control subjects) from the outpatient clinic of our hospital dermatology department in Granada, Spain. All patients and control subjects were studied during one 4-week period to avoid seasonal variations in vitamin D levels.

Results

Serum 25-OHD levels were significantly lower in psoriatic patients than in control subjects even after adjusting for confounding factors in a multivariate analysis (odds ratio 2.89, 95% confidence interval 1.02-7.64, P < .03 for vitamin D insufficiency). Low 25-OHD levels were negatively associated with C-reactive protein (inflammatory activation marker) and body mass index in multiple linear regression analysis. Psoriatic patients with body mass index greater than or equal to 27 kg/m2 had a higher risk of 25-OHD insufficiency (sensitivity of 82.3% and specificity of 51.7%).

Limitations

Further studies with larger numbers of patients are required to analyze the pathogenic mechanisms underlying the relationship between 25-OHD deficiency and psoriasis.

Conclusions

The 25-OHD values are significantly lower in psoriatic patients than in control subjects. Low 25-OHD levels are negatively associated with C-reactive protein, an inflammatory activation marker, and with obesity. Psoriatic patients with a body mass index of 27 or more are likely to have vitamin D insufficiency.

Section snippets

Patients and control subjects

This case-control study included 86 outpatients: 43 patients with psoriasis randomly selected from among patients of the psoriasis unit and 43 randomly selected age- and sex-matched control subjects (28 male and 15 female in each group) with nonphotosensitive dermatologic diseases other than psoriasis (mainly nevi, seborrheic keratosis, or verruca) from the Dermatology Department of San Cecilio University Hospital, Granada, Spain. Randomization was conducted using randomized number tables. All

Results

We studied 43 Caucasian patients (28 male and 15 female) with generalized psoriasis plaques. The mean time period with psoriasis was 19.91 years, the mean PASI value was 4.42, and the mean body surface area was 4.38. Of these 43 patients with psoriasis 14% had nail psoriatic arthritis and 7% had psoriatic arthritis. No gender differences were observed in any of the above parameters. A family history of psoriasis was reported by 46.8% of psoriatic patients versus 8.7% of the control subjects (P

Discussion

In this study, multivariate analysis showed that serum 25-OHD levels were significantly lower in psoriatic patients than in control subjects after adjusting for confounding factors. The 25-OHD levels were negatively associated with CRP, a marker of inflammatory activation, and with BMI in multiple linear regression analysis. Psoriatic patients with BMI greater than or equal to 27 kg/m2 were found to have a greater risk of 25-OHD insufficiency, with high sensitivity and specificity. A strength

References (56)

  • C. Mathieu et al.

    The coming of age of 1,25-dihydroxyvitamin D (3) analogs as immunomodulatory agents

    Trends Mol Med

    (2002)
  • J.I. Silverberg et al.

    A pilot study assessing the role of 25 hydroxy vitamin D levels in patients with vitiligo vulgaris

    J Am Acad Dermatol

    (2010)
  • B.S. Park et al.

    Vitamin D receptor polymorphism is associated with psoriasis

    J Invest Dermatol

    (1999)
  • R. Bouillon

    Genetic and environmental determinants of vitamin D status

    Lancet

    (2010)
  • D.T. Ngo et al.

    Does vitamin D modulate asymmetric dimethylarginine and C-reactive protein concentrations?

    Am J Med

    (2010)
  • M.A. Lowes et al.

    Pathogenesis and therapy of psoriasis

    Nature

    (2007)
  • T.L. Clemens et al.

    Immunocytochemical localization of the 1,25-dihydroxyvitamin-D3 receptor in target cells

    Endocrinology

    (1988)
  • M.R. Haussler et al.

    The nuclear vitamin D receptor: biological and molecular regulatory properties revealed

    J Bone Miner Res

    (1998)
  • W.E. Stumpf et al.

    Brain target sites for 1,25-dihydroxyvitamin D3

    Science

    (1982)
  • D. Zehnder et al.

    Extrarenal expression of 25-hydroxyvitamin D(3)-1 alpha-hydroxylase

    J Clin Endocrinol Metab

    (2001)
  • A.K. Bhalla et al.

    Specific high-affinity receptors for 1,25-dihydroxyvitamin D3 in human peripheral blood mononuclear cells: presence in monocytes and induction in T lymphocytes following activation

    J Clin Endocrinol Metab

    (1983)
  • D.M. Provvedini et al.

    1,25-Dihydroxyvitamin D3 receptors in human leukocytes

    Science

    (1983)
  • L.A. Merlino et al.

    Vitamin D intake is inversely associated with rheumatoid arthritis: results from the Iowa Women’s Health Study

    Arthritis Rheum

    (2004)
  • S. Devaraj et al.

    Low vitamin D levels correlate with the proinflammatory state in type 1 diabetic subjects with and without microvascular complications

    Am J Clin Pathol

    (2011)
  • J. Nieves et al.

    High prevalence of vitamin D deficiency and reduced bone mass in multiple sclerosis

    Neurology

    (1994)
  • Y. Ono et al.

    Seasonal changes of serum 25-hydroyvitamin D and intact parathyroid hormone levels in a normal Japanese population

    J Bone Metab

    (2005)
  • A.R. Webb et al.

    Influence of season and latitude on the cutaneous synthesis of vitaminD3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin

    J Clin Endocrinol Metab

    (1988)
  • M.F. Holick

    Vitamin D deficiency

    N Engl J Med

    (2007)
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    Funding sources: None.

    Conflicts of interest: None declared.

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