High-Dose Vitamin D Dramatically Improves skin issues

Vitamin D insufficiency is a pandemic affecting nearly half of the people worldwide, while one billion people are classified as vitamin D deficient. Hypovitaminosis D, or vitamin D deficiency, is an independent predictor of total mortality in the general population, and, conversely, vitamin D supplementation has been shown to be protective against mortality.

Vitamin D enhances absorption of dietary calcium and phosphorus by 30-40% and 80%, respectively, but its physiological functions extend well beyond mineral assimilation and balance. Vitamin D is known as a pleiotropic hormone, meaning it elicits diverse, multifaceted effects. In fact, local vitamin D production governs the expression of up to 200 genes. That vitamin D receptors are found in so many organ systems, including the muscles, intestines, pancreas, and nervous system, illustrates its expansive and far-reaching effects.

In particular, vitamin D regulates the cell cycle, suppressing cell division and inducing terminal differentiation to generate specialized, organ-specific cell types. It likewise regulates the pathway of cell suicide, known as apoptosis, promoting programmed cell death in neoplastic cell lines to prevent cancer. Vitamin D exerts various endocrine effects, such as inhibiting renin and stimulating insulin secretion. It also possesses anti-inflammatory and anti-fibrotic effects and enhances host defense against both invading pathogens and tumor development.

The vitamin D receptor complex regulates 3% of the human genome, and about 10% of human genes are directly or indirectly responsive to vitamin D. The effects of vitamin D are far-reaching, as demonstrated by the fact that a multitude of human cells, including bone, blood vessel, brain, breast, colon, immune, muscle, prostate, and skin cells express the enzyme 25-hydroxyvitamin D-1 alpha-hydroxylase. Also known as cytochrome P450 27B1 (CYP27B1), this enzyme is responsible for catalyzing the hydroxylation of calcifediol to calcitriol, the bioavailable, metabolically active form of vitamin D that elicits effects at a cellular level. Regarding vitamin D production, researchers state, “… extrarenal intracrine and paracrine 1,25(OH)2D3 synthesis may critically affect the activities of many tissues and organs.”

Deficiency of vitamin D is implicated in a vast array of conditions, including infections, hypertension, diabetes, cardiovascular disease, depression, fractures and falls, and lethal cancers. Pivotally, vitamin D, which is critical to immune homeostasis, has also been demonstrated to be deficient in autoimmune diseases such as rheumatoid arthritis, type 1 diabetes, autoimmune thyroiditis, and multiple sclerosis (MS) (12, 1). In fact, studies have found that autoimmune disorders occur more frequently at higher latitudes, where vitamin D levels are lower.

Vitiligo is an autoimmune disorder characterized by patchy loss of skin color, affecting 1% of the world’s population. More than half of individuals with vitiligo develop it before age 20. Vitiligo can be divided into the more ubiquitous symmetrical form, called generalized vitiligo, and a less common segmental variety, which affects one side of the body. The former is hypothesized to represent an autoimmune condition targeting the pigment cells, called melanocytes.

Psoriasis, on the other hand, is an inflammatory skin disorder typified by painful and pruritic lesions affecting an estimated 125 million individuals worldwide, or two to four percent of the population. Although psoriasis is speculated to have an autoimmune origin, other researchers propose that it represents an abnormal response to the skin's bacterial microbiota. Approximately one in five individuals with psoriasis reports substantial dissatisfaction with their treatment. Even when the red scaling plaques are not extensive, subjective accounts indicate that the psoriasis takes a substantial toll on their life.

In a pilot study, 35,000 IU of vitamin D3 was administered daily to sixteen vitamin D-deficient patients with vitiligo and nine patients with psoriasis for six months in concert with a calcium-restricted diet and adequate hydration. This represents an enormous amount compared to the 1000 IU a day that many health care providers recommend, and was chosen to overcome the effects of genetic polymorphisms common in autoimmune disease.

After the study period, significant increases in serum 25-hydroxyvitamin D3 levels were observed, reaching mean levels of 106.3 ng/mL and 132.5 ng/mL in psoriasis and vitiligo patients, respectively. Parathyroid hormone levels, a hormone important in bone remodeling that is secreted in response to low blood calcium levels and promotes the release of calcium from bones, were significantly decreased. Vitamin D levels were inversely related to PTH levels. In fact, Finamor and colleagues suggest that a reduction in serum PTH concentration may be the best surrogate marker for determining the maximal therapeutic dose of vitamin D3 for autoimmunity.

As evidenced by the dramatic photos included in this publicly available study, there was significant improvement in lesion severity across all psoriasis patients, as indicated by the Psoriasis Area and Severity Index (PASI) score, compared to baseline. Further, in fourteen of sixteen vitiligo subjects, 25-75% re-pigmentation occurred. In addition, laboratory and clinical manifestations of vitamin D toxicity, such as hypercalciuria, hypercalcemia, and kidney dysfunction, were not observed in any subjects. The researchers conclude that “High-dose vitamin D3 therapy may be effective and safe for vitiligo and psoriasis patients.”

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High-Dose Vitamin D Dramatically Improves skin issues