Vitamin D Analogues For Psoriasis

How Do Vitamin D Analogues Work

Synthetic vitamin D analogue is a topical medication. That means itâs available as a cream or ointment that you put directly on affected skin. It binds with vitamin D receptors on specific genes to slow down the rapid skin cell production and buildup that triggers itchy and scaly psoriatic patches. Synthetic vitamin D analogue also stimulates keratinocytes, a major cell type found in the outermost layer of skin called the epidermis, to correct the fast cell turnover that leads to psoriasis.

Vitamin D analogues can:

• Treat scalp psoriasis

Medications that contain vitamin D analogue:

Calcipotriene. Itâs the most common prescription medication to treat psoriasis. When used alone, twice daily, itâs shown to improve psoriasis symptoms in 60% to 70% of people with chronic plaque psoriasis. Itâs available as a cream or ointment.

Calcitriol. Itâs available as an ointment and can be safely used by children over the age of 2.

Is Vitamin D Good For Psoriasis

You can get vitamin D from food or supplements, but your body mainly creates Vitamin D from the sun .

Unfortunately, its pretty easy to develop a vitamin D deficiency if you live in a cloudy climate . Its estimated that about 41 percent of Americans have a vitamin D deficiency, which can lead to a weak immune system.

Research also suggests psoriasis may be linked to vitamin D deficiency. Those with psoriasis often have low levels of vitamin D. And because vitamin D helps keep your immune system in tip-top shape, not getting enough can leave you vulnerable to skin and health probs.

Fortunately, boosting your vitamin D intake may help relieve or eliminate psoriasis symptoms.

Clinical Use Of Calcitriol And Analogs In Psoriasis

In 1985, MacLaughlin et al. reported that psoriatic fibroblasts were partially resistant to the antiproliferative effects of 1,252D3.44 This laboratory finding prompted them to speculate that calcitriol may be effective in the treatment of the hyperproliferative skin disease psoriasis.

Another line of investigation was the result of a clinical observation. In 1985, Morimoto and Kumahara reported that an osteoporosis patient, who was treated orally with 1-D3, had a remission of psoriatic skin lesions.45 They demonstrated in a follow up study that almost 80% of 17 patients with psoriasis who were treated orally with 1-D3 at a dose of 1.0 µg/day for up to 6 months showed clinically significant improvement.46

In the last years, numerous studies have reported that various vitamin D analogs, including calcitriol, calcipotriol, tacalcitol, hexafluoro-1,25-dihydroxyvitamin D3 and maxacalcitol are effective and safe in the topical treatment of psoriasis .4755

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Vitamin D Regulation Of Apoptosis In Keratinocytes

Calcitriol stimulates the synthesis of ceramide by inducing the neutral Mg2+-dependent sphingomyelinase and in return, ceramide enhances the pro-differentiating effect of calcitriol on keratinocytes in a feedback loop . It has been demonstrated that physiological concentrations of calcitriol do not initiate apoptosis in cultured keratinocytes but, in contrast, pharmacological concentrations of calcitriol exert a pro-apoptotic effect on keratinocytes .

What You Need To Know About Psoriasis Vitamin D Analogues For Psoriasis

Is Your Stomach to Blame?

Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.

Could Arthritis Be the Cuplrit?

The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.

Could a Virus Be the Cause?

Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.

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An Update On Vitamin D3 Analogues In The Treatment Of Psoriasis

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Modulation Of Proliferation And Differentiation In Keratinocytes

Many in vitro and in vivo studies demonstrate dose-dependent effects of vitamin D analogs on cell proliferation and differentiation. At lower concentrations , 1,252D3 promotes proliferation of keratinocytes in vitro, at higher pharmacological doses keratinocyte proliferation is inhibited.5,15,16 In psoriatic skin, immunohistochemical and biochemical analyses have demonstrated antiproliferative and pro-differentiating effects in epidermal keratinocytes along with treatment with 1,252D3 or analogs in vivo.7,8 It has been shown that the immunohistochemical staining pattern for various markers of epidermal proliferation and differentiation changes in lesional psoriatic skin along with topical treatment with 1,252D3 or analogs almost completely to the staining pattern characteristic for nonlesional psoriatic or normal skin.7,8 Although the mechanisms that mediate the antiproliferative and pro-differentiating effects of vitamin D analogs on keratinocytes are not completely understood, it is well known that these effects are at least in part genomic and mediated via VDR. It has been demonstrated that keratinocytes from vitamin D receptor-deficient mice do not respond in vitro to the antiproliferative effects of vitamin D analogs.22 It has been reported that 1,252D3 suppresses the proliferation rate of wild-type keratinocytes maintained in low calcium , while in contrast, no modulation of proliferation is observed in keratinocytes from VDR null mice.22

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The Sitch With Supplements: How Much Vitamin D Should You Take For Psoriasis

An easy way to get a daily dose of D are supplements that come in both liquid and pill forms. Just make sure you chat with your doctor before adding a supplement to your routine. They can test your vitamin D levels and help you pick the right dosage.

For adults, the daily recommended dietary allowance for vitamin D is 15 micrograms .

Its best to opt for a lower dose at first and gradually increase your amount over time with your docs blessing. Just make sure youre not exceeding the upper limit of 100 micrograms a day. Too much vitamin D can be toxic.

Supplements not your thing? You can also get that sweet D through foods, like:

• tuna or other fatty fish

• gels
• lotions

According to the American Academy of Dermatology topicals in general can be helpful in treating psoriasis for those with less than 5 percent of the body affected. If you have more severe psoriasis, they suggest combining topicals with other psoriasis treatments.

Effects Of Vitamin D On The Cutaneous Immune System

Psoriasis pathogenesis implicates the innate and adaptive segments of the immune system. In particular, it is centrally controlled by T cells, in which an important role is played by T-helper 1, Th17 and Th22, interplaying with numerous cell types via different cytokines, including tumour-necrosis factor- , IL-6 and IL-17 . The activity of these cells is modulated by specific T lymphocytes, named regulatory T cells . Regulatory T cells are able to inhibit the immunological response and to preserve the cutaneous immunological homeostasis, preventing autoimmune response against self-antigens .

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The Dermatologists Point Of View

Patients suffering from psoriasis present a broad range of clinical phenotypes. Psoriatic lesions are classified into plaque, guttate, pustular, and erythrodermic types according to clinical features, especially regarding lesions size and distribution . Disease onset may occur at any age, including childhood, with two peak age ranges, 16 to 22 and 57 to 60 years . Psoriasis lesions are characterized by hyper-proliferation with incomplete differentiation of epidermal keratinocytes and decreased keratinocyte apoptosis, associated with inflammatory cellular infiltrate in both dermis and epidermis . Psoriasis Area and Severity Index score is currently the preferred method for the assessment of the disease severity and extent .

What You Need To Know About Psoriasis Vitamin D Analogues With Steroid For Psoriasis

Is Your Stomach to Blame?

Who would have thought that a severe psoriasis outbreak could start because of something going wrong inside of your stomach and intestines? Yet, new research developed by psoriasis expert Edgard Cayce shows a distinct link between a leaky gut and a scaly psoriatic episode. According to Cayce, the primary source of psoriasis can be found in the intestinal tract, where toxins are leached into the body. This causes the immune system to react by thickening the skin. At the same time, the skin tries to purge the toxins through its layers, which can cause scabs and sores to form.

Could Arthritis Be the Cuplrit?

The intestines arent the only link to psoriasis found by researchers arthritis seems to also contribute to it. As many as one-third of all psoriasis patients eventually develop some form of psoriatic arthritis. Unlike normal forms of arthritis, those with psoriatic arthritis do not exhibit a rheumatoid factor when their blood is tested. This indicates that the arthritic condition comes solely from either the psoriasis itself or the underlying cause of the skin affliction.

Could a Virus Be the Cause?

Arthritis has been linked to certain virus and so have other auto-immune disorders. This leads some researchers to think that psoriasis too may start with a virus, which is what kicks the immune system into overdrive.

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Let The Sun Shine: Is Light Therapy Legit For Treating Psoriasis

Light therapy uses the power of ultraviolet light to help reduce inflammation and slow skin cell production in psoriasis patients. During a phototherapy sesh, the affected area is exposed to artificial UVB light which penetrates the skin to help ease symptoms.

With light therapy, consistency is key. Its important to follow a regular treatment schedule to up your chances of seeing results. Just note, you may also be upping your risk of skin cancer.

Research has shown that ultraviolet light can significantly improve psoriasis symptoms. But some studies have also found this is likely thanks to more than just vitamin D. Bottom line: More research is needed to fully determine why light therapy is so darn effective in treating psoriasis and other skin conditions.

There can be a dark side to vitamin D. While adding a bit of D to your day may help ease psoriasis symptoms, its not without potential side effects.

A 2016 study found that using vitamin D topicals can cause skin to become:

Combination Of Vitamin D Analogs With Other Therapies

Kragballe and coworkers reported that efficacy of topical calcipotriol treatment in psoriasis can be ameliorated by simultaneous ultraviolet-B phototherapy.72 This therapeutic efficacy of UV-B in psoriasis may be at least in part due to an increased cutaneous vitamin D synthesis. Vitamin D analogs can be topically applied at any time up to two hours before or immediately after UV-radiation. The combination of topical treatment with vitamin D analogs and UV-radiation does not alter the tolerability or safety of therapy.72,73

Results of a controlled, right/left study have demonstrated that pretreatment of psoriasis with tacalcitol increases the responsiveness to 311-nm UV-B74 and that tacalcitol ointment and 0.1% tazarotene gel are both comparably effective in improving the therapeutic result of PUVA therapy in patients with chronic plaque-type psoriasis.75,76 Adverse reactions occurred more often with 0.1% tazarotene than with tacalcitol but were generally mild and completely reversible upon using a lower concentration of 0.05% tazarotene.75 It has been concluded that both agents, besides accelerating the treatment response, might also help to reduce possible long-term hazards of PUVA treatment by virtue of their UV-A dose-sparing effect. A case report previously described two patients treated with a combination treatment of calcipotriol and bath psoralens and UV-A who developed hyperpigmentation at the lesional sites where calcipotriol ointment was applied.77

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Traditional Treatment Cautions Vitamin D Analogues In Psoriasis

You make an appointment to see your doctor because your psoriasis is flaring. He takes a look and then whips out his prescription pad to order one of the following:

. A prescription strength topical treatment

. phototherapy

. oral and injection therapy

. over the counter drugs

Any of these treatments may work fine to relieve your symptoms and make you feel better for now. The trouble with conventional treatment methods is that they rarely work to cure the underlying cause of this skin condition and that can leave you suffering repeat attacks. Still it is important to know what helps are available, and how they may help or hurt your chance of treatment success.

Topical Ointments Vitamin D Analogues in Psoriasis

Topical ointments are used at the first sign of psoriasis. If caught early enough they can sometimes stave off a full-blown attack. Unfortunately, most people report becoming immune to them when used often, which makes them useless for long term use. Still, using the occasional cream or gel can help relieve some of your symptoms. Steroids

Both topical and internal steroids can be prescribed to help ease psoriasis swelling inflammation and itching. Immunomodulators

An immune suppressing drug that was originally used to help transplant patients beat organ rejection, Cyclosporine helps to inhibit T lymphocyte production so that scaly plaque is unable to grow on the surface of the skin.

Oral Retinoid Vitamin D Analogues in Psoriasis

. stretch marks

Why Dermatologists Prescribe Synthetic Vitamin D To Treat Psoriasis

Synthetic vitamin D can:

• Slow rapidly growing skin cells

• Flatten thick psoriasis

• Synthetic vitamin D is considered safe for most patients, including children

• It clears psoriasis in some patients, including patients who have scalp psoriasis

• Most people notice an improvement after using it for two weeks

• If a patient needs stronger medicine, synthetic vitamin D can be safely combined with a strong corticosteroid

Studies show that using both tends to be more effective than using either medication alone.

• Using both synthetic vitamin D and a corticosteroid can also reduce the possible side effects that come with using a strong corticosteroid

• The combination can be used for much longer than a strong corticosteroid alone

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Other Vitamins And Supplements For Psoriasis

At present, there is not much evidence to suggest that other vitamins or supplements may help reduce symptoms of psoriasis.

However, oily fish are a good source of vitamin D, and some people with psoriasis believe that omega-3 fatty acid supplements can help ease their psoriasis. Omega-3 fatty acids may reduce inflammation, which suggests it could help with inflammatory conditions, such as psoriasis.

Currently, however, there are not enough long-term clinical trials to show whether these supplements are effective for treating psoriasis.

Risks And Shortcomings Of Vitamin D

Vitamin D can help many people with psoriasis. Still, its often not an effective long-term treatment on its own. Some people will need topical medications with other active ingredients, including corticosteroids. Vitamin D also wont work for everyone, regardless of what form its taken in.

The biggest risk of taking vitamin D is taking too much. Vitamin D in moderation is good for you, but taking too much can hurt you. It causes a condition called hypervitaminosis D, or vitamin D toxicity. This condition can cause a buildup of too much calcium in the blood, which can cause frequent urination, weakness, and eventually kidney problems. Its typically only caused by excessive doses of vitamin D supplements. It almost never occurs from diet or sunlight exposure.

As long as you take vitamin D in moderation, you should be able to avoid vitamin D toxicity. Your risk increases, though, if you have liver or kidney conditions already.

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Vitamin D And Psoriasis Linkage

In psoriasis, vitamin D is involved in the maintenance of cutaneous barrier homeostasis. Several studies identified an association between polymorphisms of vitamin D receptor and psoriasis susceptibility . Richetta et al., have found that the A-1012G promoter polymorphism of the VDR gene is associated with psoriasis risk through a lower expression of VDR mRNA, favoring conditions that may alter cutaneous barrier and the development of psoriatic lesions . In addition, in psoriatic skin a decreased expression of VDR and reduced tight-junction proteins is associated . Tight junctions are fundamental to regulate adhesion and permeability of keratinocytes, and to polarize cutaneous cell differentiation, to regulate extracellular calcium gradient, interacting with nuclear and cytoplasmic proteins and influencing the regulation of specific genes involved in keratinocytes differentiation and proliferation . Different studies have focused on the possible role of low vitamin D status in the pathogenesis of psoriasis .

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