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Comparison of Vitamin D Levels in Patients with and without Acne: A Case-Control Study Combined with a Randomized Controlled Trial

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Background Vitamin D plays an important role in the immune system, and its deficiency has been implicated in various skin diseases, including atopic dermatitis and psoriasis. Acne is a common inflammatory skin disease; however, the association with vitamin D remains unclear. Objectives We evaluated vitamin D levels in patients with acne to determine the effect of vitamin D supplementation. Methods This study included 80 patients with acne and 80 healthy controls. Serum 25-hydroxyvitamin D (25(OH)D) levels were measured, and demographic data were collected. Vitamin D-deficient patients were treated with oral cholecalciferol at 1000 IU/day for 2 months. Results Deficiency in 25(OH)D was detected in 48.8% of patients with acne, but in only 22.5% of the healthy controls. The level of 25(OH)D was inversely associated with the severity of acne, and there was a significant negative correlation with inflammatory lesions. In a subsequent trial, improvement in inflammatory lesions was noted after supplementation with vitamin D in 39 acne patients with 25(OH)D deficiency. Limitations Limitations of the study include the small number of patients in the supplementation study and the natural fluctuation of acne. Conclusions Vitamin D deficiency was more frequent in patients with acne, and serum 25(OH)D levels were inversely correlated with acne severity, especially in patients with inflammatory lesions.
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RESEARCH ARTICLE
Comparison of Vitamin D Levels in Patients
with and without Acne: A Case-Control Study
Combined with a Randomized Controlled
Trial
Seul-Ki Lim
1
, Jeong-Min Ha
1
, Young-Ho Lee
2
, Young Lee
1
, Young-Joon Seo
1
, Chang-
Deok Kim
1
, Jeung-Hoon Lee
1
, Myung Im
1
*
1Department of Dermatology, School of Medicine, Chungnam National University, Daejeon, Korea,
2Department of Anatomy, School of Medicine, Chungnam National University, Daejeon, Korea
*im1177@hanmail.net
Abstract
Background
Vitamin D plays an important role in the immune system, and its deficiency has been impli-
cated in various skin diseases, including atopic dermatitis and psoriasis. Acne is a common
inflammatory skin disease; however, the association with vitamin D remains unclear.
Objectives
We evaluated vitamin D levels in patients with acne to determine the effect of vitamin D
supplementation.
Methods
This study included 80 patients with acne and 80 healthy controls. Serum 25-hydroxyvita-
min D (25(OH)D) levels were measured, and demographic data were collected. Vitamin D-
deficient patients were treated with oral cholecalciferol at 1000 IU/day for 2 months.
Results
Deficiency in 25(OH)D was detected in 48.8% of patients with acne, but in only 22.5% of the
healthy controls. The level of 25(OH)D was inversely associated with the severity of acne,
and there was a significant negative correlation with inflammatory lesions. In a subsequent
trial, improvement in inflammatory lesions was noted after supplementation with vitamin D
in 39 acne patients with 25(OH)D deficiency.
Limitations
Limitations of the study include the small number of patients in the supplementation study
and the natural fluctuation of acne.
PLOS ONE | DOI:10.1371/journal.pone.0161162 August 25, 2016 1/11
a11111
OPEN ACCESS
Citation: Lim S-K, Ha J-M, Lee Y-H, Lee Y, Seo Y-J,
Kim C-D, et al. (2016) Comparison of Vitamin D
Levels in Patients with and without Acne: A Case-
Control Study Combined with a Randomized
Controlled Trial. PLoS ONE 11(8): e0161162.
doi:10.1371/journal.pone.0161162
Editor: Yiqun G. Shellman, University of Colorado
Denver School of Medicine, UNITED STATES
Received: November 5, 2015
Accepted: July 30, 2016
Published: August 25, 2016
Copyright: © 2016 Lim et al. This is an open access
article distributed under the terms of the Creative
Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are
credited.
Data Availability Statement: Data are available from
the Chungnam National University Hospital (E-mail:
cnuhirb@cnuh.co.kr, Phone: 82-42-280-6715).
Funding: The author(s) received no specific funding
for this work. This study was supported by a grantof
the Korea Healthcare technology R&D Project,
Ministry of Health & Welfare, Republic of Korea
(Grant No.: HI14C1379).
Competing Interests: The authors have declared
that no competing interests exist.
Conclusions
Vitamin D deficiency was more frequent in patients with acne, and serum 25(OH)D levels
were inversely correlated with acne severity, especially in patients with inflammatory
lesions.
Introduction
Acne is a common and complex skin disorder that distresses many patients because of its
chronicity. Although multiple factors contribute to acne development, chronic inflammation is
an important mechanism. Several inflammatory mediators such as cytokines, defensins, and
neuropeptides have been identified in acne lesions.[1] In addition, Propionibacterium acnes (P.
acnes) triggers cytokine activation by Toll-like receptors, which means that the innate immune
system is also important for acne development.[2]
Vitamin D has a number of functions in addition to its well-known role as a modulator of cal-
cium metabolism and homeostasis. It affects both the innate and adaptive immune system
through its effects on T and B lymphocytes, dendritic cells, and macrophages,[3,4] and it is asso-
ciated with systemic inflammatory diseases such as rheumatoid arthritis, systemic lupus erythe-
matosus, and inflammatory bowel disease.[5,6] In dermatological diseases, it plays an important
role as an immune modulator in atopic dermatitis, psoriasis, vitiligo, and alopecia.[710]
A few in vitro studies have published data that support the theory that vitamin D has a func-
tional role in acne development. Identifying vitamin D receptors in human sebocytes and mod-
ulation of lipid and cytokine production by vitamin D suggest the possible association between
vitamin D and acne pathophysiology.[1113] However, evidence is lacking regarding the clini-
cally relevant action of vitamin D in the development of acne, and its potential efficacy as a
therapeutic agent in acne also requires clarification. Accordingly, we evaluated vitamin D levels
in serum of acne patients compared to healthy controls, and the effects of vitamin D supple-
mentation. To the best of our knowledge, this is the first study to have investigated the role of
vitamin D in the pathogenesis and treatment of acne in a clinical setting.
Materials and Methods
Subjects
This case-control study included 80 patients with acne and 80 age- and sex-matched healthy
controls. All of the patients and controls were enrolled in this study from November 2014 to
February 2015 to avoid seasonal variation in vitamin D levels (recruitment end date, 28 Febru-
ary 2015; overall trial end date, 30 April 2015). Demographic data such as age, sex, body mass
index (BMI), smoking history, and sunscreen use were collected prior to enrollment. Exclusion
criteria prohibited enrollment of patients and controls who were receiving therapeutic inter-
ventions such as acne treatment, systemic corticosteroids, vitamin D supplements, or subjects
with concomitant inflammatory diseases. This study was approved by the Institutional Review
Board of Chungnam National University Hospital (CNUH 2014-07-013; date of approval, 24
July 2014). All of the subjects provided written informed consent before participating in the
study. We did not include children in this study; written consent was obtained from the sub-
jects themselves. This study was also approved by the ISRCTN registry (ISRCTN11007935;
date of approval, 15 October 2015). Because we were initially unaware of the ISRCTN registry,
the registration data were obtained after the study end date. The authors confirm that all ongo-
ing and related trials for this drug/intervention are registered.
Vitamin D and Acne
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Serum vitamin D analysis
Patients and controls had their serum 25-hydroxyvitamin D3 (25(OH)D) concentrations
measured. Blood samples were collected from veins and analyzed within 24 h of sampling
using the Roche Cobas e411 (Roche Diagnostics System, Switzerland). Levels of 25(OH)D
were categorized as adequate (>20 ng/mL), inadequate (1220 ng/mL), or deficient (<12 ng/
mL) according to the guidelines set by the Food and Nutrition Board of the Institute of Medi-
cine.[14]
Vitamin D supplementation
A subsequent blinded controlled study was performed in acne patients with 25(OH)D defi-
ciency. Each of the 39 patients were provided with a unique patient number and randomly
assigned to one of two groups by computer: one group underwent 2-month oral administration
of cholecalciferol (one drop of 1000 IU/day), and the other group received an identical-appear-
ing placebo drop. Any other topical or systemic acne treatments, except for standard washing
and moisturizing, were not allowed. The patients were assessed at the beginning of treatment
and at 2, 4, and 8 weeks during treatment.(Fig 1)
Fig 1. Flow diagram of randomized trial (CONSORT 2010 Flow Diagram).
doi:10.1371/journal.pone.0161162.g001
Vitamin D and Acne
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Clinical assessment
Clinical assessments were performed by three blinded independent dermatologists, and their
objective assessments and inter-rater reliability were evaluated. Digital photographs at baseline
and at each follow-up visit were used for the clinical assessments. Counts of non-inflammatory
lesions (comedones) and inflammatory lesions (papules, pustules, and nodules) were also
made at each visit.
The severity of acne was assessed according to the global acne grading system (GAGS)
score.[15] GAGS divides the face, chest, and back into six areas (forehead, each cheek, nose,
chin, chest, and back) and assigns a factor to each area on the basis of the surface area and dis-
tribution/density of pilosebaceous units. Each type of lesion is given a value depending on
severity: no lesions = 0; comedones = 1; papules = 2; pustules = 3; and nodules = 4. The score
for each area (local score) is calculated using the formula: Factor × Grade (04). The global
score is the sum of the local scores, and acne severity is graded using the global score. A score
of 118 is considered mild; 1930, moderate; 3138, severe; and >39, very severe.
Statistical analysis
Statistical analyses were performed using SPSS version 15 (SSPS Inc., Chicago, IL). The chi-
square test was performed to compare the categorical data (Tables 1and 2). The correlation
between the serum vitamin D level and inflammatory acne lesions was evaluated using Pear-
sons correlation analysis. Changes in the vitamin D levels after vitamin D supplementation
were evaluated with the Wilcoxon signed-rank test. The vitamin D levels according to disease
severity and the median percentile changes from baseline in acne lesions after vitamin D sup-
plementation were analyzed by the KruskalWallis test followed by the MannWhitney U test
for post hoc comparison. Pvalues of <0.05 were considered statistically significant.
Results
The age, sex, BMI, smoking history, and use of sunscreen were the same when comparing the
two groups (Table 1). There were no significant differences in the mean 25(OH)D concentra-
tion between the groups, although it was lower in patients compared to the controls. However,
the prevalence of 25(OH)D deficiency was significantly higher in patients with acne compared
to healthy controls (48.8% vs. 22.5%; P= 0.019) (Table 1,Fig 2). The threshold of 25(OH)D
deficiency in this study was defined as <12 ng/mL, according to the guidelines set by the Food
and Nutrition Board of the Institute of Medicine.[14] The distribution pattern of the 25(OH)D
levels in the two groups showed the widest gap in the 12-ng/mL area (S1 Fig).
Table 1. Baseline demographic and clinical characteristics of patients with acne and controls.
Acne (n = 80) Controls (n = 80) Pvalue
Age (years) 20.9 ±4.1 21.0 ±5.7 0.768
Sex (F/M), n (%) 47/33 (58.6/41.4) 41/39 (51.3/48.7) 0.482
BMI (kg/m
2
)21.8 ±3.8 20.2 ±4.9 0.894
Smoking (yes), n (%) 16 (20.0) 11 (13.8) 0.645
Using sunscreen, n (%) 47 (58.8) 58 (72.5) 0.356
Serum 25(OH)D (ng/mL) 13.1 ±9.8 15.2 ±7.2 0.112
Vitamin D deciency, n (%) 39 (48.8) 18 (22.5) 0.019*
All values are presented as mean ±SD unless otherwise stated. BMI, body mass index; 25(OH)D, 25-hydroxyvitamin D.
*P<0.05
doi:10.1371/journal.pone.0161162.t001
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We determined whether vitamin D deficiency was influenced by any factor. No significant
correlation was seen between deficient 25(OD)D levels and age, sex, disease duration, BMI,
family history, smoking, sunscreen use, and trunk involvement. The only factor affecting 25
(OH)D deficiency was disease severity. In total, 15 of the 18 patients (83.3%) in the severe
group were 25(OH)D-deficient, whereas only 6 of the 27 (22.2%) patients in the mild group
were deficient (Table 2). In addition, the mean 25(OH)D concentration was inversely associ-
ated with the severity of acne (Fig 3). There was not a significant correlation between 25(OH)D
levels and the number of non-inflammatory lesions. However, the number of inflammatory
lesions was significantly and negatively correlated with vitamin D concentrations (r = 0.512;
P<0.001) (Fig 4), signifying a possible link between the extent of vitamin D deficiency and the
degree of acne inflammation.
We also assessed the therapeutic efficacy of vitamin D supplementation in acne patients
with 25(OD)D deficiency. The 39 patients showing vitamin D deficiency were randomly
assigned to the vitamin D (n = 20) or placebo (n = 19) group. The two groups did not
Table 2. Results of vitamin D deficiency according to influencing factors.
Total Mean 25(OH)D Vitamin D Deciency Pvalue
no. (ng/mL) n (%)
Age (years)
<20 36 13.19 ±2.8 20 (55.6)
20 44 11.01 ±1.8 19 (43.2) 0.624
Sex
M 33 11.22 ±3.8 17 (53.1)
F 47 12.98 ±3.2 22 (46.9) 0.892
Duration (years)
<3 41 10.89 ±1.8 24 (58.5)
3 39 13.31 ±2.2 15 (38.5) 0.211
BMI (kg/m
2
)
Normal or less (<23) 50 10.89 ±1.4 28 (56.0)
Overweight or obese (23) 30 13.31 ±1.2 11 (36.7) 0.189
Family history
No 58 9.99 ±1.4 30 (51.7)
Yes 22 14.21 ±0.5 9 (40.9) 0.503
Smoking
No 64 10.44 ±0.8 29 (45.3)
Yes 16 13.76 ±1.8 10 (62.5) 0.412
Using sunscreen
No 33 13.51 ±1.2 14 (42.4)
Yes 47 10.69 ±0.6 25 (53.2) 0.398
Trunk lesions
No 54 15.56 ±1.3 22 (40.7)
Yes 26 8.69 ±0.7 17 (65.3) 0.098
Disease severity
Mild 27 17.37 ±0.6 6 (22.2)
Moderate 35 11.89 ±1.0 18 (51.4)
Severe 18 7.04 ±0.5 15 (83.3) 0.002**
25(OH)D values are presented as mean ±SD. Pvalues are for comparison of vitamin D deciency. BMI, body mass index; 25(OH)D, 25-hydroxyvitamin D.
**P<0.01
doi:10.1371/journal.pone.0161162.t002
Vitamin D and Acne
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significantly differ by any demographic or clinical factor. Vitamin D supplementation for 2
months resulted in a statistically significant increase in 25(OH)D levels (P<0.001) (Fig 5A)
and produced a clinical improvement compared to placebo (Fig 5B). There were no differences
in the non-inflammatory and total lesion counts between the groups. However, the inflamma-
tory lesions showed a statistically significant improvement in the vitamin D group compared
with the control group (P<0.05). Inflammatory lesions in the vitamin D group decreased by
34.6% after 8 weeks of treatment, whereas those in the control group decreased by 5.8% (Fig
5C). None of the patients reported discontinuation of the intervention, and there were no
adverse events.
Discussion
To the best of our knowledge, this is the first study to assess vitamin D status in acne patients.
There were no significant differences in the mean vitamin D concentration between acne
Fig 2. Percentages of patients with different vitamin D levels.
doi:10.1371/journal.pone.0161162.g002
Fig 3. Vitamin D levels and disease severity (*P<0.05, ***P<0.001).
doi:10.1371/journal.pone.0161162.g003
Vitamin D and Acne
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patients and healthy controls. This may be the result of the characteristics of vitamin D status
in the Korean population. As shown in Fig 1, most healthy control subjects had inadequate lev-
els of vitamin D, as reported previously in the general Korean population.[1618] However,
the prevalence of 25(OH)D deficiency was significantly higher in patients with acne (48.8%)
compared to healthy controls (22.5%). A similar finding was reported in a previous clinical
trial in which patients with nodulocystic acne showed relatively low serum vitamin D levels.
[19]
To understand the vitamin D status associated with acne patients, we investigated the fac-
tors that influence vitamin D deficiency. Although obesity and decreased sun exposure using
sunscreen are known to be associated with low 25(OH)D levels,[2024] they were not associ-
ated with vitamin D deficiency in this study. The serum vitamin D level is also influenced by
food such as fish oil or pork[16,17]; unfortunately, however, we were unable to evaluate the die-
tary habits of the patients. Our analysis revealed that the only factor associated with 25(OH)D
deficiency was acne severity, similar to previous findings that disease severity of atopic derma-
titis, psoriasis, and vitiligo is associated with lower levels of vitamin D.[79] Patients with
severe acne may be subject to more psychological stress, and may tend to avoid spending
extended periods outdoors, suggesting a possible explanation for low vitamin D levels in
patients with severe acne.
Fig 4. Correlation between vitamin D levels and inflammatory acne.
doi:10.1371/journal.pone.0161162.g004
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In the randomized controlled trial of 39 acne patients with vitamin D deficiency, oral vita-
min D supplementation produced a significant improvement in acne inflammation. In con-
trast, a previous study found no effect of vitamin D supplementation on acne lesions.[25]
However, this result was due to the fact that patients with acne had polycystic ovary syndrome,
and there was no consideration of the specific acne type, such as inflammatory lesions. The
observed anti-inflammatory effects of vitamin D have several biological mechanisms. The
expression of inflammatory biomarkers, such as interleukin (IL)-6, IL-8, and matrix metallo-
proteinase 9, is reduced by treatment with vitamin D in cultured sebocytes.[12] There is also
published evidence that vitamin D inhibits P.acnes-induced Th17 differentiation with reduced
expression of IL-17, an inflammatory cytokine that is increased in acne patients.[13] In addi-
tion, vitamin D has antimicrobial effects by inducing antimicrobial peptides such as LL-37 in
human sebocytes.[26] These previous reports support the theory that vitamin D has an
immune regulatory function in sebocytes, which supports the possible anti-inflammatory
effects of vitamin D in acne patients.
Our vitamin D supplementation trial had a few potential limitations, such as the use of a
low dose and short duration of treatment. The daily dose of vitamin D in this study was 1000
Fig 5. Clinical effects of vitamin D supplementation in patients with acne. (A) Change in vitamin D levels after vitamin D supplementation
(***P<0.001). (B) Photographs showing clinical improvement in a patient with acne. Photographs showing baseline (left) and last visit (right).
(C) Median percentile changes from baseline in acne lesions (*P<0.05).
doi:10.1371/journal.pone.0161162.g005
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IU/day, lower than in previous studies.[27,28] However, some studies have shown that a daily
dose of 1000 IU vitamin D is an effective treatment for atopic dermatitis.[29,30] In addition, as
shown in Fig 4, the vitamin D level was significantly improved by 1000 IU/day for 2 months,
although it was an inadequate level. Future trials need to examine the impact of regimens that
are more likely to achieve adequate levels of vitamin D, which is often associated with optimal
health. Moreover, given the frequent disease fluctuations that characterize acne, future trials of
more patients with a longer treatment duration are needed to determine if acne lesions recur
after the initial improvement or if the benefits are sustained by longer duration of treatment.
In conclusion, we found that vitamin D deficiency was more frequent in patients with acne,
which was inversely correlated with disease severity, indicating a potential role of vitamin D
deficiency in acne pathogenesis. A further study with a larger sample size is needed to confirm
our results because of the small number of patients in the supplementation study and the natu-
ral fluctuation of acne. Evaluation of the tissue level of vitamin D in patients with acne will also
require a further study to reveal direct evidence of the effect of vitamin D on acne.
Supporting Information
S1 Fig. Distribution pattern of 25(OH)D levels in patients and controls. The horizontal axis
represents the 25(OH)D levels (ng/mL), and the vertical axis represents the cumulative fre-
quency of 25(OH)D levels (%).
(JPG)
S1 File. CONSORT 2010 Checklist.
(DOC)
S2 File. Study information and protocol.
(DOCX)
S3 File. Study information and protocol (Original language).
(DOCX)
Acknowledgments
This study was supported by a grant of the Korea Healthcare technology R&D Project, Ministry
of Health & Welfare, Republic of Korea (Grant No.: HI14C1379).
A preliminary version of the results was presented in the 67
th
annual meeting of Korean der-
matological association.
Author Contributions
Conceptualization: MI YL YJS CDK JHL.
Data curation: MI SKL.
Formal analysis: MI YHL.
Funding acquisition: MI CDK JHL.
Investigation: SKL.
Methodology: MI SKL.
Project administration: MI.
Resources: SKL.
Vitamin D and Acne
PLOS ONE | DOI:10.1371/journal.pone.0161162 August 25, 2016 9/11
Software: MI YHL.
Supervision: MI JHL.
Validation: MI YHL.
Visualization: MI.
Writing original draft: SKL JMH.
Writing review & editing: MI.
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Vitamin D and Acne
PLOS ONE | DOI:10.1371/journal.pone.0161162 August 25, 2016 11 / 11

Supplementary resources (4)

... However, few clinical studies have attempted to justify the role of vitamin D in acne and those studies had their own limitations. Major limitations in these studies were small sample size, failure to address confounders and match case and control as per age and sex (5,6,7,8,9). ...
... Vitamin D acts as an immunomodulator, regulates proliferation and differentiation of keratinocytes and sebocytes as well has a comedolytic effect (7,16). Hence, vitamin D deficiency may have an important role in the pathogenesis of acne. ...
... There was no statistically significant differences between cases and control while comparing with the above parameters. Hence, serum vitamin D3 taken as both continuous and categorical parameters, serum vitamin D is low in patients with acne (6,7,9,12). Hence, vitamin D deficiency has an important role in the pathogenesis of acne. ...
Article
Background: Vitamin D may have an important role in the pathogenesis of acne vulgaris (AV) as it has an immunomodulatory effect and regulates the proliferation and differentiation of keratinocytes. Oral isotretinoin used in the management of moderate-to-severe acne binds to the retinoid receptor which can form a heterodimer with vitamin D receptor (VDR) and may decrease the level of vitamin D by increasing catabolism. Two studies published so far investigating the effect of oral isotretinoin on serum vitamin D level are contradictory to one another. Objective: This study aimed to compare the serum vitamin D levels in patients with moderate-to-severe acne and age- and sex-matched healthy controls and to determine the serum level of vitamin D in patients with moderate-to-severe acne following 3 months of oral isotretinoin treatment. Methods: A total of 120 patients with moderate-to-severe acne and 90 age- and sex-matched healthy controls were enrolled in the study. The patients were treated with oral isotretinoin at 0.50-0.75 mg/kg/day and serum vitamin D was measured at baseline and 3 months after the treatment. Result: Serum vitamin D was insufficient and deficient in 90.50% of cases in comparison with 43.33% of controls (p = 0.001). Serum vitamin D had an inverse correlation with the severity of acne. Following 3 months of oral isotretinoin, there was no significant change in serum vitamin D level (p = 0.127). Conclusion: Vitamin D was low in patients with moderate-to-severe acne in compared with control. Vitamin D level did not change with short-term therapy with oral Isotretinoin.
... [5] A few in vitro studies have published data that suggest the possible association between vitamin D and acne pathophysiology. [6][7][8][9] The development of acne vulgaris can be seen through the degree of severity, where the degree is very important to guide the decision of treatment options. [10] Many studies revealed that serum 25-hydroxy vitamin D[25(OH)D] levels tend to be significantly low in acne vulgaris patients. ...
... The sample size of the studies ranged from 15 to 150. The studies were conducted in South Korea, [6] Egypt, [13,[15][16][17][18][19][20] Saudi Arabia, [12] and Iran [ Table 1]. [14] Moreover, eight studies were case-control studies, one case-control combined with a randomized controlled trial study, [6] and one cross-sectional combined with a randomized controlled trial study [ Table 2]. ...
... The studies were conducted in South Korea, [6] Egypt, [13,[15][16][17][18][19][20] Saudi Arabia, [12] and Iran [ Table 1]. [14] Moreover, eight studies were case-control studies, one case-control combined with a randomized controlled trial study, [6] and one cross-sectional combined with a randomized controlled trial study [ Table 2]. [18] Outcomes Some of the studies stated vitamin D status in the form of deficiency, insufficiency, or sufficiency. ...
Article
Background: Vitamin D is thought to play a role in the pathogenesis of acne, and its levels can change in patients with acne vulgaris. Several studies have revealed that serum 25-hydroxy vitamin D levels tend to be low and statistically significant in acne vulgaris patients. However, the relationship between vitamin D levels and acne severity is still poorly understood. Objective: This study aims to identify the correlation between serum 25-hydroxy vitamin D levels and the severity of acne vulgaris. Method: This systematic review study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline based on several studies taken from the PubMed, PMC, Semantic Scholar, and ResearchGate databases until June 2021. Full-text case-control, randomized controlled trial, or cross-sectional study in English or Indonesian language reporting on the serum 25-hydroxy vitamin D levels and the severity of acne vulgaris on human participants were included. Result: From a total of 401 studies, 10 studies met the criteria. Almost all studies (8 of 10) revealed lower serum 25-hydroxy vitamin D levels as the acne severity progresses, although 2 of them were not statistically significant. Conclusion: The evidence of an inverse correlation between serum 25-hydroxy vitamin D levels and the severity of acne vulgaris suggests the need for screening of vitamin D levels in acne patients and offers a new prospect in the field of acne prevention and treatment.
... Acne inflammatory lesions were decreased by 34.6 % after 8 weeks of vitamin D supplementation in a study done by Lim et al, which showed a greater improvement than the present study. 24 On comparing anthropometric parameters of the two groups post therapy in present study, mean weight in group A and B were significantly reduced. In the present study, mean BMI pre therapy in group A was 24 22,[27][28][29] In the current study we did a baseline and post therapy for LH, FSH, LH/FSH, total testosterone, glycemic parameters-fasting, post prandial blood sugar, fasting and post prandial insulin, HOMA-IR. ...
... 24 On comparing anthropometric parameters of the two groups post therapy in present study, mean weight in group A and B were significantly reduced. In the present study, mean BMI pre therapy in group A was 24 22,[27][28][29] In the current study we did a baseline and post therapy for LH, FSH, LH/FSH, total testosterone, glycemic parameters-fasting, post prandial blood sugar, fasting and post prandial insulin, HOMA-IR. LH/FSH ratio improved in 23% of participants. ...
Article
Full-text available
Background: Polycystic ovarian syndrome is one of the most common metabolic and endocrine disorders among women, whereas vitamin D is a steroid with hormone like activity and also considered as a missing link between insulin resistance and PCOS due to its underlying mechanism of action in reducing insulin resistance thereby altering pathogenesis behind PCOS symptoms.Methods: A prospective cohort comparative observational study was carried out from July 2019 to December 2020 in 96 vitamin D deficient females with PCOS (polycystic ovarian-syndrome). All females were randomly recruited under group A and B with equal proportion of 1:1, where group A were given metformin (500 mg twice daily) only and group B were given metformin (500 mg twice daily) plus vitamin D 60000 IU weekly for 24 weeks. Baseline clinical, hormonal, metabolic, sonographic parameters were compared before and after treatment.Results: Significant improvement was seen in various parameters in both the groups, like oligomenorrhoea improved in 41.67% individuals. FG score improved from mean of 10.28±2.02 in group B to 8.44±2.23 with p<0.0001. Acne improved in both groups equally in 22.92%. Polycystic ovary pattern improved in 14.58% individuals of group B with p<0.0001. Serum total testosterone improved in 16.71% in group A and in 22.92% in group B. HOMA-IR was also reduced in both groups effectively and was statistically significant with p=0.017 in group A and p=0.001 in group B.Conclusions: Remarkable improvement was seen in clinical, hormonal, metabolic and sonographic parameters in group B and noteworthy reduction in HOMA-IR, BP and triglyceride values was also seen. Hence, supplementation of vitamin D is highly effective in improving PCOS and preventing future consequences as well.
... Vein blood samples were taken, and the Roche Cobas e411 was used to analyze them within 24 hours (Roche Diagnostics System, Switzerland). 25(OH)D blood levels were divided into acceptable (>20 ng/ml), inadequate (12-20 ng/ml), and deficient (12 ng/ml) categories based on the recommendations of the Food and Nutrition Board of the Institute of Medicine [12]. ...
Article
Full-text available
Background and aim: Psoriasis is a chronic, relapsing and inflammatory multisystemic disease with both genetic predisposition and autoimmune pathogenic traits. Several types of vitamin D receptor (VDR) polymorphisms have been investigated as a predisposing factor for psoriasis susceptibility with controversial results. However, the exact pathophysiological effect of the VDR gene on psoriasis susceptibility remains poorly understood. We aimed to determine whether VDR gene polymorphisms, specifically rs7975232 (ApaI), afford psoriasis susceptibility in a given community in Saudi Arabia. Also, to assess its possible relation with disease severity. Subjects and methods: In a comparative case-control study comprising 53 psoriatic patients and 41 matched healthy controls, we measured serum ApaI levels, and the PCR-RFLEP technique detected ApaI genetic polymorphism (rs7975232) for both groups. Serum vitamin D level was measured in both groups. Result: Our results revealed that A/A genotype of ApaI was significantly more predominant in patients than controls, while A/a genotype was more common in healthy subjects. Furthermore, A allele was significantly over-represented in the patients' group compared to the controls (P≤0.001). Serum vitamin D levels were significantly higher in mild psoriatic patients than in those with moderate and severe types (P=0.002). Mild psoriatic patients with a/a genotypes have higher vitamin D levels than severe patients with A/A genotypes and A/a moderate patients (P≤0.001). Conclusion: Our data indicated clearly that VDR gene polymorphism, namely ApaI, is associated with psoriasis susceptibility. Furthermore, serum vitamin D level in psoriatic patients varies among different ApaI genotypes, where it is lowest in AA genotype.
... According to the Food and Nutrition Board of the Institute of Medicine, sVDLs were classified as adequate (>20 ng/ml), inadequate (12-20 ng/ml) and deficient (12 ng/ml). 21 ...
Article
Full-text available
Background: Several types of polymorphisms in vitamin D receptor (VDR) have been found in psoriasis. Aim: this study looked at the role of the TaqI polymorphism in the VDR gene as a factor in changing plasma 25-hydroxyvitamin D (25(OH)D) levels in psoriasis patients and to see if it had any relationship with disease severity. Subjects and Methods Clinical examination, serum (25(OH)D) levels measurement, molecular studies, TaqI genotyping by PCR and RFLP subjected for the two groups. Results: T/t genotypes of TaqI polymorphism genotypes were most common in patients, while t/t genotypes were more abundant in healthy subjects. The T allele was high in the patient group in comparing to the normal subjects, but there were no significant differences (P=0.421). Patients with T/t TaqI genotypes had higher levels of 25(OH)D) than T/T and t/t (P=0.004). Moderate psoriatic patients with the T/t genotype have relatively high 25(OH)D) levels than moderate patients with the T/t and t/t genotypes (P=0.001). Conclusion: The increase in 25(OH)D) titers in moderate patients is greater than that in mild and severe patients. T/t genotypes are associated with increased 25(OH)D) levels in moderate and mild patients.
... Изучение уровня ВD у 80 пациентов показало, что дефицит чаще встречается у пациентов с акне по сравнению с контрольной группой. Была обнаружена обратная корреляция показателей с тяжестью заболевания при воспалительной форме [104]. Обследование 39 пациентов с акне выявило дефицит ВD, но существенной разницы с пациентами контрольной группы и пациентов с разной тяжестью акне не обнаружено [105]. ...
Article
Vitamin D (VD) comes only in a small amount externally, since the main source is synthesis in the skin. Its activation also occurs in the body, it has its own nuclear receptors and is essentially a prohormone. In addition to the "classic" action on calcium-phosphorus metabolism, VD regulates the expression of genes that control functions such as proliferation, differentiation, metabolism, ion transport, DNA repair, protection against reactive oxygen species, and apoptosis through its receptors in many cell types. This is associated with participation in the immune response, angiogenesis, aging, detoxification, and suppression of inflammation. The majority of the world's population is deficient of VD. The treatment and maintenance of optimal blood levels affect not only the probability of occurrence and severity of certain malignant tumors, autoimmune, infectious, cardiovascular, allergic, nervous, bronchopulmonary and skin diseases, but also their outcome and life expectancy.
... Clinical studies using daily oral supplementation containing pantothenic acid in healthy human adults with mild and moderate acne has shown the reduction of total facial acne and blemishes after 8-and 12-weeks respectively versus placebo control [53,54] . A deficiency in Vitamin D (25 hydroxyvitamin D3) was shown to correlate with increased severity of acne lesions, which could be mitigated by supplementation with oral cholecalciferol at 1000 IU/day for 2 months [55] . ...
Article
Full-text available
Collagen-based supplements have become a keystone in the management of the ageing process, with proven ability to repair skin damage, bestowing a youthful and healthy appearance sought in the pursuit of beauty. Collagen is an essential scaffold protein that gives smoothness and elasticity to skin, but its production declines with age. Finding ways to tackle this problem is now strongly promoted as an effective way to transform skin and hair, repairing age-related deterioration. A growing number of scientific studies show exciting evidence that it is possible to rejuvenate ageing or damaged skin, improve function of worn joints, and support personal wellbeing and vitality. In recent times, research on the mechanisms which impact the production of collagen in skin and the ideal organization into functional fibres which give skin its characteristic elasticity and firmness has provided new insights into how this bio-scaffold can support cells, tissues and organs. The factors which influence collagen production over a lifetime (e.g., puberty, pregnancy, menopause, andropause), intrinsic factors (e.g., genetics, age, ethnicity) and extrinsic factors (e.g., UV-radiation, pollution, smoking) and the potential for new technologies, ingredients and devices to restore collagen and matrix components to their optimal condition are improving the ability to deliver anti-aging strategies with unprecedented results. This paper will review skin collagen production, structure and function throughout the lifestages, emphasizing its relationship with health, appearance and beauty.
... Vitamin D (VD) and vitamin D receptor (VDR) polymorphisms play important roles in the pathogenesis of AV, which when detected early can be considered in the treatment of the disease [4][5][6][7]. ...
Article
Importance Acne and rosacea have substantial implications for quality of life, and it is therefore important to ensure the patient’s voice is being captured in pivotal randomized clinical trials (RCTs). Although patient-reported outcome measures (PROMs) are a valuable tool to capture the patient perspective, little is known about use of PROMs in RCTs on acne and rosacea. Objective To characterize the use of PROMs in RCTs on acne and rosacea. Evidence Review A systematic literature search was conducted using the search terms acne vulgaris and rosacea in the following databases: MEDLINE through PubMed, Embase, Cochrane Central Register of Controlled Trials, and Cochrane Database of Systematic Reviews. A modified search hedge for RCTs from the McGill Library was applied. All phase 2, 3, and 4 RCTs published between December 31, 2011, through December 31, 2021, that evaluated the efficacy and safety of therapies for acne and rosacea vs any comparator were eligible for inclusion. Findings A total of 2461 publications describing RCTs were identified, of which 206 RCTs met the inclusion criteria (163 trials [79%] on acne and 43 [21%] on rosacea). At least 1 PROM was used in 53% of trials (110) included; PROM use was more common in rosacea RCTs (67% [n = 29]) compared with acne RCTs (50% [n = 81]). At least 1 dermatology-specific (13% [n = 27]) or disease-specific (14% [n = 28]) PROM was included in the RCTs analyzed. Only 7% of trials (14) included a PROM as a primary outcome measure. There was no statistically significant increase in PROM inclusion over the study period (11 of 21 trials in 2011 vs 5 of 12 trials in 2021). Conclusions and Relevance In this systematic review, PROMs were included in approximately one-half of acne and rosacea RCTs performed over the study period. In addition, PROMs were rarely used as a primary outcome measure, and inclusion of PROMs has not increased substantially over the past 10 years. Increasing use of PROMs in RCTs can ensure that the patient’s perspective is captured during the development of new treatments for acne and rosacea.
Article
Vitamin D is vital for bone health and its deficiency deemed as a disease of the past has re-emerged as an important health concern. Thanks to modern research, the role of vitamin D has been studied in detail and goes far beyond the concepts of regulating the mineral composition of bones. A small amount of active vitamin in the form of cholecalciferol is obtained by the body with food of animal origin, in the form of ergocalciferol and previtamin D ― with food of plant origin. Another way to get vitamin D is exposure to solar radiation. Both insufficient and excessive levels of vitamin D have adverse effects on the body. A constant blood level above 200 ng/ml is considered toxic and is manifested by anorexia, weight loss, polyuria and cardiac arrhythmia. Vitamin D toxicity increases the risk of kidney stones, calcification of blood vessels and tissues, as well as complications associated with these changes. The growing interest in the role played by vitamin D in skin disease has given rise to the publication of many studies of the relationship between this vitamin and cutaneous dermatoses. Undoubtedly, a complete understanding of the synthesis of vitamin D, the main sources of its production by the body, indicators of the normal content of vitamin D levels in the blood, as well as factors that can influence their changes, are important. Of particular interest are the latest discoveries about the role of vitamin D in skin diseases such as lupus erythematosus, ichthyosis, atopic dermatitis, hidradenitis suppurativa, acne, alopecia areata, androgenetic alopecia, melanoma, and nonmelanoma skin cancer. Also of interest is the importance of vitamin D as adjuvant therapy in patients on long-term treatment with corticosteroids. In this review, we provide an overview of the most important and most recent information regarding the relationship between vitamin D and skin disease and discuss the importance of assessing individual vitamin D status and correcting deficiencies.
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Sun exposure is the main source of vitamin D. Due to many lifestyle risk factors vitamin D deficiency/insufficiency is becoming a worldwide health problem. Low 25(OH)D concentration is associated with adverse musculoskeletal and non-musculoskeletal health outcomes. Vitamin D supplementation is currently the best approach to treat deficiency and to maintain adequacy. In response to a given dose of vitamin D, the effect on 25(OH)D concentration differs between individuals, and it is imperative that factors affecting this response be identified. For this review, a comprehensive literature search was conducted to identify those factors and to explore their significance in relation to circulating 25(OH)D response to vitamin D supplementation. The effect of several demographic/biological factors such as baseline 25(OH)D, aging, body mass index(BMI)/body fat percentage, ethnicity, calcium intake, genetics, oestrogen use, dietary fat content and composition, and some diseases and medications has been addressed. Furthermore, strategies employed by researchers or health care providers (type, dose and duration of vitamin D supplementation) and environment (season) are other contributing factors. With the exception of baseline 25(OH)D, BMI/body fat percentage, dose and type of vitamin D, the relative importance of other factors and the mechanisms by which these factors may affect the response remains to be determined.
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Abstract Objective: Acne vulgaris is a chronic inflammatory disease, and hormonal influences, follicular plugging and follicular hyperkeratinization, increased sebum secretion, Propionibacterium acnes colonization, and inflammation are involved in its pathogenesis. Recently, a significant body of evidence has accumulated that describes the comedolytic properties of vitamin D and its roles as a modulator of the immune system, a regulator of the proliferation and differentiation of sebocytes and keratinocytes, and as an antioxidant. In this study, we aimed to compare serum vitamin D levels in a group of patients with nodulocystic acne with vitamin D levels in a group of control subjects to determine whether there was any relationship between the vitamin D and acne. Methods: Levels of 25-hydroxyvitamin D (25[OH]D) were measured in 43 patients with newly diagnosed nodulocystic acne and in 46 healthy control subjects, and participants were grouped according to their 25[OH]D levels as follows: normal/sufficient (>20 ng/mL) or insufficient/deficient (<20 ng/mL). Serum concentrations of calcium (Ca), phosphorus (P), alkaline phosphatase (ALP), and parathyroid hormone (PTH) were measured. Results: Forty-three patients and 46 control individuals, with mean ages of 23.13 (± 5.78) years and 25.23 (± 4.73) years, respectively, were included in this study. There were no significant differences between the groups in relation to their body mass indices and Ca, P, ALP, and PTH levels. However, the patients with nodulocystic acne had significantly lower 25[OH]D levels than the subjects in the control group (P< 0.05). Conclusion: The patients with nodulocystic acne had relatively low serum vitamin D levels compared with the subjects in the control group. The findings from this study suggest that there is a connection between low vitamin D levels and acne. Larger epidemiologic studies are needed to confirm the status of vitamin D levels in patients with acne.
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Acne vulgaris is the most common skin disorder affecting millions of people worldwide and inflammation resulting from the immune response targeting Propionibacterium acnes plays a significant role in its pathogenesis. In this study, we have demonstrated that P. acnes is a potent inducer of Th17 and Th1, but not Th2 responses in human PBMCs. P. acnes stimulated expression of key Th17-related genes, including IL-17A, RORα, RORc, IL-17RA and IL-17RC, and triggered IL-17 secretion from CD4(+), but not CD8(+) T cells. Supernatants from P. acnes-stimulated PBMCs were sufficient to promote the differentiation of naïve CD4(+)CD45RA T cells into Th17 cells. Furthermore, we found that the combination of IL-1β, IL-6 and TGF-β neutralizing antibodies completely inhibited P. acnes-induced IL-17 production. Importantly, we showed that IL-17-expressing cells were present in skin biopsies from acne patients but not from normal donors. Finally, vitamin A (all-trans retinoic acid) and vitamin D (1,25-dihydroxyvitamin D3) inhibited P. acnes-induced Th17 differentiation. Together, our data demonstrate that IL-17 is induced by P. acnes and expressed in acne lesions and that both vitamin A and vitamin D could be effective tools to modulate Th17-mediated diseases such as acne.Journal of Investigative Dermatology accepted article preview online, 7 August 2013. doi:10.1038/jid.2013.334.
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Vitamin D seems to influence the evolution of atopic dermatitis (AD) in children. We tested the vitamin D serum levels of 39 children with AD (AD group t0) and of 20 nonallergic healthy controls (C group). AD severity was evaluated using the AD scoring system (SCORAD index). Cytokine serum levels (IL-2, IL-4, IL-6, IFN-γ, TNF-α) and atopy biomarkers were also measured. The patients were then treated with vitamin D oral supplementation of 1,000 IU/day (25 mg/day) for 3 months. We then reevaluated the vitamin D serum levels, AD severity and cytokine serum levels in all of the treated children (AD group t1). The cross-sectional analysis on patients affected by AD (AD group t0) showed that the initial levels of all the tested cytokines except for TNF-α were higher than those of the healthy control group (C group), falling outside the normal range. After 3 months of supplementation the patients had significantly increased vitamin D levels (from 22.97 ± 8.03 to 29.41 ± 10.73 ng/ml; p = 0.01). A concomitant significant reduction of both the SCORAD index (46.13 ± 15.68 at the first visit vs. 22.57 ± 15.28 at the second visit; p < 0.001) and of all the altered cytokines (IL-2, IL-4, IL-6, IFN-γ) was also found. This study showed vitamin D supplementation to be an effective treatment in reducing AD severity in children through normalization of the Th1 and Th2 interleukin serum pattern. © 2015 S. Karger AG, Basel.
Article
Poly cystic ovary syndrome (PCOS) is considered one of the most common endocrine disorders of women in reproductive age. The aim of this study was evaluating the efficacy of calcium and Vitamin D supplementation on the regularity of menstrual cycles, body mass index (BMI) and hyper androgenism state of women with PCOS. In this clinical trial, 80 women with PCOS were evaluated. They randomly located in four groups receiving metformin (group 1), metformin plus calcium and Vitamin D (group 2), calcium and Vitamin D (group 3) and placebo (group 4) for 4 months. BMI, regularity of menstrual cycles, hyperandrogenism (hirsutism and acne) and serum calcium and Vitamin D levels were compared in four studying groups at baseline and 4 months after the trial. All studied subjects were similar at baseline (P > 0.05). After trial, the frequency of hirsutism and acne were not different among groups. Frequency regular menstrual cycle and dominant follicle were significantly higher in group 1 and 2 than others (P < 0.05). After trial, there was no significant difference with respect to BMI among groups. Vitamin D and calcium supplementation in addition to metformin therapy in women with PCOS could result in a better outcome in a variety of PCOS symptoms including menstrual regularity, and ovulation.
Article
Background Epidemiologic and preclinical data, and a small randomized trial in Boston, suggest that vitamin D supplementation may improve winter-related atopic dermatitis (AD). Objective To determine the effect of vitamin D supplementation on winter-related AD. Methods We performed a randomized, double-blind, placebo-controlled trial of Mongolian children with winter-related AD (clinicaltrials.gov identifier: NCT00879424). Baseline eligibility included age 2 to 17 years, AD score 10 to 72 using the Eczema Area and Severity Index (EASI), and winter-related AD (eg, history of AD worsening during the fall-to-winter transition). Subjects were enrolled in Ulaanbaatar during winter and randomly assigned to oral cholecalciferol (1000 IU/day) versus placebo for 1 month. All children and parents received emollient and patient education about AD and basic skin care. The main outcomes were changes in EASI score and in Investigator's Global Assessment. Results The 107 enrolled children had a mean age of 9 years (SD 5), and 59% were male. Their median age of AD onset was 3 months (interquartile range 2 months to 1 year) and mean EASI score at baseline 21 (SD 9). One-month follow-up data were available for 104 (97%) children. Compared with placebo, vitamin D supplementation for 1 month produced a clinically and statistically significant improvement in EASI score (adjusted mean change: −6.5 vs −3.3, respectively; P = .04). Moreover, change in Investigator's Global Assessment favored vitamin D over placebo (P = .03). There were no adverse effects in either group. Conclusion Vitamin D supplementation improved winter-related AD among Mongolian children, a population likely to have vitamin D deficiency in winter.
Article
Background Alopecia areata is a T-cell mediated autoimmune disease that causes inflammation around anagen-stage hair follicles. Deficient vitamin D levels have been implicated in patients with a variety of autoimmune diseases in recent years. Previous reports have described the effects of vitamin D on hair follicles.Objectives The aim of the study was to evaluate the status of vitamin D in patients with alopecia areata and the relationship between vitamin D levels and disease severity.MethodsA cross-sectional study was conducted of 86 patients with alopecia areata, 44 patients with vitiligo, and 58 healthy controls. Serum vitamin D levels of the study group were determined by liquid chromatography/tandem mass spectrometry.ResultsSerum 25(OH)D levels in patients with alopecia areata were significantly lower than those of the patients with vitiligo and the healthy controls (P= 0.001 and P<0.001, respectively). The prevalence of 25(OH)D deficiency was significantly higher in the patients with alopecia areata (90.7%) compared with the patients with vitiligo (70.5%) and the healthy controls (32.8%) (P= 0.003 and P<0.001, respectively). Furthermore, a significant inverse correlation was found between disease severity and serum 25(OH)D level in the patients with alopecia areata (r= - 0.409; P<0.001).Conclusion Deficient serum 25(OH)D levels are present in alopecia areata patients and inversely correlate with disease severity. Accordingly, screening alopecia areata patients for vitamin D deficiency seems to be of value for the possibility of vitamin D supplementation.This article is protected by copyright. All rights reserved.
Article
The effect of vitamin D on allergic conditions is unclear. In particular, large-scale, population-based studies examining this relationship in adult Asian populations are lacking. To evaluate the association between serum vitamin D levels and allergic conditions in the general adult Korean population. A cross-sectional study was performed by using data collected from 15,212 individuals 19 years or older who participated in the Korean National Health and Nutrition Examination Survey from 2008 to 2010. The confounder-adjusted mean serum 25-hydroxyvitamin D (25[OH]D) levels of participants with and without allergic conditions (including atopic dermatitis, asthma, allergic rhinitis, and increased total and allergen-specific serum IgE) were compared by using multiple linear regression analyses. Multiple logistic regression analyses with confounder adjustment estimated the odds ratios (ORs) for developing each condition according to adequate, inadequate, or deficient serum 25(OH)D levels. After adjusting for potential confounders, mean serum 25(OH)D levels were significantly lower in participants diagnosed with atopic dermatitis than in those without this diagnosis (mean ± SE, 18.58 ± 0.29 ng/mL vs 19.20 ± 0.15 ng/mL; P = .02). Compared with participants with adequate vitamin D levels (≥20 ng/mL), confounder-adjusted ORs of atopic dermatitis were significantly higher in those with inadequate (12-19.99 ng/mL) or deficient (<12 ng/mL) levels (OR [95% CI], 1.50 [1.10-2.06] and 1.48 [1.04-2.12], respectively; P = .02). This relationship was not observed in participants with the other allergic conditions. Vitamin D-insufficient adult individuals within the general Korean population have an increased likelihood of atopic dermatitis, but not asthma, allergic rhinitis, or IgE sensitization.
Article
The conventional perspective of acne pathogenesis holds that Propionibacterium acnes colonizes the duct of the sebaceous follicle, causing an innate immune response and the progression from a so-called noninflammatory comedo to an inflammatory papule, pustule, or nodule. However, this viewpoint has come under increasing scrutiny over the last decade, as evidence has emerged supporting a role for inflammation at all stages of acne lesion development, perhaps subclinically even before comedo formation. The immunochemical pathways underlying the initiation and propagation of the inflammation in acne are complex and still being elucidated, but may involve Propionibacterium acnes as well as several inflammatory mediators and their target receptors, including cytokines, defensins, peptidases, sebum lipids, and neuropeptides. This review presents evidence to support the notion that acne is primarily an inflammatory disease, challenging the current nomenclature of noninflammatory versus inflammatory acne lesions and suggesting that the nomenclature is outdated and incorrect. The evidence in support of acne as an inflammatory disease also has clinical implications, in that anti-inflammatory drugs used to treat the disease can be expected to exert effects against all lesion stages, albeit via distinct mechanisms of anti-inflammation.
Article
Inflammatory cytokines are the key factor in the pathophysiology of acne. It is well known that keratinocytes synthesize many kinds of inflammatory cytokines. In addition, it is reported that inflammatory cytokines are also expressed from sebocytes, which originate from the same stem cells with keratinocytes. To clarify changes in the expression of inflammatory biomarkers from cultured sebocytes after treatment with vitamin D. Reverse transcription-polymerase chain reaction (RT-PCR) was done to measure changes in the expression of inflammatory biomarkers, including interleukin-1β (IL-1β), IL-6, IL-8, and tumor necrosis factor-α (TNF-α), and several subtypes of matrix metalloproteinases (MMPs) after treatment of a group of cultured sebocytes with vitamin D. Vitamin D receptor (VDR) small interfering RNA (siRNA) was added in the other group of cultured sebocytes to assure the role of vitamin D on the expression of inflammatory biomarkers. Enzyme-linked immunosorbent assay (ELISA) was also performed in the vitamin D-treated sebocytes. Cultured sebocytes showed non-significant changes in the gene expression of inflammatory biomarkers after treatment with vitamin D. In cultured sebocytes treated with a VDR siRNA, the expression of inflammatory biomarkers was not blocked after treatment with vitamin D. ELISA showed a significant decrease in the expression of IL-6, IL-8, and MMP-9, but a significant increase in the expression of MMP-1 and MMP-3, after treatment with vitamin D (10(-6) M). Expression of inflammatory biomarkers is influenced by treatment with vitamin D in cultured sebocytes, but not through VDR.