Estimation of Serum Vitamin D and Zinc Level among Psoriatic Patients

Abstract

Background: Psoriasis is chronic skin diseases that infect about 3 % of the world
population. It affects by many factors such as vitamin D that have main
immunomodulatory effects in psoriasis, in addition trace elements specially zinc
element. Objectives: To evaluate vitamin D and zinc serum levels in patients with
psoriasis. Methods: A cross-sectional study was conducted including 18 psoriatic
patients and 18 healthy as control groups. Vitamin D and zinc serum levels were
measured. Results, the result show lowering vitamin D and zinc element in psoriatic
patients as compared with control subjects at P < 0.05. Conclusion: It’s concluded
vitamin D and zinc were decreased significantly in psoriatic patients.

Full text

Australian Journal of Basic and Applied Sciences, 11(10) July 2017, Pages: 151-154
AUSTRALIAN JOURNAL OF BASIC AND
APPLIED SCIENCES
ISSN:1991-8178 EISSN: 2309-8414
Journal home page: www.ajbasweb.com
Open Access Journal
Published BY AENSI Publication
© 2017 AENSI Publisher All rights reserved
This work is licensed under the Creative Commons Attribution International License (CC BY).
http://creativecommons.org/licenses/by/4.0/
To Cite This Article: Dr. Salim Hussein Hassan Al-Greti and Jaafar Khalaf Ali., Estimation of Serum Vitamin D and Zinc Level among
Psoriatic Patients. Aust. J. Basic & Appl. Sci., 11(10): 151-154, 2017
Estimation of Serum Vitamin D and Zinc Level among Psoriatic Patients
1Dr. Salim Hussein Hassan Al-Greti & 2Jaafar Khalaf Ali
1,2Community health Dept. Karbala Technical Institute, Al-Furat Al-Awsat University, kufa, Iraq.
Address For Correspondence:
Salim H. H. AL-Greti, Community health Dept. Karbala Technical Institute, Al-Furat Al-Awsat University, kufa, Iraq.
Tel: 009647702638133; E-mail: sa.hussein1996@gmail.com
A RT I C LE I NF O
A B ST R AC T
Article history:
Received 28 May 2017
Accepted 22 July 2017
Available online 26 July 2017
Keywords:
psoriasis; vitamin D; zinc;
autoimmune disease.
Background: Psoriasis is chronic skin diseases that infect about 3 % of the world
population. It affects by many factors such as vitamin D that have main
immunomodulatory effects in psoriasis, in addition trace elements specially zinc
element. Objectives: To evaluate vitamin D and zinc serum levels in patients with
psoriasis. Methods: A cross-sectional study was conducted including 18 psoriatic
patients and 18 healthy as control groups. Vitamin D and zinc serum levels were
measured. Results, the result show lowering vitamin D and zinc element in psoriatic
patients as compared with control subjects at P < 0.05. Conclusion: It’s concluded
vitamin D and zinc were decreased significantly in psoriatic patients.
INTRODUCTION
Psoriasis is a skin autoimmune disease in which genetic and environmental issues have a major role. Its
name derived from Greek term„ psora‟ which is mean „itch‟. Psoriasis is inflammatory, dry, non-contagious,
and ugly skin illness, which can implicate entire system of individual (Ashwin et al., 2011). The most frequently
affected sites are the tips of finger, scalp, and toes. In this disease, the skin has scaling like flakes named
psoriatic plaques as a result of rapid and too much proliferation of epidermis cells which look like skin of fish
skin and finally peels off as exfoliation (Rahman and Elder, 2005). Psoriasis exists as several morphological
variants like plaque, pustular, and flexural. Some other variety also exist like nail psoriasis, drug induced,
inverse psoriasis, psoriatic arthritis and seborrheic. Approximately ninety percent of affected patients have
plaque psoriasis, categorized by well-defined round or oval panels that vary in size and often unite (Griffiths and
Barker, 2007).
Vitamin D (25-hydroxyvitamin D) is a hormone that stimulate by cutaneous contact to ultraviolet B
radiation UVB (Maia et al., 2007). It acts on calcium homeostasis, bone metabolism and has immune flexible
functions that have been newly documented. Vitamin D inhibits creation, induce fatal differentiation of human
keratinocytes and display immunomodulation properties (Marques et al., 2010). Some studies have
demonstrated a relationship between vitamin D insufficiency and psoriasis (Szodoray et al., 2008; Orgaz-Molina
et al., 2012). Vitamin D has pleotropic functions; it acts as a hormone by regulatory calcium homeostasis as well
as utilizing autocrine/paracrine effects on tissues. Moreover, its local effects; calcitriol may also act in psoriasis
through its immunomodulatory properties through hindering T-cell multiplying and Th1 progress, controlling
antigen presenting cell “APCs” function, making hypo responsiveness to antigen, preventing manufacture of IL-
2, IL-17, IL-8 and interferon-γ, as well as increasing the production of IL-10 and regulatory T cells (Arnoson et
al., 2007; Adams and Hewison, 2010). There are many studies on high-dose vitamin D in the psoriasis
treatment, while systemic administration of this vitamin for the treatment of psoriasis might be limited by its
toxicity. Small number of trials shows the effectiveness and care of vitamin D metabolites in the cure of
psoriasis and psoriatic arthritis (Gaal et al., 2009; Perez et al., 1996; Hukins et al., 1990).

152 Dr. Salim Hussein Hassan Al-Greti and Jaafar Khalaf Ali, 2017
Australian Journal of Basic and Applied Sciences, 11(10) July 2017, Pages: 151-154
Zinc (Zn) is second to iron as the most abundant trace component in the body. More than 300 metal
enzymes occur in all six categories of enzyme systems. Some enzymes, such as Cu and Zn superoxide
dismutase, structural stability is confirmed in zinc protein binding and catalytic action of the enzyme by the
active copper site. Sign and symptom of the zinc deficiency include increased occurrence of infections, possibly
related to change in immune function; diarrhea; skin lesions; alopecia; eyesight defect and other adverse clinical
outcomes (Carl et al., 2012). About fifty years ago, progress has been made about association of zinc with
numerous skin pathology (Bibi and Cohen, 2006). Zinc stabilizes the cell membrane, protect their integrity by
reducing the formation of free radicals and prevention of lipid peroxidation, zinc is also required for immune
system function, protein synthesis and wound healing (Coleman, 1992 ; Jen et al., 2008). The present study was
aimed to evaluate vitamin D and zinc levels in blood of psoriasis patients.
MATERIALS AND METHODS
All Patients with psoriasis who included in this study were attending the outpatient clinic of the
Dermatology department in Hilla hospital. The study was performed on 18 (11 male and 7 female) psoriatic
patients and 18 (10 male & 8 female) non-psoriatic healthy individuals (controls). A paper of information was
filled from each patient who includes name, age, sex, and presence of other autoimmune disease, occupation,
and family history of psoriasis. Blood sample (5 ml) was taken from each patient and control groups to evaluate
the levels of vitamin D by (i- Chroma technique) and Zinc according to the procedure that provided with the kit
(Spectrum Com. Egypt). The study results were calculated as mean ± S.D at p value less than 0.05 significant.
Results:
The results of this study were pointed to high incidence of psoriasis in male (61%) versus in female was
(38.9 %), and results show 13 (72%) cases out of 18 at age less or equal 40 years and only 5 cases (28%) were
above 40 years, also the control group was in the same age range as illustrated in table (1). Also the results show
the mean value of vitamin D level was decrease significantly in psoriasis patients (11.81 ng/ml) as compare with
control (29.55 ng/ml) as illustrate in table (2), and in same time the results of zinc concentration appeared low
level in patients (73.01 mg/dl) as compared with control (94.88 mg/dl) at P < 0.05 as explained in table (3).
Table 1: the frequency of gender and age among patients and control
Gender
Frequency No.
Percentage %
Patients
Male
11
61.1%
Female
7
38.9%
Control
Male
10
55.5%
Female
8
44.5%
Age
Patients
<40
13
72%
>40
5
28%
Control
<40
8
50%
>40
8
50%
Table 2: the mean value of vitamin D in psoriatic patients and control
Vitamin D
Mean (ng/ml)
SD
Patients
11.81
4.36
Control
29.55
7.52
P = 0.017
SD: standard deviation
Table 3: Comparison of zinc level between patients and control
Zinc
Mean (mg/dl)
SD
Patients
73.01
15.11
Control
94.88
7.71
P = 0.005
Discussion:
The present study showed the vitamin D level was decreased significantly in patients with psoriasis as
comparing with healthy control, and this may be as a result of scalping of skin cells that lead to exposure to sun
light which is a main source of vitamin D is few. Decreased level of vitamin D has great effects in the
pathogenesis of psoriasis. It acts directly on the receptor of vitamin D to control keratinocyte growth and
distinction, but also has an important effect on immune roles of dendritic cells and T lymphocytes (Maria et al.,

153 Dr. Salim Hussein Hassan Al-Greti and Jaafar Khalaf Ali, 2017
Australian Journal of Basic and Applied Sciences, 11(10) July 2017, Pages: 151-154
2014; Zuchi et al., 2015). Vitamin D3 effect on “the production of interleukin IL-2 and IL-6, blocks interferon
gamma transcription and granulocyte-macrophage colony-stimulating factor mRNA, as well as inhibits
cytotoxic T cells, B cells and natural killer cell action” (Gisondi et al., 2012). It also plays an important role as
an immune modulator in many dermatological diseases, as in psoriasis, atopic dermatitis, vitiligo, and alopecia
(Ricceri et al., 2013). The ancestor of vitamin D is 7-dehydrocholesterol that is located in the membranes of
keratinocytes of the basal and spinous layer of epidermis (Al-Jebory, 2012). By the action of UVB (wavelength
between 290 and 315 nm), through a photochemical reaction, the B ring of 7-dehydrocholesterol is destroyed to
form cholecalciferol (pre-vitamin D3), which is then transformed first to 25-hydroxyvitamin D (25OHD) by the
enzymatic reactions and then to 1, 25-hydroxyvitamin D or (calcitriol) which is the active form of vitamin D
(Ozturk et al., 2001). Physiologically, the active formula of vitamin D and its receptor control the distinction
and proliferation of keratinocytes, the balance of the cutaneous immune system and the process of apoptosis.
The 1, 25(OH) D has been shown to exert anti-proliferative effects on keratinocytes (Margit et al., 2015). Other
study was conducted on the psoriasis shown a relationship between vitamin D and psoriasis by compared the
levels of vitamin D in serum of psoriatic patients and controls that carried out by (Rocha et al., 2004) [24]. In
the study done by Gisondi et al. 2012 show that the patients with psoriasis have a two times higher risk of
vitamin D deficiency than healthy people. Ricceri et al. 2013 study found a vitamin D deficiency in 68% and
97% insufficiency in psoriatic patients, while in control group was only 10% with vitamin D deficiency and
about 53% insufficiency. The results of this study agreement with many previous studies (Orgaz-Molina et al.,
2012; Rocha et al., 2004; Tang et al., 2003) who stated vitamin D decreased significantly in patients with
psoriasis as compared with control subjects.
Regarding zinc concentration, there is a study was designed to estimate the zinc level in serum of patients
with psoriasis and its association with clinical types of disease, duration and surface area; the results has shown
a low level of serum zinc among patients in a percent of 98% and only 4% among controls (Al-Jebory, 2012). In
2015 Margit, et al. who study the role of serum copper and zinc in pathogenesis of psoriasis were stated the
mean value of serum zinc in severe Psoriasis is significantly low as compared to Controls. A current study was
concluded the levels of vitamin D and zinc in psoriatic patients’ serum were decreased significantly.
REFERENCES
Adams, J.S., M. Hewison, 2010. Update in vitamin D. J Clin Endocrinol Metab., 95(2): 471-8.
Al-Jebory, Adnan Abd Oun Hashim PhD., 2012. Serum zinc in psoriatic patients. Mustansiriya Medical
Journal, 11(2): 20-23.
Arnson, Y., H. Amital, Y. Shoenfeld, 2007. Vitamin D and autoimmunity: new etiological and therapeutic
considerations. Ann Rheum Dis., 66(9): 1137-42.
Ashwin B. Kuchekar, Rohini R. Pujari, Shantanu B. Kuchekar, Shashikant N. Dole and Payal M. Mule,
2011. Psoriasis: A comprehensive review, international journal of pharmacy and life sciences, 2(6): 857-877.
Bibi Nitzan Y and A.D. Cohen, 2006. Zinc in skin pathology and care. J Dermatol og Treat, 17: 205-10.
Carl, A Burtis, Edward Ashwood, David E Burns, 2012. Teitz Textbook of Clinical Chemistry and
Molecular diagnostics; Fifth edition, Chapter 31:Vitamin and trace elements, pp: 948-964.
Coleman, J.E., 1992. Zinc proteins: enzymes, storage proteins, transcription factors and replication proteins.
Annu Rev Biochem, 61: 897-946.
Gaal, J., G. Lakos, P. Szodoray, J. Kiss, I. Horvath, E. Horkay, et al., 2009. Immunological and clinical
effects of alphacalcidol in patients with psoriatic arthropathy: results of an open, follow-up pilot study. Acta
Derm Venereol, 89(2): 140-4.
Gisondi, P., M. Rossini, A. Di Cesare, L. Idolazzi, S. Farina, G. Beltrami, et al., 2012. Vitamin D status in
patients with chronic plaque psoriasis. Br J Dermatol, 166: 505-10.
Griffiths, C.E. and J.N. Barker, 2007. Pathogenesis and clinical features of psoriasis. Lancet, 370: 263-71.
Huckins, D., D.T. Felson, M. Holick, 1990. Treatment of psoriatic arthritis with oral 1,25-
dihydroxyvitamin D3: a pilot study. Arthritis Rheum, 33(11): 1723-7.
Jen, M., K.N. Shah, A.C. Yan, 2008. Cutaneous changes in nutritional diseases In: Goldswith LA, Katz SI
editors Fitzpatricks Dermatology in clinical medicine. 7th Ed. New York Mc Graw Hill, pp: 1209-16.
Maia, M., S.S. Maeda and C. Marçon, 2007. Correlation between photo protection and 25 hydroxyvitamin
D and parathyroid hormone levels. An Bras Dermatol., pp: 233-7.
Margit Gajjar, Dr.H.B. Sirajwala, Dr. Dipti Gajjar, Dr. Ipsa Pandya, 2015. role of serum copper and zinc in
pathogenesis of psoriasis. IOSR Journal of Biotechnology and Biochemistry (IOSR-JBB); 1(6): 77-81.
Maria Morales Suárez-Varela, Paloma Reguera-Leal, William B. Grant, Nuria Rubio-López and Agustín
Llopis-González, 2014. Vitamin D and Psoriasis Pathology in the Mediterranean Region, Valencia (Spain), Int.
J. Environ. Res. Public Health, 11: 12108-12117; doi: 10.3390/ijerph111212108.
Marques, C.D.L., A.T. Dantas, T.S. Fragoso and A.L.B.P. Duarte, 2010. The importance of vitamin D
levels in autoimmune diseases. Rev Bras Reum, 50: 73-80.

154 Dr. Salim Hussein Hassan Al-Greti and Jaafar Khalaf Ali, 2017
Australian Journal of Basic and Applied Sciences, 11(10) July 2017, Pages: 151-154
Orgaz-Molina, J., A. Buendía-Eisman, M.A. Arrabal-Polo, J.C. Ruiz, S. Arias-Santiago, 2012. Deficiency
of serum concentration of 25-hydroxyvitamin D in psoriatic patients: a case-control study. J J Am Acad
Dermatol, 67: 931-8.
Oztürk, G., D. Erbaş, E. Gelir, A. Gülekon and T. Imir, 2001. Natural killer cell activity, serum
immunoglobulins, complement proteins, and zinc levels in patients with psoriasis vulgaris. Immunol Invest,
30: 181-90.
Perez, A., R. Raab, T.C. Chen, A. Turner, M.F. Holick, 1996. Safety and efficacy of oral calcitriol (1,25-
dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol., 134(6): 1070-8.
Rahman, P. and J.I. Elder, 2005. Genetic epidemiology of psoriasis and psoriasis arthritis. Ann Rheum Dis.,
64(2): 37.
Ricceri, F., L. Pescitelli, L. Tripo and F. Prignano, 2013. Deficiency of serum concentration of 25-
hydroxyvitamin D correlates with severity of disease in chronic plaque psoriasis. J Am Acad Dermatol, 68: 511-
2. Rocha-Pereira, P., A. Santos-Silva, I. Rebelo, A. Figueiredo, A. Quintanilha and F. Teixeira, 2004. The
inflammatory response in mild and in severe psoriasis. Br J Dermatol., 150: 917-28.
Szodoray, P., B. Nakken, J. Gaal, R. Jonsson, A. Szegedi, E. Zold, et al., 2008. The complex role of vitamin
D in autoimmune diseases. Scand J Immunol., 68(3): 261-9.
Tang, L., Y. Yu, J. Chen et al., 2003. The inhibitory effect of VitD3 on proliferation of keratinocyte cell
line HACAT is mediated by down-regulation of CXCR2 expression. Clin. Exp. Dermatol, 28: 416-19. 25-25
Zuchi, M.F., P.O. Azevedo, A.A. Tanaka, J.V. Schmitt, L.E.A.M. Martins, 2015. Serum levels of 25-
hydroxy vitamin d in psoriatic patients. An Bras Dermatol., 90(3): 430-2.