Serum folate levels after UVA exposure: a two-group parallel randomised controlled trial

Background  

Photodegradation of certain vitamins such as riboflavins, carotinoids, tocopherol, and folate has been well-documented. Previous observations suggest that ultraviolet (UV) radiation may cause folate deficiency. This is of great importance since folate deficiency is also known to be linked with the development of neural tube defects. To investigate the influence of UVA radiation on serum folate levels in vivo, we conducted a two-group randomised controlled trial on healthy subjects.     

慢性自发性荨麻疹患者血清25(OH)D和IL-25水平检测

目的：检测慢性自发性荨麻疹( CSU)患者血清中25(OH) D和IL-25的水平。方法：电化学发光方法和ELISA分别检测40例CSU患者及30例健康对照血清中的25(OH)D和IL-25水平。结果：CSU组血清25(OH) D水平为(19.48±7.41) ng/ mL低于对照组的(23.23±6.43) ng/mL,（P<0.05）。CSU组血清IL-25水平 为(124.59±19.32) pg/ mL高于对照组的(107.33±14.57) pg/ mL,差异有统计学意义(P<0.05)。结论：血清25(OH)D和IL-25水平可能与CSU发病相关。     

Serum 25‐hydroxyvitamin D serum levels in a large German cohort of patients with melanoma

Background Observational studies have suggested that 25‐hydroxyvitamin D [25(OH)D] is associated with better outcomes in patients with malignant melanoma (MM). Objectives To study the relationship between serum 25(OH)D levels and clinical parameters in a large German cohort of patients with MM. Methods We prospectively investigated the 25(OH)D serum levels of 764 patients with MM using the direct competitive chemiluminescence LIAISON^® immunoassay. Patients with MM who were taking 25(OH)D supplements were not included. Results Median serum 25(OH)D baseline levels were 12·3 ng mL^?1 (lower quartile: 7·3 ng mL^?1, upper quartile: 20·2 ng mL^?1). Of the 764 patients, 564 (73·8%) had 25(OH)D deficiency [25(OH)D < 20 ng mL^?1], 145 (18·8%) had 25(OH)D insufficiency [25(OH)D ≥ 20, < 30 ng mL^?1] and only 55 (7·2%) had serum 25(OH)D levels within the normal range (≥ 30 ng mL^?1). Using a multiple regression model, lower 25(OH)D levels were significantly associated with higher Breslow tumour thickness (class: < 1 mm; 1–4 mm; > 4 mm, regression coefficient ?1·45, P = 0·028) and higher American Joint Committee on Cancer 2002 melanoma stage (regression coefficient: ?0·79, P = 0·036). Conclusions In patients with MM, decreased 25(OH)D serum levels are associated with increased tumour thickness and advanced tumour stage. Hence, evidence is accumulating that patients with MM might benefit from 25(OH)D supplements.     

Serum levels of 25-hydroxy vitamin D in psoriatic patients

Studies have shown a relationship between vitamin D and psoriasis. We compared serum levels of vitamin D of 20 psoriasis patients and 20 controls. The median vitamin D level was 22.80 ± 4.60 ng/ml; the median in the cases was 23.55 ± 7.6 ng/ml, and in controls 22.35 ± 3.10 ng/ml (p = 0.73). Only 2 cases and 4 controls had sufficient levels of vitamin D, although without statistical significance between the groups (p = 0.608). Levels were lower in women with psoriasis compared with those in male patients (20.85 ± 6.70 x 25.35 ± 2.90 ng/ml, p = 0.03), a finding that was not observed among controls.     

The association of vitamin D receptor gene polymorphisms and serum 25-hydroxyvitamin D levels with generalized vitiligo

Summary Background Vitiligo is an acquired depigmentation autoimmune disorder that has been described as being associated with lower levels of 25-hydroxyvitamin D [25(OH)D]. Genetic variations within the vitamin D receptor (VDR) gene could lead to significant receptor dysfunction, and could further affect the formation of the biologically active 25(OH)D. Therefore, we hypothesized that VDR polymorphisms might be involved in vitiligo by affecting the formation of 25(OH)D. Objectives To evaluate the potential association between VDR polymorphisms and vitiligo susceptibility and the serum levels of 25(OH)D. Methods We performed a hospital-based study of 749 patients with vitiligo and 763 matched controls. We investigated four VDR polymorphisms (FokI, BsmI, ApaI and TaqI) to determine whether they are associated with vitiligo susceptibility in the Chinese population. In addition, the levels of 25(OH)D were measured to evaluate possible associations between the VDR polymorphic variants and clinical and laboratory findings of vitiligo. Results A significantly decreased risk of developing vitiligo was found to be associated with the BsmI-B, ApaI-A and TaqI-t alleles. According to the genotype distribution, 25(OH)D concentrations were significantly higher in patients carrying the FokI ff or ApaI AA genotypes compared with those carrying the FF or aa genotypes. Logistic regression analysis also showed a dose-response relationship between decreased risk of vitiligo and increased 25(OH)D levels in ApaI-A variant genotype carriers. Conclusions Our findings suggest that these VDR polymorphisms are associated with 25(OH)D levels and that there exists a genetic predisposition for vitiligo in the Chinese population.     

Expression of 25-hydroxyvitamin D3-1alpha-hydroxylase in subcutaneous fat necrosis

Background  The most serious complication of subcutaneous fat necrosis (SCFN), a rare condition of the newborn characterized by indurated purple nodules, is hypercalcaemia. However, the mechanism for this hypercalcaemia remains unclear.
Objectives  To determine whether the hypercalcaemia associated with SCFN involves expression of the vitamin D-activating enzyme 25-hydroxyvitamin D₃-1α-hydroxylase (1α-hydroxylase) in affected tissue.
Methods  Skin biopsies from two male patients with SCFN and hypercalcaemia were taken. The histological specimens were assessed using a polyclonal antibody against 1α-hydroxylase.
Results  Histology in both cases showed strong expression of 1α-hydroxylase protein (brown staining) within the inflammatory infiltrate associated with SCFN. This was consistent with similar experiments in other granulomatous conditions.
Conclusions  Hypercalcaemia in SCFN appears to be due to abundant levels of 1α-hydroxylase in immune infiltrates associated with tissue lesions. This is consistent with previous observations of extrarenal 1α-hydroxylase in skin from other granulomatous conditions such as sarcoidosis and slack skin disease.     

UVB phototherapy and skin cancer risk: a review of the literature

BACKGROUND: UVB phototherapy is a common treatment modality for psoriasis and other skin diseases. Although UVB has been in use for many decades, many clinicians are hesitant to use this type of phototherapy because of concern over increasing the skin cancer risk. Over the past 20 years, numerous studies have been published examining this issue, but a consensus or analysis of the skin cancer risk is required for the dermatologist to make an educated risk-benefit analysis. OBJECTIVE: To assess the risk of skin cancer associated with UVB phototherapy. METHODS: All prospective or retrospective studies were identified in MEDLINE from 1966 to June 2002. Bibliographies were searched to identify any additional studies examining this issue. All studies that attempted to quantify or qualify any additional skin cancer risk from UVB phototherapy were included. Study selection was performed by two independent reviewers. RESULTS: Eleven studies (10 of which concerned psoriasis patients), involving approximately 3400 participants, were included. Of note, three of the studies involved the same cohort: members of the 16-center US Psoralen plus UVA (PUVA) Follow-up Study: Other than the most recent Finnish study, all studies eventually showed no increased skin cancer risk with UVB phototherapy. One of the PUVA cohort studies examined genital skin cancers, and found an increased rate of genital tumors associated with UVB phototherapy, although this study has not been duplicated. CONCLUSION: The evidence suggests that UVB phototherapy remains a very safe treatment modality.     

Serum homocysteine,folate and vitamin B12 levels in patients with psoriasis: a systematic review and meta-analysis

Patients with psoriasis have an increased risk of coronary heart disease and stroke. It has been suggested that psoriasis causes raised blood levels of homocysteine. High levels of homocysteine are linked to atherosclerosis (“furring up” of the arteries). The breakdown of homocysteine is dependent on folic acid and vitamin B12. Low blood levels of folic acid have been reported in psoriasis, partly due to its consumption by increased cell turnover in the skin and partly due to reduced absorption in the gut. The authors, based in Taiwan, reviewed the published studies and confirmed that patients with psoriasis indeed had high levels of homocysteine and low levels of folic acid in their blood compared with controls (people without psoriasis). There was no difference in the blood levels of vitamin B12 between psoriasis patients and controls. The authors express a note of caution, since many other confounding factors may affect the results. However, they recommend testing homocysteine blood levels in psoriatic patients to identify those at risk of cardiovascular disease. Further studies are recommended, particularly to investigate whether giving folic acid or vitamin B12 reduces the risk of these complications.     

Narrowband UVB phototherapy for the treatment of psoriasis: a review and update.

An advance in UVB-based phototherapy has been the introduction of fluorescent lightbulbs (Philips TL-01) that deliver monochromatic light at 311-nm UVB, a narrowband wavelength that seems to maximize clearing of plaques relative to its erythrogenic potential. Narrowband UVB phototherapy has considerable advantages over traditional treatment options such as broadband UVB and psoralen plus UVA (PUVA). It is clearly more effective than broadband UVB, safer than PUVA, and well tolerated by patients when taken at suberythemogenic doses. Narrowband UVB represents an important new therapy for psoriasis.     

14~55岁特应性皮炎患者严重程度与维生素D、总IgE和嗜酸性粒细胞的相关性

目的探究青少年及成人特应性皮炎患者疾病严重程度与血清25-羟基维生素D、总IgE和嗜酸性粒细胞计数的相关性。方法参考SCORAD评分法评估112例青少年及成人特应性皮炎患者疾病严重程度,并检测患者及70例健康组血清25-羟基维生素D水平以及患者总IgE、嗜酸性粒细胞数计数。结果特应性皮炎组患者血清25-羟基维生素D水平(20.42±6.96)ng/mL明显低于健康组(28.68±7.85)ng/mL,差异有统计学意义(P=0.000<0.01)。重度患者血清25-羟基维生素D水平(18.93±7.06)ng/mL低于轻中度患者(21.62±6.70)ng/mL,差异有统计学意义(P=0.041<0.05);重度患者总IgE水平(5184.08±7533.82)IU/mL明显高于轻中度患者(1075.07±1777.37)IU/mL,差异有统计学意义(P=0.000<0.01);重度患者嗜酸性粒细胞计数升高(37/50)的比例明显高于轻中度患者(17/62),差异有统计学意义(P=0.000<0.01);血清25-羟基维生素D、总IgE、嗜酸性粒细胞计数均与SCORAD评分相关。结论青少年及成人特应性皮炎患者的血清25-羟基维生素D水平较健康人明显偏低,且与病情严重程度呈负相关;总IgE、嗜酸性粒细胞计数与病情严重程度呈正相关。     

Narrow-band UVB phototherapy combined with tacrolimus ointment in vitiligo: a review of 110 patients

BACKGROUND: Narrow-band ultraviolet B (NB-UVB) phototherapy and topical tacrolimus are included among the most innovative approaches to vitiligo. OBJECTIVE: To evaluate the efficacy and tolerability of combined treatment with NB-UVB and topical tacrolimus in vitiligo. METHODS: After informed consent, adult patients with chronic (> 1-year duration) stable vitiligo refractory to conventional treatments were enrolled in an open-labelled prospective study. Treatment regimen consists of once-daily application, in the evening, of tacrolimus 0.03% ointment to the lesions of the face, or tacrolimus 0.1% ointment to the vitiligous patches located on other areas. Concomitant NB-UVB phototherapy was performed twice weekly for 16 weeks. RESULTS: Study population included 110 patients (mean age, 42) with a total of 403 lesions. Within the treatment period, variable repigmentation was evident on more than 70% of lesions. Clinical response (repigmentation more than 50%) was observed in 42% of lesions. Response was strictly dependent on the site, being more frequent for face lesions (73%), followed by limbs (68%) and trunk (53.5%). The therapeutic effect on the extremities and genital areas was quite disappointing. Treatment was well tolerated. CONCLUSIONS: Our preliminary data suggest that the combination of topical tacrolimus with NB-UVB phototherapy can represent an alternative highly effective approach to refractory vitiligo located on the face, trunk and limbs. Long-term safety data and randomized controlled trials on a large number of patients are required.