Department of Dermatology and Venereology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, 413 45 Gothenburg, Sweden.
Center for Clinical Research Dalarna, Uppsala University, 791 82 Falun, Sweden.
Int J Mol Sci. 2024 Aug 8;25(16):8632. doi: 10.3390/ijms25168632.
Vitamin D plays a role in inflammatory skin disease, but the exact mechanisms and the clinical significance remain unclear. According to the free hormone hypothesis, it is the free concentration of 25-hydroxy vitamin D (25(OH)D) that is biologically active. Vitamin D-binding protein (DBP) acts as the major transporter of vitamin D in the circulation, and DBP concentration defines the free 25(OH)D levels. DBP levels are elevated in various inflammatory conditions, including psoriasis. Narrowband-ultraviolet B (NB-UVB) is the most widely used phototherapy and is an established first-line treatment for psoriasis and atopic dermatitis (AD), often used before proceeding to systemic treatment. The aim of this study was to investigate the influence of NB-UVB phototherapy on DBP and high-sensitivity C-reactive protein (hsCRP) levels, as markers of systemic inflammation, in inflammatory skin disease. Thirty adults (psoriasis ( = 20) and AD ( = 10)) were treated with NB-UVB. Serum DBP, hsCRP, total and free 25(OH)D, and 1,25-dihydroxy vitamin D (1,25(OH)D) were measured before and after NB-UVB. Disease severity was assessed with Psoriasis Area and Severity Index (PASI), SCORing Atopic Dermatitis (SCORAD), and Visual Analogue Scale (VAS). DBP decreased in psoriasis patients and varied with no clear trend in AD patients. HsCRP decreased in both groups, but this did not reach statistical significance. PASI, SCORAD, and VAS improved, and vitamin D levels increased after NB-UVB. Sub-analysis indicated a better response to NB-UVB for patients with vitamin D deficiency and insufficiency compared to vitamin D-sufficient patients. The decrease in DBP after NB-UVB in psoriasis patients suggests a potential systemic anti-inflammatory effect of phototherapy. Measurement of vitamin D levels may potentially serve as a tool to identify patients who would derive the greatest benefit from NB-UVB phototherapy.
维生素 D 在炎症性皮肤病中发挥作用，但确切机制和临床意义仍不清楚。根据游离激素假说，具有生物活性的是 25-羟维生素 D（25（OH）D）的游离浓度。维生素 D 结合蛋白（DBP）作为循环中维生素 D 的主要转运蛋白，而 DBP 浓度决定了游离 25（OH）D 水平。DBP 水平在各种炎症性疾病中升高，包括银屑病。窄谱-中波紫外线（NB-UVB）是最广泛使用的光疗方法，是银屑病和特应性皮炎（AD）的既定一线治疗方法，通常在进行系统治疗之前使用。本研究旨在探讨 NB-UVB 光疗对炎症性皮肤病中作为全身炎症标志物的 DBP 和高敏 C 反应蛋白（hsCRP）水平的影响。30 名成年人（银屑病（=20）和 AD（=10））接受 NB-UVB 治疗。在 NB-UVB 治疗前后测量血清 DBP、hsCRP、总 25（OH）D、游离 25（OH）D 和 1,25-二羟维生素 D（1,25（OH）D）。用银屑病面积和严重程度指数（PASI）、特应性皮炎评分（SCORAD）和视觉模拟评分（VAS）评估疾病严重程度。银屑病患者的 DBP 下降，AD 患者的 DBP 变化无明显趋势。两组 hsCRP 均下降，但无统计学意义。PASI、SCORAD 和 VAS 改善，NB-UVB 后维生素 D 水平升高。亚分析表明，与维生素 D 充足的患者相比，维生素 D 缺乏和不足的患者对 NB-UVB 的反应更好。银屑病患者 NB-UVB 后 DBP 下降提示光疗具有潜在的全身抗炎作用。维生素 D 水平的测量可能是识别从 NB-UVB 光疗中获益最大的患者的一种工具。
