Journal of Dermatological
Science,
1 (1990) 211-282
Elsevier DESC 00032
Inverse relation between severity of psoriasis and serum 1,25=dihydroxyvitamin D level Shigeto Morimoto, Kunihiko Yoshikawa’, Keisuke Fukuo, Tsunehito Shiraishi, Eio Koh, Shunji Imanaka, Shoichi Kitano, and Toshio Ogihara Department of Geriatric Medicine, and ‘Department
of Dermatoloo,
Osaka University Medical School, Fukushima-ku,
Osaka,
Japan
(Received 6 May 1989; accepted
Key words: 1,25-Dihydroxyvitamin
14 March 1990)
D; Psoriasis;
Clinical severity
Abstract
The serum levels of calcium, inorganic phosphate, parathyroid hormone, calcitonin, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured in 34 patients with psoriasis vulgaris and compared with the severity of skin lesions. Severity of psoriasis was evaluated by three indices, the area-severity index (ASI), the area index (AI) and the severity index (SI), determined as the product of the area and severity, the area, and the severity of the individual skin lesions, respectively. The mean basal levels of these serum parameters were within the normal range. AS1 and SI showed significant inverse correlations (r = - 0.387, P < 0.05 and r = - 0.638,P < 0.01, respectively) with the serum level of 1,25-dihydroxyvitamin D, but not with any other serum parameters, but AI was not correlated with any of these serum parameters. These data suggest that psoriatic patients are not deficient in 1,25-dihydroxyvitamin D, but that development of this skin disease may be related to a slightly decreased level of active metabolites of vitamin D or abnormalities in the responsiveness of the skin cells to them.
Introduction Psoriasis is a chronic inflammatory skin disease characterized by rapid turnover of epidermal keratinocytes, and showing topical symptoms such as erythema, infiltration, and desquamation of the skin lesions. Some cases of various forms of this skin disease have been found to show disturbances in systemic calcium metabolism [l-3]. Association of mild hypocalcemia with Correspondence to: Shigeto Morimoto, Department of Geriatric Medicine, Osaka University Medical School, Fukushima-ku, Osaka 553, Japan.
0923-181 l/90/$03.50
0 1990 Elsevier Science Publishers
pustular psoriasis of von Zumbush, a rather severe form of psoriasis, has been observed [ 11. Reportedly, hypoparathyroidism may cause the onset or aggravate psoriasis in patients with surgical hypoparathyroidism and primary hypoparathyroidism [2]. Association of the disease with pseudohypoparathyroidism was also reported
[31. Moreover, we showed that topical application of 1,25dihydroxyvitamin D, [ 1,25-(OH),D,], a well known calcitropic hormone, improved skin lesions of psoriatic patients [4,5]. Although the basal levels of calcium-related factors in the circulation were within normal ranges in our previous
B.V. (Biomedical
Division)
218
cases [4,5], we did not study their relation to the severity of the skin lesions in patients with psoriasis vulgar-is, the most common form of psoriasis. In the present work, we examined the serum levels of calcium-related factors, including 1,25_dihydroxyvitamin D [ 1,25-(OH),D] in patients with psoriasis vulgaris, as possible factors related to the severity of the skin lesions, A significant negative correlation was found between the serum concentration of 1,25-(OH),D and the degree of severity of the skin lesions. Materials and Methods Patients Studies were made on 34 patients with psoriasis vulgar-is who visited the dermatology clinic of Osaka University Hospital. These patients consisted of 19 males and 15 females with a mean (k SD) age of 47.5 k 16.1 years (range 16-77 years; mean for males, 49.5 _+ 14.0 years; mean for females, 44.9 f. 18.6 years). They had been suffering from psoriasis vulgar-is for 9.6 + 7.4 years (range 0.2-37 years). None of them received and systemic or topical medication that might alter calcium or vitamin D metabolism. Physical examination and laboratory tests showed no abnormalities except psoriasis vulgaris. The diagnosis of psoriasis was made by experienced dermatologists on the basis of macroscopic observation of the skin lesions, characterized by erythematous plaques of various sizes with silver-white scales. At the time of blood sampling, all other medications for psoriasis had been stopped for at least two months, except topical application of white petrolatum. No medication that might alter Ca metabolism was given to any of these patients. Blood sampling for assays was done between 8 : 00 and 9 : 00 a.m. after the patients had fasted overnight. Sera obtained by centrifugation were frozen and kept at - 20 “C until assayed. Determination of clinical severity of psoriasis The severity of psoriasis was determined on the basis of total area of the skin lesions and
severity of the individual psoriatic skin lesions by a modification of a previous method [ 61. Briefly, the three main body areas were assessed as the trunk (t), the upper extremities (u) and the lower extremities (l), corresponding to 30, 20 and 40% of the total body area, respectively. The head area, corresponding to the remaining 10%) was not included, because skin lesions in this area are not easy to evaluate correctly. The area of psoriatic involvement of these three main areas (At, Au and Al) was assigned a numerical value: 0 = no involvement ; 1=
Science,
1 (1990) 211-282
Elsevier DESC 00032
Inverse relation between severity of psoriasis and serum 1,25=dihydroxyvitamin D level Shigeto Morimoto, Kunihiko Yoshikawa’, Keisuke Fukuo, Tsunehito Shiraishi, Eio Koh, Shunji Imanaka, Shoichi Kitano, and Toshio Ogihara Department of Geriatric Medicine, and ‘Department
of Dermatoloo,
Osaka University Medical School, Fukushima-ku,
Osaka,
Japan
(Received 6 May 1989; accepted
Key words: 1,25-Dihydroxyvitamin
14 March 1990)
D; Psoriasis;
Clinical severity
Abstract
The serum levels of calcium, inorganic phosphate, parathyroid hormone, calcitonin, 25-hydroxyvitamin D and 1,25-dihydroxyvitamin D were measured in 34 patients with psoriasis vulgaris and compared with the severity of skin lesions. Severity of psoriasis was evaluated by three indices, the area-severity index (ASI), the area index (AI) and the severity index (SI), determined as the product of the area and severity, the area, and the severity of the individual skin lesions, respectively. The mean basal levels of these serum parameters were within the normal range. AS1 and SI showed significant inverse correlations (r = - 0.387, P < 0.05 and r = - 0.638,P < 0.01, respectively) with the serum level of 1,25-dihydroxyvitamin D, but not with any other serum parameters, but AI was not correlated with any of these serum parameters. These data suggest that psoriatic patients are not deficient in 1,25-dihydroxyvitamin D, but that development of this skin disease may be related to a slightly decreased level of active metabolites of vitamin D or abnormalities in the responsiveness of the skin cells to them.
Introduction Psoriasis is a chronic inflammatory skin disease characterized by rapid turnover of epidermal keratinocytes, and showing topical symptoms such as erythema, infiltration, and desquamation of the skin lesions. Some cases of various forms of this skin disease have been found to show disturbances in systemic calcium metabolism [l-3]. Association of mild hypocalcemia with Correspondence to: Shigeto Morimoto, Department of Geriatric Medicine, Osaka University Medical School, Fukushima-ku, Osaka 553, Japan.
0923-181 l/90/$03.50
0 1990 Elsevier Science Publishers
pustular psoriasis of von Zumbush, a rather severe form of psoriasis, has been observed [ 11. Reportedly, hypoparathyroidism may cause the onset or aggravate psoriasis in patients with surgical hypoparathyroidism and primary hypoparathyroidism [2]. Association of the disease with pseudohypoparathyroidism was also reported
[31. Moreover, we showed that topical application of 1,25dihydroxyvitamin D, [ 1,25-(OH),D,], a well known calcitropic hormone, improved skin lesions of psoriatic patients [4,5]. Although the basal levels of calcium-related factors in the circulation were within normal ranges in our previous
B.V. (Biomedical
Division)
218
cases [4,5], we did not study their relation to the severity of the skin lesions in patients with psoriasis vulgar-is, the most common form of psoriasis. In the present work, we examined the serum levels of calcium-related factors, including 1,25_dihydroxyvitamin D [ 1,25-(OH),D] in patients with psoriasis vulgaris, as possible factors related to the severity of the skin lesions, A significant negative correlation was found between the serum concentration of 1,25-(OH),D and the degree of severity of the skin lesions. Materials and Methods Patients Studies were made on 34 patients with psoriasis vulgar-is who visited the dermatology clinic of Osaka University Hospital. These patients consisted of 19 males and 15 females with a mean (k SD) age of 47.5 k 16.1 years (range 16-77 years; mean for males, 49.5 _+ 14.0 years; mean for females, 44.9 f. 18.6 years). They had been suffering from psoriasis vulgar-is for 9.6 + 7.4 years (range 0.2-37 years). None of them received and systemic or topical medication that might alter calcium or vitamin D metabolism. Physical examination and laboratory tests showed no abnormalities except psoriasis vulgaris. The diagnosis of psoriasis was made by experienced dermatologists on the basis of macroscopic observation of the skin lesions, characterized by erythematous plaques of various sizes with silver-white scales. At the time of blood sampling, all other medications for psoriasis had been stopped for at least two months, except topical application of white petrolatum. No medication that might alter Ca metabolism was given to any of these patients. Blood sampling for assays was done between 8 : 00 and 9 : 00 a.m. after the patients had fasted overnight. Sera obtained by centrifugation were frozen and kept at - 20 “C until assayed. Determination of clinical severity of psoriasis The severity of psoriasis was determined on the basis of total area of the skin lesions and
severity of the individual psoriatic skin lesions by a modification of a previous method [ 61. Briefly, the three main body areas were assessed as the trunk (t), the upper extremities (u) and the lower extremities (l), corresponding to 30, 20 and 40% of the total body area, respectively. The head area, corresponding to the remaining 10%) was not included, because skin lesions in this area are not easy to evaluate correctly. The area of psoriatic involvement of these three main areas (At, Au and Al) was assigned a numerical value: 0 = no involvement ; 1=
