The 'sunshine vitamin' boosts overall health and can be an effective psoriasis treatment
Like many psoriasis patients, Caroline Carroll has had to experiment with different treatments after one stops working. But she's pretty sure keeping up with a healthy dose of vitamin D in her regimen makes a big difference.
"I have had the most success sunbathing or with my light box," says Carroll, 53, of Simi Valley, Calif., who has moderate plaque psoriasis on her trunk, elbows, knees, forearms and thighs. "I also switch up between using a strong cortisone, which works for awhile, and Vectical, which my dermatologist calls a new-generation vitamin D ointment." Long known as the "sunshine vitamin," vitamin D in your diet helps maintain healthy bones, says Richard Gallo, M.D., professor of medicine and pediatrics and chief of the dermatology division at the University of California-San Diego.
"It helps with the absorption and distribution of calcium in the body," Gallo says. "There is also quite a bit of evidence that is not as firmly established that it may be important in aspects of health—the prevention of cancer and maintenance of a normal and effective immune system."
For psoriasis patients, vitamin D has shown to be an effective treatment for a couple of reasons, Gallo says. "One of the effects of vitamin D is changing the way cells grow. Since the symptoms of psoriasis on skin include an increase of the skin's cells, if you put something on the skin that slows growth, (it) may cause the plaques to become thinner and less scaly. That may be one way it works. The other way is we also know vitamin D affects how the immune system functions. Since psoriasis is an abnormality in the function of the immune system, it could be that vitamin D is shifting the balance in a good way."
Two prescription medications—Vectical and Dovonex, which are applied to the skin—include vitamin D as their main active ingredient.
Edee Scott, 72, of Corona, Calif., says vitamin D medication has helped calm her psoriasis, which is most severe on the palms of her hands and feet. She's had psoriasis since age 14, but it's only in the past 15 years that her psoriasis "has taken on a life of its own," she says. "I've used Dovonex and Vectical," she says. "They work sometimes and sometimes they don't. I usually resort back to mineral oil. That seems to help me a lot."
Carroll, who developed psoriasis while pregnant with her third child at age 32, says she noticed a definite improvement in her skin after moving from Seattle to Southern California. She attributes this, in part, to sunnier weather. "Between the (vitamin D) ointment and the sun, I do find in the summer the psoriasis on my arms improves a lot," says Carroll, who wears sunscreen while enjoying outdoor activities such as hiking.
Vitamin D and overall health
For all its benefits, experts say it's important to know how best to incorporate vitamin D into your diet—for both overall health and as a psoriasis treatment. Being mindful of the amount you are getting also is wise since it is possible to have too much vitamin D.
"Vitamin D is one of the few vitamins that if you take too much of it, it can hurt you," Gallo says, citing potential problems in skin and hair as well as the possibility of developing kidney stones. "It takes a high level, but it can happen."
Health professionals continue to study vitamin D's effects on overall health, says Gallo, who suggests patients talk with their doctor for a recommended amount. A simple blood test can determine your current vitamin D levels, he says. "What we're trying to figure out is what's safe, what's adequate and how high you can go before it starts to be dangerous."
Contrary to popular belief, Gallo says it's not so much where you live as it is how you live when it comes to having sufficient levels of vitamin D. Those who are at the most risk for vitamin D deficiency are chronically ill individuals and the elderly who may be indoors quite often and have health problems.
"We know that complete absence of sun exposure and lack of adequate dietary vitamin D leads to deficient levels of vitamin D," he says.
While it's true that the sun is one way to get vitamin D, Gallo and other health professionals are quick to point out that too much sun is never smart. "There's been a lot of controversy over how best to get vitamin D," Gallo says. "If you're severely vitamin D deficient, a small amount of light will make a big difference in vitamin D levels. But if you have moderate levels of vitamin D and want more, it takes much more, and that degree (of sunlight) is carcinogenic. Light can't be the only source."
The American Academy of Dermatology continues to recommend obtaining vitamin D from nutritional sources and dietary supplements, and not from unprotected exposure to ultraviolet (UV) radiation from the sun or indoor tanning devices, as UV radiation is a known risk factor for developing skin cancer.
According to the Academy, which updated its position statement on vitamin D in 2009, individuals who regularly and properly practice sun protection, such as the daily use of sunscreen on exposed skin or the wearing of sun protective clothing, may be at risk for vitamin D insufficiency. This means a higher dose of vitamin D may be necessary for these individuals and others with known risk factors for vitamin D insufficiency, such as those with dark skin, the elderly, photosensitive individuals, people with limited sun exposure, obese individuals or those with fat malabsorption.
So how else can you ensure you have adequate vitamin D in your diet? Consuming certain foods such as wild fish and some types of mushrooms, fortified cereals and milks, and dietary supplements are the other ways to obtain the vitamin, Gallo says.
Some topical treatments—Dovonex perhaps being the most well known—contain an "active" form of vitamin D. This is different from the vitamin D (also known as vitamin D3) found in dietary supplements as well as in sunlight.
"When we swallow vitamin D, it goes into our blood and tissue but our liver and kidney change it to this active form," Gallo says. "We recently discovered that skin cells can convert it into the active form. The topical drugs are a form of vitamin D3 in its active form."
Phototherapy is another way psoriasis patients can get vitamin D, though Gallo wouldn't recommend it as a means to up your vitamin D levels. "Using phototherapy is going to cause some increase in your vitamin D levels, but I would not rely on that as evidence you have adequate vitamin D. What I would recommend is that you see your doctor and have a vitamin D blood test. Psoriasis patients, like any other patients, need to be worried about skin cancer."
Edee Scott had been using light therapy three times weekly with some success but recently returned to using the vitamin D ointments Vectical and Dovonex after the UV light began making her psoriasis worse, she says. "Because I've had such adverse reactions to the light treatments, I've been using the ointments, which are soothing," she says.
Even so, she remains frustrated with topical medications— and many other psoriasis treatments—that work only for a while. "I think the vitamin D can be helpful, but it's not a long-term thing, at least for me. It's off and on. But I'm 72 and I'm in pretty good health outside of psoriasis complications. And it doesn't hold me down."