**7. Conclusion**

Recent literature has provided plenty of information concerning the preventive and therapeutic role of vitamin D in many inflammatory diseases including psoriasis. Vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. Phototherapy (UVB and heliotherapy) improved psoriasis and lipid and carbohydrate status of the patients, increased serum 25(OH)D synthesis and reduced serum PTH concentrations. UVB therapy heals psoriasis and supplies these patients with vitamin D, which might have positive effects on bone status as well.

The beneficial role of vitamin D for psoriasis might be due to both a skin and systemic increase in vitamin D metabolism. Cutaneous 1,25(OH)2D generated in psoriatic skin after UVB exposure develops a growth-inhibitory effect on proliferating epidermal keratinocytes similar to topically applicated calcitriol. It is unknown if skin affected by diseases such as psoriasis or eczema differ in vitamin D production compared to normal skin. Further research is needed to achieve a more comprehensive understanding of the synthesis of vitamin D in psoriatic skin and the role of vitamin D status in the prevention and treatment of psoriasis.

#### **8. References**

132 Psoriasis

unrelated to serum 25(OH)D concentrations(130). Diet might also influence glucose and lipid metabolism. Although climate therapy did not change the basal glucose levels of the patients, the HbA1c levels decreased about 10 %, indicating improved insulin sensitivity (56). The observed associations between vitamin D, insulin, and glucose metabolism in humans have not yet been confirmed by intervention studies and, hence, a causal

A high prevalence of atherosclerosis is also reported in psoriasis patients. High serum lipid levels have been suggested in the pathogenesis of atherosclerosis. High serum lipid levels are more common in psoriasis and may be responsible for an elevated prevalence of cardiovascular accidents in this group of patients(137). Patients with psoriasis exhibit a dyslipidemic profile, including increased levels of plasma cholesterol, triglycerides (TG), LDL, very low-density lipoprotein (VLDL) cholesterol and decreased levels of HDL cholesterol. Lipid abnormalities in psoriasis patients may be genetically determined(138). The ratio of low-density lipoprotein cholesterol (LDL) and high-density lipoprotein cholesterol (HDL) decreased, and the levels of hemoglobin A1c (HbA1c) also decreased in psoriasis patients during heliotherapy(56). Serum concentrations of 25(OH)D at baseline in psoriasis patients treated with heliotherapy correlated positively with serum HDL at

Psoriasis is associated with obesity, which is a component of metabolic syndrome. Obesity has been shown to be an independent risk factor for the development of psoriasis, and is also associated with more severe psoriasis (140). Abdominal obesity is a proinflammatory state with the visceral adipose tissue providing a rich source of inflammatory molecules known as adipocytokines including leptin, adiponectin, visfatin and resistin. This may explain an important association between obesity, insulin resistance and related

Inflammation plays a key role in the pathogenesis of psoriasis and a number of chronic inflammatory systemic diseases listed above. Activated inflammatory cells and proinflammatory cytokines, such as TNF-α and IL-1β, contribute to the development of

Recent literature has provided plenty of information concerning the preventive and therapeutic role of vitamin D in many inflammatory diseases including psoriasis. Vitamin D inhibits proinflammatory processes by suppressing the enhanced activity of immune cells that take part in the autoimmune reaction. Phototherapy (UVB and heliotherapy) improved psoriasis and lipid and carbohydrate status of the patients, increased serum 25(OH)D synthesis and reduced serum PTH concentrations. UVB therapy heals psoriasis and supplies these patients with vitamin D, which might have positive effects on bone status as well.

The beneficial role of vitamin D for psoriasis might be due to both a skin and systemic increase in vitamin D metabolism. Cutaneous 1,25(OH)2D generated in psoriatic skin after UVB exposure develops a growth-inhibitory effect on proliferating epidermal keratinocytes similar to topically applicated calcitriol. It is unknown if skin affected by diseases such as psoriasis or eczema differ in vitamin D production compared to normal skin. Further research is needed to achieve a more comprehensive understanding of the synthesis of vitamin D in psoriatic skin

and the role of vitamin D status in the prevention and treatment of psoriasis.

association has not been established(130).

inflammatory disorders.

**7. Conclusion** 

baseline(56), consistent with a previously published study(139).

psoriatic lesions and play an important role in atherosclerosis (141).


UVB and Vitamin D in Psoriasis 135

[38] Muller K, Bendtzen K. 1,25-Dihydroxyvitamin D3 as a natural regulator of human immune functions. J Investig Dermatol Symp Proc. 1996 Apr;1(1):68-71. [39] Pinette KV, Yee YK, Amegadzie BY, Nagpal S. Vitamin D receptor as a drug discovery

[40] Tobler A, Gasson J, Reichel H, Norman AW, Koeffler HP. Granulocyte-macrophage

[41] Kang S, Yi S, Griffiths CE, Fancher L, Hamilton TA, Choi JH. Calcipotriene-induced

interleukin-10 levels within lesions. Br J Dermatol. 1998 Jan;138(1):77-83. [42] Michel G, Gailis A, Jarzebska-Deussen B, Muschen A, Mirmohammadsadegh A,

expression in human epidermal cells. Inflamm Res. 1997 Jan;46(1):32-4. [43] Nagpal S, Na S, Rathnachalam R. Noncalcemic actions of vitamin D receptor ligands.

alloreactive T cell activation. J Immunol. 2000 Mar 1;164(5):2405-11. [45] Adorini L, Penna G, Giarratana N, Uskokovic M. Tolerogenic dendritic cells induced by

and autoimmune diseases. J Cell Biochem. 2003 Feb 1;88(2):227-33.

chronic plaque psoriasis. Br J Dermatol. 1996 Sep;135(3):385-9.

plaque psoriasis. Br J Dermatol. 2002 Mar;146(3):414-22.

[44] Penna G, Adorini L. 1 Alpha,25-dihydroxyvitamin D3 inhibits differentiation,

[46] Bourke JF, Iqbal SJ, Hutchinson PE. The effects of UVB plus calcipotriol on systemic

[47] Fogh K, Kragballe K. Recent developments in vitamin D analogs. Curr Pharm Des. 2000

[48] Langner A, Ashton P, Van De Kerkhof PC, Verjans H. A long-term multicentre

[49] van de Kerkhof PC, Berth-Jones J, Griffiths CE, Harrison PV, Honigsmann H, Marks R,

[50] Kragballe K. Vitamin D and UVB radiation therapy. Cutis. 2002 Nov;70(5 Suppl):9-12. [51] Nguyen T, Gattu S, Pugashetti R, Koo J. Practice of phototherapy in the treatment of

[52] Barbagallo J, Spann CT, Tutrone WD, Weinberg JM. Narrowband UVB phototherapy for the treatment of psoriasis: a review and update. Cutis. 2001 Nov;68(5):345-7. [53] Storbeck K, Holzle E, Schurer N, Lehmann P, Plewig G. Narrow-band UVB (311 nm)

[54] Larko O. Treatment of psoriasis with a new UVB-lamp. Acta Derm Venereol.

[55] Schiener R, Behrens-Williams SC, Pillekamp H, Kaskel P, Peter RU, Kerscher M.

moderate-to-severe psoriasis. Curr Probl Dermatol. 2009;38:59-78.

for psoriasis. J Am Acad Dermatol. 1993 Feb;28(2 Pt 1):227-31.

colony-stimulating factor. Sensitive and receptor-mediated regulation by 1,25 dihydroxyvitamin D3 in normal human peripheral blood lymphocytes. J Clin

improvement in psoriasis is associated with reduced interleukin-8 and increased

Ruzicka T. 1,25-(OH)2-vitamin D3 and calcipotriol induce IL-10 receptor gene

maturation, activation, and survival of dendritic cells leading to impaired

vitamin D receptor ligands enhance regulatory T cells inhibiting allograft rejection

calcium homeostasis in patients with chronic plaque psoriasis. Clin Exp Dermatol.

assessment of the safety and tolerability of calcitriol ointment in the treatment of

et al. Long-term efficacy and safety of tacalcitol ointment in patients with chronic

versus conventional broad-band UVB with and without dithranol in phototherapy

Calcipotriol vs. tazarotene as combination therapy with narrowband ultraviolet B (311 nm): efficacy in patients with severe psoriasis. Br J Dermatol. 2000

target. Mini Rev Med Chem. 2003 May;3(3):193-204.

Invest. 1987 Jun;79(6):1700-5.

Endocr Rev. 2005 Aug;26(5):662-87.

1997 Nov;22(6):259-61.

Jun;6(9):961-72.

1989;69(4):357-9.

Dec;143(6):1275-8.


[19] Arnson Y, Amital H, Shoenfeld Y. Vitamin D and autoimmunity: new aetiological and therapeutic considerations. Ann Rheum Dis. 2007 Sep;66(9):1137-42. [20] Adams JS, Hewison M. Update in vitamin D. J Clin Endocrinol Metab. Feb;95(2):471-8. [21] Werner de Castro GR, Neves FS, Pereira IA, Fialho SC, Ribeiro G, Zimmermann AF.

[22] Hollox EJ, Huffmeier U, Zeeuwen PL, Palla R, Lascorz J, Rodijk-Olthuis D, et al.

[23] Okita H, Ohtsuka T, Yamakage A, Yamazaki S. Polymorphism of the vitamin D(3) receptor in patients with psoriasis. Arch Dermatol Res. 2002 Jul;294(4):159-62. [24] Dayangac-Erden D, Karaduman A, Erdem-Yurter H. Polymorphisms of vitamin D

[25] Park BS, Park JS, Lee DY, Youn JI, Kim IG. Vitamin D receptor polymorphism is

[26] Zuel-Fakkar NM, Kamel MM, Asaad MK, Mahran MZ, Shehab AA. A study of ApaI

[27] Gaal J, Lakos G, Szodoray P, Kiss J, Horvath I, Horkay E, et al. Immunological and

[28] Perez A, Raab R, Chen TC, Turner A, Holick MF. Safety and efficacy of oral calcitriol

[29] Huckins D, Felson DT, Holick M. Treatment of psoriatic arthritis with oral 1,25 dihydroxyvitamin D3: a pilot study. Arthritis Rheum. 1990 Nov;33(11):1723-7. [30] Feldman D, Chen T, Hirst M, Colston K, Karasek M, Cone C. Demonstration of 1,25-

[31] Provvedini DM, Tsoukas CD, Deftos LJ, Manolagas SC. 1,25-dihydroxyvitamin D3 receptors in human leukocytes. Science. 1983 Sep 16;221(4616):1181-3. [32] Morimoto S, Kumahara Y. A patient with psoriasis cured by 1 alpha-hydroxyvitamin

[33] Nagpal S, Lu J, Boehm MF. Vitamin D analogs: mechanism of action and therapeutic

[34] van der Vleuten CJ, Gerritsen MJ, Steijlen PM, de Jong EM, van de Kerkhof PC. A

[35] Pillai S, Bikle DD. Role of intracellular-free calcium in the cornified envelope formation

[36] Ratnam AV, Bikle DD, Cho JK. 1,25 dihydroxyvitamin D3 enhances the calcium

[37] Manolagas SC, Provvedini DM, Tsoukas CD. Interactions of 1,25-dihydroxyvitamin D3 and the immune system. Mol Cell Endocrinol. 1985 Dec;43(2-3):113-22.

associated with psoriasis. J Invest Dermatol. 1999 Jan;112(1):113-6.

open, follow-up pilot study. Acta Derm Venereol. 2009;89(2):140-4.

Rheumatol Int. Feb 3.

Dec;299(10):487-91.

Jun;134(6):1070-8.

1980 Dec;51(6):1463-5.

Genet. 2008 Jan;40(1):23-5.

Clin Exp Dermatol. Jun;36(4):355-9.

D3. Med J Osaka Univ. 1985 Mar;35(3-4):51-4.

applications. Curr Med Chem. 2001 Nov;8(13):1661-79.

of therapeutic options. Acta Derm Venereol. 1996 Jan;76(1):65-7.

response of keratinocytes. J Cell Physiol. 1999 Feb;178(2):188-96.

dihydroxyvitamin D3. J Cell Physiol. 1991 Jan;146(1):94-100.

Resolution of adalimumab-induced psoriasis after vitamin D deficiency treatment.

Psoriasis is associated with increased beta-defensin genomic copy number. Nat

receptor gene in Turkish familial psoriasis patients. Arch Dermatol Res. 2007

and TaqI genotypes of the vitamin D receptor in Egyptian patients with psoriasis.

clinical effects of alphacalcidol in patients with psoriatic arthropathy: results of an

(1,25-dihydroxyvitamin D3) for the treatment of psoriasis. Br J Dermatol. 1996

dihydroxyvitamin D3 receptors in human skin biopsies. J Clin Endocrinol Metab.

therapeutic approach to erythrodermic psoriasis: report of a case and a discussion

of keratinocytes: differences in the mode of action of extracellular calcium and 1,25


UVB and Vitamin D in Psoriasis 137

[71] Olds WJ, McKinley AR, Moore MR, Kimlin MG. In vitro model of vitamin D(3)

[72] Holick MF, MacLaughlin JA, Doppelt SH. Regulation of cutaneous previtamin D3

[73] Ryan C, Moran B, McKenna MJ, Murray BF, Brady J, Collins P, et al. The effect of

[74] Devgun MS, Paterson CR, Johnson BE, Cohen C. Vitamin D nutrition in relation to

[75] Armas LA, Hollis BW, Heaney RP. Vitamin D2 is much less effective than vitamin D3 in

[76] Holick MF. Vitamin D: A millenium perspective. J Cell Biochem. 2003 Feb 1;88(2):296-

[77] Chen TC, Chimeh F, Lu Z, Mathieu J, Person KS, Zhang A, et al. Factors that influence

[78] McCarty CA. Sunlight exposure assessment: can we accurately assess vitamin D

[79] Matsuoka LY, Wortsman J, Hollis BW. Use of topical sunscreen for the evaluation of regional synthesis of vitamin D3. J Am Acad Dermatol. 1990 May;22(5 Pt 1):772-5. [80] Morimoto S, Yoshikawa K. Psoriasis and vitamin D3. A review of our experience. Arch

[81] Lehmann B, Querings K, Reichrath J. Vitamin D and skin: new aspects for dermatology.

[82] Chesney RW, Rosen JF, Hamstra AJ, Smith C, Mahaffey K, DeLuca HF. Absence of

[83] Adams JS, Clemens TL, Parrish JA, Holick MF. Vitamin-D synthesis and metabolism

[84] Lips P, Wiersinga A, van Ginkel FC, Jongen MJ, Netelenbos JC, Hackeng WH, et al. The

[85] Bikle DD, Nemanic MK, Gee E, Elias P. 1,25-Dihydroxyvitamin D3 production by

[86] Vanhooke JL, Prahl JM, Kimmel-Jehan C, Mendelsohn M, Danielson EW, Healy KD, et

[87] Reichrath J. Vitamin D and the skin: an ancient friend, revisited. Exp Dermatol. 2007

[88] Lehmann B. The vitamin D3 pathway in human skin and its role for regulation of biological processes. Photochem Photobiol. 2005 Nov-Dec;81(6):1246-51.

in elderly subjects. J Clin Endocrinol Metab. 1988 Oct;67(4):644-50.

season and occupation. Am J Clin Nutr. 1981 Aug;34(8):1501-4.

humans. J Clin Endocrinol Metab. 2004 Nov;89(11):5387-91.

Photochem Photobiol B. 2008 Nov 13;93(2):88-93.

Ireland. Arch Dermatol. Aug;146(8):836-42.

6;211(4482):590-3.

2007 Apr 15;460(2):213-7.

Jul;53(1):139-42.

Jan 3;103(1):75-80.

Jul;16(7):618-25.

Dermatol. 1989 Feb;125(2):231-4.

Med. 1982 Mar 25;306(12):722-5.

Exp Dermatol. 2004;13 Suppl 4:11-5.

307.

(Cholecalciferol) synthesis by UV radiation: Dose-response relationships. J

photosynthesis in man: skin pigment is not an essential regulator. Science. 1981 Feb

narrowband UV-B treatment for psoriasis on vitamin D status during wintertime in

the cutaneous synthesis and dietary sources of vitamin D. Arch Biochem Biophys.

exposure from sunlight questionnaires? Am J Clin Nutr. 2008 Apr;87(4):1097S-101S.

seasonal variation in serum concentrations of 1,25-dihydroxyvitamin D despite a rise in 25-hydroxyvitamin D in summer. J Clin Endocrinol Metab. 1981

after ultraviolet irradiation of normal and vitamin-D-deficient subjects. N Engl J

effect of vitamin D supplementation on vitamin D status and parathyroid function

human keratinocytes. Kinetics and regulation. J Clin Invest. 1986 Aug;78(2):557-66.

al. CYP27B1 null mice with LacZreporter gene display no 25-hydroxyvitamin D3- 1alpha-hydroxylase promoter activity in the skin. Proc Natl Acad Sci U S A. 2006


[56] Osmancevic A, Nilsen LT, Landin-Wilhelmsen K, Soyland E, Abusdal Torjesen P,

[57] Osmancevic A, Landin-Wilhelmsen K, Larko O, Mellstrom D, Wennberg AM, Hulthen

[58] Osmancevic A, Landin-Wilhelmsen K, Larko O, Wennberg AM, Krogstad AL. Vitamin

[59] Osmancevic A, Landin-Wilhelmsen K, Larko O, Krogstad AL. Vitamin D status in

[60] Cicarma E, Mork C, Porojnicu AC, Juzeniene A, Tam TT, Dahlback A, et al. Influence of

[61] Vahavihu K, Ala-Houhala M, Peric M, Karisola P, Kautiainen H, Hasan T, et al.

[62] Osmancevic A, Nilsen LT, Landin-Wilhelmsen K, Soyland E, Abusdal Torjesen P,

[63] MacLaughlin J, Holick MF. Aging decreases the capacity of human skin to produce

[64] Barth J, Gerlach B, Knuschke P, Lehmann B. Serum 25(OH)D3 and ultraviolet exposure

[65] Holick MF, Matsuoka LY, Wortsman J. Age, vitamin D, and solar ultraviolet. Lancet.

[66] Need AG, Morris HA, Horowitz M, Nordin C. Effects of skin thickness, age, body fat,

[67] MacLaughlin JA, Anderson RR, Holick MF. Spectral character of sunlight modulates

[68] Lehmann B, Knuschke P, Meurer M. The UVB-induced synthesis of vitamin D3 and

[69] Leenutaphong V, Sudtim S. A comparison of erythema efficacy of ultraviolet B

[70] Porojnicu AC, Bruland OS, Aksnes L, Grant WB, Moan J. Sun beds and cod liver oil as vitamin D sources. J Photochem Photobiol B. 2008 May 29;91(2-3):125-31.

Dermatol Venereol. 2009 Oct;23(10):1133-40.

Oct;23(5):172-8.

Oct 22.

2009 Jun;25(3):119-23.

Photobiol B. Nov 3;101(2):117-23.

Br J Dermatol. Aug;163(2):321-8.

Dermatol Venereol. 2009 Apr 24.

Photomed. 1992 Oct;9(5):229-31.

1989 Nov 4;2(8671):1104-5.

May 28;216(4549):1001-3.

vitamin D3. J Clin Invest. 1985 Oct;76(4):1536-8.

Steroid Biochem Mol Biol. 2007 Mar;103(3-5):682-5.

Photomed. 1998 Jun-Aug;14(3-4):112-5.

Hagve TA, et al. Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis. J Eur Acad

L, et al. UVB therapy increases 25(OH) vitamin D syntheses in postmenopausal women with psoriasis. Photodermatol Photoimmunol Photomed. 2007

D production in psoriasis patients increases less with narrowband than with broadband ultraviolet B phototherapy. Photodermatol Photoimmunol Photomed.

psoriasis patients during different treatments with phototherapy. J Photochem

narrowband UVB phototherapy on vitamin D and folate status. Exp Dermatol. 2009

Narrowband ultraviolet B treatment improves vitamin D balance and alters antimicrobial peptide expression in skin lesions of psoriasis and atopic dermatitis.

Hagve TA, et al. Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis. J Eur Acad

of residents in an old people's home in Germany. Photodermatol Photoimmunol

and sunlight on serum 25-hydroxyvitamin D. Am J Clin Nutr. 1993 Dec;58(6):882-5.

photosynthesis of previtamin D3 and its photoisomers in human skin. Science. 1982

1alpha,25-dihydroxyvitamin D3 (calcitriol) in organotypic cultures of keratinocytes: effectiveness of the narrowband Philips TL-01 lamp (311 nm). J

irradiation from Philips TL12 and TL01 lamps. Photodermatol Photoimmunol


UVB and Vitamin D in Psoriasis 139

[105] Frediani B, Allegri A, Falsetti P, Storri L, Bisogno S, Baldi F, et al. Bone mineral density in patients with psoriatic arthritis. J Rheumatol. 2001 Jan;28(1):138-43. [106] Borman P, Babaoglu S, Gur G, Bingol S, Bodur H. Bone mineral density and bone turnover in patients with psoriatic arthritis. Clin Rheumatol. 2008 Apr;27(4):443-7. [107] Pedreira PG, Pinheiro MM, Szejnfeld VL. Bone mineral density and body composition

[108] Osmancevic A, Landin-Wilhelmsen K, Larko O, Mellstrom D, Wennberg AM, Hulthen

[110] Naldi L, Chatenoud L, Linder D, Belloni Fortina A, Peserico A, Virgili AR, et al.

[111] Fogelman I, Blake GM. Different approaches to bone densitometry. J Nucl Med. 2000

[112] Riggs BL. Pathogenesis of osteoporosis. Am J Obstet Gynecol. 1987 May;156(5):1342-6. [113] Cummings SR, Nevitt MC, Browner WS, Stone K, Fox KM, Ensrud KE, et al. Risk

[114] Johnell O, Gullberg B, Kanis JA, Allander E, Elffors L, Dequeker J, et al. Risk factors for

[115] Cummings SR, Melton LJ. Epidemiology and outcomes of osteoporotic fractures.

[116] Aniansson A, Zetterberg C, Hedberg M, Henriksson KG. Impaired muscle function

[117] Cooper C, Barker DJ, Wickham C. Physical activity, muscle strength, and calcium

[118] Silman AJ, O'Neill TW, Cooper C, Kanis J, Felsenberg D. Influence of physical activity

[119] Frandin K, Grimby G, Mellstrom D, Svanborg A. Walking habits and health-related

[120] Greendale GA, Barrett-Connor E, Edelstein S, Ingles S, Haile R. Lifetime leisure

[121] Chapuy MC, Arlot ME, Duboeuf F, Brun J, Crouzet B, Arnaud S, et al. Vitamin D3 and

Group. N Engl J Med. 1995 Mar 23;332(12):767-73.

Study. J Bone Miner Res. 1995 Nov;10(11):1802-15.

of the femur. Clin Orthop Relat Res. 1984 Dec(191):193-201.

Osteoporosis Study. J Bone Miner Res. 1997 May;12(5):813-9.

factors in a 70-year-old population. Gerontology. 1991;37(5):281-8.

Lancet. 2002 May 18;359(9319):1761-7.

Feb 7;13(1):R16.

Dec;80(6):1645-9.

Jul;125(1):61-7.

6.

15;141(10):951-9.

3;327(23):1637-42.

Dec;41(12):2015-25.

in postmenopausal women with psoriasis and psoriatic arthritis. Arthritis Res Ther.

L, et al. Risk factors for osteoporosis and bone status in postmenopausal women with psoriasis treated with UVB therapy. Acta Derm Venereol. 2008;88(3):240-6. [109] Tangpricha V, Turner A, Spina C, Decastro S, Chen TC, Holick MF. Tanning is

associated with optimal vitamin D status (serum 25-hydroxyvitamin D concentration) and higher bone mineral density. Am J Clin Nutr. 2004

Cigarette smoking, body mass index, and stressful life events as risk factors for psoriasis: results from an Italian case-control study. J Invest Dermatol. 2005

factors for hip fracture in white women. Study of Osteoporotic Fractures Research

hip fracture in European women: the MEDOS Study. Mediterranean Osteoporosis

with aging. A background factor in the incidence of fractures of the proximal end

intake in fracture of the proximal femur in Britain. Bmj. 1988 Dec 3;297(6661):1443-

on vertebral deformity in men and women: results from the European Vertebral

exercise and osteoporosis. The Rancho Bernardo study. Am J Epidemiol. 1995 May

calcium to prevent hip fractures in the elderly women. N Engl J Med. 1992 Dec


[89] Sigmon JR, Yentzer BA, Feldman SR. Calcitriol ointment: a review of a topical vitamin

[90] Tanghetti EA. The role of topical vitamin D modulators in psoriasis therapy. J Drugs

[91] Lehmann B, Knuschke P, Meurer M. UVB-induced conversion of 7-dehydrocholesterol

[92] Lehmann B, Sauter W, Knuschke P, Dressler S, Meurer M. Demonstration of UVB-

[93] Merke J, Schwittay D, Furstenberger G, Gross M, Marks F, Ritz E. Demonstration and

[95] Kim SK, Park S, Lee ES. Toll-like receptors and antimicrobial peptides expressions of

[96] van de Kerkhof PC. Biological activity of vitamin D analogues in the skin, with special reference to antipsoriatic mechanisms. Br J Dermatol. 1995 May;132(5):675-82. [97] Sahota O, Mundey MK, San P, Godber IM, Lawson N, Hosking DJ. The relationship

[98] Landin-Wilhelmsen K, Wilhelmsen L, Lappas G, Rosen T, Lindstedt G, Lundberg PA, et

[99] Webb AR, Kline L, Holick MF. Influence of season and latitude on the cutaneous

[100] Vieth R. Vitamin D supplementation, 25-hydroxyvitamin D concentrations, and safety.

[101] Landin-Wilhelmsen K, Wilhelmsen L, Bengtsson BA. Postmenopausal osteoporosis is

[102] Attia EA, Khafagy A, Abdel-Raheem S, Fathi S, Saad AA. Assessment of osteoporosis

[103] Millard TP, Antoniades L, Evans AV, Smith HR, Spector TD, Barker JN. Bone mineral

[104] Nymann P, Kollerup G, Jemec GB, Grossmann E. Decreased bone mineral density in patients with pustulosis palmaris et plantaris. Dermatology. 1996;192(4):307-11.

of neonatal and adult mice. Calcif Tissue Int. 1985 May;37(3):257-67. [94] Hosomi J, Hosoi J, Abe E, Suda T, Kuroki T. Regulation of terminal differentiation of

to 1 alpha,25-dihydroxyvitamin D3 (calcitriol) in the human keratinocyte line

induced synthesis of 1 alpha,25-dihydroxyvitamin D3 (calcitriol) in human skin by

characterization of 1,25-dihydroxyvitamin D3 receptors in basal cells of epidermis

cultured mouse epidermal cells by 1 alpha,25-dihydroxyvitamin D3.

psoriasis: correlation with serum vitamin D level. J Korean Med Sci.

between vitamin D and parathyroid hormone: calcium homeostasis, bone turnover, and bone mineral density in postmenopausal women with established

al. Serum intact parathyroid hormone in a random population sample of men and women: relationship to anthropometry, life-style factors, blood pressure, and

synthesis of vitamin D3: exposure to winter sunlight in Boston and Edmonton will not promote vitamin D3 synthesis in human skin. J Clin Endocrinol Metab. 1988

more related to hormonal aberrations than to lifestyle factors. Clin Endocrinol

in psoriasis with and without arthritis: correlation with disease severity. Int J

density of patients with chronic plaque psoriasis. Clin Exp Dermatol. 2001

D analog for psoriasis. J Dermatolog Treat. 2009;20(4):208-12.

HaCaT. Photochem Photobiol. 2000 Dec;72(6):803-9.

microdialysis. Arch Dermatol Res. 2003 Apr;295(1):24-8.

Dermatol. 2009 Aug;8(8 Suppl):s4-8.

Endocrinology. 1983 Dec;113(6):1950-7.

osteoporosis. Bone. 2004 Jul;35(1):312-9.

Am J Clin Nutr. 1999 May;69(5):842-56.

(Oxf). 1999 Oct;51(4):387-94.

Dermatol. Jan;50(1):30-5.

Jul;26(5):446-8.

vitamin D. Calcif Tissue Int. 1995 Feb;56(2):104-8.

Oct;25(10):1506-12.

Aug;67(2):373-8.


**1. Introduction** 

lot of attention in recent years.

The nail has four epithelial components:

circumstances, there is no granular layer.

**9** 

**Nail Psoriasis** 

*1Dept Dermatol, Inselspital, Univ Bern, Bern, 2Practice of Dermatology Dermaticum, Freiburg,* 

*4Dept Dermatol, Acad Hosp, Univ Gent, Gent,* 

*3Centro de Dermatología Epidermis, Instituto CUF, Porto,* 

During the 8th gestational week, a condensation of cells develops on the distal dorsal aspect of the digital tip. At week 9, this migrates proximally to form a flat groove, the nail field. At week 11, an invagination develops from the proximal groove, which later forms the nail pocket or cul-de-sac, with the matrix at its bottom. Nail production starts around week 13. At the age of 20 weeks, the nail production is similar to that of an adult. From week 32 on,

The nail apparatus consists of epithelial and connective tissue components and covers the tip of the fingers and toes (Figure 1) (Lewin, 1965, Morgan et al, 2001, Zook et al, 1980). Its functions are support, protection and maintenance of the digital tips as well as enhancement of the sensory functions of the digital pulps, and the nail is a tool for scratching, defense, fine manual work, etc. The cosmetic-aesthetic and social functions of the nail have attained a

 The matrix epithelium is the sole structure to produce the nail plate. It is commonly divided into the proximal, medial and distal matrix (Figure 2). The existence of a socalled dorsal matrix is controversial. Most of the matrix is covered by the proximal nail fold. Under normal circumstances, its distal portion, the whitish lunula, is only seen in the thumb, index and middle finger as well as the great toe; however, manicure with pushing the free margin of the proximal nail fold back makes more of the matrix visible

The matrix epithelium consists of a basal compartment seen as cuboid basophilic cells that migrate up to form the more eosinophilic superficial compartment (Perrin et al, 2004). Whenever a nail is avulsed the superficial compartment remains attached to it. During onychotisation, the superficial cells undergo nuclear fragmentation. Under normal

all nail components can be recognized (Lewis, 1954, Zaias, 1963).

through the nail and lets the nail plate appear longer.

Eckart Haneke

*1Switzerland 2Germany 3Portugal 4Belgium* 

