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**1. Introduction** 

**UVB and Vitamin D in Psoriasis** 

*Dept of Dermatology, Sahlgrenska University Hospital, Gothenburg,* 

Psoriasis is a chronic, inflammatory disease affecting the skin and potentially the joints. Both genetic and environmental factors are important in the etiology of the disease. Psoriasis is characterized by keratinocyte hyperproliferation, abnormal keratinocyte differentiation, and

Disease management is dependent on severity, psychosocial effects and the patient's lifestyle. Currently, psoriasis may be treated with phototherapy or by using various topical, systemic, and biologic drug treatments. Topical treatments include creams and ointments containing tar, dithranol, corticosteroids, salicylic acid or vitamin D-related compounds.

Vitamin D3 analogs inhibit proliferation, induce terminal differentiation of human keratinocytes and exhibit immunomodulating properties. Several studies have shown vitamin D analogs to be a safe, efficacious and long-term treatment option for psoriasis.

Phototherapy (broadband UVB, narrowband UVB (NBUVB) and heliotherapy – treatment with natural sunlight) is a commonly used treatment modality for widespread psoriasis. A similar wavelength spectrum of UVB (280-315 nm) is responsible for vitamin D synthesis in the skin. Vitamin D3, or cholecalciferol, is produced from 7-dehydrocholesterol in the basal epidermis when exposed to UVB, and is then hydroxylated in the liver into 25 hydroxyvitamin D [25(OH)D], which is the major circulating metabolite. Further hydroxylation into 1,25-dihydroxyvitamin D [1,25(OH)2D] occurs primarily in the kidneys. Hydroxylation in the kidneys is stimulated by parathyroid hormone (PTH) and suppressed by phosphate. Homeostatic mechanisms include parathyroid activity, serum calcium and serum 1,25(OH)2D3 itself. Vitamin D is an essential steroid not only for calcium homeostasis and skeletal health, but also for regulation of cellular growth, cell proliferation and cell differentiation. Vitamin D is obtained by skin production in response to UVB or by intake of vitamin D rich food or supplements. Vitamin D status is measured by serum/blood

The wavelength spectrum of UVB responsible for vitamin D synthesis (broadband UVB, 290-320 nm) has been used successfully for years to treat psoriasis and other chronic inflammatory skin disorders. This chapter aims to increase knowledge about the effects of UVB on vitamin D production during treatment with phototherapy in patients with psoriasis and to investigate the impact of UVB-induced vitamin D on psoriasis, bone, lipid

immune-cell infiltration into the epidermis and dermis.

concentration of its metabolite 25(OH)D.

Vitamin D3 analogs are also used in combination with phototherapy.

A. Osmancevic

 *Sweden* 

Wu, JJ. & Tsai, TF. (2008). Recurrent hyperglycemia during adalimumab treatment in a patient with psoriasis. *Arch Dermatol.,*144(10),1403-4. **8** 
