Correlation of Serum Vitamin D in Psoriasis in a Tertiary Care Hospital

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International Journal of Medical Science and Current Research (IJMSCR)

Available online at: www.ijmscr.com

Volume2, Issue 3,Page No: 407-411

May-June 2019

407

Medicine ID-101739732

Correlation of Serum Vitamin D in Psoriasis in a Tertiary Care Hospital

1

Mohd Ramzan Bhatti, 2Shabnam Sarfraz, 3Majid Ali Sarfraz 1

MD Dermatology, Senior Resident, 2MD Pathology, Senior Resindent, 3Resident ENT, GMC Rajouri J&K

*Corresponding Author: Shabnam Sarfraz

MD Pathology, Senior Resindent GMC Rajouri J&K

Type of Publication: Original Research Paper Conflicts of Interest: Nil

ABSTRACT

Aims: To study relationship between vitamin D3 and Psoriasis. Material and Methods: Hospital based case control study with 20 patients of psoriasis and 20 age and sex matched control were undertaken. A detailed history was taken and examination including PASI was done. Other systemic involvement like psoriatic arthropathy, nail involvement was also noted. Results: Mean vitamin D3 level was not significantly different between psoriasis patients and controls. Mean vitamin D3 level in cases was 20.48 ± 8.51and that in controls was22.80 ± 9.46. However, vitamin D3 level were significantly lower in females as compared to males in both cases and controls Conclusion: In our study there is no correlation between vitamin D3 level and severity of psoriasis.

Keywords: Psoriasis, Vitamin D, Dermatologist.

INTRODUCTION

Psoriasis is chronic systemic immune mediated polygenic dermatological disorder [1] with a prevalence of 2-3% in general population worldwide [2]. Although cause of psoriasis remains idiopathic, there is increased evidence suggesting that psoriasis is a complex systemic disorder caused by interaction of multiple genes, environmental factors and immune system [3]. Low level of vitamin D is associated with development of some autoimmune diseases [4]. Vitamin D regulates both innate and adaptive immunity [5]. Vitamin D is important in proliferation and differentiation of keratinocytes. Recently the role of vitamin D in the pathogenesis of various skin diseases including psoriasis has been reported [6-8]. From many years vitamin D analogues are used for treatment of psoriasis. In this study we analyse possible correlation between vitamin D and psoriasis.

Materials and Methods

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examination including type of lesions, extent of disease, body mass index (BMI), PASI of patient along with local examination of psoriatic plaque were undertaken. Estimation of serum vitamin D level were undertaken. Severity of PASI score was graded as mild, moderate and severe with scores of <5, 5-10, >10 respectively. Revised body mass index (BMI) for Asian Indian recommended by World Health Organisation (WHO). WHO was considered as reference value and interpreted as follows, <18.5- underweight, 18.5-23- Normal, 23-27.5- overweight, >27.5- obese. Deficiency, insufficiency and normal level of serum vit D was considered at level <20ng/ml, 20-30ng/ml and 30-100ng/ml respectively.

Results

A total of 20 patients with psoriasis and 20 age and sex matched controls were included in this study. 12 were Male and 8 were female with Male: Female ratio of 3:2. Average age was 43.05 ±16.11 years in cases and 43.30±15.94 years in controls. Majority of psoriasis patients (65%) belongs to age group 31-60yrs. Table 1 showing demographic profile and clinical characteristics. Table 2 showing mean and standard deviation of various parameters in patients with and without psoriasis.

15 (75%) patients has psoriasis for <5 years duration whereas 5 (25%) has >5 years duration. The mean duration of psoriasis was 3.72 years. Out of 20 patients. 1(5%) patients had associated psoriatic arthropathy, 2(10%) had guttate psoriasis and 1(5%) patients had each Erythrodermic psoriasis and Pustular psoriasis. 1(5%) patient consume alcohol and 3(15%) patients smoke on regular basis. It was significantly less in control, only 2(10%) smoked and none was consuming alcohol. Among 20 patients with psoriasis 6(30%) has severe disease, 9(45%) has moderate disease. 5(25%) patients has mild disease. The mean PASI with psoriasis was 8.61. There was a/no significant association between duration of the disease and severity of psoriasis ( P = 0.001) In our study 90% of patients with psoriasis and 85% of patients without psoriasis had lower levels of Vitamin D. There is no significant difference seen in levels of

Vitamin D among cases and controls (P = 0.21). We

found that psoriasis patients with severe disease were among those with Vitamin D deficiency. However, it was not significant correlation between severity of

association was found between serum Vitamin D levels and duration of disease (P = 0.275).

Discussion

The severity of psoriasis did not correlate with vitamin D levels.

Table 1: Demographic and clinical characteristics

Group

Study n(%) Control n(%)

Age

15-30 4 (20) 4 (20)

31-45 8 (40) 8 (40)

46-60 5 (25) 5 (25)

>60 3 (15) 3 (15)

Sex

Male 12 (60) 12 (60)

Female 8 (40) 8 (40)

Duration(years)

<1 4 (20) -

1-5 11 (55) -

>5 5 (25) -

PASI

<5(mild) 5 (25) -

5-10(moderate) 9 (45) -

>10(severe) 6 (30) -

BMI

Underweight 4 (20) 3 (15)

Normal 12 (60) 13 (65)

Overweight 3 (15) 2 (10)

Obese 1 (5) 2 (10)

Psoriasis type

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410

CPP+ psoriatic arthritis 1 (5) -

Guttate 2 (10) -

Erythroderma 1 (5) -

Pustular psoriasis 1 (5) -

Serum vitamin D

Deficient 12 (60) 10 (50)

Insufficient 6 (30) 7 (35)

Sufficient 2 (10) 3 (15)

CPP: Chronic plaque psoriasis, PASI: Psoriasis Area and Severity Index, BMI: Body mass index.

Table 2: Mean and standard deviation of various parameters in patients with and without psoriasis

Patients with Control without

Psoriasis psoriasis

Mean±SD Mean±SD

Age (years) 43.05 ± 16.11 43.30 ± 15.94

BMI (kg/m²) 21.03 ± 16.11 21.54 ± 3.40

PASI 8.61 ± 4.64 NA

Vitamin D (ng/ml) 20.48 ± 8.51 22.80 ± 9.46

PASI: Psoriasis Area and Severity Index, BMI: Body mass index.

Table 3: Studies showing association between vitamin D and psoriasis

Study by Place of study Cases (n) Control

(n)

Mean value (ng/ml) P

Chandrashekar et

al.17

Puducherry, India

43 43 Cases -13.3±6.9

Control-22.4±18.4 0.004

Al-Mutairi et al.18 Kuwait 100 100 Cases-31.5±14.41

Control-53.5±19.6 0.005

Atwa et al.11 Egypt 43 43 Cases-11.74±1.74

Control-24.55±9.3 0.000

Studies showing no association between vitamin D and psoriasis

Zuchi et al.19 Brazil 20 20 Cases-23.55±7.60

Control-22.35±3.10

0.735

Morimoto et al.20 Japan 34 24 Cases-22±7

Control-21±15

NS

Wilson 5 USA 148 5693 Cases-24.2±1.5

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