Serum 25-hydroxyvitamin D levels in patients with skin diseases including psoriasis, infections, and atopic dermatitis

Figures & data

Figure 1. Scatter Plot of Serum 25(OH)D Levels Relative to Patient Age of Study Population (Fig. 1a) and Healthy Subgroup (Fig. 1b). Data are shown as box and whisker plots, whereby the box extends from the 25th percentile to the 75th percentile, with a horizontal line at the median (50th percentile) and the whiskers extend down to the smallest value and up to the largest.

Table 1. Distribution of diagnoses sorted by the size of the subpopulation in descending order.

Diseases	n	M	F	Mean 25(OH)D level [ng/mL]	Standard Deviation	25(OH)D level % ≤ 20 ng/mL	Mean age (y)
Atopic dermatitis	205	89	116	24.2	11.5	39.0%	36.3
Psoriasis vulgaris	180	100	80	22.6	10.7	43.9%	49.4
Non-atopic eczema	133	67	66	25.0	12.7	38.3%	47.2
Vitiligo	113	57	56	24.5	10.9	41.2%	38.2
Male pattern baldness	111	22	89	32.1	16.9	20.7%	46.6
Severe acute and/or chronic infectious diseases of the skin	94	48	46	19.2	9.5	66.0%	44.3
Acne vulgaris	86	31	55	27.4	14.5	27.9%	21.2
Others	80	33	47	27.1	9.9	26.3%	48.2
Rosacea subtype II (papulopustular rosacea)	70	24	46	25.6	12.3	30.0%	53.7
Allergic rhinitis	69	33	36	27.0	12.6	36.2%	35.7
Hand eczema	68	24	44	25.3	12.7	38.2%	44.9
Chronic urticarial	42	19	23	25.4	13.0	33.3%	44.8
Malign tumour of the skin	28	17	11	21.4	12.1	55.2%	70.2
Acne tarda	23	3	20	26.8	14.7	39.1%	40.1
Pruritus	23	14	9	23.5	12.2	52.2%	65.7
Perioral dermatitis	22	0	22	26.6	17.5	45.5%	46.5
Food allergy	19	6	13	20.8	9.8	52.6%	38.2
Rosacea subtype I (erythematotelangiectatic rosacea)	18	6	12	32.5	13.9	5.6%	49.3
Severe allergic reaction	16	8	8	18.4	8.9	62.5%	50.9
Alopecia areata	15	6	9	21.3	12.1	46.7%	38.8
Acne conglobata	11	5	6	21.0	5.3	36.4%	20.1
Prurigo	11	7	4	21.6	9.3	54.5%	57.5
Lichen planus	10	5	5	31.2	24.1	40.0%	63.1
Allergic Asthma	6	3	3	17.4	12.2	50.0%	45.2
Burn out syndrome	5	5	0	19.0	9.4	40.0%	43.2
Rosacea conglobata	2	0	2	14.0	1.7	100.0%	36.5
Subgroup a (total)	1,461	632	829	24.9	12.7	38.9%	43.5
Healthy subgroup b	71	17	54	44.1	10.7	1.4%	49.2

¹ severe acute skin infections mean for example zoster. acute abscess. severe impetigo and chronic recurrent skin infections mean for example chronic abscesses. severe chronic folliculitis. severe recalcitrant pityriasis versicolor. etc.

² subgroup of inflammatory skin diseases (e.g. granuloma anulare. lupus erythematosis) with smaller numbers of patients.

Figure 2. Median Serum 25(OH)D Levels (ng/mL ± SD) in Atopic Dermatitis and Psoriasis in Comparison with the Whole Study Population and Healthy Controls at their First Appointment in our Centre. Data are shown as box and whisker plots, whereby the box extends from the 25th percentile to the 75th percentile, with a horizontal line at the median (50th percentile) and the whiskers extend down to the smallest value and up to the largest. Note : As the data are not normally distributed, we performed the non-parametric Kruskal-Wallis test in combination with Dunn's post-hoc test to compare the respective diagnostic groups.

Table 2. Comparative significance calculation of the most frequent diagnoses also in comparison to the healthy subgroup regarding the mean values of 25(OH)D in the serum. Differences between groups were analyzed using the Kruskal-Wallis nonparametric ANOVA with Dunn's post-hoc test. Diagnoses are listed according to the size of the corresponding subgroup.

DUNN'S POST-HOC TEST	AD	Psoriasis vulgaris	Non-atopic eczema	Vitiligo	Male pattern baldness	Infectious diseases	Acne vulgaris	Rosacea subtype II	Allergic rhinitis	Hand eczema	Chronic urticaria	Healthy subgroup
AD		0.080	0.301	0.432	<0.001	<0.001	0.059	0.225	0.081	0.371	0.419	<0.001
Psoriasis vulgaris	0.080		0.039	0.086	<0.001	0.007	0.004	0.039	0.009	0.091	0.149	<0.001
Non-atopic eczema	0.301	0.039		0.383	<0.001	<0.001	0.152	0.376	0.179	0.468	0.448	<0.001
Vitiligo	0.432	0.086	0.383		<0.001	<0.001	0.104	0.289	0.127	0.433	0.467	<0.001
Male pattern baldness	<0.001	<0.001	<0.001	<0.001		<0.001	0.021	0.005	0.025	0.002	0.006	<0.001
Infectious diseases	<0.001	0.007	<0.001	<0.001	<0.001		<0.001	<0.001	<0.001	<0.001	0.004	<0.001
Acne vulgaris	0.059	0.004	0.152	0.104	0.021	<0.001		0.276	0.485	0.171	0.189	<0.001
Rosacea subtype II	0.225	0.039	0.376	0.289	0.005	<0.001	0.276		0.299	0.365	0.360	<0.001
Allergic rhinitis	0.081	0.009	0.179	0.127	0.025	<0.001	0.485	0.299		0.193	0.208	<0.001
Hand eczema	0.371	0.091	0.468	0.433	0.002	<0.001	0.171	0.365	0.193		0.477	<0.001
Chronic urticaria	0.419	0.149	0.448	0.467	0.006	0.004	0.189	0.360	0.208	0.477		<0.001
Healthy subgroup	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001	<0.001

Table 3. Correlations of diagnosis-specific severance indicators with 25(OH) vitamin D serum level.

	Correlation with Vitamin D serum levels	p-value	n
DLQI Value
DLQI Atopic dermatitis	0.107	0.27	106
DLQI Psoriasis vulgaris	0.077	0.43	109
VAS Pruritus
VAS Atopic dermatitis	−0.065	0.42	155
PGA
PGA Psoriasis vulgaris	0.035	0.70	118
PGA Atopic dermatitis	−0.089	0.27	155

¹ Note: Correlations are calculated as Spearman's Rho.

Table 4. Variation of definitions of vitamin D status.

Vitamin D Council Definition^Citation67	Endocrine Society Definition^Citation26^,^Citation68	Institute of Medicine Definition^Citation69	“Central Europe”^Citation70
Deficient: 0–40 ng/mL	Deficiency ≤ 20 ng/mL	Risk/deficiency ≤12 ng/mL	Deficient: ≤ 20 ng/mL
Sufficient: 40–80 ng/mL	Insufficiency = 20–29 ng/mL	Risk/insufficiency = 12–20 ng/mL	Suboptimal: 20–30 ng/mL
High normal: 80–100 ng/mL	Preferred range = 40–60 ng/mL	Sufficient = 20 ng/mL	Optimal: 30–50 ng/mL

Table 5. Relationship between 25(OH)D serum levels or oral vitamin D supplementation and clinical activity of atopic dermatitis [changed and updated according to Quirk SK et al.²⁰].

Negative (inverse) correlation	Positive (direct) correlation	No significant correlation
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^a Authors could not find a significant difference between serum vitamin D levels of 95 AD patients and 58 healthy controls. Vitamin D supplementation, however, improved clinical scores of patients.

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