Indian J Dermatol Venereol Leprol. 2013 Nov-Dec;79(6):750-8. doi: 10.4103/03786323.120720.

The role of vitamin D in melanogenesis with an emphasis

on vitiligo.
AlGhamdi K1, Kumar A, Moussa N.

Author information
Abstract
Vitiligo is a common pigmentary disorder caused by the destruction of
functional melanocytes. Vitamin D is an essential hormone synthesized in the
skin and is responsible for skin pigmentation. Low levels of vitamin D have
been observed in vitiligo patients and in patients with other autoimmune
diseases. Therefore, the relationship between vitamin D and vitiligo needs to
be investigated more thoroughly. We reviewed the literature to date regarding
the role of vitamin D in skin pigmentation. Our review revealed that vitamin D
deficiency has been identified in many conditions, including premature and
dysmature birth, pigmented skin, obesity, advanced age, and malabsorption.
Vitamin D increases melanogenesis and the tyrosinase content of cultured
human melanocytes by its antiapoptotic effect. However, a few growthinhibitory effects on melanocytes were also reported. Vitamin D regulates
calcium and bone metabolism, controls cell proliferation and differentiation,
and exerts immunoregulatory activities. Vitamin D exerts its effect via a
nuclear hormone receptor for vitamin D. The topical application of vitamin D
increased the number of L-3,4-dihydroxyphenylalanine-positive melanocytes.
The topical application of vitamin D yields significant results when used in
combination with phototherapy and ultraviolet exposure to treat vitiligo in
humans. Vitamin D decreases the expression of various cytokines that cause
vitiligo. In conclusion, application of vitamin D might help in preventing
destruction of melanocytes thus causing vitiligo and other autoimmune
disorders. The association between low vitamin D levels and the occurrence
of vitiligo and other forms of autoimmunity is to be further evaluated

Vitamin D status and the effects of oral

vitamin D treatment in children with
vitiligo: A prospective study
Glay Karagzel
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, Nil P. Sakarya, Sevgi Bahadr, Seluk Yaman, Ayenur kten

DOI: http://dx.doi.org/10.1016/j.clnesp.2016.05.006 |

Article Info

AbstractFull TextImagesReferences

Summary
Background & aims
Vitiligo is a pigmentary disorder and autoimmune pathogenesis seems
most likely. Decreased vitamin D levels have been related to several
autoimmune diseases. Little is known about the association of vitiligo and
vitamin D. We aimed to evaluate serum 25-hydroxyvitamin D [25(OH)D]
levels in children with vitiligo and to determine the efficacy of oral vitamin
D therapy on the repigmentation of vitamin D deficient patients.

Methods

Thirty patients aged 617 years with vitiligo and 30 sex- and age-matched
apparently healthy controls were included in this prospective study. Size of
the vitiligo representative area was estimated using the point counting
method and blood samples were obtained at the beginning and month six.
By the end of the study, all patients treated with topical tacrolimus for six
months and the patients who were vitamin D deficient (n = 14) had been
on combination treatment of oral vitamin D and topical tacrolimus. A dose
of 1500 IU/day vitamin D was given if the serum 25(OH)D levels
<20 ng/ml and 3000 IU/day was given if the levels <10 ng/ml for six
months. Serum 25(OH)D levels were measured by high-performance liquid
chromatography.

Results
Serum 25(OH)D levels of patients and controls were not significantly
different (p > 0.05). Lesion size decreased from 66.1 58.3 cm2 to
48.0 52.6 cm2 after six months of treatment in patients who received
combination treatment (p < 0.001) and increased in patients who received
only topical therapy from 34.8 48.1 cm2 to 53.5 64.9 cm2 (p < 0.01).

Conclusions

Although we did not determine decreased serum 25(OH)D levels in

children with vitiligo, we showed that combination treatment with oral
vitamin D and topical tacrolimus is more effective in reaching
repigmentation than topical tacrolimus alone. Oral vitamin D
supplementation might be useful for children with vitiligo who are also
deficient in vitamin D.

Keywords:

25-Hydroxyvitamin D, Children, Oral vitamin D, vitiligo

abbreviation:

25(OH)D (25-hydroxy vitamin D)

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This study was presented as a poster at ESPE 2013, Milan, Italy.
2016 European Society for Clinical Nutrition and Metabolism. Published
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Low 25-hydroxyvitamin D levels are

associated with vitiligo: a systematic
review and meta-analysis

Authors

Sikarin Upala,Close author notes

1

Department of Internal Medicine, Bassett Medical

Center and Columbia University College of Physicians and
Surgeons, Cooperstown, NY, USA
2
Department of Preventive and Social Medicine,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand

Search for more papers by this authorAnawin

author notesCorresponding

1
2

SanguankeoClose

author

ORCID:orcid.org/0000-0002-3662-4136
Department of Internal Medicine, Bassett Medical
Center and Columbia University College of Physicians and
Surgeons, Cooperstown, NY, USA
3
Department of Preventive and Social Medicine,
Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok,
Thailand
4
Correspondence: Anawin Sanguankeo, M.D.,
Department of Internal Medicine, Bassett Medical Center, 1 Atwell
Road, Cooperstown, NY 13326, USATel: +1 607 547 4805Fax: +1
607 547 6612e-mail: anawin.sanguankeo@bassett.org
Search for more papers by this author

First published: 14 April 2016Full publication history

DOI: 10.1111/phpp.12241View/save citation
Cited by: 0 articlesCitation tools

;
;

Conflicts of interest:The authors declare that they have no financial

conflicts of interest related to this study.
Source(s) of support:None.

Summary
Background

Vitamin D deficiency is associated with a number of

autoimmune diseases. We completed a meta-analysis of

observational studies to establish whether there was a

relationship between hypovitaminosis D and the autoimmune
skin disease vitiligo.

Methods
Comprehensive search was applied in the MEDLINE and
EMBASE databases from their inception to December 2015.
Inclusion criteria were observational studies that assessed 25hydroxyvitamin D (25(OH)D) levels in adults with vitiligo. The
main outcome was the mean difference in serum 25(OH)D level
between patients with vitiligo and controls.

Results
Our search strategy identified 383 articles; seventeen studies
met the criteria for full-length review and seven studies,
containing the data of 1200 patients, were included in a
random-effects model meta-analysis. The pooled mean
difference in serum 25-hydroxyvitamin D concentration between
patients with vitiligo and controls was 7.45 ng/ml (95%
confidence interval, 12.99 to 1.91, P-value = 0.01). The
between-study heterogeneity (I2) was 96%, P = value<0.001.

Conclusions
This meta-analysis identifies a significant relationship between
low 25-hydroxyvitamin D levels and vitiligo, but does not prove
causation. Our findings emphasize the importance of
measuring 25-hydroxyvitamin D levels in patients with vitiligo.
Further studies will be needed to establish whether vitamin D
supplementation in this population improves the outcome of
vitiligo.

A pilot study assessing the role of 25

hydroxy vitamin D levels in patients with

vitiligo vulgaris
Jonathan I. Silverberg, MD, PhD, MPH, Arnold I. Silverberg, MD,
Edmond Malka, MPH, CPH, CSci, CChem, MRSC, FAIC, Nanette B.
Silverberg, MD
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See commentary on page 942
DOI: http://dx.doi.org/10.1016/j.jaad.2009.11.024

AbstractFull TextReferences

Background

Very low vitamin D levels have been noted in patients with a variety of
autoimmune diseases.

Objective
To determine whether low vitamin D levels are associated with
autoimmunity in the setting of vitiligo vulgaris.

Methods

A prospective cohort study was conducted on 45 consecutive patients with

vitiligo vulgaris. 25-Hydroxyvitamin D levels were determined from sera
collected at the time of study enrollment. Logistic regression analysis of
the relationship of 25-hydroxyvitamin D levels to disease state was
performed, including surface area, recent-onset vitiligo, Fitzpatrick skin
type and ethnicity, dairy intake, and both personal and family history of
autoimmunity. Multiple univariate and multivariate logistic regression
models were developed to assess the interrelationship of these
parameters.

Results
25-Hydroxyvitamin D levels were divided into 3 groups: 31.1% were
normal (>30 ng/mL), 55.6% were insufficient (<30 ng/mL), and 13.3%
were very low (<15 ng/mL). Insufficient 25-hydroxyvitamin D levels were
associated with increasing Fitzpatrick phototypes (odds ratio [OR] = 1.76,
95% confidence interval [CI] = 1.12-2.77). Very low 25-hydroxyvitamin D
levels were associated with comorbid autoimmune illness (OR = 10.00,
95% CI = 1.06-94.7), but not with age, gender, race/ethnicity, family
history of vitiligo or autoimmune disease, new-onset disease, or body
surface area affected. None of the surveyed patients reported daily
vitamin D intake of greater than 200 IU.

Limitations

This study consists of a small cohort that assesses point prevalence

without assessing seasonal variation in vitamin D levels.

Conclusions
Very low 25-hydroxyvitamin D levels (<15 ng/mL) appear to be a
reasonable screening tool for the presence of comorbid autoimmunity.
Furthermore, we demonstrate that Fitzpatrick phototype, rather than
ethnicity, is specifically associated with 25-hydroxyvitamin D levels that
are insufficient (<30 ng/mL).