Patients with acne should be screened for vitamin D deficiency and insufficiency, according to researchers of a recent study investigating vitamin D's link to acne.
Vitamin D deficiencies are more frequent in people with acne than in healthy controls, report Ghadah Alhetheli and her coauthors in a first-ever study1 on this topic in the Kingdom of Saudi Arabia. “This difference is statistically significant with P-value=0.003,” adds Alhetheli, MD, assistant professor, Department of Dermatology and Cutaneous Surgery, College of Medicine, Qassim University, Buraidah, Saudi Arabia. However, researchers found no significant difference between lower serum 25-hydroxyvitamin D (25 OH) levels and the severity of acne, nor were there substantive variations based on age, gender and sun exposure.
“The precise purpose of vitamin D has yet to be established,” writes Alhetheli and her col- leagues. However, because of vitamin D's regulatory effect on the immune system as well as its antioxidant and anti-comedogenic properties, deficiencies could contribute to the pathogenesis of acne.2 Alhetheli's cross-sectional study evaluates serum levels of vitamin D through a representative sample and investigates any correlation with acne severity.
They conducted their study in outpatient dermatology clinics at Qassim University, Saudi Arabia between October 2016 and March 2017 to minimize the effect of seasonal variations on serum vitamin D levels. They enrolled 68 patients with acne vulgaris (27 male, 41 female) and 50 matched healthy controls (24 male, 26 female). Subjects in the patient and control groups had not taken any vitamin D supplementation and were not suffering from any comorbidity or complication of vitamin D deficiency.
Acne grading was classified as mild in 21 patients (30.88%), moderate in 24 (38.24%), and severe in 21 (30.88%). Inclusion criteria required that male and female patients had been diagnosed with acne vulgaris according to the global acne grading system (GAGS) score. Baseline demographics show that patients with acne were younger than healthy controls, with a mean standard deviation (SD) for males with acne in the study of 20.7 ± 3.8 and 21.3 ± 3.6 for females with acne versus 39.8 ± 11.8 for males in the control group and 39.8 ± 14.85 for females.
Blood samples were collected from patients’ veins and analyzed within 24 hours of sampling using the Roche Cobas e411 (Roche Diagnostic Systems, Rotkreuz, Switzerland). Serum 25-hydroxyvitamin D3 [25 (OH) D] in patients and controls were categorized into adequate(>20 ng/mL), inadequate (12–20 ng/ mL), or deficient (<12 ng/mL),2 following the guidelines of the Food and Nutrition Board of Medicine.
“Our results indicate that serum concentrations of vitamin D in controls were significantly higher than those in acne vulgaris patients (P-value = 0.003),” writes Alhetheli. “These results are in line with several other studies that found no elevation of serum vitamin D levels in acne patients.”3, 4, 5, She adds that the study data show no relationship between sun exposure and improvement in vitamin D readings in patients with acne.
“This can be explained by several factors, such as the impact of psychological distress on patients with acne’s avoidance of spending extended periods outdoors. This suggests a possible explanation of low vitamin D levels in patients with acne vulgaris,” writes Alhetheli. “These results were consistent with Lim et al who revealed that lower levels of serum vitamin D in severe acne vulgaris patients might be due to psychological stress.3
“We found no significant association between vitamin D deficiency and gender (P-value = 0.199),” says Alhetheli. “The results of our study indicate the mean value of vitamin D was abetted higher in moderate acne (31.4±6.9) than in mild and severe acne. (26±9.4 and 28.4±6.7, respectively). This difference was not statistically significant (P-value =0.067), perhaps due to the small sample size of our study. Also, we found no significant relationship between vitamin D deficiency and the severity of acne vulgaris.”
She adds, “This study reveals a statistical significantly low serum vitamin D levels in patients with acne vulgaris. This highlights the importance of screening patients with acne for vitamin D insufficiency and deficiency... Further clinical trials are needed to determine if acne treatment with both topical vitamin D analogs and vitamin D supplementation is of significant effect.”
The authors report no conflicts of interest in this work.
1. AlhetheliG, ElneamAIA,AlsenaidA,Al-DhubaibiM.VitaminDLevelsinPatientswith and without Acne and Its Relation to Acne Severity: A Case-Control Study. Clin Cosmet Investig Dermatol. 2020;13:759-765 https://doi.org/10.2147/CCID.S271500
2. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Calcium and Vitamin D. Washington, DC: National Academy Press; 2010.
3. Yildizgören MT, Togral AK. Preliminary evidence for vitamin D deficiency in nodulocystic acne. Dermatoendocrinol. 2015;6(1):e983687. doi:10.4161/derm.29799
4. Lim SK, Ha JM, Lee YH, et al. Comparison of vitamin D levels in patients with and withoutAcne:aCase-ControlStudyCombinedwitharandomizedcontrolledtrial. PLoS One. 2016;11(8): e0161162. doi:10.1371/journal.pone.0161162
5. Toossi P, Azizian Z, Yavari H, Fakhim T H, Amini S H, Enamzade R. Serum 25- hydroxy vitaminD levels in patients with acne vulgaris and its association with disease severity. Clin Cases Miner Bone Metab. 2015;12(3):238–242. doi:10.11138/ ccmbm/2015.12.3.238