Vitamin D for Patients with Rheumatologic Skin Disease

What is vitamin D?

Vitamin D, which acts as both a vitamin and a hormone, is essential for good health. It is a fat-soluble vitamin that can be obtained from certain  foods (fish, fortified dairy products, fortified cereal, eggs, mushrooms) as well as sunlight, especially ultraviolet-B light (sunburning rays). It is important for calcium regulation and bone health.

What happens if my vitamin D is low?

We have known for many years that vitamin D deficiency can lead to rickets in children, softening of the bones in adults (called osteomalacia), and decreased bone mineral density leading to fragile bones (called osteoporosis). More recently vitamin D deficiency has been linked to other health problems including autoimmune diseases, such as psoriasis and lupus, frequent colds, depression, and muscle and joint pain. Deficiency may even be associated with an increased risk for some internal cancers, but this remains controversial.

How can I make sure I have enough vitamin D?

Obtaining vitamin D from sunlight is not recommended for patients with autoimmune diseases such as lupus and dermatomyositis (DM), because sun exposure almost invariably causes flaring of these diseases.  Many patients with lupus and dermatomyositis are vitamin D deficient because they are so careful about avoiding the sun.    Patients with lupus and dermatomyositis need to get enough vitamin D in their diets, or add a vitamin D supplement to their medications.  Vitamin D replacement is especially important in patients with rheumatologic disease, since vitamin D deficiency may cause exacerbation of these conditions.

Patients with autoimmune skin diseases should have baseline vitamin D blood tests.  If the vitamin D level is low, replacement is very important.  Prescription strength vitamin D may be required if levels of vitamin D are significantly low.  Prescription strength vitamin D is usually taken once a week for eight weeks and then over the counter vitamin D supplements are recommended to keep the levels normal.  For patients with autoimmune skin disease who have normal vitamin D levels, over the counter vitamin D supplements are typically recommended for maintenance of adequate levels.  Over the counter supplementation usually starts at 1000 units per day, with elevation of the dose if this is not enough to keep the vitamin D level within normal range.

For more information

The Rheumatologic Dermatology Society (RDS) has compiled this list to give you a starting point for additional information. The RDS does not endorse or maintain these Web sites, and is not responsible for any information or claims provided on them. It is always best to talk with your dermatologist for more information and before making any decisions about your care.

UptoDate information on vitamin D

WebMD information on vitamin D