There is a known association between psoriasis and low levels of vitamin D. Gluten is thought to reduce vitamin D absorption, and a gluten-free diet (GFD) is often recommended for those with psoriasis.

Would it be beneficial to give suprapharmacologic doses of vitamin D3 in cases of severe psoriasis? Would vitamin D3 combined with acitretin (Soriatane) result in a synergistic action? — Brijesh Babio, MD, Delhi, India

Psoriasis has a similar inflammatory cytokine profile as celiac disease (CD); a GFD in CD patients improves the absorption of essential nutrients and prevents alimentary deficiencies of iron and certain vitamins.

An increased incidence of immunoglobulin (Ig)G/IgA antigliadin antibodies has been observed in individuals with psoriasis; in these patients, disease severity improved after three months of a GFD (Indian J Dermatol Venereol Leprol. 2010;76:103-115).

In a pilot study, psoriatic plaques resolved or moderately improved in two of eight psoriasis patients after two to six months of treatment with an oral vitamin D3 derivative (Mayo Clin Proc. 1993;68:835-841). Subsequently, a prospective randomized study of oral calcitriol (Rocaltrol) with acitretin compared with acitretin alone in psoriasis patients showed a greater reduction in the Psoriasis Area and Severity Index in the individuals receiving combination therapy (Acta Derm Venereol. 2007;87:449-450). — Philip R. Cohen, MD (172-3)


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