Vitamin D Shows Promise in Treating Skin Injured by Cancer Therapy

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A report published January 15 in the journal Disaster Medicine and Public Health Preparedness discusses the use of high-dose vitamin D in 2 patients, 1 with acute radiation dermatitis and 1 with acute radiation recall dermatitis following chemotherapy.¹

Both patients saw improvement in their pain and swelling after treatment with high-dose oral vitamin D.

The 2 female patients were being treated for breast cancer.They each received one dose of 50,000 – 100,000 IU oral ergocalciferol (vitamin D2) with a repeat dose 1 week later.

In this study, patient 1, who had acute radiation dermatitis, required systemic and topical steroids along with oral opiates for pain control prior to the addition of high-dose vitamin D, according to the report. Following intervention with high-dose vitamin D, she had significant subjective improvement in pain and swelling within 3 to 7 days. The patient is currently alive, and her disease is in remission.

Patient 2 developed radiation recall dermatitis 1 week following administration of navelbine. She also experienced improvement in her acute symptoms of swelling and burning pain following vitamin D treatment, but due to carcinoma en cuirasse of the left breast skin, she continued to have induration and developed skin ulceration with fibrinous and necrotic crusting, according to the report. This patient ultimately developed further systemic metastases and died from disease progression.

Although the patients both received vitamin D2, “vitamins D3 and D2 are known to have comparable physiological and biological function,” coauthor Kurt Lu, MD, told Dermatology Times. “We have treated several patients with both forms based on availability and the clinical setting interchangeably.” He noted that vitamin D3 has been used in the outpatient or home setting and vitamin D2 on an inpatient basis with similar outcomes.

“We have previously reported that vitamin D helps mitigate certain forms of skin rash from chemotherapy,”² Lu said. “Our studies are ongoing to better understand how it helps heal the skin for patients undergoing chemotherapy and radiotherapy.”

Regarding the safety of high-dose vitamin D, the authors noted, “in a meta-analysis of 7 clinical trials that included 716 critically ill patients, administration of single vitamin D doses ranging from 200,000 to 600,000 IU demonstrated no significant adverse events, especially in calcium levels or renal function.”³ In fact, patients in these trials who received high-dose vitamin D demonstrated a significant reduction in mortality compared to placebo groups, they added.

Oral vitamin D has been shown to reduce inflammation from sunburn.⁴ In a double-blinded, placebo-controlled interventional trial, 20 healthy adults were randomized to receive either placebo or a high dose (200,000 IU) of cholecalciferol (vitamin D3) one hour after experimental sunburn induced by an erythemogenic dose of UVR.

Compared with placebo, participants receiving vitamin D3 demonstrated reduced expression of proinflammatory mediators tumor necrosis factor-α (P = 0.04) and inducible nitric oxide synthase (P = 0.02) in skin biopsy specimens 48 hours after experimental sunburn, the researchers reported.

Other studies have shown that patients’ vitamin D status when experiencing burn injury affects their injury outcomes.^5,6 Those patients who were vitamin D deficient or insufficient upon hospital admission had worse outcomes than those who had sufficient levels, providing further evidence of vitamin D’s ability to ameliorate skin injury due to burns.

References

1. Nguyen CV, Lu KQ. Vitamin D3 and its potential to ameliorate chemical and radiation-induced skin injury during cancer therapy. Disaster Medicine and Public Health Preparedness. 2024;18:e4. doi:10.1017/dmp.2023.211
2. Nguyen CV, Zheng L, Lu KQ. High-dose vitamin D for the management acute radiation dermatitis. JAAD Case Rep. 2023;39:47-50. Published 2023 Jul 8. doi:10.1016/j.jdcr.2023.07.001
3. Putzu, A, Belletti, A, Cassina, T, et al. Vitamin D and outcomes in adult critically ill patients. A systematic review and meta-analysis of randomized trials. J Crit Care. 2017;38:109-114.
4. Scott JF, Das LM, Ahsanuddin S, et al. Oral vitamin D rapidly attenuates inflammation from sunburn: an interventional study. J Invest Dermatol. 2017;137(10):2078-2086.
5. Blay B, Thomas S, Coffey R, Jones L, Murphy CV. Low vitamin D level on admission for burn injury is associated with increased length of stay. Journal of Burn Care & Research. Volume 38, Issue 1, January-February 2017, Pages e8–e13, https://doi.org/10.1097/BCR.0000000000000445
6. Al-Tarrah K, Hewison M, Moiemen N, Lord JM. Vitamin D status and its influence on outcomes following major burn injury and critical illness. Burns & Trauma. Volume 6, 2018. https://doi.org/10.1186/s41038-018-0113-4