Friday, July 22, 2016
Impact of high dosage of Vitamin D on children with congenital ichthyosis
Vitamin D is important for the prevention and treatment of rickets and congenital ichthyosis (scaly skin) in children. Blood levels of 25-hydroxyvitamin D (25[OH]D) less than 8 ng/mL and parathyroid hormone (PTH) levels more than 75 pg/mL in children with ichthyosis raises the risk for rickets. The earlier management therapy included administering 60,000 IU of oral vitamin D for 6 weeks, followed by 60,000 IU once a month. However, patients could not adhere to the treatment protocol due to long-distance travel and poor socioeconomic status. When the daily dose of 60,000 IU for 5 days was administered, a remarkable response was observed. A new study published in the journal Pediatrics examined the effects of short-term, high-dose vitamin D supplementation in children with congenital ichthyosis.
Sethuraman et al. reported the cases of seven children aged 9 months to 8 years with congenital ichthyosis and hospitalized for treatment with oral cholecalciferol. A high dose of oral vitamin D3 was administered for a period of 10 days for all the children except an infant who was treated for only 5 days. The children were subsequently administered the recommended daily allowance of 400 to 600 IU of vitamin D3, and an additional 40 mg/kg/day of elemental calcium was given. Outcomes such as scaly skin and stiffness of the body in the children were measured. Blood tests and urine samples were evaluated on the day of administration and then after 10 days, 1 month, and 3 months.
All subjects were diagnosed with severe vitamin D deficiency and secondary hyperparathyroidism (secretion of parathyroid hormone as a result of low levels of blood vitamin D levels). Rickets was diagnosed in 6 children. Following supplementation with vitamin D3, there was a significant reduction in scaly skin and stiffness in the children. After 1 month of supplementation, the scaling disappeared and the skin seemed normal, especially on the face and the trunk region.
However, the study had some drawbacks. This is a case series with a small sample of subjects that was conducted at a single centre. Moreover, the children were not followed up properly for clinical and biochemical assessment after a period of 1 month.
The study indicated that short-term, high-dose vitamin D3 supplementation was effective in reducing scaling in children with congenital ichthyosis and in ameliorating the associated vitamin D deficiency. Further research with long-term randomised clinical studies is essential to assess the safety and efficacy of vitamin D supplementation in children with congenital ichthyosis.
News source - Sethuraman G, Marwaha RK, Challa A, Yenamandra VK, Ramakrishnan L, Thulkar S, Sharma VK. Vitamin D: A new promising therapy for congenital ichthyosis. Pediatrics. 2016 Jan 1;137(1):1-5.