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Use of Calcitriol (1,25-Dihydroxyvitamin D3) for Treatment of Psoriasis

Michael F. Holick, PhD, MD; Ellen Smith, PhD; Stephanie Pincus, MD

Arch Dermatol. 1987;123(12):1677-1683a.

Abstract
• Vitamin D is a hormone, not a vitamin. The skin is responsible for producing vitamin D. During exposure to sunlight, ultraviolet radiation penetrates into the epidermis and photolyzes provitamin D₃ to previtamin D₃. Previtamin D₃ can either isomerize to vitamin D₃ or be photolyzed to lymisterol and tachysterol. Vitamin D is also sensitive to sunlight and is photolyzed to 5,6-transvitamin D₃, suprasterol I, and suprasterol II. In Boston, solar irradiation only produces previtamin D₃ in the skin between the months of March and October. Aging, sunscreens, and melanin all diminish the capacity of the skin to produce previtamin D₃. Once formed, vitamin D₃ enters the circulation and is sequentially metabolized to 25-hydroxyvitamin D₃ and 1,25-dihydroxyvitamin D₃ (1,25-[OH]₂-D₃). The epidermis possesses receptors for 1,25-(OH)₂-D₃.1,25-(OH)₂-D₃D₃ inhibits the proliferation of cultured keratinocytes and induces them to terminally differentiate. The topical or oral administration of 1,25-(OH)₂-D₃ has proved to be effective for the treatment of psoriasis. Therefore, the skin is the site for the synthesis of vitamin D and a target tissue for its active metabolite. The successful use of 1,25-(OH)₂-D₃ for the treatment of psoriasis heralds a new approach for the treatment of this enigmatic disorder.

(Arch Dermatol 1987;123:1677-1683a)

Author Affiliations
From the US Department of Agriculture/Human Nutrition Research Center and Department of Physiology, Tufts University (Drs Holick and Smith), and Department of Dermatology, New England Medical Center (Dr Pincus), Boston. Dr Holick is now with Boston University Medical School.

Footnotes
Accepted for publication May 21, 1987.

Read before the 36th Annual Symposium on the Biology of Skin ("Molecular Basis of Nutritional Dermatoses"), Salishan Lodge, Gleneden Beach, Ore, Oct 20, 1986.

Reprint requests to Boston University Medical School, Bldg M, Rm 1013, 80 E Concord St, Boston, MA 02118 (Dr Holick).

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