Vitamin D Update
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PHOTODERMATOLOGY (B ADLER AND V DELEO, SECTION EDITORS)
Vitamin D Update Mary S. Matsui 1 Accepted: 17 September 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The goal of this review is to provide an update in the field of vitamin D, in particular, the role of vitamin D in nonskeletal health, the complexity of providing patient guidance regarding obtaining sufficient vitamin D, and the possible involvement of vitamin D in morbidity and mortality due to SARS-CoV-2 (COVID-19). Recent Findings In addition to bone health, vitamin D may play a role in innate immunity, cardiovascular disease, and asthma. Although rickets is often regarded as an historical disease of the early twentieth century, it appears to be making a comeback worldwide, including “first-world” countries. Broad-spectrum sunscreens (with high UVA filters) that prevent erythema are unlikely to compromise vitamin D status in healthy populations. Summary New attention is now focused on the role of vitamin D in a variety of diseases, and more individualized patient recommendation schemes are being considered that take into account more realistic and achievable goals for achieving sufficient vitamin D through diet, supplements, and sun behavior. Keywords Vitamin D . Pigmentation . Ultraviolet light . Rickets . Osteomalacia . Sunscreen
Introduction In the last 10 years, over 41,000 peer-reviewed research studies have been published on vitamin D, and since its original discovery as a sunlight-generated factor important to bone health, a more complex story of vitamin D has continued to evolve. Vitamin D, technically not a vitamin, has been linked not just to rickets in children and osteomalacia in adults, but also has been suggested to play a role in diabetes, celiac disease, asthma, atopic dermatitis, tuberculosis, and, most recently, COVID-19. This review will briefly summarize fundamental, well-established aspects of vitamin D and human health and then will also discuss (a) some of the most recent work related to vitamin D and non-skeletal-associated health issues; (b) the complexity of establishing meaningful vitamin D measurement metrics and assessing vitamin D status; c)decisionmaking for obtaining vitamin D through diet, supplements, or sun exposure; (d) the impact of skin type, pigmentation, and sunscreen on vitamin D levels; and (e) evidence for a potential This article is part of the Topical Collection on Photodermatology * Mary S. Matsui
1
Teaneck, NJ, USA
influence of vitamin D on the mortality and morbidity of COVID-19 through modulation of the pro-inflammatory cytokine response and respiratory response to the virus.
Vitamin D Basics Some would urge us to move away from the nomenclature of vitamin D as a vitamin and, instead, acknowledge that vitamin D3 is a prohormone produced in skin through ultraviolet irradiation of 7-dehydrocholesterol (7DHC or provitamin D3) [1•]. This previtamin D3 is biologically inert and must undergo thermal isomerization and two hydroxylations. The first hydroxylation o
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