Patients with facial actinic keratoses (AK) pretreated with high-dose oral vitamin D before blue light photodynamic therapy (PDT) show an increase in lesion clearance, according to study data published in the Journal of the American Academy of Dermatology.
The study was comprised of 2 groups. In group 2, the interventional group, patients participated in a prospective, nonrandomized trial in which patients with AK were given photodynamic therapy after a pretreatment with a high-dose oral vitamin D supplement. In group 1, the control group, patients were selected by multivariate matching from a large longitudinal database registry in which patients receiving PDT had given blood samples for measurement of baseline serum 25OH-D3 levels and vitamin D receptors as potential correlates to responsiveness to photodynamic therapy.
The main goal of the study was to observe clinical efficacy, defined by a percent decrease in AK lesion count from the first and last visit. The hypothesis underlying this study was that vitamin D status is essential for the AK lesion clearance response after PDT. To prove this hypothesis, the researchers first looked for a relationship between vitamin D3 serum levels and clearance rate for facial AK lesions, and they did this by arranging patients in order of increasing 25OH-D3 serum levels. Results showed that vitamin D3-deficient patients had a lower average clearance rate than patients with normal vitamin D3 levels, and the administration of high-dose oral VD3 increased the clearance rate mean to 72.5%, an 18% increase.
Limitations to this study include that the study design was not randomized, there were 2 physician evaluators which may have caused some inter-observer variance, and the understanding of the mechanism of action involved in high-dose vitamin D3 and its influence on PDT responsiveness is still being determined.
Researchers concluded that, “Despite remaining biological unknowns, the practical value of this new VD3/PDT regimen is that practitioners can use it immediately to benefit patients with widespread facial AK.”
Bullock T, Negrey J, Hu B, Warren C, Hasan T, Maytin E. Significant improvement of facial actinic keratoses after blue light photodynamic therapy with oral vitamin D pretreatment: An interventional cohort-controlled trial. J Am Acad Dermatol. Published online March 18, 2022. doi: https://doi.org/10.1016/j.jaad.2022.02.067