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High-Dose Oral Vitamin D as an Emerging Therapeutic for Skin Toxicities Associated With Cancer Treatment
abstract
This abstract is available on the publisher's site.
Access this abstract now Full Text Available for ClinicalKey SubscribersHigh dose oral vitamin D (hdVD) is an emerging treatment modality within supportive oncodermatology. Vitamin D has been shown to attenuate skin inflammation following ultraviolet radiation-induced sunburn in both mice models and human subjects. The anti-inflammatory function of vitamin D may be secondary to the upregulation of M2 macrophage autophagy and arginase-1 expression. Oral hdVD has been found to mitigate nitrogen mustard-induced skin toxicity by reducing inflammatory IL-17 signaling with durable clinical effects. There are emerging applications of hdVD in treating skin toxicities associated with cancer treatment, specifically toxic erythema of chemotherapy (TEC) and acute radiation dermatitis (RD). hdVD is a safe therapeutic that can be utilized in the inpatient setting to rapidly ameliorate symptoms associated with TEC and RD and decrease duration of the toxicity.
Additional Info
High-dose oral vitamin D: An emerging therapeutic for skin toxicities associated with cancer treatment
J Am Acad Dermatol 2024 May 18;[EPub Ahead of Print], S Choi, C IriarteFrom MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.
Recent case series have identified high-dose oral vitamin D as an option for the management of skin toxicities related to cancer treatment. This article reviews the use of high-dose oral vitamin D in alleviating symptoms of toxic erythema of chemotherapy (TEC) and acute radiation dermatitis. The impetus for using high-dose oral vitamin D in patients with these skin toxicities is based on our fundamental observations of skin immune resolution by high-dose oral vitamin D. In a blinded study involving patients with sunburns from experimentally-induced UV skin injury, the administration of high-dose oral vitamin D allowed for dose-dependent rapid improvement of symptoms. Typically, pain and swelling start to improve within 24 hours, and, subsequently, recovery of erythema and skin erosions occur within the next 3 to 7 days.
The recommendations for clinicians include:
It should be noted that high-dose oral vitamin D has been studied at much higher doses of up to 600,000 IU in critically ill patients or patients with cancer without noting adverse effects. Although the studies using high-dose oral vitamin D for TEC and acute radiation dermatitis have all been small case series (and need further evaluation to determine efficacy), it appears that the use of high-dose oral vitamin D has a low-risk profile. The authors in this review note that they have administered high-dose oral vitamin D to dozens of patients with acute radiation dermatitis or TEC. It will be interesting to see patient outcomes in future larger studies. Identifying treatments, such as high-dose oral vitamin D, may allow patients to continue cancer therapy uninterrupted and improve outcomes.