Scientific studies have reported a possible link between vitamin D deficiency and psoriasis, including scalp psoriasis.

Scientific studies have reported a possible link between vitamin D deficiency and psoriasis, including scalp psoriasis. People with psoriasis have lower levels of vitamin B12, which often occurs concurrently with lower vitamin D3 levels in the blood.

• Vitamin D deficiency is critical in psoriasis. This is the primary reason why psoriasis improves during the summer when sun exposure increases the levels of this vitamin.
• Several studies have reported that vitamin D3 is effective in the treatment of psoriasis. High doses of up to 35,000 IU administered over several months have significantly reduced psoriasis symptomatology.
• Vitamin D can help your immune system by strengthening it and reducing flare-ups. Moreover, it can slow the growth of new cells and help thin the plaques that form on your skin, making any flare-ups you do have less severe.

Although there is some evidence that taking vitamin D orally may help clear psoriasis on the skin, more research and large-scale clinical trials are needed to prove this.

Vitamin D

A daily dose of 1,000 to 4,000 IU is usually considered safe for maintaining healthy vitamin D levels. People may require a much higher dose in certain circumstances, particularly if their current levels are very low or they have limited exposure to sunlight.

The optimal vitamin D blood level has not been determined, but it is likely to be between 20 and 50 ng/mL.

There are three ways to get vitamin D, including:

1. Food
2. Sunlight 
3. Supplements

Seafood 

• Fatty fish and seafood are among the best natural sources of vitamin D.

Mushrooms

• Mushrooms are the only completely plant-based natural source of vitamin D.

Vitamin B12

• It directly contributes to the breakdown of food into energy molecules that your cells can easily use.
• It helps maintain the health of your blood and nerve cells, preventing you from developing anemia, which can make you weak and tired.
• Animal products, such as fish, meat, and dairy products, are high in vitamin B12. Many foods are fortified with B12, making it possible to meet your daily requirements with a well-balanced diet.
• Vitamin B12 boosts energy and stamina. It appears to be especially important as one of the best vitamins for fatigue if you're tired due to physical pain or a nagging injury.
• If you suspect you have a B12 deficiency, always consult your doctor and request a blood test. Check for folic acid as well because high levels of folic acid can mask a true B12 estimation.

Foods such as egg yolks, liver, red meat, and fortified foods provide vitamin D. Sun exposure is one of the best ways to get vitamin D.

Although research suggests that people with psoriasis are more likely to have low vitamin D levels, this is not considered a causal link. However, the use of sunlight and topical vitamin D treatments to help manage and treat psoriasis is well established.

Oral vitamin D supplementation is not always beneficial. Your dermatologist can determine whether supplements are part of the best treatment plan for your specific skin concerns.

What is psoriasis?

Psoriasis is a common autoimmune skin condition that accelerates the growth of skin cells, leading to itchy scales and patches on the skin. The increased multiplication of skin cells causes cells to rapidly accumulate on the surface of the skin, forming characteristic lesions. 

Psoriasis is a long-term chronic condition associated with flare-ups and remissions (periods of reduced symptoms).

What are the symptoms of psoriasis?

Psoriasis symptoms differ from person to person and depend on the type. Patches can range in size from a few spots to large lesions.

The most frequently affected areas include:

• Scalp
• Elbows
• Knees
• Hands
• Feet

Symptoms of psoriasis include:

• Red patches appear on the skin, which is covered by silvery thick scales.
• These spots itch, cause a burning sensation and cause soreness.
• The skin may bleed occasionally as a result of excessive dryness or scratching.
• Nail psoriasis causes nail thickness, pitting, and discoloration and the nails may come away from the nail bed at times.
• Psoriasis can cause scaly-red, cracked skin with pus-filled eruptions on the hands and feet.

Typically, these symptoms exhibit periodicity or waxing and waning cycles.

Symptoms may be severe for a few days or weeks and then subside, or they may even clear up and become unnoticeable. Symptoms then reappear as a result of any of the triggering factors.

Psoriasis causes the top layer of skin cells to become inflamed and grow too quickly and flake off.
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What causes psoriasis?

The exact mechanism or cause of these skin cells going haywire is unknown, but it is thought to be due to some factors related to immunity and genetics.

• Genetics:
  • Research suggests that certain genes may play important roles in causing psoriasis.
  • You are at a high risk of psoriasis if any of your immediate family members have the disease.
  • However, only about two to three percent of people with such a genetic background have psoriasis.
• Immune system abnormality:
  • Psoriasis is a disease in which your body's defense cells attack your skin cells. T-lymphocytes and neutrophils are two examples of these cells. 
  • Psoriasis is an autoimmune disease caused by the malfunction of these cells. 
  • The exact causes of mutation or malfunction are unknown, but genetics, along with environmental factors, are thought to play a role.

What factors trigger psoriasis?

Certain factors may trigger or aggravate psoriasis symptoms. It is preferable to identify these factors so that they can be avoided to the greatest extent possible.

These precipitating factors include:

• Bacterial infections (throat or skin infection) commonly caused by Streptococci
• Skin injury due to a bug bite, cut, or sunburns
• Smoking
• Alcohol
• Stress
• Obesity
• Vitamin D deficiency
• Certain medications such as antimalarial drugs, iodides, beta-blockers, and lithium
• Human immunodeficiency virus infection

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How to diagnose psoriasis

A thorough medical history and physical examination usually point to psoriasis, but it can be confused with eczema. Therefore, a biopsy is used to confirm the diagnosis.

• Physical examination:
  • A thorough examination of the skin (of the affected area) and proper medical history almost always confirm the diagnosis.
  • It aids in determining disease severity by evaluating the affected total body surface area.
• Skin biopsy:
  • A small skin sample taken under local anesthesia aids in the diagnosis of psoriasis.
  • When examined closely under a microscope, it can help determine the type of psoriasis.
• X-ray:
  • To rule out other causes of arthritis in the case of psoriatic arthritis, several blood tests such as rheumatoid factor, vitamin D3 levels, C-reactive protein levels, and others are evaluated, along with an X-ray of the affected joint.

Stages of psoriasis

Doctors may stage psoriasis based on the results of diagnostic tests. Psoriasis is rarely staged and is instead classified based on the severity of the condition. The total body surface area affected by psoriasis determines its severity.

Certain factors such as redness, scaling, and skin thickness are considered when categorizing it.

• Mild psoriasis: Psoriasis is considered mild when it affects less than three percent of the total body surface area.
• Moderate psoriasis: Moderate psoriasis is defined as affecting 3 to 10 percent of the total body surface area.
• Severe psoriasis: More than 10 percent of the total body surface is affected by severe psoriasis.

What are the treatment options for psoriasis?

Despite a wide range of treatment options, psoriasis can be difficult to manage. Treatments are determined by the type of psoriasis, severity, and affected areas of skin.

• Topical therapies:
  • Topical moisturizing creams and ointments are the first lines of treatment for mild to moderate localized disease, and they can help with itching and scaling.
  • Scalp lesions are treated with medicated shampoos, foams, or solutions.
• Topical corticosteroids:
  • They are used as first-line therapy for plaques and lesions that have proven resistant to other treatments.
  • Low-potency steroids can be used on the face and intertriginous areas (such as armpits, under the breasts, and between buttocks), whereas higher-potency steroids, should be reserved for the scalp and thick plaques on extensor surfaces.
  • However, steroid cream resistance can develop quickly, and withdrawal may result in disease exacerbation. Long-term or excessive use can cause skin thinning, bruising, and systemic side effects.
• Vitamin D analogs (calcipotriene):
  • They can be used alone or in combination with topical steroids to slow keratin growth, flatten lesions, and remove scales.
• Anthralin:
  • It slows skin cell proliferation by inhibiting deoxyribonucleic acid synthesis.
• Tazarotene:
  • A retinoid slows skin cell proliferation, but it can cause skin irritation and is not recommended for pregnant or planning to become pregnant women.
  • Short contact therapy (20 minutes) followed by washing is as effective as and more tolerable than traditional tazarotene therapy.
  • It can be used on its own or in conjunction with topical steroids.
• Coal tar:
  • It is probably the oldest known treatment and is generally used to reduce scalp inflammation, itching, and scaling.
  • It is available as shampoo and can be combined with steroid creams or ointments.
  • Some formulations may be just as effective as vitamin D analogs.
• Topical calcineurin inhibitors (tacrolimus and pimecrolimus):
  • The U.S. Food and Drug Administration (FDA) has not approved them for psoriasis, and they have not been proven effective for plaque psoriasis, but they may be used off label for psoriasis that affects the face and intertriginous areas, where they may be effective and allow people to avoid chronic corticosteroid use.
  • Although no definitive cause and effect relationship has been established, the FDA issued a warning about a possible link between these medications and cases of lymphoma and skin cancer in children and adults.
• Phototherapy:
  • It is known to be beneficial and is used in the treatment of moderate-to-severe psoriasis (where more than 5 to 10 percent of the body surface area is affected) or severe psoriasis.
  • Natural sunlight (lesions usually improve during the summer), ultraviolet B radiation, and psoralen plus ultraviolet A radiation are more common options.
  • Treatment with a high-energy excimer laser is effective and safe for treating localized psoriasis while requiring fewer office visits and sparing uninvolved skin.
  • To improve efficacy, phototherapy can be combined with other treatments.
  • Phototherapy may increase the risk of skin cancer.
• Systemic therapy:
  • People with moderate-to-severe, severe or treatment-resistant psoriasis, as well as those with psoriatic arthritis, may require this treatment.
  • These can have serious side effects and are not recommended for pregnant women.
  • Immunomodulatory medications are frequently used to treat psoriatic arthritis, particularly in severe and refractory cases.
• Psychological approaches may be valuable in individuals with psoriasis:
  • Stress appears to impair lesion clearance in phototherapy-treated people and plays an important role in the onset, exacerbation, and prolongation of psoriasis.
  • Some evidence suggests that hypnosis and cognitive-behavioral stress management programs can reduce the severity of symptoms.
  • Virtual communities allow psoriasis people to communicate through the internet to support one another and gain access to educational resources.
• Nonsteroidal anti-inflammatory drugs (NSAIDs):
  • Psoriatic arthritis is sometimes treated with NSAIDs, which can help reduce inflammatory symptoms although there is some evidence that NSAIDs may exacerbate skin lesions.
  • When NSAIDs are insufficient, disease-modifying antirheumatic drugs are required.

Current data show that vitamin D deficiency is common in people with psoriasis, but large randomized controlled trials are needed to confirm if correcting deficiency results in a statistically significant clinical improvement after controlling for confounding factors such as body mass index.

A better understanding of vitamin D receptor polymorphisms may help us understand differential treatment responsiveness and even allow for the development of new treatments that correct the abnormal protein transcription caused by defective receptors.