alexa Effect of Narrowband Ultraviolet B Therapy on Serum Vitamin D in Saudi Patients with Vitiligo | Open Access Journals
ISSN: 2329-6887
Journal of Pharmacovigilance
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Effect of Narrowband Ultraviolet B Therapy on Serum Vitamin D in Saudi Patients with Vitiligo

Abdulaziz A Alnoshan1*, Amal Al-Najjar2, Fatimah M Al-Mutairi3 and Reem Saad Alsubiae3
1Department of Dermatology, Security Forces Hospital, Riyadh, Saudi Arabia
2Pharmacy Services, Security Forces Hospital Riyadh, Kingdom of Saudi Arabia
3College of Pharmacy, Princess Nourah bint Abdulrahman University Riyadh, Kingdom of Saudi Arabia
*Corresponding Author : Abdulaziz A Alnoshan
Consultant, Head of Dermatology Division
Security Forces Hospital
Riyadh, Kingdom of Saudi Arabia
Tel: +966 50 555 1144
E-mail: [email protected]
Received February 16, 2016; Accepted February 23, 2016; Published February 29, 2016
Citation: Alnoshan AA, Al-Najjar A, Al-Mutairi FM, Alsubiae RS (2016) Effect of Narrowband Ultraviolet B Therapy on Serum Vitamin D in Saudi Patients with Vitiligo. J Pharmacovigilance 4:198. doi:10.4172/2329-6887.1000198
Copyright: © 2016 Alnoshan AA, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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Abstract

Objective: To evaluate the effect of NB-UVB therapy on serum levels of 25-hydroxyvitamin D [25(OH)D] in Saudi patients with vitiligo.

Method: We estimated the levels of 25-hydroxy vitamin D [25(OH)D] before, and after NB-UVB radiation in patients with vitiligo who did not take vitamin D supplement. A comparison was done between subsets of patients concerning gender and duration of treatment of NB-UVB.

Results: There were 39 patients with vitiligo. Females were 22 (56.4%) and males were 17 (43.6%).The mean vitamin D level before NB-UVB treatment was 29.575 ± 16.315 nmol/L. while vitamin D level was increased to 78.871 + 22.776 after treatment with significant differences (P < 0.0001). The males had mean vitamin D level 36.232 ± 19.505 nmol/L, while females had mean vitamin D level 24.431 ± 11.321 nmol/L at baseline. After NB-UVB treatment the males had vitamin D level of 78.888 ± 25.683 nmol/L. While females had mean vitamin D level78.859 ± 20.884 nmol/L. After 6 months of the NB-UVB treatment the delta change in vitamin D level was 38.888 ± 20.255 nmol/L while after 12 - 24 months of treatment with NB-UVB the delta change in vitamin D level was 60.252 ± 17.565 nmol/L (P = 0.001).

Conclusion: Patients who received narrow band ultra violet B radiation at wave length 309 nm as treatment of vitiligo are less likely to need vitamin D supplement to correct their vitamin D deficiency. More studies are needed in order to confirm these results and to establish UVB as treatment modalities to correct vitamin D levels in patients who cannot absorb vitamin D either orally or parentally.

Keywords
Vitiligo; Vitamin D; NB-UVB; Melanogenesis
Introduction
Aim
To find and document local data on the influence of NB-UVB therapy on vitamin D serum level among Saudi patients with vitiligo.
Objectives
1. To describe the correlation between NB-UVB therapy and vitamin D serum level in patients with vitiligo.
2. To investigate a new modalities of the treatment for patients with vitamin D deficiency.
Hypotheses
1. NB-UVB irradiation used in treatment vitiligo patients has no effect on vitamin D serum level.
2. NB-UVB irradiation used in treatment vitiligo patients increases vitamin D serum level.
Methodology
The data of this retrospective, observational study was collected from the patients’ files at SFHP, Riyadh. This data was collected through, Data collection sheet prepared by the investigators. Including patient’s demographic data, clinical information such as past medical history, previous and concomitant medications and results from blood sample tested for 25(OH) D at baseline and after NB-UVB therapy. The study included 39 patients (17 males and 22 females) of vitiligo with age ranging from 6 - 68 years who were visiting dermatology clinic. Baseline serum 25-hydroxy vitamin D levels were measured in all patients before starting NB-UVB therapy.
NB-UVB phototherapy was given using (Spectra 305 / 350 by Daavlin, 222Piagest. Bryan, Ohio 43506 U.S.A.) at wave length 309 nm. The duration of treatment was between 4 to 24 months. After the course of treatment, the level of 25(OH)D was measured.
Exclusion and Inclusion Criteria
Inclusion criteria
Patients with vitiligo disease treated with NB-UVB therapy, and did not take vitamin D supplement before or other products that affect vitamin D serum level.
Exclusion criteria
Any patients has taken a vitamin D supplementation before starting the NB-UVB therapy weather the supplement is from our hospital or from any other source.
Any patient has taken a vitamin D supplementation at the start (within 2 - 3 weeks) of the NB-UVB therapy.
Data Analysis
Statistical analysis was performed using Statistical Package for the Social Sciences (SPSS) version 21 software (SPSS Inc., Chicago, ILUSA).We calculated minimum, maximum, mean and standard deviation for numerical variables (measurable variables), and we calculated percentages and frequencies for nominal variables (gender, duration of treatment).We used pair T - test to compare between the level of vitamin D before and after treatment. Also, we used student t-test for independent groups to compare between males and females groups and to compare between patients who had been treated within 4 to 6 months and patients who had been treated within 7 to 24 months with respect to the level of vitamin D before and after treatment. We assumed there was a statistically significant difference when P-value less than 0.05.
Results
The mean age of the 39 patients was 38.08 years (range, 6 - 68 years) who were exposed to treatment period with NB-UVB therapy for an average of mean ± SD (8.82 ± 5.078) months (Table 1), (43.6%) were men, and 22 (56.4%) were women. We noticed that the percent of vitiligo was more among female (56.4%) in our sample (n = 39), (Table 2). The difference between short treatment duration (4 - 6 months) and long treatment duration (7 - 24 months) among our sample was not significant (Table 3).
Vitamin D serum level on the beginning of study with the patients diagnosed with vitiligo who did not take vitamin D as supplement was 7.38 nmol/l as minimum level and 70.90 nmol/l as maximum level (mean 29.57 nmol/l). Those patient were exposed to NB-UVB radiation at wave length 309 nm as treatment modality for their vitiligo for a minimum period of 4 months and a maximum period of 24 months. Resulting in changing of vitamin D level between 37.91 nmol/l as a minimum change and 140.40 nmol/l as a maximum change (mean 78.871 nmol/l) as shown in (Table 4), with a significant P - value < 0.0001 (Table 5 and Figure 1).
From other point of view, vitamin D serum level was less in females before treatment with NB-UVB therapy (24.431 ± 11.321) nmol/l while in males was (36.232 ± 19.505) nmol/l with significant difference P - value = 0.023. However vitamin D serum level after treatment was the same among males and females (mean 78.88 vs. 78.859l) nmol/l, and the duration of treatment was almost the same among males and females (mean 8.35 vs. 9.18) months, (Table 6 and Figure 2).
The overall improvement in vitamin D level after NB - UVB treatment there was statistically significant change in the mean vitamin D level. And after 6 months of the NB - UVB treatment, the delta change in vitamin D level was (38.888 ± 20.255) nmol/l while after 12 - 24 months of treatment with NBUVB the delta change in vitamin D level was (60.252 ± 17.565) nmol/l (P - value = 0.001) (Table 7 and Figure 3).
Discussion
Approximately, 0.1–2% of the world’s population is currently affected by vitiligo [7]. Various factors have been implicated in the etio-pathogenesis vitamin-D receptor-Apa-1 polymorphism [8], and low levels of circulating 25-OH vitamin D [9]. Vitamin D insufficiency is common in Kingdom of Saudi Arabia in spite of good sunshine throughout the year. Vitamin D is produced by UVB in the skin and can also be provided by dietary sources such as fat fish [10]. Vitamin D is considered to be the precursor of a hormone (1,25-dihydroxyvitamin D, 1,25(OH)2D), which plays a role for bone health, autoimmune diseases, cardiovascular diseases and cancer [11,12]. Moreover, there are different mechanisms by which vitamin D may help treat Vitiligo. Vitamin D can suppress the activation of T cells and the release of cytokines such as TNF-alpha (tissue necrosis factor alpha). Because vitamin D suppresses some cells of the immune system, it can protect melanocytes against autoimmune attack. And by promoting the differentiation and proliferation of melanocytes, vitamin D ensures that the production of new melanocytes exceeds the rate at which old melanocytes are dying and have antioxidant properties [13]. Interestingly, patients receiving NB-UVB radiation have shown an increase in the levels of 25(OH) vitamin D [14]. Vitamin D at cellular level modulates melanogenesis [15].The results of our study that reveals of serum 25(OH)D was elevated following NB-UVB treatment in vitiligo patients. Before treatment vitamin D serum level was Mean ± SD (29.575 ± 16.315 nmol/l) and after treatment was (78.871 ± 22.776 nmol/l) with significant p - value (P < 0.0001). Our findings are in agreement of previous studied who found an increase in the levels of 25(OH) vitamin D by treatment with NB-UVB [16,17].We found that the levels of 25(OH) vitamin D were more after 6 months of treatment and still more after 12-24 months of treatment. And there was a statistically significant (p - value 0.001) with prolonged treatment. Other study confirm that the vitamin D levels increased with increase in duration of phototherapy [3].There was a gender dimorphism among patients with vitiligo and levels of 25(OH) vitamin D were more in males gender than females. However the magnitude of response was more marked in females. And the delta change was 54.428 ± 19.734 which was higher than delta change in males. Other studies revealed that the increase of 25(OH)D was largest in the patients with the lowest baseline values [18-20].
The limitations of the study are the relatively small number of patients included and the wide age range of the patients. In addition, some factors, such as sun exposure and clothing habits, could have some influence on the results.
Conclusion
Patients who received ultra violet B therapy at wave length 309 nm as treatment of vitiligo are less likely to need vitamin D supplement to correct their vitamin D deficiency. More studies are needed in order to confirm these results and to establish UVB as treatment modalities to correct vitamin D levels in patients who cannot absorb vitamin D either orally or parentally.
References

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