Vitamin B group levels and supplementations in dermatology

Abstract

Irregularities of vitamin levels are being increasingly identified associated with skin conditions, and systemic and topical therapies have shown promising improvements. There have been some remarkable improvements achieved, but large variations in outcomes suggest that these conditions are not simply related to a single deficiency or solved by providing a single supplement. Cyanocobalamin, pyridoxine (B6) and riboflavin (B2) supplementation were linked with exacerbating existing acne. There were also reports of allergic reactions to parenteral cobalamin including acne, rosacea, allergic site reactions or anaphylaxis with cobalamin injections. This was also reported in patients who had allergic contact dermatitis to cobalt, where cobalamin therapy resulted in cutaneous manifestations such as chronic vesicular hand dermatitis, cheilitis and stomatitis. The use of niacinamide in acne vulgaris as an alternative to clindamycin or adjunct is also notable, as well as its application for hyperpigmentation. Vitamin B3 also has promise in chemoprevention in particular nonmelanoma skin cancer prophylaxis. Folic acid has a developing role in psoriasis. The data for vitiligo remains inconclusive. Assessment for potential vitamin deficiency, particularly B vitamins, should form part of the normal work-up for a wide range of skin conditions. Introduction Irregularities of vitamin levels are being increasingly identified associated with skin conditions, and systemic and topical therapies have shown promising improvements. The World Health Organisation (WHO) has estimated >2 billion people globally have suboptimal intakes of some essential vitamins and minerals, and that this trend is increasing.1 The reasons are complex, including poverty and food shortages in many countries, but also through poor diets and food choices in the developed world.1 Unbalanced diets featuring high energy and extensively processed foods are contributing to the problems. There have also been reports that changes in farming and intensive cultivation methods has led to a reduction in vitamin content in certain foods,2 although others have suggested that the level of reduction is more than compensated through higher yields and therefore, plentiful supply.3 WHO further reports that in 2020, worldwide, 462 million people are underweight, but 1,9 billion are overweight or obese. Being overweight increases the risk from a range of diseases including the metabolic syndrome and type 2 diabetes mellitus.1 These conditions and their associated complications and comorbidities are characterised by high levels of oxidative stress. Against this background, extensive interest is focussing on the role played by vitamins and vitamin deficiencies in skin disorders.4,5 There have been some remarkable improvements achieved, but large variations in outcomes suggest that these conditions are not simply related to a single deficiency or solved by providing a single supplement. In both cellular metabolism and in protection against oxidative stress, the roles of the B vitamins are intertwined and inter-dependent at the cellular level, and also linked to the effects of other vitamins. The B vitamins are listed in Table 1, although several can occur, and may be administered therapeutically, in more than one chemical form.