Vitamin D in psoriasis

Abstract

A 59-year-old African American male presented to clinic for evaluation of plaque-type psoriasis. The clinical diagnosis was confirmed by biopsy of the right forearm plaque, which revealed prominent parakeratosis with an absent granular cell layer, epidermal acanthosis with suprapapillary plate thinning, and superficial dermal mononuclear perivascular cell infiltrate consistent with psoriasiform dermatitis. The patient was placed on 20 mg acitretin daily, calcipotriol cream daily on weekdays, and clobetasol ointment daily during weekends and experienced symptomatic improvement. At that time, all thick leg plaques were cleared. However, the patient’s triglycerides were found to be elevated at 569 mg/dL in non-fasting conditions and 528 mg/dL in fasting conditions (normal range, 35–160 mg/dL). Acitretin was decreased to 10 mg daily, and the patient was started on gemfibrozil. Triglyceride levels stabilized at 252 mg/dL within the same month, and the patient was advised to maintain 10 mg daily acitretin dose as long as CBC, CMP, and lipid panels remained within normal limits. The patient subsequently reported psoriasis flares while on 10 mg acitretin daily, and the dosage was increased back to 20 mg daily.