Psoriasis ve D Vitamini
Özet
Psoriasis, deri, tırnak ve eklemlerde bulgulara neden olan kronik ve inflamatuvar bir hastalıktır. Hastalığın patogenezinde artmış epidermal turnover ve inflamasyon öne çıkarken, etyolojisinde genetik zemin ile D vitamini ve kalsiyum eksikliği gibi tetikleyici faktörlerin rol oynadığı düşünülmektedir. Aktif D vitamini metaboliti olan 1,25-dihidroksi vitamin D3, keratinosit proliferasyonunu baskılayıp farklılaşmayı destekleyerek deri bariyerini korur ve kutanöz bağışıklığı regüle eder. D vitamini reseptör (VDR) gen polimorfizmleri (Apal, BsmI, FokI, TaqI) ile psoriasis arasındaki ilişkiyi inceleyen meta-analizler çelişkili sonuçlar vermektedir; bazı çalışmalar belirli popülasyonlarda korelasyon bulsa da genel bir genetik varyant ilişkisi sağlam şekilde kanıtlanamamıştır. Psoriasisli hastalarda serum D vitamini düzeylerinin kontrollere göre daha düşük olduğu ve hastalık şiddetiyle negatif korelasyon gösterdiği belirlenmiştir. Tedavide yaygın olarak kullanılan geniş ve dar bant UVB ile PUVA fototerapileri, D vitamini sentezini artırarak serum düzeylerini normal aralığa yükseltir. Sistemik oral D vitamini takviyelerinin hastalık şiddetini azaltmadaki olumlu etkisi klinik çalışmalarda henüz kesin olarak doğrulanamamıştır. Topikal tedavide ise kalsipotriol gibi D vitamini analogları, keratinosit proliferasyonunu azaltıcı etkileriyle özellikle plak psoriasisinin birinci basamak tedavisinde tek başına veya steroidlerle kombine edilerek güvenle kullanılmaktadır.
Psoriasis is a chronic, inflammatory disease causing symptoms in the skin, nails, and joints, characterized by an increased epidermal turnover and inflammation in which vitamin D deficiency and calcium levels are considered triggering factors. The active metabolite of vitamin D3 regulates cutaneous immunity and suppresses keratinocyte proliferation while supporting differentiation. Meta-analyses examining vitamin D receptor (VDR) gene polymorphisms and psoriasis yield conflicting results, showing no robust, reproducible genetic variant association. Circulating 25(OH)D levels are significantly lower in psoriasis patients and negatively correlate with disease severity. Phototherapy modalities like broadband UVB, narrowband UVB, and PUVA effectively enhance vitamin D synthesis and elevate serum levels to the normal range, contributing to clinical improvement. Although the therapeutic impact of oral vitamin D supplementation remains unconfirmed due to insufficient randomized controlled trials, topical vitamin D analogs such as calcipotriol are successfully utilized as a first-line treatment for plaque psoriasis to normalize epidermal growth, either alone or combined with topical corticosteroids.
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