Fototerapi ve D Vitamini
Özet
Fototerapi yöntemlerinin epidermal keratinositlerde D vitamini sentezi üzerindeki etkilerini ve çeşitli deri hastalıklarının tedavisindeki rolünü inceleyen bu çalışma, güneş ışığının antik çağlardan beri tedavi amaçlı kullanıldığını belirtmektedir. Modern dermatolojide fototerapi; sedef hastalığı (psoriasis), atopik dermatit, vitiligo, mikozis fungoides ve alopesi areata gibi rahatsızlıklarda yaygın olarak tercih edilmektedir. D vitamininin en önemli kaynağı, UVB ışınları aracılığıyla ciltte endojen olarak üretilmesidir. Epidermal keratinositler, yüzeylerindeki D vitamini reseptörleri ve sahip oldukları mitokondriyal enzimler sayesinde kendi aktif D vitaminini üretebilme kapasitesine sahiptir. Çalışmalar, geniş bant ve dar bant UVB uygulamalarının serum 25-OH-D vitamini seviyelerini anlamlı derecede artırdığını, buna karşın UVA ve PUVA tedavilerinin D vitamini sentezi üzerinde bir etkisinin olmadığını göstermektedir. Sedef ve atopik dermatit hastalarında genellikle D vitamini eksikliği gözlenmekte ve UVB fototerapisi hem bu eksikliği gidermekte hem de lokal inflamasyonu ve antimikrobiyal peptit ekspresyonunu düzenleyerek klinik iyileşme sağlamaktadır. Vitiligoda ise fototerapi, kıl foliküllerindeki melanositleri aktive ederek repigmentasyonu uyarır. Sonuç olarak, UVB fototerapisi özellikle emilim bozukluğu olan hastalarda oral takviyelere kıyasla D vitamini seviyelerini yükseltmede daha etkili ve güvenli bir terapötik yaklaşım sunmaktadır.
Examining the effects of phototherapy methods on vitamin D synthesis in epidermal keratinocytes and its role in the treatment of various skin diseases, this study notes that sunlight has been used for therapeutic purposes since ancient times. In modern dermatology, phototherapy is widely preferred for conditions such as psoriasis, atopic dermatitis, vitiligo, mycosis fungoides, and alopecia areata. The most crucial source of vitamin D is its endogenous production in the skin via UVB rays. Epidermal keratinocytes are capable of producing their own active vitamin D thanks to the vitamin D receptors on their surface and their internal mitochondrial enzymes. Studies demonstrate that broadband and narrowband UVB applications significantly increase serum 25-OH-D vitamin levels, whereas UVA and PUVA treatments have no effect on vitamin D synthesis. Vitamin D deficiency is commonly observed in patients with psoriasis and atopic dermatitis, and UVB phototherapy provides clinical improvement by correcting this deficiency while regulating local inflammation and antimicrobial peptide expression. In vitiligo, phototherapy stimulates repigmentation by activating melanocytes in hair follicles. Consequently, UVB phototherapy presents a more effective and safe therapeutic approach for elevating vitamin D levels compared to oral supplements, especially in patients with malabsorption syndromes.
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