Vitamin D Analogues for Psoriasis - Health Central

If you've been using topical corticosteroids to manage your psoriasis and want to cut back on them, your dermatologist may suggest a vitamin D analogue. These synthetic forms of vitamin D, which are applied as a cream or ointment, may improve the health and appearance of your skin. They work by helping to "decrease scaling by stopping skin cells from multiplying," explains Stephanie Saxton-Daniels, M.D., a board-certified dermatologist with Westlake Dermatology in Dallas. Here's a closer look at how the treatment works, who it can help, and whether it's right for you.

How Topical Vitamin D Works for Psoriasis

Psoriasis is chronic autoimmune condition that causes skin inflammation, and is typically marked by thick, scaly, red or silvery skin patches. It occurs when the immune system becomes overactive and attacks healthy skin cells, according to the American Academy of Dermatology (AAD). The body responds to these attacks by making more and more healthy skin cells in rapid succession, causing them to pile up and form those scaly patches. It's treatable with a number of different therapies and medications, which are often used in combination with the goal of keeping a person's skin nearly symptom-free.

One treatment option is vitamin D analogues, a man-made form of the vitamin. Vitamin D has an anti-inflammatory effect, regulates the immune system, and when applied topically it can slow the body's overactive skin cell production, notes the Journal of Clinical and Aesthetic Dermatology. "Vitamin D analogues act on the body's vitamin D receptors to regulate cell growth," Dr. Saxton-Daniels explains. "In psoriasis, the skin cells are overactive and hyperproliferate, so vitamin D helps to normalize this proliferation."

Bringing your skin cell production back down to a normal speed won't cure your psoriasis. But it can go a long way towards improving symptoms from head to toe. Per the AAD, using a vitamin D cream for psoriasis can:

• Flatten thick psoriasis scales

• Remove psoriasis scales

• Treat psoriasis in the nails

• Treat psoriasis on the scalp

Dermatologists like vitamin D cream as a treatment option because it can decrease the need for more powerful medications that are more likely to have side effects, like corticosteroids or systemic drugs like biologics, notes an International Journal of Molecular Sciences paper.

That said, the treatment is better for mild to moderate cases of psoriasis, and it's more effective at keeping relatively calm skin plaque-free than getting a flare under control. "Vitamin D is mostly used for maintenance, but it doesn't instantly relieve symptoms. When a patient is flaring, they need something to relieve the problem within days, not months," says Tien Nguyen, M.D., a dermatologist at MemorialCare Orange Coast Medical Center in Fountain Valley, CA.

Many patients who are flaring start off using topical vitamin D along with another treatment, like a corticosteroid cream, then continue using the vitamin D once their skin has improved and the steroid is no longer needed. "It's a great adjuvant. It can work to supplement other topical therapies," says Erum Ilyas, M.D., a dermatologist with Schweiger Dermatology Group in Philadelphia.

Types of Psoriasis That Can Be Treated With Vitamin D

Vitamin D can be helpful for all forms of psoriasis. "It can be used for any type," Dr. Saxton-Daniels says. Though a vitamin D cream can be applied anywhere on the body, it can be especially useful around the armpits or groin. "Because the skin is already thin in those areas," topical steroids are more likely to cause irritation, she explains.

These creams aren't a cure-all, though: Like other psoriasis treatments, they address the symptoms of the condition, not the underlying cause of the disease. They work best in people with mild to moderate forms of psoriasis; people with severe cases will likely need systemic medications to keep their symptoms under control.

Using Vitamin D Analogues With Corticosteroids

Pairing vitamin D with a corticosteroid can help clear and control psoriasis flares faster than using vitamin D alone. It can also help reduce steroids' negative effects, according to the AAD.

While topical steroids can be helpful for taking down psoriasis plaques quickly, when used for long stretches, they can cause skin to break down and become thinner and weaker, the Mayo Clinic notes. Steroids may also become less effective over time, causing a person to need increasingly higher doses to get the same benefits. "The more you use, the more your body will need. It's not something you can use for long term," Dr. Nguyen explains.

That's not the case for vitamin D, which appears to maintain its effectiveness over time and can be used indefinitely, notes one Reviews in Endocrine & Metabolic Disorders paper. "The strategy is to use the steroid as a fast-acting, quick relief treatment to bring back a good quality of life. As the disease gets better, you taper down the steroid and add in the vitamin D," to keep the psoriasis controlled, explains Dr. Nguyen.

Psoriasis Medications With Vitamin D

There are a few different psoriasis medications that contain vitamin D. Some only have a vitamin D analogue as the active ingredient, while others combine vitamin D with another medication like a topical steroid. "It's more convenient for the patient, so they don't have to apply two separate products," says Dr. Nguyen.

Medications that contain only vitamin D include:

• Dovonex and Sorilux (calcipotriene): Calcipotriene comes as a skin cream or as a liquid that can be used on the scalp twice a day. Up to 70% of people with chronic plaque psoriasis notice an improvement within six to eight weeks of using the med, per a review on vitamin D analogues in the journal Current Medicinal Chemistry.

• Vectical (calcitriol): Calcitriol is an ointment (these are thicker and slightly greasier than creams) that's applied to the skin twice a day. Some patients find it slightly less irritating to the skin than calcipotriene, notes the The Journal of Clinical and Aesthetic Dermatology report.

Vitamin D-steroid combination medications include:

• Taclonex (calcipotriol and betamethasone dipropionate): This combo med comes as a gel or ointment that can be applied to the skin or as a foam for the scalp once or twice a day. Itching is the most common side effect, but it's relatively rare, one Journal of Clinical Medicine review on the efficacy and safety of the combo found.

Side Effects of Vitamin D Analogues

Most people with psoriasis don't experience significant side effects from using a vitamin D topical treatment. "It tends to be well-tolerated," says Dr. Ilyas.

However, sometimes topical vitamin D can cause some mild skin irritation at first. Fortunately, the irritation tends to ease up as a person keeps using the treatment, according to the AAD. You might notice mild symptoms like:

• Burning

• Dryness

• Itching

• Peeling

• Redness

• Swelling

In rare cases topical vitamin D treatments can cause too much calcium to build up in the bloodstream. The problem, called hypercalcemia, can weaken a person's bones (since the calcium was leached from there), cause kidney stones, and affect heart or brain function. According to the AAD, the risk for hypercalcemia is low when a person applies vitamin D as prescribed.

What About Vitamin D Supplements?

If applying a vitamin D cream or ointment can improve your psoriasis, you might wonder whether taking a vitamin D supplement orally might also be helpful. So far, the science says no.

People with psoriasis are significantly more likely to have low blood levels of vitamin D compared to those without the skin condition, found one BMC Nutrition study. But there's not much good evidence showing that vitamin D pills, even in high doses, can help psoriasis symptoms, concluded the International Journal of Molecular Sciences paper.

"Topical vitamin D reduces how many skin cells the body is making," which helps stop excess skin cells from building up and forming plaques, Dr. Ilyas explains. "But oral vitamin D may not do the same thing." (That said, your overall diet could have an effect on your symptoms, so it's worth paying attention to what you eat.)

If you're interested in trying vitamin D or another supplement to manage your psoriasis, check with your dermatologist first.

The Bottom Line on Vitamin D Analogues for Psoriasis

If you have psoriasis, vitamin D ointments and creams can be a good bet for helping your skin look and feel its best. But they may not be potent enough on their own to soothe your symptoms during a flare. Instead, you'll reap the biggest benefits by bringing down your initial inflammation with a corticosteroid, then using vitamin D to maintain your clearer, calmer skin.

Notes: This article was originally published May 18, 2023 and most recently updated May 22, 2023.

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