Vitamin D deficiency and rickets in children and adolescents with ichthyosiform erythroderma in type IV and V skin

Chouhan, K.; Sethuraman, G.; Gupta, N.; Sharma, V. K.; Kabra, M.; Khaitan, B. K.; Sreenivas, V.; Ramam, M.; Kusumakar, S.; Thulkar, S.; Paller, A. S.

Br J Dermatol. 2011 Oct 5; 166(3):608-15

Abstract

Background Ichthyosiform erythroderma due to keratinizing disorders may suppress cutaneous vitamin D synthesis, leading to vitamin D deficiency and rickets. Objectives To determine the prevalence of vitamin D deficiency and rickets in children and adolescents with congenital ichthyosis and other keratinizing disorders with erythroderma and scaling. Patients and methods In this cross-sectional study, 45 children and adolescents with ichthyosiform erythroderma due to keratinizing disorders, and 66 controls (group 1: age and sex matched, with skin diseases other than keratinizing disorders; group 2: age and sex matched, healthy volunteers) were included. Evidence of rickets was determined clinically (physical examination and radiographs) and biochemically {serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D] and parathyroid hormone (PTH)}. Results All patients in the disease group had clinical, radiological or biochemical evidence of rickets [25(OH)D < 20 ng mL(-1) ], and analysis was done for all subjects with the available biochemical reports. The mean serum 25(OH)D levels of the disease group was 8.38 +/- 5.23 ng mL(-1) and was significantly lower than in control group 1 (11.1 +/- 5.8 ng mL(-1) ) (P < 0.01) and control group 2 (13.5 +/- 6.9 ng mL(-1) ) (P < 0.001). The prevalence of vitamin D deficiency [25(OH)D < 20 ng mL(-1) ] was significantly higher in the disease group (n = 38 of 39, 97.4%) than in control group 2 (n = 12, 70.6%) (P < 0.01), and total controls (n = 56, 84.8%) (P = 0.04). The frequency of hyperparathyroidism (PTH > 65 pg mL(-1) ) was also significantly higher in the disease group than in controls (P < 0.01). Conclusions Children and adolescents with various forms of ichthyosiform erythroderma, especially those with pigmented skin (types IV-VI), are at increased risk of developing vitamin D deficiency and clinical rickets.

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