Forskere fra flere universitet i Sao Paulo i Brasil viser i en pilotstudie at behandling med 35.000 IE vitamin D daglig i et halvt år ga stor bedring for psoriasispasienter, helt uten snev av bivirkninger. Bildet viser situasjonen før og etter behandlingen.
Autoimmunitet har lenge vært forbundet med vitamin D-mangel, men det har vært vanskelig for forskerne å få bekreftet at behandling med tilskudd av vitamin D virker på autoimmune sykdommer. Leger bruker vitamin D i krem på pasienter med psoriasis, men har ikke verken før eller etter forsøket i Brasil i 2014 prøvd å behandle sykdommen med store, daglige tilskudd.

Denne studien hadde som mål å vurdere effekten og sikkerheten ved langvarig høydose vitamin D3-behandling av pasienter med psoriasis og vitiligo.
Ni pasienter med psoriasis og 16 pasienter med vitiligo fikk vitamin 35 000 IE vitamin D en gang daglig i seks måneder. For å unngå økt nivå av kalsium, ble deltakerne satt på kalsiumfattig kosthold og minimum 2,5 L væske daglig.
Alle psoriasispasienter ble scoret i henhold til «Psoriasis Area and Severity Index» (PASI) ved starten av studien og etter behandling. Evaluering av klinisk respons fra vitiligopasienter krevde en kvartilskala.
Alle pasienter hadde lav vitamin D-status med under 75 nmol/L ved oppstart. Etter behandling økte vitamin D-nivåer markant fra et snitt på 37 nmol/L til 265 nmol/L. Alle deltakerne holdt seg godt under øvre trygge grense for blodnivå for vitamin D, som er 375 nmol/L.
Legene tolker det som at 35.000 IE vitamin D er trygt daglig tilskudd for pasienter med psoriasis. Kalsiumnivået i blodet endret seg ikke, og kalsiumutskillelsen i urinen økte innenfor det normale området for alle deltakerne.
PASI-poengsummen ble betydelig forbedret hos alle ni pasienter med psoriasis. Fjorten av 16 pasienter med vitiligo hadde 25–75% repigmentering.
Forskerne bak studiene konkluderer med at høydose vitamin D-behandling kan være effektiv og trygg for pasienter med vitiligo og psoriasis.
Bruker krem med vitamin D i Norge
I Norge brukes som regel krem med vitamin D i form av hormonet kalsitriol til behandling av psoriasis. Kremen tilfører det samme hormonet som cellene i kroppen selv lager fra råvaren vi kjøper som D-vitamin-tilskuddet i helsekostforretninger.
Når vi spiser tilskudd med vitamin D, er det råstoffet som kroppen produserer hormonet kalsitriol av. Hormonet kalsitriol styrer celledeling i både huden og immunceller og påvirker derfor psoriasispasienter dobbelt, ved å bedre celledelinga i huden og lage flere immundempende T-celler til immunforsvaret.
Det forskerne i studien oppnår med å gi pasientene et høyt nivå av vitamin D (råvaren til hormonet kalsitriol) i blodet, er å gi cellene i kroppen rikelig adgang til å lage hormonet kalsitriol inne i cellene. Dermed påvirkes ikke nivået med kalsitriol i blodet, slik det gjør når kalsitriol tilføres med krem.
Unngår hyperkalsemi ved å gi tilskudd
Problemet med vitamin D-kremen som brukes mot psoriasis er at kalsitriol fra kremen går gjennom huden og øker nivået med hormonet kalsitriol i blodet. Nivået av kalsitriol i blodet reguleres normalt av nyrene i forhold til nivået med kalsium i blodet. Faller nivået kalsium i blodet, produserer nyrene mer kalsitriol, som øker kalsiumnivået i blodet.
Når nivået med kalsitriol i blodet økes kunstig på grunn av kalsitriol fra psoriasis-kremen, gjør det at det blir overført for mye kalsium fra fordøyelsen til blodet. Det gjør at pasientene kan få hyperkalsemi, som kan være livstruende.
Pilotstudien er ikke fulgt opp
Selv om den brasilianske pilotstudien viser svært lovende resultater, er den ikke fulgt opp av andre forskere. Det har siden 2014 kommet flere store studier med små tilskudd av vitamin D som viser at det ikke virker mot psoriasis. Ifølge legene «beviser» studiene med små tilskudd at vitamin D ikke virker mot psoriasis.
I løpet av høsten 2021 kommer resultatet fra en undersøkelse i Tromsø, der forskerne har testet tilskudd med 5.000 IE vitamin D på pasienter med psoriasis. Tidligere undersøkelser med tilsvarende doser har vist at 5.000 IE ikke påvirker psoriasis og det er derfor sannsynlig at vi får enda en studie som «beviser» at vitamin D ikke virker mot psoriasis.
Her er referansene til forskerne som prøvde høydose vitamin D mot psoriasis:
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