Vitamin D-deficient osteomalacia due to excessive self-restrictions for atopic dermatitis

Shikino, Kiyoshi; Ikusaka, Masatomi; Yamashita, Tomoko

doi:10.1136/bcr-2014-204558

Cited by 3 publications

(3 citation statements)

References 16 publications

(10 reference statements)

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“…Indeed, 1,25-(OH) 2 vitamin D and 25-(OH) vitamin D were both markedly decreased. There have been reports of cases of osteomalacia caused by food removal therapy in infants with allergic diseases, [9] and the use of allergen-free diets and sunscreen in adults [10] . In addition, vitamin D deficiency has been shown to be induced by reduced sun exposure due to atopic dermatitis.…”

Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency osteomalacia triggered by long-term social withdrawal and unbalanced diet in a Japanese middle-aged subject

et al. 2022

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Introduction: Osteomalacia is caused by an increase in the number of osteoids owing to mineralization failure. There are various causes of osteomalacia, such as hypophosphatemia due to excess production of fibroblast growth factor 23, vitamin D deficiency, insufficient vitamin D action, and renal tubular disorders. Patient concerns: A 53-year-old man with bone pain and gait disturbance was referred to our institution. At the age of 35, he developed atopic dermatitis. He had eyesight deterioration due to atopic cataracts when he was 37 years old. Subsequently, he stayed home all the time, and his eating habits were unbalanced for a long period of time. Although he had atopic dermatitis, he did not take allergen-free diets, and he did not use sunscreen. Furthermore, when he was 43 years old, he failed to flex his legs and suffered gait disturbance. Diagnosis: Hypocalcemia and hypophosphatemia were observed as follow: calcium, 5.5 mg/dL; adjusted calcium, 6.9 mg/dL; inorganic phosphorous, 1.9 mg/dL. In addition, intact parathyroid hormone levels were as high as 277.4 pg/mL, and 1, 25-(OH) 2 vitamin D and 25-(OH) vitamin D levels were markedly reduced: 1, 25-(OH) 2 vitamin D, ≤4 pg/mL; 25-(OH) vitamin D, 11.0 ng/mL. Fibroblast growth factor 23 levels did not increase. Alkaline phosphatase (ALP) and bone-type ALP (BAP) levels were high: ALP, 784 U/L; BAP, 159.2 μg/L (reference range: 3.7–20.9 μg/L). Based on these findings, we diagnosed this patient with vitamin D-deficient osteomalacia triggered by long-term social withdrawal and an unbalanced diet. Interventions and outcomes: After hospitalization, to treat vitamin D-deficient osteomalacia, we started to administer 1 μg/day of alfacalcidol and 3 g/day of calcium lactate. Approximately one month later, 1,25-(OH) 2 vitamin D levels increased to 214 pg/mL. Consequently, calcium and inorganic phosphorus were also increased up to 7.8 mg/dL and 3.9 mg/dL, respectively, and intact parathyroid hormone was decreased to 132.0 pg/mL. Conclusions: We should bear in mind the possibility of osteomalacia triggered by social withdrawal and vitamin D deficiency even in middle-aged subjects.

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Section: Discussionmentioning

confidence: 99%

Vitamin D deficiency osteomalacia triggered by long-term social withdrawal and unbalanced diet in a Japanese middle-aged subject

et al. 2022

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“…72 Triggers of AD flares, including food allergies and UVB exposure, should be avoided in selected patients. 73 Some food allergens, however, such as fish and mushrooms contain large amounts of vitamin D. 74 These strategies, particularly when excessive and inadequate, may increase the tendency for developing vitamin D deficient rickets. 74 Borzutzky et al, 72 George et al, 74 and Arujuna et al 75 separately reported vitamin D deficient rickets in patients with AD.…”

Section: Atopic Dermatitismentioning

confidence: 99%

“…72 Therefore, prolonged vitamin D supplementation could be beneficial to selected patients with AD and food allergy to treat AD flares and prevent rickets. 73…”

Section: Atopic Dermatitismentioning

confidence: 99%

Rickets in association with skin diseases and conditions: A review with emphasis on screening and prevention

Litaiem

Chabchoub

Bacha

et al. 2020

Photoderm Photoimm Photomed

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Background Rickets is a common disease worldwide. In the developed world, its prevalence dramatically decreased but still diagnosed in at‐risk populations. The skin plays a critical role in vitamin D synthesis. Therefore, several skin diseases, especially keratinization disorders, could lead to impaired vitamin D metabolism and vitamin D deficient rickets. Objective The article aimed to summarize the current knowledge of skin diseases and conditions associated with rickets. Methods To examine the association between rickets and skin diseases, we performed a systematic review of the literature using PubMed database. The search included studies published from the database inception to August 2019. Results A total number of 75 articles were included. Identified conditions associated with rickets were ichthyosis being a more common skin diseases, alopecia, epidermal and melanocytic nevi, xeroderma pigmentosum, mastocytosis, psoriasis, and atopic dermatitis. Three types of rickets were identified: vitamin D‐dependent rickets, hypocalcemic vitamin D‐dependent rickets type 2, and hypophosphatemic rickets. Cutaneous skeletal hypophosphatemia syndrome is a newly described and under‐recognized condition. It is defined by the association of epidermal or melanocytic nevi, hypophosphatemic rickets, and elevated levels of fibroblast growth factor 23. Rickets in patients with ichthyosis was mainly due to impaired ability of ichthyotic skin to synthesize vitamin D, poor UV penetration of the skin caused by keratinocyte proliferation, and dark phototype. The latter may be considered a risk factor for rickets in patients with ichthyosis. Conclusion Despite its rarity, these associations should be properly recognized by dermatologists. Early diagnosis of rickets is important to prevent growth retardation and skeletal deformities.

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Non-classical presentation of vitamin D deficiency: a case report

Ibrahim¹,

Elnimeiri

2020

J Med Case Reports

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Background Vitamin D is a fat-soluble vitamin; vitamin D is essential to sustain health and it protects against osteoporosis. It is crucial to the human body’s physiology in terms of muscular movement and neurological signal transmission, and to the immune system in defense against invading pathogens. Case presentation This was a case of a 26-year-old Sudanese woman who presented with a 2-year history of anosmia, recurrent nasal polyps, back pain, and chronic fatigue. She was diagnosed as having a case of vitamin D deficiency and responded well to treatment. Conclusion There is an association between vitamin D deficiency and recurrent allergic nasal conditions.

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Vitamin D-deficient osteomalacia due to excessive self-restrictions for atopic dermatitis

Cited by 3 publications

References 16 publications

Vitamin D deficiency osteomalacia triggered by long-term social withdrawal and unbalanced diet in a Japanese middle-aged subject

Vitamin D deficiency osteomalacia triggered by long-term social withdrawal and unbalanced diet in a Japanese middle-aged subject

Rickets in association with skin diseases and conditions: A review with emphasis on screening and prevention

Non-classical presentation of vitamin D deficiency: a case report

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