International Journal of Dermatology and Venereology

DOI: 10.1097/JD9.0000000000000203

Assessment of Serum Vitamin D Levels in Children with Pityriasis Alba

Xiao-Yi Chen, Jing Xiao, Xiu-Wai Ji, Hai-Mei Gao, Lian-Sheng Zhong

Department of Dermatology, Children’s hospital of Fudan University at Xiamen (Xiamen

Children’s Hospital), Xiamen, Fujian 361006, China.

Corresponding author: Dr. Lian-Sheng Zhong, Department of Dermatology, Children’s

hospital of Fudan University at Xiamen (Xiamen Children’s Hospital), Xiamen, Fujian
361006, China. E-mail: zhongliansheng73@sina.com.

Funding: none.

Disclosure: The authors declare no conflicts of interest.

Abstract

Objective: This study was performed to analyze the correlation between PA and the serum 25-hydroxyvitamin
D status in children. Methods: The study population comprised 460 patients with PA and 254 age- and
sex-matched healthy controls. The serum level of 25-hydroxyvitamin D was detected by the enzyme-linked
immunosorbent assay competitive suppression method using a Roche cobas e 601 automatic
electrochemiluminescence immune analyzer. Results: The serum level of 25-hydroxyvitamin D was
significantly lower in patients with PA than in healthy controls (P < 0.001). There were statistically significant
differences in the serum vitamin D status between the PA group and control group (P < 0.001); specifically,
patients with PA had a significantly higher frequency of vitamin D deficiency (52.83% vs. 24.35%, P = 0.001)
and lower frequency of vitamin D sufficiency (22.83% vs. 37.01%, P < 0.001) than controls. Conclusions:
Vitamin D may play a role in the pathogenesis of PA. Further investigations are required to establish the
relationship between the severity of PA and the vitamin D status and to evaluate the potential for use of vitamin
D in the treatment of PA.

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Keywords: pityriasis alba, Vitamin D, 25-hydroxyvitamin D

Introduction

Pityriasis alba (PA) is a skin disease that causes hypopigmentation, and it occurs
predominantly in children and adolescents. PA is characterized by oval or round white
patches that have unclear boundaries and that are sometimes accompanied by mild scaling.
PA can arise anywhere on the skin, but it has a predilection for the face. The incidence of this
common skin disease in children ranges from about 1.9% to 5.2%, and children aged 3 to 16
years are the most prone [1,2]. PA has a high prevalence of 12% to 90% among infants and
children of low socioeconomic status in developing countries [3]. The pathogenesis of PA
remains incompletely understood; however, several theories have been suggested, such as
considering it a manifestation of atopic dermatitis, zinc deficiency, infection, or
environmental factors [4,5,6].

Vitamin D deficiency is correlated with a variety of skin diseases, such as skin cancer,
melanoma, atopic dermatitis, morphea, vitiligo, and psoriasis [7]. This study was performed to
analyze the correlation between PA and the serum 25-hydroxyvitamin D status in children.

Materials and methods

This study involved 460 Han Chinese patients with PA, all of whom were patients in Xiamen
Children’s Hospital from January 2018 to June 2020. The patients were diagnosed with PA
based on a detailed physical examination with the aid of dermoscopy and Wood’s lamp
examination in suspicious cases, and none of the patients had shown significant improvement
at the time of enrollment. This study also involved 254 age- and sex-matched healthy
individuals (controls) selected from among those who had undergone health examinations at
the same hospital. Patients with rickets, metabolic bone disorders, disorders of the thyroid
gland, autoimmune diseases, kidney or liver disorders, severe infections, and tumors were
excluded from both groups.

In both the patient and control groups, 2 mL of venous blood was collected using a vacuum
blood collection tube. The serum level of 25-hydroxyvitamin D was detected by the
enzyme-linked immunosorbent assay competitive suppression method using a Roche cobas e
601 automatic electrochemiluminescence immune analyzer (Roche Diagnostics, Basel,
Switzerland). The serum vitamin D status was classified into three groups according to the
serum 25-hydroxyvitamin D level: deficient (<20 ng/mL), insufficient (20–30 ng/mL), and
sufficient (>30 ng/mL). The data were statistically analyzed using the Wilcoxon rank sum test,
chi-square test, and t test as appropriate. A P value of <0.05 was considered statistically
significant.

Results

The demographic features of the patients and controls are presented in Table 1. No major
differences in age or sex were observed between the two groups (P > 0.05). As shown in
Table 2, the serum level of 25-hydroxyvitamin D was significantly lower in patients with PA
(24.92 ± 7.48 ng/mL) than in healthy controls (28.23 ± 7.73 ng/mL). Table 3 shows that there
were significant differences in the serum vitamin D status between the PA group and control
group (P < 0.001). Patients with PA had a higher frequency of vitamin D deficiency (52.83%
vs. 24.35%) and lower frequency of vitamin D sufficiency (22.83% vs. 37.01%) than
controls.

Discussion

Vitamin D is an essential fat-soluble vitamin for the human body. It is mainly produced by
7-dehydrocholesterol in the skin under ultraviolet radiation, although a small portion is
absorbed through the intestines. Vitamin D is absorbed into the bloodstream and synthesized
into 25-hydroxyvitamin D under the action of 25-hydroxylase in the liver. The half-life of
25-hydroxyvitamin D in the body is about 2 to 3 weeks, and it is the most abundant and
stable form of vitamin D in metabolic processes and a good indicator of the vitamin D level.
Renal 1α-hydroxylase converts 25-hydroxyvitamin D to bioactive 1,25-dihydroxyvitamin D,
which then binds to the vitamin D receptor and plays a variety of biological roles. Vitamin D
receptors are expressed in almost all tissues and organs in the body. Research has shown that
in addition to the classic role of regulating calcium and phosphorus balance and maintaining
bone health, vitamin D is also involved in the pathogenesis of malignant tumors, atopic
diseases, autoimmune diseases, cardiovascular diseases, metabolic syndrome, infections,
neuropsychiatric symptoms, and other diseases [8].

Vitamin D is believed to upregulate melanin synthesis, increase tyrosinase activity, and

inhibit melanocyte destruction [9,10], and it may play an important role in the pathogenesis of
skin diseases characterized by hypopigmentation such as vitiligo and PA. A meta-analysis
revealed a positive correlation between the incidence of vitiligo and serum
25-hydroxyvitamin D deficiency [11]. In the present study, a positive correlation was found
between PA and the vitamin D status; specifically, we found that the serum level of
25-hydroxyvitamin D was significantly lower in patients with PA than in healthy controls,
and there was a significant difference in the vitamin D status between the PA group and
control group.
Our study has some limitations, including its retrospective design and the unavailability of
data for factors that may influence the serum level of 25-hydroxyvitamin D, such as the
duration of outdoor sunlight exposure, eating habits, and seasons. Further investigations are
required to establish the relationship between the severity of PA and the vitamin D status and
to evaluate the potential for the use of vitamin D in the treatment of PA.

References

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Table 1. Demographic features in patients with PA and controls

Study group
Variables Control group (n=254) P value
(n=460)

Age (mean ± SD) 6.31±3.06 6.12±3.06 0.419

Gender
Male 237 (51%) 133 (56%)
0.830
Female 223 (49%) 121 (44%)

Table 2. Comparison of serum vitamin D level between patients with PA and controls

groups Number of cases（n） 25-hydroxyvitamin D (x±s, ng/ml)

Pityriasis alba group 460 24.92±7.48

Control group 254 28.23±7.73
P value <0.001

Table 3. Comparison of serum vitamin D status between patients with PA and controls

Vitamin D status Pityriasis alba group Control group P value

(n=460) n (%) (n=254) n (%)

Deficient 112 (24.35) 36 (14.17)

Insufficient 243 (52.83) 124 (48.82) P<0.001
Sufficient 105 (22.83) 94 (37.01)