Author: Vanessa Ngan, Staff Writer, 2005.
Vitamin D is made up from a group of fat-soluble vitamins that exist in several forms.
Hence, the skin is of unique importance in the synthesis, storage and release of vitamin D into circulation.
It is well established that sunshine is a significant source of vitamin D as UVB rays from sunlight trigger vitamin D3 manufacture in the skin. However, there is little information available about how much sunlight is necessary to make enough vitamin D3 to maintain adequate serum calcitriol levels to form and maintain healthy, strong bones. On the other hand, there is much evidence around about the dangers of over exposure to sunlight and its role in causing skin cancer. There has been much discussion about how to achieve a balance between exposing oneself to enough sunlight to maintain adequate vitamin D levels and avoiding an increase in the risk of skin cancer.
During winter months, vitamin D production is reduced. However, the body can rely on tissue stores of vitamin D for between 30 and 60 days assuming levels are adequate prior to winter. As summer approaches and more sunlight hours are available, vitamin D is produced by the skin to rebuild depleted stores.
The classic vitamin D deficiency diseases are rickets and osteomalacia.
Rickets occurs in children who are vitamin D deficient and is a bone disease characterised by softening and weakening of the bones. There is a loss of calcium and phosphate from the bones, which eventually causes destruction of the supportive matrix. vitamin D deficiency is not only caused by lack of sunlight exposure but may arise from other factors including:
In adults, vitamin D deficiency can lead to osteomalacia, which results in muscular weakness, bone pain and bone fractures. Initially symptoms of muscle weakness and bone pain may be subtle and go undetected. Long-term uncorrected vitamin D deficiency can lead to osteoporosis.
Recently some studies have been published that suggest possible beneficial effects of sun exposure in the prevention or improvement of outcome of a number of diseases including breast, prostate and colorectal cancer, autoimmune diseases such as non-Hodgkin lymphoma and multiple sclerosis, cardiovascular disease and diabetes. The mechanisms mediating the association are still under investigation. There is insufficient evidence at present to make any recommendations related to vitamin D and these diseases, however, recommendations should be reviewed when new evidence becomes available.
For most people, consuming vitamin D containing foods or vitamin D fortified foods and adequate sunlight exposure is sufficient for maintaining healthy vitamin D levels. However, there are several groups of individuals that may require dietary supplements and/or monitoring of vitamin D levels to ensure they do not become deficient. However, the blood tests can be misleading, as the normal level may depend on the time of year – one needs a high level at the end of summer to ensure vitamin stores will last through the winter. A low level at the end of winter might be quite normal. The blood tests are also quite expensive (about $50 a test in New Zealand).
Normal regular sunscreen usage has not been associated with Vitamin D insufficiency in the majority of studies (Matsouka et al 1987, Farrerons et al 2001, Marks et al 1995, Norval et al 2009). This may be because insufficient sunscreen is applied and sunscreen users may expose themselves to more sun than non-users (Im et al 2010).
Supplemental vitamin D can be taken in two forms: vitamin D2 and vitamin D3.
Too much vitamin D can cause toxicity that results in nausea, vomiting, poor appetite, constipation, weakness and weight loss. It can also raise blood calcium levels, causing mental status changes such as confusion and heart rhythm abnormalities.
Sun exposure is unlikely to result in vitamin D toxicity. Other compounds produced in the skin protect the body from synthesising too much vitamin D during periods of prolonged sun exposure. Vitamin D toxicity is likely to occur from overdose of vitamin D supplements. People taking vitamin D supplements should never exceed the recommended dose and should be made aware of the side effects of vitamin D overdose.
UVB radiation has the dual effect of promoting vitamin D3 synthesis in the skin (which can be further converted to 1,25(OH)2D3) and increasing DNA damage, leading to skin cancer. Thus, although UVR may be an efficient means of providing the nutritional requirement for vitamin D, the advantage to the skin may be countered by the increased risk of mutations.1
See the DermNet NZ bookstore.
© 2018 DermNet New Zealand Trust.
DermNet NZ does not provide an online consultation service. If you have any concerns with your skin or its treatment, see a dermatologist for advice.