Correlation between Vitamin-D and Calcium levels with severity of nail involvement in psoriasis: An observational study from Northern India

Shikha Khare, Tamal Trivedi

Abstract


Introduction: Psoriasis is a common chronic autoimmune inflammatory multisystem disease mainly involving skin, nails and joints. Several studies have reported lower levels of vitamin D and calcium in psoriasis. But there is paucity of literature regarding levels of vitamin D and calcium in nail psoriasis.
Objective: To study the level of Vitamin D and calcium in psoriasis patients with nail involvement and to correlate their levels with nail severity using Nail Psoriasis Severity Index (NAPSI).
Materials and Methods: A total of 60 psoriasis patients with nail changes were recruited for the study. The severity of nail changes was calculated using Nail Psoriasis Severity Index (NAPSI). All non-specific nail changes which were present in the psoriasis patients were noted as well. Apart from routine investigations, blood calcium level and serum vitamin D levels were also sent for investigation.
Results: Majority of the participants were male with male: female ratio of 2.75:1. The mean age at of onset of nail involvement was 42.87 17.19 years. About three-fourth of the patients were hypocalcaemic and vitamin D deficient or insufficient. There was a moderate negative correlation between NAPSI and blood calcium (mg/dL), and it was statistically significant (rho = -0.33, P = 0.011). There was a weak positive correlation between NAPSI and S. Vitamin-D (ng/mL), and this correlation was not statistically significant (rho = 0.11, P = 0.402). However, on multivariate regression analysis of NAPSI, significant association was
found between nail psoriasis severity index (NAPSI) with blood calcium level and serum vitamin D levels (P=0.01).
Conclusion: Blood calcium and serum vitamin D levels were found low in patients of nail psoriasis. Hence,
oral vitamin D and calcium supplementation may aid in the earlier response to standard nail psoriasis
treatment and further studies are required to prove the therapeutic effect of calcium and vitamin D in nail
psoriasis.

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