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Once-Daily Application of Calcipotriene 0.005%–Betamethasone Dipropionate 0.064% Ointment for Repigmentation of Facial Vitiligo
Asymptomatic Lower Lip Hyperpigmentation From Laugier-Hunziker Syndrome
Skin of Color: Nanotechnology Produces Appealing Sunscreens for Dark Skinned Patients
While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.
Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.
The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.
Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.
Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.
The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.
Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.
Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.
Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.
We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.
While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.
Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.
The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.
Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.
Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.
The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.
Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.
Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.
Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.
We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.
While the growing field of nanotechnology holds promise, particularly for darker skinned patients, it comes with its fair share of controversy.
Nanotechnology is the study of manipulating matter on a molecular scale by structuring ingredients into nanometer sized particles versus micrometer particles that are considerably larger.
The technology is currently being used in sunscreens, cosmetics, moisturizers, and anti-aging products because of properties that cannot be obtained using larger sized particles. In skin of color, nanotechnology has provided considerable benefit in the elegance of products, particularly sunscreens.
Chemical blockers in sunscreens, such as avobenzone, are greasy and difficult to blend. In addition, titanium dioxide leaves a white residue when applied to darker skin. When the ingredients are converted to nanoparticles, however, they are less greasy and leave the skin residue free while retaining their broad spectrum properties.
Because sunscreen use is much less prevalent in skin of color, particularly in black and Hispanic populations, skin cancer rates and photo-aging are on the rise in these populations. Although more educational and preventative health measures need to be undertaken, improvements in sunscreens may help drive use.
The safety of nanotechnology, however, has received considerable debate. Because the skin is the first line of defense, many dermatologists have concerns about the potential risk of nanotechnology.
Studies have shown that nanoparticles can enter skin with an altered integrity. Thus, products containing nanoparticles should never be used on damaged skin, burns, infants, and those with an inadequate skin barrier.
Considerable research on nanoparticles has shown that healthy, undamaged skin is an effective barrier for preventing the entry of nanoparticles into the deep layers of the dermis. And, the Food and Drug Administration’s Nanotechnology Task Force is currently investigating the safety of nanoparticles for skin care products because materials in the nano-scale dimension may have different chemical, physical, and biologic properties. The FDA has proposed guidelines for the use and development of nanotechnology to ensure patient safety and product efficacy.
Sunscreens are used to protect us from a known carcinogen: UV radiation. Nanoparticles have not been proven to be carcinogenic. In fact, sunscreens with nanoparticles have been shown to last longer, apply better to the skin, and provide better UVA and UVB protection than other products on the market.
We should encourage our skin of color patients that these products are safe and are more transparent than traditional products. This technology is providing more appealing products for us to offer our patients.
Blog: Treating Acne, PIH in Dark Skinned Patients
The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.
The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.
When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)
For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.
Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.
Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.
A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).
-By Naseem Miller
The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.
The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.
When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)
For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.
Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.
Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.
A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).
-By Naseem Miller
The growing diversity of the U.S. population has highlighted the importance of being able to properly treat skin of color patients.
The topic was the focus of a presentation by Dr. Wendy E. Roberts during the American Academy of Dermatology's Summer Academy Meeting in New York. She is in private practice in Rancho Mirage, Calif.
When it comes to treating skin of color, dermatologists should keep three main points in mind, said Dr. Roberts: recognition of the skin disease, treatment, and procedural safely. (Dr. Roberts explains each point in the video below.)
For instance, acne, which is the most common skin condition, can affect dark skin differently than in patients with light skin. Postinflammatory hyperpigmentation (PIH) is one of the unique characteristics of acne expression in ethnic skin.
Patients may not visit the dermatologist because of the primary lesions such as papules and postules, said Dr. Roberts. Rather, they may come in because of the brown spot on their skin.
Based on the patients' skin type and severity of acne, dermatologists have access to several treatment options for PIH, which include the gold standard hydroquinone and retinoids that help lighten the affected areas. Other options include chemical peels, microdermabrasion, and fractional lasers.
A 2010 review of acne in skin of color patients showed that clinical features such as PIH and potential irritation, "should influence the choice of anti-acne agents used when designing a treatment regimen" (J. Clin. Aesthet. Dematol. 2010;3:24-38).
-By Naseem Miller
Photoaging in Skin of Color
Successful Treatment of Chickenpox Scars With Microdermabrasion and a Nonablative, Submillisecond, 1064-nm Nd:YAG Laser
Hair Care Practices in Black Women With and Without Scarring Alopecia: A Retrospective Cohort Study
Bimatoprost Repigments Vitiligo Patient Skin
SEOUL, SOUTH KOREA – Topical bimatoprost ophthalmic solution shows promise as a novel treatment for localized, stable vitiligo, a small pilot study suggests.
Patients with recalcitrant sequential or focal vitiligo, especially on the face, responded particularly well to the topical prostaglandin F2-alpha analogue in this small prospective trial with blinded outcome assessment, Dr. Tarun Narang said at the World Congress of Dermatology.
Advantages of this off-label treatment include its low cost, the fact that patients can self-apply it with no requirement for photoexposure, and the minimal side effects, added Dr. Narang of Gian Sagar Medical College in Banur, India.
He reported on 10 patients with localized vitiligo who applied bimatoprost 0.03% ophthalmic solution at a dose of 1 drop per 2 cm2 of affected skin twice daily for 4 months.
Seven of 10 patients showed pronounced repigmentation beginning on average after 2 months of treatment: 3 patients had 100% repigmentation, 3 others had 75%-99% repigmentation, and 1 patient showed 50%-75% repigmentation.
Patients with a disease duration of 6 months or less had the best results. Lesions on the face and scalp regimented fastest, after just 4-6 weeks of treatment. Facial lesions responded best, as all three patients who had 100% clearing had vitiligo on the face.
During 6 months of follow-up, three patients with lesions on the trunk or extremities that initially responded to treatment relapsed, typically 2-3 months after conclusion of the 4-month treatment period. Interestingly, all five patients with focal or segmental vitiligo had either 100% repigmentation or 75%-99% improvement, and none relapsed off therapy, Dr. Narang noted.
The only treatment side effect was a transient burning sensation, mainly on the lips, reported by two patients.
Dr. Narang said that although vitiligo involves the disappearance of dermal melanocytes, the mechanisms involved are not completely understood. However, it is known that prostaglandins in the skin help regulate melanocytes.
The topical prostaglandin analogues prescribed for treatment of glaucoma cause increased melanogenesis as evidenced by their common side effects: periocular skin hyperpigmentation, hypertrichosis, and iris hyperpigmentation.
Ophthalmologic colleagues say these side effects are more pronounced with bimatoprost than other topical prostaglandin analogues, which is why Dr. Narang said he decided to conduct this first-ever study of the drug as a treatment for vitiligo. The long-term effects of daily bimatoprost for vitiligo will require further study, he stressed.
Dr. Narang declared having no relevant financial disclosures.
SEOUL, SOUTH KOREA – Topical bimatoprost ophthalmic solution shows promise as a novel treatment for localized, stable vitiligo, a small pilot study suggests.
Patients with recalcitrant sequential or focal vitiligo, especially on the face, responded particularly well to the topical prostaglandin F2-alpha analogue in this small prospective trial with blinded outcome assessment, Dr. Tarun Narang said at the World Congress of Dermatology.
Advantages of this off-label treatment include its low cost, the fact that patients can self-apply it with no requirement for photoexposure, and the minimal side effects, added Dr. Narang of Gian Sagar Medical College in Banur, India.
He reported on 10 patients with localized vitiligo who applied bimatoprost 0.03% ophthalmic solution at a dose of 1 drop per 2 cm2 of affected skin twice daily for 4 months.
Seven of 10 patients showed pronounced repigmentation beginning on average after 2 months of treatment: 3 patients had 100% repigmentation, 3 others had 75%-99% repigmentation, and 1 patient showed 50%-75% repigmentation.
Patients with a disease duration of 6 months or less had the best results. Lesions on the face and scalp regimented fastest, after just 4-6 weeks of treatment. Facial lesions responded best, as all three patients who had 100% clearing had vitiligo on the face.
During 6 months of follow-up, three patients with lesions on the trunk or extremities that initially responded to treatment relapsed, typically 2-3 months after conclusion of the 4-month treatment period. Interestingly, all five patients with focal or segmental vitiligo had either 100% repigmentation or 75%-99% improvement, and none relapsed off therapy, Dr. Narang noted.
The only treatment side effect was a transient burning sensation, mainly on the lips, reported by two patients.
Dr. Narang said that although vitiligo involves the disappearance of dermal melanocytes, the mechanisms involved are not completely understood. However, it is known that prostaglandins in the skin help regulate melanocytes.
The topical prostaglandin analogues prescribed for treatment of glaucoma cause increased melanogenesis as evidenced by their common side effects: periocular skin hyperpigmentation, hypertrichosis, and iris hyperpigmentation.
Ophthalmologic colleagues say these side effects are more pronounced with bimatoprost than other topical prostaglandin analogues, which is why Dr. Narang said he decided to conduct this first-ever study of the drug as a treatment for vitiligo. The long-term effects of daily bimatoprost for vitiligo will require further study, he stressed.
Dr. Narang declared having no relevant financial disclosures.
SEOUL, SOUTH KOREA – Topical bimatoprost ophthalmic solution shows promise as a novel treatment for localized, stable vitiligo, a small pilot study suggests.
Patients with recalcitrant sequential or focal vitiligo, especially on the face, responded particularly well to the topical prostaglandin F2-alpha analogue in this small prospective trial with blinded outcome assessment, Dr. Tarun Narang said at the World Congress of Dermatology.
Advantages of this off-label treatment include its low cost, the fact that patients can self-apply it with no requirement for photoexposure, and the minimal side effects, added Dr. Narang of Gian Sagar Medical College in Banur, India.
He reported on 10 patients with localized vitiligo who applied bimatoprost 0.03% ophthalmic solution at a dose of 1 drop per 2 cm2 of affected skin twice daily for 4 months.
Seven of 10 patients showed pronounced repigmentation beginning on average after 2 months of treatment: 3 patients had 100% repigmentation, 3 others had 75%-99% repigmentation, and 1 patient showed 50%-75% repigmentation.
Patients with a disease duration of 6 months or less had the best results. Lesions on the face and scalp regimented fastest, after just 4-6 weeks of treatment. Facial lesions responded best, as all three patients who had 100% clearing had vitiligo on the face.
During 6 months of follow-up, three patients with lesions on the trunk or extremities that initially responded to treatment relapsed, typically 2-3 months after conclusion of the 4-month treatment period. Interestingly, all five patients with focal or segmental vitiligo had either 100% repigmentation or 75%-99% improvement, and none relapsed off therapy, Dr. Narang noted.
The only treatment side effect was a transient burning sensation, mainly on the lips, reported by two patients.
Dr. Narang said that although vitiligo involves the disappearance of dermal melanocytes, the mechanisms involved are not completely understood. However, it is known that prostaglandins in the skin help regulate melanocytes.
The topical prostaglandin analogues prescribed for treatment of glaucoma cause increased melanogenesis as evidenced by their common side effects: periocular skin hyperpigmentation, hypertrichosis, and iris hyperpigmentation.
Ophthalmologic colleagues say these side effects are more pronounced with bimatoprost than other topical prostaglandin analogues, which is why Dr. Narang said he decided to conduct this first-ever study of the drug as a treatment for vitiligo. The long-term effects of daily bimatoprost for vitiligo will require further study, he stressed.
Dr. Narang declared having no relevant financial disclosures.
FROM THE WORLD CONGRESS OF DERMATOLOGY
Major Finding: Seven of 10 vitiligo patients showed pronounced repigmentation beginning on average after 2 months of treatment: 3 patients had 100% repigmentation, 3 patients had 75%-99% repigmentation, and 1 patient showed 50%-75% repigmentation.
Data Source: A small pilot study to evaluate an off-label use of topical bimatoprost ophthalmic solution.
Disclosures: Dr. Narang declared having no relevant financial disclosures.
Healthy People Don't Need Vitamin D Screen, Guidelines Say
BOSTON – Healthy individuals do not need to be screened for vitamin D deficiency, according to guidelines released today by the Endocrine Society.
"We do not recommend screening for vitamin D deficiency in individuals not at risk. That's an important message. So we're recommending screening for those at risk for vitamin D deficiency – those who are obese, African Americans, pregnant and lactating women, patients with malabsorption syndromes, and a whole list that we have provided in the guidelines," lead author Dr. Michael F. Holick said at the annual meeting of the Endocrine Society.
Dr. Holick headed a task force appointed by the clinical guidelines subcommittee of the Endocrine Society to formulate evidence-based recommendations on vitamin D deficiency. The subcommittee deemed vitamin D deficiency a priority area in need of practice guidelines.
The task force noted that most individuals do not get adequate vitamin D for a number of reasons. In particular, "there needs to be an appreciation that unprotected sun exposure is the major source of vitamin D for both children and adults and that in the absence of sun exposure it is difficult, if not impossible, to obtain an adequate amount of vitamin D from dietary sources without supplementation to satisfy the body’s requirement. Concerns about melanoma and other types of skin cancer necessitate avoidance of excessive exposure to midday sun," they wrote.
The task force recommended that those at risk for vitamin D deficiency be screened by measuring serum 25-hydroxyvitamin D levels using a reliable assay. Causes of vitamin D deficiency include obesity, fat malabsorption syndromes, bariatric surgery, nephrotic syndrome, a wide range of medications (anticonvulsants and anti–HIV/AIDS drugs), chronic granuloma-forming disorders, some lymphomas, and primary hyperthyroidism.
The guidelines were released at the meeting and will be published in the July issue of the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2011-0385).
The guidelines provide long-awaited recommendations on vitamin D intake and the diagnosis and treatment of vitamin D deficiency. Physicians have struggled for years to delineate how much vitamin D is necessary for different clinical groups, how to measure it, and how best to supplement deficiencies.
The task force commissioned the conduct of two systematic reviews of the literature to inform its key recommendations and followed the approach recommended by GRADE, an international group with expertise in development and implementation of evidence-based guidelines.
"All available evidence suggests that children and adults should maintain a blood level of 25(OH)D above 20 ng/mL to prevent rickets and osteomalacia, respectively. However, to maximize vitamin D's effect on calcium, bone, and muscle metabolism, the 25(OH)D blood level should be above 30 ng/mL," the group wrote.
In the new guidelines, vitamin D deficiency is defined as a 25(OH)D concentration less than 20 ng/mL (50 nmol/L). The task force suggests:
– Infants and children aged 0-1 year require at least 400 IU/day (IU = 25 ng) of vitamin D to maximize bone health.
– Children 1 year and older require at least 600 IU/day.
– Adults aged 19-50 years require at least 600 IU/day.
– Adults aged 50-70 years require at least 600 IU/day.
– Adults 70 years and older require 800 IU/day.
– Pregnant and lactating women require at least 600 IU/day.
The task force also recommends that obese children and adults and children and adults on certain medications (anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole, and medications for AIDS) be given at least 2-3 times more vitamin D for their age group to satisfy their bodies' vitamin D requirements.
Either vitamin D2 or vitamin D3 can be used for the treatment and prevention of vitamin D deficiency. The group recommends that adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for eight weeks or its equivalent of 6,000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25(OH)D greater than 30 ng/mL. This should be followed by maintenance therapy of 1,500-2,000 IU/day.
The task force also recommends vitamin D supplementation for fall prevention. "We know that there is sufficient evidence to give vitamin D for fall prevention. It's well documented that vitamin D is very important for muscle strength," said Dr. Holick, professor of medicine, physiology and biophysics at Boston University.
However, the group does not recommend prescribing vitamin D supplementation beyond recommended daily needs for the purpose of preventing cardiovascular disease or death or improving quality of life, because there is insufficient evidence.
The guidelines are cosponsored by the Canadian Society of Endocrinology and Metabolism and the National Osteoporosis Foundation.
All but one of the authors reported having significant financial relationships with pharmaceutical companies, medical organizations, and/or food industry groups.
BOSTON – Healthy individuals do not need to be screened for vitamin D deficiency, according to guidelines released today by the Endocrine Society.
"We do not recommend screening for vitamin D deficiency in individuals not at risk. That's an important message. So we're recommending screening for those at risk for vitamin D deficiency – those who are obese, African Americans, pregnant and lactating women, patients with malabsorption syndromes, and a whole list that we have provided in the guidelines," lead author Dr. Michael F. Holick said at the annual meeting of the Endocrine Society.
Dr. Holick headed a task force appointed by the clinical guidelines subcommittee of the Endocrine Society to formulate evidence-based recommendations on vitamin D deficiency. The subcommittee deemed vitamin D deficiency a priority area in need of practice guidelines.
The task force noted that most individuals do not get adequate vitamin D for a number of reasons. In particular, "there needs to be an appreciation that unprotected sun exposure is the major source of vitamin D for both children and adults and that in the absence of sun exposure it is difficult, if not impossible, to obtain an adequate amount of vitamin D from dietary sources without supplementation to satisfy the body’s requirement. Concerns about melanoma and other types of skin cancer necessitate avoidance of excessive exposure to midday sun," they wrote.
The task force recommended that those at risk for vitamin D deficiency be screened by measuring serum 25-hydroxyvitamin D levels using a reliable assay. Causes of vitamin D deficiency include obesity, fat malabsorption syndromes, bariatric surgery, nephrotic syndrome, a wide range of medications (anticonvulsants and anti–HIV/AIDS drugs), chronic granuloma-forming disorders, some lymphomas, and primary hyperthyroidism.
The guidelines were released at the meeting and will be published in the July issue of the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2011-0385).
The guidelines provide long-awaited recommendations on vitamin D intake and the diagnosis and treatment of vitamin D deficiency. Physicians have struggled for years to delineate how much vitamin D is necessary for different clinical groups, how to measure it, and how best to supplement deficiencies.
The task force commissioned the conduct of two systematic reviews of the literature to inform its key recommendations and followed the approach recommended by GRADE, an international group with expertise in development and implementation of evidence-based guidelines.
"All available evidence suggests that children and adults should maintain a blood level of 25(OH)D above 20 ng/mL to prevent rickets and osteomalacia, respectively. However, to maximize vitamin D's effect on calcium, bone, and muscle metabolism, the 25(OH)D blood level should be above 30 ng/mL," the group wrote.
In the new guidelines, vitamin D deficiency is defined as a 25(OH)D concentration less than 20 ng/mL (50 nmol/L). The task force suggests:
– Infants and children aged 0-1 year require at least 400 IU/day (IU = 25 ng) of vitamin D to maximize bone health.
– Children 1 year and older require at least 600 IU/day.
– Adults aged 19-50 years require at least 600 IU/day.
– Adults aged 50-70 years require at least 600 IU/day.
– Adults 70 years and older require 800 IU/day.
– Pregnant and lactating women require at least 600 IU/day.
The task force also recommends that obese children and adults and children and adults on certain medications (anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole, and medications for AIDS) be given at least 2-3 times more vitamin D for their age group to satisfy their bodies' vitamin D requirements.
Either vitamin D2 or vitamin D3 can be used for the treatment and prevention of vitamin D deficiency. The group recommends that adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for eight weeks or its equivalent of 6,000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25(OH)D greater than 30 ng/mL. This should be followed by maintenance therapy of 1,500-2,000 IU/day.
The task force also recommends vitamin D supplementation for fall prevention. "We know that there is sufficient evidence to give vitamin D for fall prevention. It's well documented that vitamin D is very important for muscle strength," said Dr. Holick, professor of medicine, physiology and biophysics at Boston University.
However, the group does not recommend prescribing vitamin D supplementation beyond recommended daily needs for the purpose of preventing cardiovascular disease or death or improving quality of life, because there is insufficient evidence.
The guidelines are cosponsored by the Canadian Society of Endocrinology and Metabolism and the National Osteoporosis Foundation.
All but one of the authors reported having significant financial relationships with pharmaceutical companies, medical organizations, and/or food industry groups.
BOSTON – Healthy individuals do not need to be screened for vitamin D deficiency, according to guidelines released today by the Endocrine Society.
"We do not recommend screening for vitamin D deficiency in individuals not at risk. That's an important message. So we're recommending screening for those at risk for vitamin D deficiency – those who are obese, African Americans, pregnant and lactating women, patients with malabsorption syndromes, and a whole list that we have provided in the guidelines," lead author Dr. Michael F. Holick said at the annual meeting of the Endocrine Society.
Dr. Holick headed a task force appointed by the clinical guidelines subcommittee of the Endocrine Society to formulate evidence-based recommendations on vitamin D deficiency. The subcommittee deemed vitamin D deficiency a priority area in need of practice guidelines.
The task force noted that most individuals do not get adequate vitamin D for a number of reasons. In particular, "there needs to be an appreciation that unprotected sun exposure is the major source of vitamin D for both children and adults and that in the absence of sun exposure it is difficult, if not impossible, to obtain an adequate amount of vitamin D from dietary sources without supplementation to satisfy the body’s requirement. Concerns about melanoma and other types of skin cancer necessitate avoidance of excessive exposure to midday sun," they wrote.
The task force recommended that those at risk for vitamin D deficiency be screened by measuring serum 25-hydroxyvitamin D levels using a reliable assay. Causes of vitamin D deficiency include obesity, fat malabsorption syndromes, bariatric surgery, nephrotic syndrome, a wide range of medications (anticonvulsants and anti–HIV/AIDS drugs), chronic granuloma-forming disorders, some lymphomas, and primary hyperthyroidism.
The guidelines were released at the meeting and will be published in the July issue of the Journal of Clinical Endocrinology & Metabolism (doi: 10.1210/jc.2011-0385).
The guidelines provide long-awaited recommendations on vitamin D intake and the diagnosis and treatment of vitamin D deficiency. Physicians have struggled for years to delineate how much vitamin D is necessary for different clinical groups, how to measure it, and how best to supplement deficiencies.
The task force commissioned the conduct of two systematic reviews of the literature to inform its key recommendations and followed the approach recommended by GRADE, an international group with expertise in development and implementation of evidence-based guidelines.
"All available evidence suggests that children and adults should maintain a blood level of 25(OH)D above 20 ng/mL to prevent rickets and osteomalacia, respectively. However, to maximize vitamin D's effect on calcium, bone, and muscle metabolism, the 25(OH)D blood level should be above 30 ng/mL," the group wrote.
In the new guidelines, vitamin D deficiency is defined as a 25(OH)D concentration less than 20 ng/mL (50 nmol/L). The task force suggests:
– Infants and children aged 0-1 year require at least 400 IU/day (IU = 25 ng) of vitamin D to maximize bone health.
– Children 1 year and older require at least 600 IU/day.
– Adults aged 19-50 years require at least 600 IU/day.
– Adults aged 50-70 years require at least 600 IU/day.
– Adults 70 years and older require 800 IU/day.
– Pregnant and lactating women require at least 600 IU/day.
The task force also recommends that obese children and adults and children and adults on certain medications (anticonvulsant medications, glucocorticoids, antifungals such as ketoconazole, and medications for AIDS) be given at least 2-3 times more vitamin D for their age group to satisfy their bodies' vitamin D requirements.
Either vitamin D2 or vitamin D3 can be used for the treatment and prevention of vitamin D deficiency. The group recommends that adults who are vitamin D deficient be treated with 50,000 IU of vitamin D2 or vitamin D3 once a week for eight weeks or its equivalent of 6,000 IU of vitamin D2 or vitamin D3 daily to achieve a blood level of 25(OH)D greater than 30 ng/mL. This should be followed by maintenance therapy of 1,500-2,000 IU/day.
The task force also recommends vitamin D supplementation for fall prevention. "We know that there is sufficient evidence to give vitamin D for fall prevention. It's well documented that vitamin D is very important for muscle strength," said Dr. Holick, professor of medicine, physiology and biophysics at Boston University.
However, the group does not recommend prescribing vitamin D supplementation beyond recommended daily needs for the purpose of preventing cardiovascular disease or death or improving quality of life, because there is insufficient evidence.
The guidelines are cosponsored by the Canadian Society of Endocrinology and Metabolism and the National Osteoporosis Foundation.
All but one of the authors reported having significant financial relationships with pharmaceutical companies, medical organizations, and/or food industry groups.
FROM THE ANNUAL MEETING OF THE ENDOCRINE SOCIETY