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Topical vitamin D analog for chronic graft versus host disease of the skin

Bone Marrow Transplantation volume 53, pages 628–633 (2018)Cite this article

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Chronic graft versus host disease (cGVHD) is a significant cause of post-transplant morbidity and mortality. Chronic skin GVHD with associated sclerosis, pigmentation changes, alopecia, restricted joint mobility, and intense pruritus significantly affects quality of life and self-confidence. Topical therapy options for cGVHD of the skin are limited. Topical calcineurin inhibitors, steroid applications, and emollients are often only partially effective, and oily and inconvenient for long-term use. Medications used for pruritus are often sedating and ineffective, so there is significant need for alternative therapies for these patients.

Systemic vitamin D deficiency has been linked to acute and chronic GVHD in multiple studies. We showed that over 70% of stem cell transplant recipients are vitamin D deficient, and severe vitamin D deficiency is associated with inferior survival [1,2,3]. The dermatology literature points to inadequate vitamin D receptors (VDR) in the skin in some immune mediated skin disorders [4]. Calcipotriene, a topical vitamin D analog, is thought to increase the number of VDR’s in epidermal nuclei. VDR agonists also contribute to control of the innate and adaptive immune system. Topical vitamin D analogs have been used for atopic dermatitis [5], vitiligo, morphea, and lichen sclerosus et atrophicus owing to its effects on immunoregulation, fibroblast proliferation, collagen synthesis, and endothelial cell function [6]. Vitamin D3 downregulates cellular adhesion molecule expression by inhibiting TNF-α mRNA expression, which has been suggested as a mechanism that alleviates pruritus in patients with steroid refractory prurigo [7]. Calcipotriene was approved by the FDA in 1994 for use in psoriasis only. It has proven to be effective in the treatment of other dermatoses, but there are no reports in the scientific literature using it for the treatment of skin GVHD.

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Acknowledgements

The authors thank Ms. Amber Cobb for technical assistance.

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Authors and Affiliations

  1. Division of Bone Marrow Transplant and Immune Deficiency, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Gregory Wallace, Kasiani C. Myers, Stella M. Davies, Pooja Khandelwal & Sonata Jodele

  2. Department of Pharmacy, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA

    Ashley Teusink-Cross

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  1. Gregory Wallace
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  2. Kasiani C. Myers
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Correspondence to Gregory Wallace.

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GW has patent pending for topical Vitamin D use for GVHD. All other authors declare that they have no conflict of interest.

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Wallace, G., Myers, K.C., Teusink-Cross, A. et al. Topical vitamin D analog for chronic graft versus host disease of the skin. Bone Marrow Transplant 53, 628–633 (2018). https://doi.org/10.1038/s41409-017-0031-2

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