Vitamin D Management in Cutaneous Lupus Erythematosus: Balancing Photoprotection and Immunomodulation
DOI:
https://doi.org/10.12775/QS.2026.51.68459Keywords
Systemic Lupus Erythematosus, dermatoses, photodermatoses, Vitamin D, Vitamin D deficiency, photoprotection, ImmunomodulationAbstract
Background: Cutaneous lupus erythematosus (CLE) is an autoimmune inflammatory disorder which demands strict photoprotections, leading to vitamin D deficiency. This narrative review evaluates the interplay between vitamin D status, disease activity, and modern management challenges.
Methods: A comprehensive literature search was conducted across PubMed, EMBASE, and Scopus databases for studies published up to January 2026, focusing on CLE, vitamin D metabolism, and clinical outcomes.
Results: Vitamin D insufficiency is almost universal for all CLE patients. The etiology of this insufficiency is multifactorial, including therapy involving antimalarial agents, sun-avoidance, or sunscreen use. It correlates with higher disease activity, while supplementation significantly reduces Cutaneous Lupus Erythematosus Disease Area and Severity Index- Activity (CLASI-A) scores and shortens the duration of active skin lesions. Current 2026 vitamin D supplementation protocols for the general population may not be enough for CLE patients.
Conclusions: Vitamin D should become an integral component of CLE management. Regular monitoring and individualized supplementation are crucial to overcome pharmacological and behavioral barriers. The chronological gap in existing literature suggests that there is a notable need for new randomized clinical trials that align with 2026 therapeutic standards. It would facilitate the development of supplementation protocols tailored to CLE patients.
References
1. Cutillas-Marco E, Marquina-Vila A, Grant WB, Vilata-Corell JJ, Morales-Suárez-Varela MM. Vitamin D and cutaneous lupus erythematosus: effect of vitamin D replacement on disease severity. Lupus. 2014;23(7):615-623. doi:10.1177/0961203314522338
2. Kuhn A, Landmann A. The classification and diagnosis of cutaneous lupus erythematosus. J Autoimmun. 2014;48-49:14-19. doi:10.1016/j.jaut.2014.01.021
3. Johnson KE, Wulff BC, Oberyszyn TM, Wilgus TA. Ultraviolet light exposure stimulates HMGB1 release by keratinocytes. Arch Dermatol Res. 2013;305(9):805-815. doi:10.1007/s00403-013-1401-2
4. Cusack C, Danby C, Fallon JC, et al. Photoprotective behaviour and sunscreen use: impact on vitamin D levels in cutaneous lupus erythematosus. Photodermatol Photoimmunol Photomed. 2008;24(5):260-267. doi:10.1111/j.1600-0781.2008.00373.x
5. Heine G, Lahl A, Müller C, Worm M. Vitamin D deficiency in patients with cutaneous lupus erythematosus is prevalent throughout the year. Br J Dermatol. 2010;163(4):863-865. doi:10.1111/j.1365-2133.2010.09948.x
6. Cutillas-Marco E, Morales-Suárez-Varela M, Marquina-Vila A, Grant W. Serum 25-hydroxyvitamin D levels in patients with cutaneous lupus erythematosus in a Mediterranean region. Lupus. 2010;19(7):810-814. doi:10.1177/0961203309360807
7. Gao H, Xie T, Zhang Y, et al. Vitamin D and the aging skin: insights into oxidative stress, inflammation, and barrier function. Immun Ageing A. 2025;22(1):49. doi:10.1186/s12979-025-00536-6
8. Wierzbicka JM, Piotrowska A, Purzycka-Bohdan D, et al. The Effects of Vitamin D on the Expression of IL-33 and Its Receptor ST2 in Skin Cells; Potential Implication for Psoriasis. Int J Mol Sci. 2021;22(23):12907. doi:10.3390/ijms222312907
9. Mahto H, Tripathy R, Das BK, Panda AK. Association between vitamin D receptor polymorphisms and systemic lupus erythematosus in an Indian cohort. Int J Rheum Dis. 2018;21(2):468-476. doi:10.1111/1756-185X.13245
10. Bogaczewicz J, Sysa-Jędrzejowska A, Łukaszkiewicz J, Kaleta B, Woźniacka A. Prevalence of vitamin D receptor gene Fok I polymorphism in patients with systemic lupus erythematosus – a preliminary report.
11. Zhang WT, Jin TF, Chen L. Associations of four common VDR polymorphisms with rheumatoid arthritis and systemic lupus erythematosus: evidence from a meta-analysis. Lupus. 2020;29(4):364-370. doi:10.1177/0961203320909432
12. Carlberg C. Vitamin D Signaling in the Context of Innate Immunity: Focus on Human Monocytes. Front Immunol. 2019;10:2211. doi:10.3389/fimmu.2019.02211
13. Grönhagen CM, Tang MBY, Tan VWD, Tan KW, Lim YL. Vitamin D levels in 87 Asian patients with cutaneous lupus erythematosus: a case-control study. Clin Exp Dermatol. 2016;41(7):723-729. doi:10.1111/ced.12884
14. Matsuoka LY, Ide L, Wortsman J, MacLaughlin JA, Holick MF. Sunscreens suppress cutaneous vitamin D3 synthesis. J Clin Endocrinol Metab. 1987;64(6):1165-1168. doi:10.1210/jcem-64-6-1165
15. Płudowski P, Kos-Kudła B, Walczak M, et al. Guidelines for Preventing and Treating Vitamin D Deficiency: A 2023 Update in Poland. Nutrients. 2023;15(3):695. doi:10.3390/nu15030695
16. Holick MF. The Debatable Clinical Utility of the 2024 Vitamin D Guideline: Bridging the Gap Between Current Guidelines, Practical Clinical Recommendations, and Utilization of Emerging Evidence in Vitamin D Disease Prevention. Endocr Pract Off J Am Coll Endocrinol Am Assoc Clin Endocrinol. 2025;31(3):399-402. doi:10.1016/j.eprac.2025.02.002
17. Lee HJ, Sinha AA. Cutaneous lupus erythematosus: understanding of clinical features, genetic basis, and pathobiology of disease guides therapeutic strategies. Autoimmunity. 2006;39(6):433-444. doi:10.1080/08916930600886851
18. Huisman AM, White KP, Algra A, et al. Vitamin D levels in women with systemic lupus erythematosus and fibromyalgia. J Rheumatol. 2001;28(11):2535-2539.
19. Sloka S, Silva C, Wang J, Yong VW. Predominance of Th2 polarization by vitamin D through a STAT6-dependent mechanism. J Neuroinflammation. 2011;8:56. doi:10.1186/1742-2094-8-56
20. Kamen DL, Aranow C. The link between vitamin D deficiency and systemic lupus erythematosus. Curr Rheumatol Rep. 2008;10(4):273-280. doi:10.1007/s11926-008-0044-3
21. Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin’s immune response? Exp Dermatol. 2008;17(8):633-639. doi:10.1111/j.1600-0625.2008.00768.x
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Copyright (c) 2026 Patrycja Anna Borowiecka, Aleksandra Węglarz, Jacek Głuski, Agnieszka Radziwonka, Tomasz Julian Majszyk, Agnieszka Brzozowska, Paweł Kosiorek, Ada Niezgoda, Anna Olborska, Bartłomiej Maciej Wrochna, Anna Izabela Garbacz, Gabriela Stondzik
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