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Case study: Vitamin D clears granuloma annulare

Posted on: July 9, 2012   by  John Cannell, MD

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Granuloma annulare is a chronic skin rash with reddish bumps arranged in a circle or ring. Granuloma annulare is different from warts, or ringworm. It most often affects children, young and older adults and it is slightly more common in females. It can be disfiguring when severe.

While its cause is unknown, usually it exists in otherwise healthy people, although patients with diabetes, thyroid disease and autoimmune disease are at higher risk. There is no curative treatment although doctors have tried many different drugs and both topical and oral corticosteroids.

Earlier this year, Dr. Alan Boyd of Vanderbilt University, reported a case of granuloma annulare resolving with oral activated vitamin D. The patient was a 40 years-old woman who had a 12-year history of the disease on her legs. Six months before being seen, it spread to her upper body and became intensely itchy.

Boyd AS.  Granuloma annulare responsive to oral calcitriol. Int J Dermatol. 2012 Jan;51(1):120-2. doi: 10.1111/j.1365-4632.2010.04510.x. No abstract available.

Dr. Boyd treated her with .25 micrograms per day of oral calcitriol. Within a month, her itching was gone and the rash began to disappear. He reports, “Her disease continues to resolve without incident.”

As Dr. Boyd points out, this treatment is unusual because two old papers exist suggesting vitamin D makes granuloma annulare worse.

I am interested in readers with experience with the nutrient vitamin D and granuloma annulare. Did simple vitamin D make it worse? Did vitamin D make it better? Did it have no effect? What dosage of vitamin D is or were you taking? I’d like to share your experience with Dr. Boyd.

4 Responses to Case study: Vitamin D clears granuloma annulare

  1. dlmckeemd

    My sister in law has granuloma annulare. She appears to be a hyperconverter, as on 2,000 IU/day, she developed twice the upper limit of normal for 1,25 di-OH vit D. I will have her try 1000 IU (25 mcg), and see how she does

    • Brant Cebulla

      dlmckeemd, that is interesting. How was her serum calcium?

  2. pidkb@comcast.net

    Sorry but I am slightly confused now! In regards to the person’s response above, I thought we were only suppose to do 25(OH)D tests to determine normal Vitamin D status. So if you are taking Vitamin D and let’s say for example you have a blood level of 75 ng/ml and then take a 1.25 test and it is out of range, too high or to0 low does that tell you anything?

    • Brant Cebulla

      pidkb@comcast.net, for 99.99% of the population, 1,25OH2D level is of no concern. But people with some granuloma diseases, like sarcoidosis (and possibly granuloma annulare?), sometimes have spiked levels of 1,25OH2D despite having normal or even low 25OHD levels. In medicine, this is called “endogenous” production, where vitamin D metabolites increase even without an external source, as opposed to “exogenous” production, where your vitamin D metabolites would only increase if you got sun exposure or vitamin D supplements.

      In sarcoidosis, and sometimes in other granuloma diseases, the macrophages inside the abnormal granulomas convert vitamin D into 1,25OH2D at very high rates! Scientists don’t know why this is, but have a few speculations.

      Interestingly, this is how scientists discovered that the body converts 25OHD to 1,25OH2D in tissues all over the body, not just the kidney.

      I know for some, this explanation may be over their head, and for others, this explanation is much too simplistic. Let me know if you have any more questions.

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