title: Vitamin D deficiency and rickets in children and adolescents with ichthyosiform erythroderma in type IV and V skin.
abstract: BACKGROUND
  Ichthyosiform erythroderma due to keratinizing disorders may suppress cutaneous vitamin D synthesis, leading to vitamin D deficiency and rickets.
  
  
  OBJECTIVE
  To determine the prevalence of vitamin D deficiency and rickets in children and adolescents with congenital ichthyosis and other keratinizing disorders with erythroderma and scaling.
  
  
  METHODS
  In this cross-sectional study, 45 children and adolescents with ichthyosiform erythroderma due to keratinizing disorders, and 66 controls (group 1: age and sex matched, with skin diseases other than keratinizing disorders; group 2: age and sex matched, healthy volunteers) were included. Evidence of rickets was determined clinically (physical examination and radiographs) and biochemically {serum calcium, phosphorus, alkaline phosphatase, 25-hydroxy vitamin D [25(OH)D] and parathyroid hormone (PTH)}.
  
  
  RESULTS
  All patients in the disease group had clinical, radiological or biochemical evidence of rickets [25(OH)D<20ngmL(-1) ], and analysis was done for all subjects with the available biochemical reports. The mean serum 25(OH)D levels of the disease group was 8·38±5·23ngmL(-1) and was significantly lower than in control group 1 (11·1±5·8ngmL(-1) ) (P<0·01) and control group 2 (13·5±6·9ngmL(-1) ) (P<0·001). The prevalence of vitamin D deficiency [25(OH)D<20ngmL(-1) ] was significantly higher in the disease group (n=38 of 39, 97·4%) than in control group 2 (n=12, 70·6%) (P<0·01), and total controls (n=56, 84·8%) (P=0·04). The frequency of hyperparathyroidism (PTH>65pgmL(-1) ) was also significantly higher in the disease group than in controls (P<0·01).
  
  
  CONCLUSIONS
  Children and adolescents with various forms of ichthyosiform erythroderma, especially those with pigmented skin (types IV-VI), are at increased risk of developing vitamin D deficiency and clinical rickets.
authors.affiliation: Departments of Dermatology, Endocrinology and Metabolism, Paediatrics, Biostatistics and Radiodiagnosis, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: K
authors.initials: K
authors.lastname: Chouhan
authors.forename: G
authors.initials: G
authors.lastname: Sethuraman
authors.forename: N
authors.initials: N
authors.lastname: Gupta
authors.forename: V K
authors.initials: VK
authors.lastname: Sharma
authors.forename: M
authors.initials: M
authors.lastname: Kabra
authors.forename: B K
authors.initials: BK
authors.lastname: Khaitan
authors.forename: V
authors.initials: V
authors.lastname: Sreenivas
authors.forename: M
authors.initials: M
authors.lastname: Ramam
authors.forename: S
authors.initials: S
authors.lastname: Kusumakar
authors.forename: S
authors.initials: S
authors.lastname: Thulkar
authors.forename: A S
authors.initials: AS
authors.lastname: Paller
mesh_terms: D000293:Adolescent; D000469:Alkaline Phosphatase / Q000378:metabolism; D002118:Calcium / Q000378:metabolism; D002648:Child; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D016113:Ichthyosiform Erythroderma, Congenital / Q000097:blood / Q000150:complications*; D008297:Male; D010281:Parathyroid Hormone / Q000378:metabolism; D010758:Phosphorus / Q000378:metabolism; D012279:Rickets / Q000097:blood / Q000209:etiology; D014807:Vitamin D / Q000031:analogs & derivatives / Q000378:metabolism; D014808:Vitamin D Deficiency / Q000097:blood / Q000209:etiology*
chemical_list: D010281:Parathyroid Hormone; D014807:Vitamin D; D010758:Phosphorus; C104450:25-hydroxyvitamin D; D000469:Alkaline Phosphatase; D002118:Calcium