Burns, ulcers, and wounds healed by Vitamin D - many studies

Note: Vitamin D lotions/oils applied topically will probably better than oral Vitamin D. Perhaps 100X higher concentration on burn if applied topically

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Burns, ulcers, etc.

16+ VitaminDWiki pages with BURN (not sunburn) in the title

This list is automatically updated

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9+ VitaminDWiki pages with ULCER in the title

This list is automatically updated

8.2 million Americans have chronic wounds

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Studies in both Diabetes and Skin categories

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Studies in both Trauma-Surgery and Skin categories

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Asked AI: Are burns less severe if the person has higher level of vitamin d?

The study mentioned in 1 found that 88.9% of burn patients had a vitamin D deficiency and that wound healing time (WHT) across all three burn types was a common factor associated with vitamin D levels. Particularly, electrical burn patients with vitamin D deficiency showed prolonged wound healing over a post-burn period of 2 months.
Another study 2 reported that worsening severity of vitamin D deficiency is associated with increased length of stay, surgical intensive care unit cost, and mortality in burn patients. It also noted that low serum levels of vitamin D in major burn patients persisted for at least 1 year post-injury and that there was a strong negative correlation between circulating 25(OH)D levels and scarring at year 1 post-injury.
The third study 3 concluded that major burns are associated with increased serum levels of parathyroid hormone (PTH) and decreased serum levels of vitamin D, but serum levels of calcium are not affected by major burns. The study recommended the addition of vitamin D supplements in patients with major burns and called for further studies to investigate the clinical effects of vitamin D deficiency in these patients.
Lastly, the study in 4 found that a large proportion of patients with burn injury presented with vitamin D insufficiency and deficiency, which was associated with poor outcomes, including prolonged intensive care unit and hospital length of stay.
In summary, while the search results do not provide a direct answer to whether burns are less severe if the person has higher levels of vitamin D, they do suggest that vitamin D deficiency is common in burn patients and is associated with poorer outcomes such as prolonged wound healing, increased length of stay, and higher mortality rates. Therefore, maintaining adequate vitamin D levels could potentially contribute to better recovery outcomes in burn patients, but more research is needed to fully understand the relationship between vitamin D levels and burn severity.
Hyperlinks are in Perplexity
Also has suggested follow-on questions

• what are the benefits of vitamin d supplementation for burn patients
• what is the recommended dosage of vitamin d for burn patients
• are there any side effects of vitamin d supplementation for burn patients
• how long does it take for vitamin d supplementation to improve burn recovery

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See also VitaminDWiki - Sunburn prevention and treatment

• Natural ways to prevent a sunburn – 2011, 2016
• Sunburning reduced by 200,000 IU of Vitamin D – RCT April 2017
• Photosensitivity (sun allergy) and vitamin D
• Overview Suntan, melanoma and vitamin D

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Burn with low Vitamin D: 1 day longer, infection 3X more likely when leave hospital - Feb 2024

Effect of vitamin D on clinical outcomes in patients with thermal injury
Int Wound J. 2024 Feb;21(2):e14641. doi: 10.1111/iwj.14641

Evaluating complications and mortality risks in burn patients is crucial for effective treatment planning and improving survival rates. This study investigated the relationship between the serum vitamin D level and the clinical outcomes of adult burns patients. This was a prospective cohort of adult patients hospitalized due to thermal burns at a burn centre in the north of Iran. Based on the level of 25 hydroxyvitamin D measured upon admission, patients were divided into two groups of patients with sufficient 25 hydroxyvitamin D level and insufficient 25 hydroxyvitamin D level. Descriptive statistics were used for baseline demographics. Univariate analysis was conducted using Mann-Whitney U, Chi-square, independent samples, and Fisher's exact tests. A multivariate logistic regression was performed to adjust for the effects of confounding variables. Statistical analyses were conducted using SPSS 28.0 software. A total of 220 patients were included in the study. The average total body surface area burned was 30.52 ± 9.34. Patients with insufficient vitamin D levels had longer hospital stays (12.53 vs. 11.45) and longer stays in the intensive care unit (ICU) (3.32 vs. 2.40) than those with appropriate vitamin D levels. Participants with insufficient vitamin D levels exhibited a numerically higher incidence of infections than those with adequate levels (p < 0.05). The multivariate regression found that vitamin D deficiency levels were associated with increased infection rates and prolonged hospital stay. This study suggests that vitamin D deficiency is a significant risk factor for adverse clinical outcomes in burn patients. Further research is needed to confirm these associations and to explore potential interventions to optimize vitamin D status in this patient population.
 Download the PDF from VitaminDWiki

Wonder if some burns with high Vitamin D are not severe enough to go to hospital

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Burn length of stay in hospital vs. Vitamin D level - 18 vs 12 days - Dec 2023

Vitamin D Deficiency Is Associated with Increased Length of Stay After Acute Burn Injury: A Multicenter Analysis
J Burn Care Res. 2023 Dec 23:irad201. doi: 10.1093/jbcr/irad201 PDF is behind a $41 paywall
Sarah Zavala 1, Kate O Pape 2, Todd A Walroth 3, Melissa Reger 4, Brittany Hoyte 5, Wendy Thomas 5, Beatrice Adams 6, David M Hill 7

In burn patients, vitamin D deficiency has been associated with increased incidence of sepsis and infectious complications. The objective of this study was to assess the impact of vitamin D deficiency in adult burn patients on hospital length of stay (LOS). This was a multi-center retrospective study of adult patients at 7 burn centers admitted over a 3.5 year period, who had a 25-hydroxyvitamin D concentration drawn within the first 7 days of injury. Of 1,147 patients screened, 412 were included. Fifty-seven percent were vitamin D deficient.

Patients with vitamin D deficiency had longer LOS (18.0 vs 12.0 days, p < 0.001), acute kidney injury (AKI) requiring renal replacement therapy (7.3 vs 1.7%, p = 0.009), more days requiring vasopressors (mean 1.24 vs 0.58 days, p = 0.008), and fewer ventilator free days of the first 28 days (mean 22.9 vs 25.1, p < 0.001). Univariable analysis identified burn center, AKI, TBSA, inhalation injury, admission concentration, days until concentration drawn, days until initiating supplementation, and dose as significantly associated with LOS.
After controlling for center, TBSA, age, and inhalation injury, vitamin D deficiency was associated with longer LOS. In conclusion, patients with thermal injuries and vitamin D deficiency on admission have increased length of stay and worsened clinical outcomes as compared to patients with non-deficient vitamin D concentrations.

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More intense burns associated with lower Vitamin D (might low D cause more burn)– Sept 2020

25-Hydroxycholecalciferol Concentration Is Associated with Protein Loss and Serum Albumin Level during the Acute Phase of Burn Injury
Nutrients 2020, 12(9), 2780; https://doi.org/10.3390/nu12092780
by Andrzej Krajewski 1,Krzysztof Piorun 1,Dominika Maciejewska-Markiewicz 2,*OrcID,Marta Markowska 3,Karolina Skonieczna-Żydecka 2OrcID,Ewa Stachowska 2,Zofia Polakowska 4,Maciej Mazurek 1OrcID andMałgorzata Szczuko 2OrcID
 Download the PDF from VitaminDWiki

Wonder if Burn lowered Vitamin D in a day or if Low Vitamin D made for more Burn
Hint: Less sunburn if higher level of Vitamin D

Background: Burned patients have an increased need for vitamin D supply related to the maintenance of calcium–phosphate homeostasis and the regulation of cell proliferation/differentiation. This study aimed to analyze the concentration of 25-hydroxycholecalciferol and its relationship with severe conditions after burn injury.

Methods: 126 patients were enrolled in the study. Patients were qualified due to thermal burns—over 10% of the total body surface area. On the day of admission, the following parameters were assessed: 25-hydroxycholecalciferol concentration, total protein concentration, albumin concentration, aspartate transaminase activity, alanine transaminase activity, albumin concentration, creatinine concentration, c-reactive protein concentration, procalcitonin concentration, and interleukin-6 concentration.

Results: Almost all patients (92%) in the study group had an improper level of vitamin D (<30 ng/mL), with an average of 11.6 ± 10.7 ng/mL; 17.5% of patients had levels of vitamin D below the limit of determination—under 3 ng/mL. The study showed that there are several factors that correlated with vitamin D concentration during the acute phase of burn injury, including total protein (r = 0.42, p < 0.01), albumin (r = 0.62, p < 0.01), percentage of body burns (r = 0.36, p < 0.05), aspartate aminotransferase (r = 0.21, p < 0.05), and c-reactive protein (r = 0.22, p < 0.05). We did not find any significant correlation between vitamin D concentration and body mass index.

Conclusions: Burn injury has an enormous impact on metabolism, and the risk factors of the deficiency for the general population (BMI) have an effect on burned patients. Our study showed that the concentration of 25-hydroxycholecalciferol is strongly correlated with serum albumin level, even more than total burn surface area and burn degrees as expected. We suspect that increased supplementation of vitamin D should be based on albumin levels and last until albumin levels are balanced.

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Potential ways Vitamin D can help burns - April 2019

Vitamin D status and its influence on outcomes following major burn injury and critical illness
Burns & Trauma 20186:11 https://doi.org/10.1186/s41038-018-0113-4

Vitamin D deficiency is common among the general population. It is also observed in up to 76% of critically ill patients. Despite the high prevalence of hypovitaminosis D in critical illness, vitamin D is often overlooked by medical staff as the clinical implications and consequences of vitamin D deficiency in acute contexts remain to be fully understood. Vitamin D has a broad range of pleiotropic effects on various processes and systems, including the immune-inflammatory response. 1α, 25-dihydroxy vitamin D (1,25(OH)2D), has been shown to promote a tolerogenic immune response limiting deleterious inflammatory effects, modulation of the innate immune system, and enhancement of anti-microbial peptides. Vitamin D deficiency is frequently observed in critically ill patients and has been related to extrinsic causes (i.e., limited sunlight exposure), the magnitude of injury/illness, or the treatment started by medical doctors, including fluid resuscitation. Low levels of vitamin D in critically ill patients have been associated with sepsis, organ failure, and mortality. Despite this, there are subpopulations of critical illness, such as burn patients, where the literature regarding vitamin D status and its influence on outcomes remain insufficient. Thermal injury results in damage to both burned and non-burned tissues, as well as induce an exaggerated and persistent immune-inflammatory and hypermetabolic response. In this review, we propose potential mechanisms in which burn injury affects vitamin D status and summarize current literature investigating the influence of vitamin D status on outcomes. In addition, we reviewed the literature and trials investigating vitamin D supplementation in critically ill patients and discussed the therapeutic potential of vitamin D supplementation in burn and critically ill patients. We also highlight the current limitations of studies that have investigated vitamin D status and supplementation in critical illness. Thermal injury influences vitamin D status. More studies investigating vitamin D depletion in burn patients and its influence on prognosis via standardized methodology are required to reach definitive conclusions and influence clinical practice
 Download the PDF from VitaminDWiki

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Burn Centers typically still do not test vitamin D levels- survey – March 2019

234 A Multi-center Survey of Vitamin D Monitoring and Supplementation in Patients with Thermal Injuries
Journal of Burn Care & Research, Vol 40, Issue Supt_1, 9 March 2019, Pages S97–S98, https://doi.org/10.1093/jbcr/irz013.161
S Zavala, PharmD, BCPS D M Hill, PharmD, BCPS

Results
A total of 21 responses were received. Eight respondents (38.1%) routinely check 25-hydroxyvitamin D concentrations. Two centers check concentrations on admission, two centers check within 48 hours of admission, and three centers check within one week of admission. One center specifically monitors concentrations only for patients with a > 20% total body surface area (TBSA) burned. Five centers report rechecking concentrations within weeks to months of the initial level, Four centers primarily use ergocalciferol, three use cholecalciferol, and one has no preference. Dosing varied greatly between sites. Two respondents reported adjusting the dose based on the degree of deficiency and admission concentration. One respondent reported a dosing regimen adjusted to age and percent TBSA burned. Thirteen respondents (61.9%) do not routinely check vitamin D concentrations, but may if patients are healing poorly, malnourished, or per nutritionist or nephrologist recommendations. One of the burn centers, which does not routinely monitor concentrations, supplements all burn patients who have ≥ 15% TBSA with cholecalciferol 2000 units daily. Barriers to routinely monitoring vitamin D concentrations cited have cost, inability to analyze in-house, and lack of evidential recommendations for monitoring and supplementing patients with thermal injuries.

Conclusions
The current practice of monitoring and supplementing vitamin D varies widely across burn centers. Future studies using consistent monitoring and dosing should be conducted to determine the clinical benefit of adequate vitamin D levels in burn patients.

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Burns with higher vitamin D have fewer problems - Feb 2019

The association between postburn vitamin D deficiency and the biomechanical properties of hypertrophic scars.
J Burn Care Res. 2019 Feb 26. pii: irz028. doi: 10.1093/jbcr/irz028.
Cho YS1, Seo CH1, Joo SY1, Song J2, Cha E2, Ohn SH2.

Fibroblasts, keratinocytes, mast cells, and other cells participate in hypertrophic scar formation and express the vitamin D receptor. We investigated the association between vitamin D deficiency and the biomechanical properties of hypertrophic burn scars. This cross-sectional study analyzed 486 participants enrolled from May 1, 2013, to April 30, 2017. When complete wound healing was agreed with by the two opinions, blood sampling and scar evaluation were performed. The value of melanin and erythema, trans-epidermal water loss (TEWL), and scar distensibility and elasticity were measured using pigment- and TEWL-measuring devices and a suction skin elasticity meter. 25(OH) vitamin D deficiency was defined as plasma level of < 20 ng/mL.

The vitamin D-deficient patients had significantly higher mean values of scar melanin and TEWL (P = 0.032, P = 0.007), whereas scar erythema level was similar. They also showed significantly lower values of

• Uf (final distensibility; P < 0.001),
• Ua/Uf (gross elasticity; P < 0.001) and
• Ur/Uf (biological elasticity; P = 0.014),

and higher value of Uv/Ue (viscoelasticity or potency against interstitial fluid shift; P = 0.016).
In multiple linear regression analysis, Uf, Ua/Uf, Uv/Ue, and Ur/Uf were significantly affected by 25(OH)-vitamin D level in deficient patients (Uf, P = 0.017; Ua/Uf, P = 0.045; Uv/Ue, P = 0.024; Ur/Uf, P = 0.021).
Our results demonstrated that vitamin D deficiency was significantly related to

• increased pigmentation,
• decreased skin barrier function,
• low scar distensibility and elasticity, and
• slow interstitial fluid movement in burn patients.

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Nearly all burn patients have low Vitamin D levels - May 2018

"Fracture admission rates twice as high for burn cohort than Australian population."
Vitamin D in burn-injured patients
Burns Journal DOI: https://doi.org/10.1016/j.burns.2018.04.015
$36 paywall

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50% fracture admissions occurred within 7 years of burn admission - Sept 2017

Fracture admissions after burns: A retrospective longitudinal study
Burn Journal https://doi.org/10.1016/j.burns.2017.02.014

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Burns with low vitamin D associated with more days in ICU and hospital – Jan 2017

Low Vitamin D Level on Admission for Burn Injury Is Associated With Increased Length of Stay.
J Burn Care Res. 2017 Jan/Feb;38(1):e8-e13. Doi 10.1097/BCR.0000000000000445.
Blay B1, Thomas S, Coffey R, Jones L, Murphy CV.

More Complications

Currently, there have been few studies that have evaluated the incidence of vitamin D deficiency in adult burn patients or correlated vitamin D levels with burn-related outcomes. The primary objective of the study was to identify the incidence of vitamin D deficiency and insufficiency in an adult burn population. The secondary objective was to determine the impact of vitamin D deficiency and insufficiency on clinical outcomes in burn care. A single-center, retrospective, and observational cohort analysis of adult patients admitted for initial management of burn injury, who had a 25-hydroxyvitamin D (25D) level measured on admission, was performed. Patients were categorized as vitamin D deficient (25D <10 ng/ml), insufficient (10-29 ng/ml), or sufficient (30-100 ng/ml) based on admission measurements. Clinical outcomes, including complications, intensive care unit (ICU) and hospital length of stay (LOS), and survival, were compared between patients with vitamin D deficiency/insufficiency and patients with vitamin D sufficiency. Three hundred and eighteen patients were eligible for evaluation. Admission 25D level correlated with deficiency in 46 patients (14.5%), insufficiency in 207 (65.1%), and normal in 65 (20.4%). Patients with vitamin D deficiency or insufficiency experienced higher rates of complications and longer ICU and hospital LOS compared with those with normal vitamin D levels. A large proportion of patients with burn injury presented with vitamin D insufficiency and deficiency, which was associated with poor outcomes, including prolonged ICU and hospital LOS. Additional studies are needed to further describe the relationship between vitamin D status and clinical outcomes.
 Download the PDF from Sci-Hub via VitaminDWiki

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Bone fractures after a burn - none if vitamin D, 6 if no vitamin D – RCT May 2015

On VitaminDWiki: Bone fractures after a burn - none if vitamin D, 6 if no vitamin D – RCT May 2015

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Vitamin D status after a high dose of cholecalciferol in healthy and burn subjects

Burns, DOI: http://dx.doi.org/10.1016/j.burns.2014.11.011
Anne-Françoise Rousseau afrousseau@chu.ulg.ac.be , Pierre Damas, Didier Ledoux, Pierre Lukas, Agnès Carlisi, Caroline Le Goff, Romy Gadisseur, Etienne Cavalier

Highlights

• Levels of 25OH-D at hospital admission following burn were straightaway lower than our healthy subjects.
• The efficacy of 100,000 IU cholecalciferol to raise 25OH-D levels (and free 25OH-D levels) was quite uncertain, lower or even zero, in burn patients when compared to healthy subjects.
• Higher cholecalciferol doses than general recommendations should probably be considered during acute burn care.
• The interest in free 25OH-D is still questionable.

Background
Burn patients are at risk of vitamin D (VD) deficiency and may benefit from its pleiotropic effects as soon as the acute phase. The aim of this observational study was to assess the effects of cholecalciferol (VD3) bolus on VD status in adult burn patients (Group B, GB) after admission, compared to healthy subjects (Group H, GH).

Methods
Both groups received an oral dose of 100,000 IU VD3. Blood samples were collected before (D0) and 7 days (D7) after bolus to measure 250H-D, 1,25(OH)2-D, parathyroid hormone (PTH), and fibroblast growth factor 23 (FGF23). Albumin (ALB) and VD binding protein (DBP) were measured and used to calculate the free 25OH-D level. Data were expressed as median (min–max) or proportions.

Results
A total of 49 subjects were included: 29 in GH and 20 in GB. At D0, the prevalence of VD deficiency was higher in GB: 25OH-D was 21.5 (10.1–46.3) ng/ml in GH vs. 11 (1.8–31.4) ng/ml in GB. DBP and ALB were lower in GB. At D7, DBP was stable in both groups, while ALB decreased in GB. 25OH-D increased by 66.6 (13.5–260.3)% in GH. In GB, changes in 25OH-D extended from −36.7% to 333.3%, with a median increase of 33.1%. Similar changes were observed in each group for free 25OH-D. High FGF23 levels were observed in GB.

Conclusions
This study highlighted the differences in VD status and in response to a high dose of VD3 in burn patients when compared to healthy patients. Pitfalls in VD status assessment are numerous during acute burn care: 25OH-D measurement needs cautious interpretation, and interest in free 25OH-D is still questionable. They should not prevent burn patients from receiving VD supplements during acute care. Higher doses than general recommendations should probably be considered.

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Quarterly Vitamin D injections (200,000 IU) helped muscles in burn patients - March 2015

Effects of cholecalciferol supplementation and optimized calcium intakes on vitamin D status, muscle strength, and bone health: a one-year pilot randomized controlled trial in adults with severe burns.
Burns. 2015 Mar;41(2):317-25. doi 10.1016/j.burns.2014.07.005. Epub 2014 Sep 16.
Rousseau AF1, Foidart-Desalle M2, Ledoux D3, Remy C4, Croisier JL5, Damas P3, Cavalier E6.
1Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium. Electronic address: afrousseau@chu.ulg.ac.be.
2Physical Medicine and Sports Traumatology Service, University of Liège, University Hospital, Liège, Belgium.
3Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium.
4Burn Centre and General Intensive Care Department, University of Liège, University Hospital, Liège, Belgium; Motility Science Department, University of Liège, Liège, Belgium.
5Motility Science Department, University of Liège, Liège, Belgium.
6Clinical Chemistry Department, University of Liège, University Hospital, Liège, Belgium.

OBJECTIVE:
Burn patients are at risk of hypovitaminosis D and osteopenia or sarcopenia. Vitamin D pleiotropic effects may influence bone and muscle health. The aim of this pilot study was to assess the effects of a cholecalciferol (VD3) supplementation and an optimized calcium (Ca) regimen on vitamin D (VD) status and bone and muscle health during the sequelae stage of burn injury.

DESIGN: Monocentric randomized controlled trial.

METHODS: Fifteen adults with thermal burns dating from 2 to 5 years were randomized into two groups. For 12 months, they either received a quarterly IM injection of 200,000IU VD3 and daily oral Ca (Group D) or a placebo (Group P). VD status and bone remodeling markers were assessed every 3 months. Knee muscle strength and bone mineral density were, respectively, assessed using isokinetic dynamometry and dual X-ray absorptiometry at initiation (M0) and completion (M12) of the protocol.

RESULTS: Of all the patients, 66% presented with VD deficiency, and 53% (with 3 men <40y) were considered osteopenic at inclusion. After one year, calcidiol levels significantly increased in Group D to reach 40 (37-61)ng/ml. No significant change in bone health was observed in both groups, while Group D significantly improved quadriceps strength when tested at high velocity.

CONCLUSIONS: This VD3 supplementation was safe and efficient in correcting hypovitaminosis D in burn adults. When combined with optimized Ca intakes, it demonstrated positive effects on muscle health but not on bone health. A high prevalence of hypovitaminosis D and osteopenia in these patients, as well as their wide range of muscle performances, seem to be worrying when considering rehabilitation and quality of life.

Note: 200,000 IU over 90 days is an average of only 2200 IU daily - not very much

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Both vitamins D3 and D2 (100 IU/kg) provided some help to Critically Ill Pediatric Burn Patients - June 2015

Clinical Trial of Vitamin D2 vs. D3 Supplementation in Critically Ill Pediatric Burn Patients
Michele M. Gottschlich, PhD, RD, CSP1,2,3
Theresa Mayes, RD, CSP, CCRC2,4
Jane Khoury, PhD4
Richard J. Kagan, MD3,5
1Department of Research, Shriners Hospitals for Children, Cincinnati, Ohio
2Department of Nutrition, Shriners Hospitals for Children, Cincinnati, Ohio
3Department of Surgery, University of Cincinnati College of Medicine, Cincinnati, Ohio
4Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
5Department of Surgery, Shriners Hospitals for Children, Cincinnati, Ohio
Michele M. Gottschlich, Ph.D., RD, CSP, Shriners Hospitals for Children, 3229 Burnet Ave, Cincinnati, OH 45229, USA. Email: mgottschlich@shrinenet.org

Background: Hypovitaminosis D exists postburn. However, evidence-based guidelines for vitamin D repletion are unknown. This investigation examined differences between D2 and D3 supplementation on outcomes in children with burn injuries.

Methods: Fifty patients with total body surface area burn of 55.7% ± 2.6% and full-thickness injury of 40.8% ± 3.8% were enrolled, ranging in age from 0.7–18.4 years. All participants received multivitamin supplementation per standardized clinical protocol. In addition, 100 IU/kg D2, D3, or placebo was administered daily during hospitalization using a randomized, double-blinded study design. Assay of total 25-hydroxyvitamin D (D25), 1,25-dihydroxy vitamin D (D1,25), 25-hydroxyvitamin D2 (25-OH-D2), 25-hydroxyvitamin D3 (25-OH-D3), and parathyroid hormone (PTH) was performed at 4 preplanned time intervals (baseline, midpoint, discharge, and 1-year postburn). Differences in vitamin D status were compared over time and at each specific study interval.

Results: There were no significant differences in serum vitamin D levels between groups, but >10% of patients had low D25 at discharge, and the percent deficiency worsened by the 1-year follow-up for the

• placebo (75%),
• D2 (56%), and
• D3 (25%) groups. (note: D3 lasted much longer)

There were no statistical differences in PTH or clinical outcomes between treatment groups, although vitamin D supplementation demonstrated nonsignificant but clinically relevant decreases in exogenous insulin requirements, sepsis, and scar formation.

Conclusions: The high incidence of low serum D25 levels 1 year following serious thermal injury indicates prolonged compromise. Continued treatment with vitamin D3 beyond the acute phase postburn is recommended to counteract the trajectory of abnormal serum levels and associated morbidity.

New research calls for vitamin D supplementation in critically ill pediatric burn patients Medical Express Review of the study

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97% of pediatric burn patients had low vitamin D - Feb 2016

Serum 25-Hydroxyvitamin D Levels in Pediatric Burn Patients.
Trauma Mon. 2016 Feb 6;21(1):e30905. doi: 10.5812/traumamon.30905. eCollection 2016.
Sobouti B1, Riahi A2, Fallah S3, Ebrahimi M1, Shafiee Sabet A4, Ghavami Y5.
1Burn Research Center, Shahid Motahari Burns Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
2Department of Pediatric Infectious Diseases, Ali-Asghar Children Hospital, Iran University of Medical Sciences, Tehran, IR Iran.
3Department of Neonatology, Shahid Beheshti University of Medical Sciences, Tehran, IR Iran.
4Medical Student Research Committee (MSRC), School of Medicine, Iran University of Medical Sciences, Tehran, IR Iran.
5Burn Research Center, Iran University of Medical Sciences, Tehran, IR Iran.

BACKGROUND: Previous studies have implicated the important and active role of vitamin D in the immune system.

OBJECTIVES: The aim of this study was to evaluate serum levels of 25-hydroxyvitamin D in children with burn injuries.

MATERIALS AND METHODS:
In this cross-sectional study, 118 patients with various degrees of burn injuries were enrolled. A checklist consisting of demographic data, total body surface area (TBSA) affected by the burn, degree of burn, serum level of 25(OH)D, total protein, albumin, electrolytes, and parathyroid hormone were recorded for each patient.

RESULTS: Sixty-eight (57.6%) males and 50 (42.4%) females with a mean age of 4.04 years (SD = 3.04) were evaluated. The mean level of 25(OH)D was 14.58 ng/mL (SD = 6.94). Levels of 25(OH)D in four (3.39%) cases were higher than 30 ng/mL, while 95 (81.35%) cases had levels lower than 20 ng/mL, and 19 (16.10%) cases had levels of 21 - 30 ng/mL.
The level of 25(OH)D was below recommended levels in 96.61% of cases, while 81.34% had vitamin D deficiency and 16.1% had insufficiency. We found a significant correlation between vitamin 25(OH)D and total protein, albumin, and total and ionized calcium (P < 0.001). There was also a significant negative correlation between 25(OH)D and TBSA affected by burn (P = 0.001).

CONCLUSIONS:
The levels of 25(OH)D in children suffering from severe burns were low. Supplementation might be useful in patients with very low levels of serum vitamin D.

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Pain 6 months after thermal burn and skin autography associated with low vitamin D and low Omega-3 - March 2018

Vitamin D and N-3 polyunsaturated fatty acid levels predict chronic pain following major thermal burn injury.

• "Major Thermal Burn Injury (MThBI) is a significant public health problem in which 50,000 individuals are hospitalized annually in the US. Chronic pain is common following MThBI affecting up to 60% of survivors. There are currently few treatment options to reduce chronic pain and improve mental and physical function following MThBI. Accumulating evidence suggests Vitamin D and n-3 polyunsaturated fatty acids (PUFAs, commonly found in fish oil) reduce symptom burden in other pain conditions. Therefore, we hypothesize low levels of n-3 PUFAs and Vitamin D predict greater chronic pain severity after MThBI."

DOI: https://doi.org/10.1016/j.jpain.2017.12.243. Abstract only

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Burned in factory explosion: 8X less likely to get infected if treated with Magnesium and Vitamins such as B12 - RCT Nov 2018

Additional Vitamin and Mineral Support for Patients with Severe Burns: A Nationwide Experience from a Catastrophic Color-Dust Explosion Event in Taiwan
Nutrients 2018, 10(11), 1782; https://doi.org/10.3390/nu10111782 (registering DOI)
Li-Ru Chen 1,2,†, Bing-Shiang Yang 2,†, Chih-Ning Chang 1, Chia-Meng Yu 3 and Kuo-Hu Chen 4,5,* OrcID

Major burn injuries, which encompass ≥20% of the total body surface area (TBSA), are the most severe form of trauma because of the stress response they provoke, which includes hypermetabolism, muscle wasting, and stress-induced diabetes. In 2015, a color-dust explosion disaster occurred in the Formosa Fun Coast of Taiwan and injured 499 people, who were transferred via a nationwide emergency delivery system. Some recommendations are currently available regarding vitamin and mineral support for wound healing and recovery in severe burns, but there is a lack of evidence to confirm the benefits. Thus, the current study aimed to investigate the effects of additional vitamin and mineral support for patients with severe burn injuries. Sixty-one hospitalized individuals with major burns (full thickness and ≥20% TBSA) were classified into the supplement (n = 30) and control (n = 31) groups, according to whether they received supplementation with additional vitamins, calcium, and magnesium. There were significant differences between the supplement and control groups in the

• incidence of wound infection (30.0% vs. 77.4%, p < 0.001),
• sepsis (13.3% vs. 41.9%, p = 0.021), and
• hospitalization days (51.80 vs. 76.81, p = 0.025).

After adjustment, logistic regression analysis revealed that, compared to those in the control group, patients in the supplement group had a

• lower risk for wound infection (OR 0.11; 95% CI 0.03–0.43; p = 0.002) and
• sepsis (OR 0.09; 95% CI 0.01–0.61; p = 0.014).

Supplementation of multiple vitamins, calcium, and magnesium reduces the risk of wound infection and sepsis, shortens the time of hospitalization, and can be considered for use in major burns.
 Download the PDF from VitaminDWiki
from PDF
During the first two weeks of hospitalization, daily vitamins were administered to those in the supplement group, including
vitamin A 6600 IU, vitamin B1 (thiamine) 100 mg, vitamin B6 (pyridoxine)
200 mg, vitamin B12 2000 mcg, vitamin C (ascorbic acid) 100 mg, vitamin D 0.01 mg (400 IU), and
vitamin E (dl-α-tocopheryl acetate) 20 mg. Mineral supplementation with calcium and magnesium was
provided by the administration of calcium chloride 2%, 20 mL/amp, and magnesium sulfate injection
10%, 20 mL/amp, adjusted according to serum calcium and magnesium levels after biochemistry examinations

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Vitamin D may improve wound healing in burns patients – Nov 2017

Medical News Today
Giving severe burns patients vitamin D supplements could be a simple and cost-effective way of helping their wounds to heal and avoiding infection.

Researchers find that vitamin D could improve burn healing.
This was the conclusion of the first study to examine the effects of vitamin D in burn injury recovery.

The research — which was led by the Institute of Inflammation and Aging in Birmingham, United Kingdom — is to feature at the Society for Endocrinology annual conference, held in Harrogate, U.K.]

Burns are wounds to the skin and other tissues that are caused by heat — including exposure to a flame or fire or from scalding. They can also result from friction, radiation, radioactivity, electricity, and contact with chemicals.

Burn injuries are considered a global public health problem and are responsible for around 180,000 deaths every year.

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Diabetic foot ulcers helped by 50,000 IU weekly – RCT June 2016

The effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer: A randomized, double-blind, placebo-controlled trial
June 2016 Journal of Diabetes and its Complications 31(4) DOI: 10.1016/j.jdiacomp.2016.06.017
Reza RazzaghiReza RazzaghiHamideh PourbagheriMansooreh Momen-HeraviMansooreh Momen-HeraviShow all 7 authorsZatollah AsemiZatollah Asemi

.Objective: This study was conducted to evaluate the effects of vitamin D supplementation on wound healing and metabolic status in patients with diabetic foot ulcer (DFU). Methods: This randomized, double-blind, placebo-controlled trial was performed among 60 patients with grade 3 DFU according to "Wagner-Meggitt's" criteria.

Participants were randomly divided into two groups (each 30 participants) and received either 50,000IU vitamin D supplements every 2 weeks for 12 weeks (group A) or a placebo (group . Fasting blood samples were taken at the study baseline and after the 12-week intervention to determine related markers.

Results: After 12 weeks of intervention, compared with the placebo, vitamin D supplementation
resulted in a significant reduction in

• ulcer length (-2.1±1.1 vs. -1.1±1.1cm, P=0.001),
• ulcer width (-2.0±1.2 vs. -1.1±1.0cm, P=0.02) and
• ulcer depth (-1.0±0.5 vs. -0.5±0.5cm, P<0.001), and
• erythema rate (100% vs. 80%, P=0.01).

In addition, in supplemented patients, changes in

• serum insulin concentration (-3.4±9.2 vs. +2.8±9.3 μIU/mL, P=0.01),
• homeostasis model of assessment-estimated insulin resistance (-1.5±4.1 vs. +1.7±5.1, P=0.01),
• the quantitative insulin sensitivity check index (+0.006±0.02 vs. -0.006±0.02, P=0.03) and
• HbA1c (-0.6±0.6 vs. -0.1±0.5%, P=0.004)

were significantly different from those of patients in the placebo group.

Additionally, following supplementation with vitamin D, significant reductions in

• serum total- (-15.8±18.9 vs. +5.3±31.8mg/dL, P=0.003), LDL- (-17.2±19.8 vs. +2.2±28.6mg/dL, P=0.003),
• total-/HDL-cholesterol ratio (-1.1±0.8 vs. -0.2±1.1, P=0.001),
• high sensitivity C-reactive protein (hs-CRP) (-0.4±2.5 vs. +1.9±4.2μg/mL, P=0.01),
• erythrocyte sedimentation rate (ESR) (-34.7±32.4 vs. -18.0±26.6mm/h, P=0.03) and
• plasma malondialdehyde (MDA) concentrations (-0.7±0.9 vs. -0.2±0.5μmol/L, P=0.008)

were seen compared with the placebo.

Conclusions: Overall, vitamin D supplementation for 12 weeks among patients with DFU had beneficial effects on glucose homeostasis, total-, LDL-, total-/HDL-cholesterol, ESR, hs-CRP and MDA levels. In addition, vitamin D may have played an indirect role in wound healing due to its effect on improved glycemic control.

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Wounds

9+ VitaminDWiki pages have WOUND in the title

This list is automatically updated

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The Role of the Vitamin D Receptor in the Epidermal Stem Cell Response to Wounding - Aug 2024

Receptors 2024, 3(3), 397-407; https://doi.org/10.3390/receptors3030019
by Daniel D. Bikle ORCID
San Francisco VA Medical Center, University of California San Francisco, San Francisco, CA 94143, USA

Chronic skin wounds are estimated to affect 6.5 million patients in the US, at a cost of over USD 25 billion. Efforts to prevent and/or treat such wounds will result in reduced morbidity and economic losses. This project is focused on the role of vitamin D signaling in the epidermis in the control of stem cell (SC) activation and function during the initial response to the wounding of the skin, a response that, if defective, contributes to poor wound healing or cancer. In this review, I first describe the anatomy of the skin, focusing first on the epidermis, describing the different cell layers which in a spatial way also represent the differentiation process of the interfollicular epidermis (IFE) as it undergoes continuous regeneration. I then describe the other components of the skin, particularly the hair follicle (HF), which undergoes a cyclic pattern of regeneration. Adult SCs residing in these regenerative tissues play essential roles in the maintenance of these tissues. However, when the skin is wounded, the progeny of SCs from all regions of the HF and IFE contribute to the healing process by changing their initial cell fate to take on an epithelial genotype/phenotype to heal the wound. Although earlier lineage tracing studies helped to define the contributions SCs from the different niches made to wound healing, scRNAseq studies have demonstrated a considerably more nuanced picture. The role of vitamin D signaling will be introduced by reviewing the unique role played by the epidermal keratinocyte first in producing vitamin D and then in metabolizing it into its active form 1,25(OH)2D. 1,25(OH)2D is the principal ligand for the vitamin D receptor (VDR), a transcription factor that helps to mediate the genomic changes in the stem cells in their response to wounding. In these actions, the VDR is regulated by coregulators, of which the steroid receptor coactivator complexes SRC 2 and 3 and the mediator complex (MED) play essential roles. The VDR generally acts in association with other transcription factors such as p63 and β-catenin that can colocalize with the VDR in the genes it regulates. Although much remains to be understood, the role of the VDR in the stem cell response to wounding is clearly essential and quite different from its classic roles in regulating calcium metabolism, although calcium is essential for the actions of vitamin D signaling in the skin.
 Download the PDF from VitaminDWiki

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Diabetic foot ulcers healed 2X faster with 6,400 IU daily - RCT June 2021

Improved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial
Int J Low Extrem Wounds. 2021 Jul 2;15347346211020268. doi: 10.1177/15347346211020268
Peter M Halschou-Jensen 1, Jannie Sauer 2, Pierre Bouchelouche 2, Jesper Fabrin 2, Stig Brorson 2, Søren Ohrt-Nissen 2

Background. Chronic foot ulcers are a major cause of morbidity in people with diabetes, with a lifetime risk of 25%. Treatment is challenging, and the recurrence rates of foot ulcers are >50% after 3 years. Vitamin D deficiency is more common in people with diabetes with chronic foot ulcers, compared to both people without diabetes as well as people with diabetes but without foot ulcers. Purpose/aim of the study. To assess the efficacy of high-dose compared to low-dose Cholecalciferol vitamin D3 on the healing of chronic diabetic foot ulcers.

Materials and methods. We included people with diabetes with one or more foot ulcers lasting for more than 6 weeks. Patients were randomly allocated to either a daily oral intake of high-dose (170 μg) or low-dose (20 μg) vitamin D3 (Cholecalciferol). We saw patients in the outpatient clinic after 4, 12, 24, 36, and 48 weeks. At each visit, we measured the ulcer with a specialized camera, and associated software and the area (cm2) was calculated. Patients and assessors were blinded to treatment allocation. We followed all patients for 48 weeks or until wound healing or surgical treatment.

Findings/results. We included 48 patients in the analysis (24 in each group), with a total of 64 ulcers. Among them, 41 ulcers were followed until healing or 48-week follow-up, and 20 ulcers were surgically treated during the study period. Three patients were lost for follow-up. The intention-to-treat analysis showed a significantly higher rate of ulcer healing in the high-dose group, with 21 of 30 (70%) healed ulcers compared to 12 of 34 (35%) in the low-dose group (P = .012). Median ulcer reduction at the final follow-up was 100% (interquartile range IQR: 72-100) in the high-dose group and 57% (IQR: -28 to 100) in the low-dose group. Furthermore, we found a significant effect of high-dose vitamin D on ulcer reduction in the repeated measures analysis of variance.

Conclusions. We found high-dose vitamin D3 to be efficient, compared to low-dose vitamin D3, in promoting healing in chronic diabetic foot ulcers.
 Download the PDF from VitaminDWiki
4.1X more likely to heal within 1 year than placebo

Clipped from PDF
Why does vitamin D improve wound healing? Several reports dating back to the 1970s described striking morphological changes in the skeletal muscle in patients with vitamin D deficiency.17 Since then, a variety of mechanisms by which vitamin D impacts muscle cells and fibers have been elucidated. Vitamin D regulates calcium-mediated functions of muscle, namely contraction, plasticity, mitochondrial function, and insulin signaling.18 Furthermore, vitamin D deficiency is associated with insulin resistance,19 intramuscular fatty deposition,20 and muscle weakness.21 These observational studies suggest broader implications for the pathogenesis of type 2 diabetes. Studies have shown a modest reduction of HbA1C, reduction in blood pressure, and fasting glucose concentration, as well as improvements in insulin sensitivity after vitamin D treatment in adults with type 2 diabetes.22,23

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Diabetic foot ulcers healed 2X faster with 6,800 IU daily - RCT Sept 2023

Improved Healing of Diabetic Foot Ulcers After High-dose Vitamin D: A Randomized Double-blinded Clinical Trial

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The Vitamin D Deficiency Epidemic (pulsating wound) Jan 2018

online Sept 2017 - Includes a video of pulsing and a static image after the wound was healed by Vitamin D

• “What scares me is not that 80% of the tests I have drawn in the past 12 months have been low- and I mean really, really low – even in patients taking Vitamin D supplements. What scares me is how many I may have missed because I’ve only been really paying attention to this in the past year.”
• “This is a 70-year-old man who underwent podiatric surgery for a ganglion cyst in October. Ten days later, when the sutures were removed, the wound just fell open.” 17 ng
• “I prescribed 50,000 units once a week for 4 weeks. After 3 weeks, it’s a different wound entirely.”

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Vitamin D for Healing Wounds – Nov 2014

Advanced Tissue
In order for the body to properly recover, it must have the right balance of vitamins, nutrients, and other essential elements. One of the important components for wound healing is vitamin D. It often goes overlooked during recovery as many people take the vitamin for granted and do not fully appreciate the part it plays in every aspect of health. But with a greater understanding of vitamin D and its role in healing, you may want to consider monitoring your own levels of the nutrient.

The relationship between vitamin D and wound healing
An ample amount of vitamin D is essential for proper healing. According to the series “Nutrition Minute” published in the journal Advances in Skin & Wound Care, sustaining an injury causes the cells in the skin to require higher amounts of vitamin D. That’s because of the many vital roles the element plays in the recovery process. It controls genes that promote the creation of cathelicidin, an antimicrobial peptide that the immune system uses to fight off wound infections. When someone has a deficiency in vitamin D, their immune function can become compromised, making you more susceptible to potentially harmful bacteria and other foreign invaders.

Another interesting aspect of the connection between this element and healing is that wounds tend to cause a deficiency in vitamin D levels. This complicated relationship between vitamin D and wound healing has been proven by the scientific community. A study conducted by researchers at the Evangelical University Hospital of Curitiba in Brazil looked into the relationship between vitamin D insufficiency and healing. The study utilized a group of 26 patients with leg ulcers and a control group of the same size without ulcers. Factors such as age, gender, hypertension, and tobacco use were taken into consideration. Half of the ulcer group received vitamin D for a period of two months, while the other half was given a placebo.

The testing showed that those who had ulcers on their legs had a deficiency in vitamin D levels compared to the participants with no wounds. Those who underwent treatment with vitamin D supplementation saw a decrease in the size of the ulcer, while those who did not take a supplement saw no significant change. As such, the researchers concluded that patients with wounds are more likely to have a vitamin D deficiency, and there exists a trend toward better wound healing in people who undergo a vitamin D regimen to counter their deficiencies.
More online

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