TOPLINE

High-dose oral vitamin D (hdVD) was associated with rapid symptomatic relief within 10 days in many patients with toxic erythema of chemotherapy (TEC) and acute radiation dermatitis (ARD), in a retrospective study.

METHODOLOGY

• Researchers conducted a retrospective multicenter case series of 33 patients with TEC or ARD who received hdVD between December 2021 and January 2024. The mean age was 60.9 years; 58% were women; most (79%) were White.
• Participants received one or two oral doses of 100,000 international units of oral vitamin D; 85% received a second dose within 7 days; 15% received only one dose because symptoms resolved before day 7.
• Time to patient-reported symptom relief and clinician-assessed erythema improvement with the 5-point Likert scale were the primary outcomes.
• The analysis involved 28 patients (85%) with TEC across various subtypes, including hand-foot syndrome (33%), flexural/intertriginous eruptions (24%), Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS-TEN)-like eruptions (12%), and neutrophilic eccrine hidradenitis (6%). An additional five patients (15%) had ARD.

TAKEAWAY

• Among 30 evaluable patients, 26 (87%) reported symptom relief within 10 days of treatment, 23 (77%) showed clinician-documented improvement, and the median time to improvement response was 5 days overall (range, 1-28) and 3 days (range, 1-16) in the inpatient group.
• Mean Likert erythema scores improved from 4.36 at baseline to 3.17 by day 5 and 2.21 by day 10, for a mean reduction of 1.92 points; the inpatient subgroup showed a greater mean decline of 2.42 points than the overall group.
• Patients with neutrophilic eccrine hidradenitis and SJS-TEN-like eruptions showed the most rapid responses, with 10-day Likert reductions of 3.0 and 2.5 points, respectively.
• Chemotherapy or radiation continued without interruption in 24 (73%) of the patients, and no treatment-related adverse events or clinically meaningful serum calcium changes were observed.

IN PRACTICE

“This case series shows that as cancer treatments grow increasingly complex, incorporating hdVD into supportive care protocols may minimize treatment interruptions, mitigate cutaneous toxic effects, and improve patient outcomes,” the authors of the study concluded. “hdVD warrants further exploration to define its role in the evolving oncodermatology landscape, where rapid, effective, and safe interventions are urgently needed, particularly for toxic effects from chemotherapy and radiation,” they added.

SOURCE

The study was led by Mihir K. Patil, Carle Illinois College of Medicine, University of Illinois Urbana-Champaign, and Goranit Sakunchotpanit, Tufts University School of Medicine, Boston. It was published online on July 15 in JAMA Dermatology.

LIMITATIONS

The findings were limited by the retrospective study design, the absence of a placebo or comparison group, inconsistent follow-up, possible selection bias, incomplete laboratory monitoring, and reliance on an unvalidated Likert scale to assess erythema.

DISCLOSURES

The authors did not disclose any funding sources. The authors disclosed receiving personal fees from SynOx Therapeutics, authorship royalties from McGraw Hill, honoraria from Elsevier and Merck Manuals, and grants from the American Board of Medical Specialties and the American Academy of Dermatology outside the submitted work. No other relevant conflicts of interest were reported by the authors.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.