High-Dose Oral Vitamin D Shows Rapid Relief for Cancer Therapy–Induced Skin Toxicities
Key Insights
A multicenter retrospective case series found that 87% of patients receiving high-dose oral vitamin D reported symptom relief from chemotherapy- or radiation-induced skin toxicities within 10 days.
Median time to improvement was 5 days overall and just 3 days among hospitalized patients, with no treatment-related adverse events or meaningful changes in serum calcium.
Nearly three-quarters (73%) of patients were able to continue anticancer therapy without interruption after vitamin D intervention.
A retrospective multicenter case series published in JAMA Dermatology has found that high-dose oral vitamin D may provide rapid, safe relief for patients suffering from chemotherapy- and radiation therapy–induced skin toxicities, a common and often debilitating complication that can force treatment interruptions.
Researchers evaluated 33 patients treated at three academic medical centers between December 2021 and January 2024. The cohort included 28 patients with toxic erythema of chemotherapy (search) (TEC) and five with acute radiation dermatitis (search) (ARD). Participants, with a mean age of 60.9 years and 58% female, received one or two oral doses of 100,000 IU of cholecalciferol or ergocalciferol and were followed for at least 10 days.
Rapid Symptom Relief and Objective Improvement
Within 10 days of treatment, 26 of 30 evaluable patients (87%) reported subjective symptom relief, and 23 patients (77%) had clinician-confirmed clinical improvement. The median time to improvement was 5 days (range: 1–28 days) overall, dropping to just 3 days (range: 1–16 days) among the 12 hospitalized patients.
Clinician-assessed erythema improved substantially, with mean Likert scores decreasing from 4.36 at baseline to 2.21 by day 10. The most rapid responses were observed in patients with neutrophilic eccrine hidradenitis (search) and Stevens–Johnson syndrome (search)/toxic epidermal necrolysis (search)–like presentations.
Reassuring Safety Profile
Importantly, investigators reported no treatment-related adverse events and no clinically meaningful changes in serum calcium levels following high-dose vitamin D administration. This finding addresses a key safety concern historically associated with high-dose vitamin D therapy.
Treatment continuity emerged as another notable outcome: 24 of 33 patients (73%) were able to continue their anticancer therapy without interruption after receiving vitamin D. As the investigators noted, "severe cutaneous toxic effects from chemotherapy and radiation [therapy] often require treatment interruptions," and incorporating high-dose oral vitamin D "into supportive care protocols may minimize treatment interruptions, mitigate cutaneous toxic effects, and improve patient outcomes."
An Unmet Need in Oncodermatology
Chemotherapy- and radiation-related skin toxicities can significantly impair quality of life and frequently necessitate treatment delays, yet effective therapeutic options remain limited. The authors observed that high-dose vitamin D has previously demonstrated immunomodulatory effects in preclinical studies and small clinical investigations, but evidence specific to oncology populations has been scarce.
"Patients who received high-dose oral vitamin D therapy were subsequently noted to have rapid improvement in radiation [therapy]– and chemotherapy-related toxic effects of the skin without any substantial safety concerns," the investigators concluded.
Limitations and Future Directions
The retrospective design and small sample size limit definitive conclusions. The authors, led by corresponding author Christopher Iriarte, MD, of Beth Israel Deaconess Medical Center in Boston, emphasized that high-dose oral vitamin D "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 [therapy]." Larger prospective, controlled studies are now warranted to confirm efficacy, establish optimal dosing, and further evaluate long-term safety in patients undergoing cancer treatment.