Vitamin D: What, if any relevance does it have with Laser Tattoo Removal procedures?
Introduction
Skin health and immune function are vital to successful, trouble-free, and scar-free tattoo removals.
We at City Tattoo Removal DO NOT treat our clients at a level where the tattoo is likely to blister. Blisters for us are an abnormal reaction and we alter a person’s treatment plan should blisters occur.
From time to time, however, blisters have been known to form, even if the treatment has been well within therapeutic levels.
We recently had a patient start to develop blisters on the treatment site, which is located on her ankle. Our client had previously been treated on multiple occasions with no ill-effects or reported issues during the aftercare period. We changed our client’s treatment plan accordingly, which involved leaving longer periods between treatments and treating at lower levels than previously used. Notwithstanding these efforts, blisters continued to form on the treatment site.
We took a break from treatment to study what could be causing these issues for her. Our client has had medical investigations undertaken with her GP. She has now been diagnosed with a significant vitamin D deficiency.
This got us asking: “What, if anything, does vitamin D have to laser tattoo removal and treatment outcomes?”
Well, as it turns out, could be extremely influential to laser tattoo removal aftercare procedures. Interested? Read on for more!!!
The traditional understanding of Vitamin D
Vitamin D, ironically, is not actually a vitamin. It is “fat-soluble prohormone which has endocrine, paracrine and autocrine functions”(1).
Traditionally vitamin D is associated with muscle-skeletal health. It helps to keep bones strong and healthy and decreases the risk of muscle weakness (2). It is oftentimes also associated with calcium because one of its primary roles is to control the levels of calcium found in the bloodstream by facilitating its absorption in the body (3).
The understanding of vitamin D in the new millennium
Studies have now shown there is a vitamin D receptor in a multiplicity of cells throughout the human body, including in adipose tissue, brain tissue, adrenal glands, bladder, colon, fibroblasts, kidney, liver, lung, lymphocytes, pituitary glands, and skin, to name a few (4).
Vitamin D deficiencies have been linked with significant health complications such as cardiovascular events, obesity, bone metabolism, metabolic syndrome, type 2 diabetes, various types of cancer, immune disorders, increased mortality, and adverse pregnancy outcomes (5).
Modern medicine now acknowledges vitamin D actions and interactions are not confined to the skeletal system.
Vitamin D and its role within the immune system
The body’s immune system is designed to protect individuals from foreign substances, vectors, and invaders. Simply put, when an individual’s immune system recognizes something in the body which is not its natural DNA, for example, a virus, the immune system mounts an attack against the foreign substance to rid the body of it (6). These immune responses also apply to dead cells or any other foreign body, such as bacteria, even ink particles which make up tattoos.
In the past 20 years, the medical community has investigated more into the understanding of vitamin D and its interactions within the body. One of the most important activities recently observed is the role of vitamin D “to enhance and bring to a completion the inflammatory reaction after injury (7).”
There is also increasing data linking vitamin insufficiency with common immune disorders. Published clinical observations suggest vitamin D is a key factor linking innate and adaptive immunity, both of which may be compromised in the cause of vitamin D deficiency (8).
Rene F. Chun et al. noted vitamin D mediated responses that may occur following a pathogen challenge (9) and can influence the body’s innate immune responses to pathogens. Innate immunity can be defined as the rapid activation "following exposure to foreign agents (e.g., bacteria and viruses), and represents a first line of defense, but lacks specificity" (10). The second line of defense is supplied adaptive immunity, which unsurprisingly is engaged at a later time and involves receptors with the capacity to rearrange and recognize an almost infinite number of non-self antigens" (11).
Vitamin D’s importance to immune function is being discovered to the point it is now clear that macrophages (12) and dendritic cells (13) act as messengers between the innate and the adaptive immune systems and are able to respond to the major circulating vitamin D metabolite, thereby “providing a link between the function of these cells and the variations in vitamin D status common to many humans” (14).
Vitamin D also affects the body’s ability to activate T cells which play a crucial role in helping to fight off infections.
The effects of vitamin D on the immune system perhaps cannot be understated in the understanding of an increasing body of literature which suggests a link between vitamin D levels, immune disorders, risk of cancer and cancer-associated mortality (15).
Vitamin D and skin diseases
Vitamin D deficiency has been linked with a multitude of cutaneous disorders including skin disorders, including blistering disorders and infections (16).
It is unclear, however, whether vitamin D deficiency “primarily contributes to disease pathogenesis” or whether it “merely represents a consequential event to the inflammatory processes involved” (17).
What is clear, however is that vitamin D deficiency appears to be a clear marker of ill health, whether it be the cause, or by association.
Vitamin D and thermal injuries
Vitamin D levels have been shown to decrease following thermal injury (18). Al-Terrah et al opined “This may be both as a primary effect of the injury or a secondary response to the injury itself and/or the clinical management initiated such as fluid resuscitation and use of pressure garments” (19).
A study conducted by Rousseau et al. showed et al. improved muscle recovery and strength in burn patients supplemented with vitamin D and implied that the vitamin D supplementation had positive effects on muscle health and may play a role during rehabilitation. This is the only study thus far investigating the possible therapeutic benefits of vitamin D following a thermal injury.
A study conducted by Cho YS et al. sought to investigate the association between vitamin D deficiency and the biomechanics properties of hypertrophic burn scars. The study was conducted over 486 patients and found that vitamin deficiency was significantly related to post burn issues including slow interstitial fluid movements in burns patients (20). Interstitial fluid aids in bringing oxygen and nutrients to cells and to remove waste products from them. Old interstitial fluid is replaced by new fluid. The old fluid drains towards the lymph vessels where it can then be processed and secreted via the body’s waste systems (21). One wonders whether the slowing of interstitial fluid in these cases increases the risk of patients developing blisters after a burn injury. The article did not specifically address this issue.
Professor Janet Lord and Mir. Khaled Al-Tarrah, at the Institute of Inflammation and Aging in Birmingham, assessed the recovery progress over one year, in patients with severe burns. Professor Lord found “Low vitamin D levels were associated with worse outcomes in burn patients including life-threatening infections, mortality and delayed wound healing.” It was also associated with worse scarring outcomes (22).
A curious finding in the Birmingham study was the apparent rapid loss of vitamin D in patients immediately following a burn injury. The amount of vitamin D reduction did not seem to be related to the severity of the burn, so levels may also be decreased in more minor burn injuries (23). The phenomena of low vitamin D levels following thermal injury was also noted in a study published in 2018 (24). As yet, the medical community appears to be unaware of the long term and short term health outcomes from low vitamin D levels (25).
Vitamin D and wound healing
Vitamin D may have many effects which may be advantageous to burns patients, including immune regulation, promotion and wound healing. Additionally, vitamin D has antibacterial properties which help combat infection and aid in wound healing to burns patients“ (26).
Critical to our particular considerations in relation to tattoo removal is this passage from a review article published in 2015:
…Dihydroyvitamin D3 regulates the expression of cathelicidin (27) …, an antimicrobial protein that appears to mediate innate immunity in skin by promoting wound healing and tissue repair. One human study found that cathelicidin expression is up-regulated during early stages of wound healing. Other studies have shown that cathelicidin modulates inflammation in skin, induces angiogenesis, and improves reepithelialization (the process of restoring the epidermal barrier to reestablish a functional barrier that protects underlying cells from environmental exposure). The active form of vitamin D and its analogs have been shown to up-regulate cathelicidin expression in cultured keratinocytes. However, more research is needed to determine the role of vitamin D in wound healing and epidermal barrier function, and whether oral vitamin D supplementation or topical treatment with vitamin D analogs is helpful in healing surgical wounds” (28)
Vitamin D and photo-protection
It has long been recognized that skin may be damaged by UV light. Mouse studies conducted found that when vitamin D was topically applied to the skin before or immediately following irradiation it provided a photo-protective effect with documented effects being decreased DNA damage, reduced apoptosis (the death of cells which occurs as a normal and controlled part of an organism's growth or development) ,increased cell survival and decreased erythema (superficial reddening of the skin, usually in patches, as a result of injury or irritation causing dilatation of the blood capillaries) (29).
Is there an issue with Vitamin D levels in the general population?
Australian statistics show approximately 30% of the population display mild, moderate or severe forms of vitamin D deficiency (30). This is much better than data extracted in relation to the United States where it showed more than 90% of dark-skinned and 3/4 of the white-skinned population had a vitamin D deficiency (31).
How long does it take for a vitamin D insufficient person to build up their vitamin D levels sufficiently?
Traditionally, after 2 courses of 4 to 5 weeks, the patient builds up their vitamin D levels. Thereon vitamin D supplements are taken orally on a monthly basis to maintain healthy vitamin D levels (33). Dosage levels are checked annually to ensure healthy levels of vitamin D are maintained (33).
Can vitamin D be taken topically on the skin with effective results?
Randomized control studies conducted by Mir Sadat-Ali et al. showed vitamin D could, in fact, be delivered effectively via the dermal route. Of course, medical supervision is recommended and required for the recommended treatments of vitamin D, however it may, in fact, be very beneficial to apply vitamin D cream after laser treatment to assist vitamin D depletion which may occur after a laser tattoo removal treatment (34).
Conclusion
Vitamin D deficiency is linked to the health of the immune system, which plays a vital role in clearing away the ink particles fractured during a tattoo removal treatment session.
The observed phenomenon of slowed interstitial fluid in vitamin D deficient individuals could go a long way to explaining the occurrence of blisters after a laser tattoo removal treatment, (conducted within therapeutic guidelines), especially if the treatment is conducted on the distal limbs, which are located the furthest away from the body’s regional lymph nodes.
Extrapolating from the available data, we think vitamin D levels could be affected by laser tattoo removal treatment and consideration could be given (under medical guidance, of course) to supplementing vitamin D levels throughout the course of the laser tattoo removal treatment period.
Vitamin D could also have a significant role to play in the healing and recovery of a treatment site after a laser tattoo removal treatment, therefore consideration could be given to using topical vitamin D creams before and after laser tattoo removal treatments to assist in the healing of the site after treatment.
Details about this article:
Author: Natasha D Collings for City Tattoo Removal
Tuesday 13 August 2019
ENDNOTES:
1. “Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 794
2. "Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 2
3. "Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 794
4. Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 2
5. Clinical implications of vitamin D deficiency”, Beata Matyjaszek-Matuzek et al, Prz Menopauzalny 2015; 14 (2) 75- 81 page 75 and “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1
6. For an interesting article in relation to the immune system, what it does and how it does it, see: https://www.medicalnewstoday.com/articles/320101.php
7. "The role of Vitamin D in the Immune System as a Pro-Survival Molecule”, Clinical Therapeutics/ Volume 39, number 5, 2017, p902
8. “Vitamin D and immune function: an overview”, Hewson M, Proc Nutr Soc 12 Feb;71(1);50-61, page 50
9. "Impact of Vitamin D on immune function: lessons learned from genome-wide analysis”, Rene F. Chun et al, Frontiers in Physiology 21 April 2014, volume 5, Article 151, page 9
10. https://www.novusbio.com/research-areas/immunology
11. https://www.novusbio.com/research-areas/immunology
12. "A type of white blood cell, of the immune system, that engulfs and digests cellular debris, foreign substances, microbes, cancer cells, and anything else that does not have the type of proteins specific to healthy body cells on its surface[2] in a process called phagocytosis,”- https://en.wikipedia.org/wiki/Macrophage
13. "Antigen-presenting cells of the mammalian immune system. Their main function is to process antigen material and present it on the cell surface to the T cells of the immune system.”- https://en.wikipedia.org/wiki/Dendritic_cell
14. “Impact of vitamin D on immune function: lessons learned from genome wide analysis”, Rene F. Chun et al, Frontiers in Physiology, 21 April 2014, volume 5, ArticleArticle 151 1-15, page 1
13. “Vitamin D and immune function: an overview”, Hewson M, Proc Nutr Soc 12 Feb;71(1);50-61, page 50
15. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798
16. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798
17. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 4, Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1
18. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page 4
19. https://www.ncbi.nlm.nih.gov/pubmed/30806461
20. https://www.cancer.gov/publications/dictionaries/cancer-terms/def/interstitial-fluid
21. “Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1
22. Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1
23. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1
24. “Vitamin D status and its influence on outcomes following major burn injury and critical illness”, Al-Tarrah et al Burns and Trauma (2018) 6:11, page1
25. “Vitamin D in burn-injured patients”, ˆBurns” Issue 45 (2019) 32 - 41, page 39
26. “Vitamin D may be a simple treatment to enhance burn healing”: https://medicalxpress.com/news/2017-11-vitamin-d-simple-treatment.html, page 1
27. “Cathelicidin-related antimicrobial peptides are a family of polypeptides primarily stored in the lysosomes of macrophages and polymorphonuclear leukocytes (PMNs).Cathelicidins serve a critical role in mammalian innate immune defense against invasive bacterial infection.” https://en.wikipedia.org/wiki/Cathelicidin
28. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798
29. Vitamin D and the skin: Focus on a complex relationship: A review” Wedad Z. Mostafa, Rehab A Hegazy, Journal of Advanced Research (215) 6, 793-804, page 798
30. https://www.osteoporosis.org.au/vitamin-d
31. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 471.
32. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 475
33. “Update in Vitamin D”, John S. Adams and Martin Hewson, Clin Endocrinol Metab, February 2010, 95(2):471-478, page 475
No comments:
Post a Comment