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The relationship between vitamin D and the skin starts with the synthesis of vitamin D in the skin. New mechanisms on how the most researched vitamin affects the biggest organ in the human body are constantly investigated and observed. The aim is to review the current knowledge on vitamin D and skin interaction, as well as the effect of vitamin D levels on skin diseases. According to some studies, suboptimal vitamin D levels are found in as many as 30 – 90% of the population, with an estimated vitamin D insufficiency in about one billion people worldwide. In 25.6 – 68% of patients with psoriasis, there is a deficiency of vitamin D and insufficiency of vitamin D in as many as 97% of patients. Furthermore, a series of observational studies and meta-analyses have shown that the serum levels of calcidiol are lower in children and adults with atopic dermatitis, and some studies have shown that up to 70.5% of patients with vitiligo have vitamin D deficiency. Low levels of vitamin D are associated with the progression of malignant melanoma, but it is unknown at which point UV exposure ceases to be protective through vitamin D and begins to be a risk factor for the development of skin tumours. Despite many studies that have been conducted, the nature of the relationship between vitamin D and certain skin diseases is still unknown, whether it is causal or accidental, while in others, such as psoriasis, evidence of the correlation with vitamin D levels is used in daily work with patients – in diagnosis and treatment. [ABSTRACT FROM AUTHOR]

Aim: To report a case of a patient with pityriasis lichenoides et varioliformis acuta, emphasising the challenges in the diagnosis and treatment of this clinical entity. Case report: A 30-year-old patient was referred to the Department of Dermatology and Venereology due to skin changes accompanied by itching persisting for one and a half month. Red papules and papulocrusts were found on the trunk, upper and lower limbs, but in a larger number and more severely affecting the trunk than the limbs. The patient stated the occasional use of febuxostat for the treatment of chronic hyperuricemia that has been diagnosed four years prior. Treatment with desloratadine and a combination of bethametasone and gentamicin was started. The laboratory results showed neutropenia, high levels of low density lipoprotein cholesterol and high levels of urate. The biopsy of the skin lesion has been done. Doxycycline treatment and continuing treatment with bethametasone and gentamicin were recommended to the patient. Pathohistological finding described ulcerated epidermis with oedema, granulation tissue and erythrocyte extravasation in the floor of the ulceration. Lymphocytic and histiocytic infiltrates were found in the base of the ulceration and subepidermally. The epidermis on the edge of the ulceration was irregularly hyperplastic and showed spongiosis. The diagnosis of pityriasis lichenoides et varioliformis acuta has been confirmed. Upon completion of doxycycline treatment skin changes were in regression and urate levels decreased. Conclusions: Not only caution in diagnosis and treatment, but also regular follow-up is necessary in patients diagnosed with pityriasis lichenoides et varioliformis acuta because of a wide range of differential diagnoses and a possibility of misdiagnosis. Further research on the etiopathogenesis of this disorder is needed in order to improve treatment outcomes. [ABSTRACT FROM AUTHOR]