« Previous Article
Next Article »

Original Research (Original Article) 


Shumoukh Saleh Fuhaid AlAfnan et al, 2020;4(3):730–734.

International Journal of Medicine in Developing Countries

The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia

Shumoukh Saleh Fuhaid AlAfnan1*, Fayez Saud Alreshidi2

Correspondence to: Shumoukh Saleh Fuhaid AlAfnan

*College of Medicine, University of Hail, Hail, Saudi Arabia.

Email: shmokhalafnan2 [at] hotmail.com

Full list of author information is available at the end of the article.

Received: 13 January 2020 | Accepted: 21 January 2020


ABSTRACT

Background: Recently, many studies examined the benefits of vitamin D for different conditions. Also, vitamin D plays a significant role in the prevention and management of skin diseases. However, data on the knowledge of the general public toward the importance of vitamin D is unclear, especially its role in dermatological conditions. This survey analysis aims to explore the level of knowledge among the Saudi population living in Hail city, Saudi Arabia, toward the importance of vitamin D level in dermatological diseases.


Methodology:

A self-administered structured questionnaire was distributed online, including questions on the importance of vitamin D level in the prevention and treatment of different dermatological diseases, in addition to socio-demographic data. Data analysis was done through the Statistical Package for the Social Sciences program version 24.


Results:

500 participants responded to this survey. The mean score for the knowledge question over the whole cohort was 3.33 ± 2.105, with a minimum score of zero and a maximum score of seven. Females had a significantly higher score (3.50 ± 1.937) compared to males at (p-value = 0.005). Also, subjects who had a previous leveling for vitamin D showed a considerably higher score (3.83 ± 1.988) compared to subjects who did not have the investigation before (p-value < 0.001).


Conclusion:

The level of knowledge toward the role of vitamin D in dermatology among the Saudi community in Hail is considered unsatisfactory. Future studies should focus on exploring the reasons behind this inadequate level of knowledge about vitamin D.


Keywords:

Vitamin D, dermatologic, Hail region, Saudi Arabia.


Introduction

Recently, the benefits of vitamin D have become trending in the medical literature and the scientific community [1]. Additionally, deficiency of vitamin D is currently found to be underestimated globally, while the symptoms of vitamin D can range between mild fatigue to severe osteomalacia and dermatological problems [2]. Moreover, vitamin D deficiency has been correlated to a wide range of cancers, diabetes, and heart diseases [3]. Vitamin D is activated in the skin through exposure to sunlight [4]. Hence, reduced sunlight exposure is identified as a major cause of vitamin D deficiency [5]. Even in sunny countries, such as Saudi Arabia, a high incidence of vitamin D deficiency has been reported [6]. Studies on the epidemiology of vitamin D deficiency showed that females are at higher risk of vitamin D deficiency [7]. This can be attributed to breastfeeding without vitamin D supplementation in addition to lower exposure to sunlight, especially in Middle East countries [8]. Furthermore, in spite of the more sunny weather in eastern countries, they recorded higher rates of vitamin D deficiency compared to western countries [9]. Vitamin D benefits on skin health and integrity have been rigorously tested [10]. Vitamin D is proved to aid in wound healing [11]. It can also delay premature skin aging through anti-oxidant action. Vitamin D can also treat signs and symptoms of skin stretch [12]. Vitamin D deficiency is also linked to an increased incidence of acne, psoriasis, and eczema [13]. In spite of the numerous data on the significant role of vitamin D in dermatology, the level of knowledge of the general populations toward these benefits is still unclear, especially in Middle Eastern countries, where vitamin D deficiency is highly prevalent [14].

Therefore, the goal of this investigation is to examine the level of knowledge of the Saudi public in Hail, Saudi Arabia, toward the importance of vitamin D level in the prevention and management of different types of dermatological diseases.


Subjects and Methods

This is a cross-sectional observational survey study that was carried out in Hail, Saudi Arabia, where an online self-developed questionnaire was distributed, via a link to Google forms to the general public. Completed surveys only were included in the analysis. Data were collected through a self-administered designed questionnaire that was available in the form of an online google form. Data contained in the survey was as follows: Socio-demographic characteristics, questions about testing vitamin D previously for dermatological purposes, in addition to the questions on the importance of vitamin D for the prevention and treatment of dermatological diseases. Data were represented in the form of frequencies (number of responders) and valid percentages for categorical variables. A one-way analysis of variance (ANOVA) test was used to compare means between different subgroups. All p values < 0.05 were considered as statistically significant. IBM SPSS (IBM Corp, Armonk, NY) was used to perform all statistical calculations, version 24 for Microsoft Windows. Institutional research ethics board approval was acquired before conducting the study protocol. A statement was included at the beginning of the questionnaire clarifying that the participation in this study is voluntary and that collected data will be anonymous and will only be used for this study.


Results

Five hundred participants responded to this online questionnaire in this study. Only participants who completed all the questions in the survey were included. Socio-demographics of participants and analysis of the questionnaire are shown below:

General characters of responders:

Out of 500 participants, 69% of the responders were females, while 31% were males. Age was subcategorized into five groups, starting with less than 20-year old and ending with 51- to 60-year old. Most of the responders (26.2%) belonged to the age group 20- to 30-year old. On the other hand, the age group who were 51- to 60-year old had the least number of responses, with 10.4% of responses. Turning to marital status, 53.6% were married, while 4.6% only were divorced. All socio-demographic data is shown in detail in Table 1.

Participants were also asked if they had tested the level of vitamin D previously, only 31.6% of the responders have a previous leveling for vitamin D for a dermatological investigation, as shown in Figure 1.

Knowledge about the role of vitamin D in ­Dermatology

Participants were asked a set of questions to evaluate their knowledge of the role of vitamin D in preventing and treating skin disorders. 70.8% of the responders agreed that vitamin D could be used to treat hair falling, and 41% agreed that it could improve wound and burn to heal. Also, 42.8% agreed that vitamin D is related to acne, 33.8% agreed that it is related to psoriasis, and 33.2% agreed that it is related to eczema.

Table 1. Socio-demographic characters of participants.

Frequency (N) Percent (%)
Gender
Female 345 69.0
Male 155 31.0
Age
Less than 20-year old 100 20.0
20–30 131 26.2
31–40 110 22.0
41–50 107 21.4
51–60 52 10.4
Marital status
Single 209 41.8
Married 268 53.6
Divorced 23 4.6

Figure 1. Previous leveling of vitamin D for the dermatological purpose.

Moreover, 59.4% of participants knew that vitamin D contains antioxidants that can delay premature aging of the skin, and 51.6% knew that vitamin D could treat the signs of skin stretching. All responses are detailed in Table 2.

Comparison of the level of knowledge toward vitamin D and dermatology over different variables

The total score for knowledge questions was calculated and compared over different demographic variables using one way ANOVA test at a level of significance p-value < 0.05. The mean score for the whole cohort was 3.33 ± 2.105, with a minimum score of zero and a maximum score of seven. The comparison demonstrated that females had a significantly higher score (3.50 ± 1.937) compared to males at (p-value = 0.005). Also, the subjects who had a previous leveling for vitamin D showed a considerably higher score (3.83 ± 1.988) compared to the subjects who did not have the investigation before (p-value < 0.001). All comparisons are detailed in Table 3.

Table 2. Responses of knowledge about vitamin D role in dermatology.

Frequency (N) Percent (%)
Is vitamin D used for hair fall problems? No 146 29.2
Yes 354 70.8
Does vitamin D improve wound and burn to heal No 295 59.0
Yes 205 41.0
Is vitamin D related to acne? No 286 57.2
Yes 214 42.8
Is vitamin D related to psoriasis? No 331 66.2
Yes 169 33.8
Is vitamin D related to eczema? No 334 66.8
Yes 166 33.2
Does vitamin D contain anti-oxidants, delaying premature aging of the skin? No 203 40.6
Yes 297 59.4
Does vitamin D treat the signs of stretching of the skin? No 242 48.4
Yes 258 51.6

Discussion

Vitamin D deficiency can represent a significant risk factor for a wide range of diseases. One of these diseases is skin disorders [15]. Vitamin D deficiency is more common in females, especially in Middle Eastern countries, yet prevention can be attained through vitamin D supplementation and good exposure to sunlight [16]. However, the first step to reducing the incidence of vitamin D deficiency is to improve the knowledge of the public about the hazards of vitamin D deficiency [17]. The present study examined the level of knowledge of the Saudi community in Hail toward the role of vitamin D in the prevention and treatment of dermatological diseases. It was shown that the mean score for the knowledge question over the whole cohort was 3.33 ± 2.105, with a minimum score of zero and a maximum score of seven. Additionally, females had a significantly higher score (3.50 ± 1.937) compared to males at (p-value = 0.005). Also, subjects who had a previous leveling for vitamin D showed a significantly higher score (3.83 ± 1.988) compared to subjects who did not have the investigation before (p-value < 0.001). The level of knowledge toward vitamin D has been evaluated in a different setting. Boland et al. [18] assessed the level of knowledge of Canadian students about vitamin D leveling through a survey analysis. Boland et al. [18] included 1,088 undergraduate students in this investigation. Boland et al. [18] demonstrated that the students had a poor level of knowledge about the vitamin and its role in different disorders, including skin disorders. Boland et al. [18] also recommended implementing educational courses within the university to improve the level of knowledge of the students about the importance of vitamin D [18]. Although the present study investigated the level of knowledge in the general population, it supports the findings of Boland et al. [18] in terms of the poor level of knowledge toward the role of vitamin D, particularly in dermatological diseases. Also, Al Bathi et al. [19] evaluated the level of knowledge of patients visiting primary care units toward vitamin D role in dermatological disorders in Kuwait. Through a cross-sectional study, Al Bathi et al. [19] included 200 patients with vitamin D deficiency aging more than 18-year old. Al Bathi et al. [19] revealed that the level of knowledge of patients about the role of vitamin D is considered very poor and that most of the patients did not realize that they might have low levels of vitamin D except after having significant manifestations of the disease [19]. Similarly, the present study showed a poor level of knowledge of the general population about the role of vitamin D in the treatment and prevention of dermatological diseases. However, the present study recruited subjects from the general population rather than including patients. Moreover, Christie et al. [20] evaluated the knowledge and attitude of females living in Riyadh, toward the consequences of vitamin D deficiency. Through a survey analysis, Christie et al. [20] showed that the level of knowledge of females toward vitamin D deficiency and its dermatological consequences was very poor and required actions to be improved [20]. Similarly, in Hail, the level of knowledge of the general population was very poor. However, females had a significantly higher score (3.50 ± 1.937) compared to males at (p-value = 0.005). Finally, the present study had some limitations; Questions assessing the knowledge of patients could be further expanded, which is recommended in future studies. Also, the research was done in one city in Saudi Arabia, which could question the external validity of the outcomes. To our knowledge, this is the first study in Saudi Arabia to evaluate the level of knowledge of the Saudi population toward vitamin D role in dermatological diseases.

Table 3. Comparison of the level of knowledge toward vitamin D and dermatology over different variables.

Mean Standard deviation p-value
Gender Female 3.50 1.937 0.005*
Male 2.94 2.400
Age 10 - 20 3.37 1.790 0.164
20 - 30 3.04 1.974
30 - 40 3.26 2.123
40 - 50 3.43 2.295
50 - 60 3.88 2.463
Marital status Single 3.22 1.913 0.333
Married 3.37 2.265
Divorced 3.87 1.792
Have you previously tested your vitamin D level for dermatological complaints? No 3.09 2.120 <0.001*
Yes 3.83 1.988

*p-value at level of significance < 0.05.


Conclusion

The level of knowledge toward the role of vitamin D in dermatology among the Saudi community is considered unsatisfactory. More efforts should be exerted through awareness campaigns in social events and community premises about the importance of checking vitamin D level, and the dermatological consequences of vitamin D deficiency. Also, future studies should evaluate the awareness and practices of the Saudi population toward the hazards of vitamin D deficiency, rather than an assessment of their knowledge only. Future studies should also focus on exploring the reasons behind this unacceptable level of knowledge about vitamin D.


Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical approval

The research was approved by university of hail on 21 August 2019 [EC-00071].


Author details

Shumoukh Saleh Fuhaid AlAfnan1, Fayez Saud Alreshidi2

  1. Medical student, University of Hail, Saudi Arabia
  2. Family Medicine Consultant, Assistant Professor, College of Medicine, University of Hail, Saudi Arabia

References

  1. Naeem Z. Vitamin d deficiency-an ignored epidemic. Int J Health Sci. 2010;4(1):V.
  2. Al-Mogbel ES. Vitamin D status among adult Saudi females visiting primary health care clinics. Int J Health Sci. 2012;6(2):116. https://doi.org/10.12816/0005987
  3. Zouboulis CC, Makrantonaki E. Clinical aspects and molecular diagnostics of skin aging. Clin Dermatol. 2011;29(1):3–14. https://doi.org/10.1016/j.clindermatol.2010.07.001
  4. Moy RJ, McGee E, Debelle GD, Mather I, Shaw NJ. Successful public health action to reduce the incidence of symptomatic vitamin D deficiency. Arch Dis Childhood. 2012;97(11):952–4. https://doi.org/10.1136/archdischild-2012-302287
  5. Woo DK, Eide MJ. Tanning beds, skin cancer, and vitamin D: an examination of the scientific evidence and public health implications. Dermatol Ther. 2010;23(1):61–71. https://doi.org/10.1111/j.1529-8019.2009.01291.x
  6. Narayanan DL, Saladi RN, Fox JL. Ultraviolet radiation and skin cancer. Int J Dermatol. 2010;49(9):978–86. https://doi.org/10.1111/j.1365-4632.2010.04474.x
  7. Vu LH, van der Pols JC, Whiteman DC, Kimlin MG, Neale RE. Knowledge and attitudes about vitamin D and impact on sun protection practices among urban office workers in Brisbane, Australia. Cancer Epidemiol Biomarkers Prev. 2010 ;19(7):1784–9. https://doi.org/10.1158/1055-9965.EPI-10-0127
  8. Heine G, Lahl A, Müller C, Worm M. Vitamin D deficiency in patients with cutaneous lupus erythematosus is prevalent throughout the year. Br J Dermatol. 2010;163(4):863–5. https://doi.org/10.1111/j.1365-2133.2010.09948.x
  9. Al-Mutairi N, Issa BI, Nair V. Photoprotection and vitamin D status: a study on awareness, knowledge and attitude towards sun protection in general population from Kuwait, and its relation with vitamin D levels. Indian J Dermatol Venereol Leprol. 2012;78(3):342. https://doi.org/10.4103/0378-6323.95451
  10. Masood Z, Mahmood Q, Ashraf KT. Vitamin D deficiency-an emerging public health problem in Pakistan. JUMDC. 2010;1(1):4–9.
  11. Oren Y, Shapira Y, Agmon-Levin N, Kivity S, Zafrir Y, Altman A, Lerner A, Shoenfeld Y. Vitamin D insufficiency in a sunny environment: a demographic and seasonal analysis. Isr Med Assoc J. 2010;12(12):751.
  12. Agbai ON, Buster K, Sanchez M, Hernandez C, Kundu RV, Chiu M, et al. Skin cancer and photoprotection in people of color: a review and recommendations for physicians and the public. J Am Acad Dermatol. 2014;70(4):748–62. https://doi.org/10.1016/j.jaad.2013.11.038
  13. Cashman KD, Kiely M. Towards prevention of vitamin D deficiency and beyond: knowledge gaps and research needs in vitamin D nutrition and public health. Br J Nutr. 2011;106(11):1617–27. https://doi.org/10.1017/S0007114511004995
  14. Toher C, Lindsay K, McKenna M, Kilbane M, Curran S, Harrington L, et al. Relationship between vitamin D knowledge and 25-hydroxyvitamin D levels amongst pregnant women. J Hum Nutr Diet. 2014;27(3):261–9. https://doi.org/10.1111/jhn.12150
  15. Benson AA, Toh JA, Vernon N, Jariwala SP. The role of vitamin D in the immunopathogenesis of allergic skin diseases. Allergy. 2012;67(3):296–301. https://doi.org/10.1111/j.1398-9995.2011.02755.x
  16. Wadhwa B, Relhan V, Goel K, Kochhar AM, Garg VK. Vitamin D and skin diseases: a review. Indian J Dermatol Venereol Leprol. 2015;81(4):344. https://doi.org/10.4103/0378-6323.159928
  17. Toniato E, Spinas E, Saggini A, Kritas SK, Caraffa A, Antinolfi P, et al. Immunomodulatory effects of vitamin D on skin inflammation. J Biol Regul Homeost Agents. 2015;29(3):563–7.
  18. Boland S, Irwin JD, Johnson AM. A survey of university students’ vitamin D-related knowledge. J Nutr Educ Behav. 2015;47(1):99–103. https://doi.org/10.1016/j.jneb.2014.08.013
  19. Al Bathi BA, Al Zayed KE, Al Qenai M, Makboul G, El-Shazly MK. Knowledge, attitude and practice of patients attending primary care centers toward vitamin D in Kuwait. Alexandria J Med. 2012;48(3):277–82. https://doi.org/10.1016/j.ajme.2012.02.003
  20. Christie FT, Mason L. Knowledge, attitude and practice regarding vitamin D deficiency among female students in Saudi Arabia: a qualitative exploration. Int J Rheumatic Dis. 2011;14(3):e22–9. https://doi.org/10.1111/j.1756-185X.2011.01624.x


How to Cite this Article
Pubmed Style

AlAfnan SSF, Alreshidi FS. The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. IJMDC. 2020; 4(3): 730-734. doi:10.24911/IJMDC.51-1578904975


Web Style

AlAfnan SSF, Alreshidi FS. The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. http://www.ijmdc.com/?mno=81773 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1578904975


AMA (American Medical Association) Style

AlAfnan SSF, Alreshidi FS. The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. IJMDC. 2020; 4(3): 730-734. doi:10.24911/IJMDC.51-1578904975



Vancouver/ICMJE Style

AlAfnan SSF, Alreshidi FS. The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. IJMDC. (2020), [cited March 29, 2020]; 4(3): 730-734. doi:10.24911/IJMDC.51-1578904975



Harvard Style

AlAfnan, S. S. F. & Alreshidi, . F. S. (2020) The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. IJMDC, 4 (3), 730-734. doi:10.24911/IJMDC.51-1578904975



Turabian Style

AlAfnan, Shumoukh Saleh Fuhaid, and Fayez Saud Alreshidi. 2020. The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 730-734. doi:10.24911/IJMDC.51-1578904975



Chicago Style

AlAfnan, Shumoukh Saleh Fuhaid, and Fayez Saud Alreshidi. "The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 730-734. doi:10.24911/IJMDC.51-1578904975



MLA (The Modern Language Association) Style

AlAfnan, Shumoukh Saleh Fuhaid, and Fayez Saud Alreshidi. "The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia." International Journal of Medicine in Developing Countries 4.3 (2020), 730-734. Print. doi:10.24911/IJMDC.51-1578904975



APA (American Psychological Association) Style

AlAfnan, S. S. F. & Alreshidi, . F. S. (2020) The Awareness of Vitamin D Importance for Dermatologic Conditions in Hail Region Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 730-734. doi:10.24911/IJMDC.51-1578904975