Twelve children (aged 4-14 years) who had been burned on a mean of 52% of their total body surface area were studied a mean of 14 months after their burn injury. Eight of 11 children (73%) had a low serum 25-hydroxyvitamin D concentration, indicative of vitamin D deficiency. Skin biopsy samples revealed that the conversion of 7-dehydrocholesterol to previtamin D3 after exposure to ultraviolet B light was significantly reduced in both burn scar and adjacent healthy-appearing skin, compared with the conversion in the skin of normal, unburned children (p = 0.004).

Comment: Osteoporosis is a long-term consequence of severe burns, occurring in more than half of patients during long-term follow-up. In the early stages after a burn, immobilization and high concentrations of cortisol both contribute to bone loss. Vitamin D deficiency also plays a role in the development of osteoporosis. Children with burn scars often avoid sun exposure, because it causes itching and burning. The results of the present study suggest that impaired synthesis of vitamin D in response to sun exposure is another factor contributing to vitamin D deficiency. Long-term supplementation with vitamin D should be considered for all people who have suffered severe burns.

Klein GL, et al. Synthesis of vitamin D in skin after burns. Lancet 2004;363:291-292.

Garrel D. Burn scars: a new cause of vitamin D deficiency? Lancet 2004;363:259-260.