Atopic dermatitis (AD), also known as eczema, is a condition that makes the skin red and itchy but the pathology of AD is not entirely understood. It's believed to involve a complex interplay of dysfunctions of immune response, genetic and environmental factors. The conventional AD treatments include immune modulatory agents, such as topical and/or oral steroids and topical calcineurin inhibitors but there is growing interest in the possible role of vit D deficiency in the development of AD.
A recent meta‐analysis of interventional studies documented that Vit D supplementation was linked to clinically relevant reduction in AD disease severity both in adult and pediatric patients.
The current double blind, randomised, parallel, placebo controlled clinical trial is the first to investigate potential benefits of Vit D supplementation in children and adolescents with severe AD. Therefore, the primary aim of this trial was to determine the impact of Vit D supplementation in conjunction with standard treatment in severe AD.
The present study, involving 92 participants with severe AD, concludes that an oral daily Vit D supplement might provide clinical improvement in children with severe AD.
The study
Subjects, aged from 5 to 16 years old, were enrolled from the National Hepatology and Tropical Medicine Research Institute (NHTMRI), Cairo, Egypt, in the period from 6th June to 1th September, 2018.
Participants were allocated in 1:1 ratio to receive either vitamin D3 1600 IU/day or placebo, plus baseline therapy of topical 1% hydrocortisone cream twice daily for three months.
A dietary history was obtained at study entry with attention to potential sources of vitamin D, no significant group differences were prominent, and diets were stable during the study. At baseline patient demographic data, laboratory analysis and clinical characteristics were collected.
Resulting data indicate, at baseline, there was no significant difference between the two groups in serum level of 25(OH)D and high prevalence of 25(OH)D deficiency was notable. At the end of the study, the mean percentage change from baseline in EASI score was significantly greater with vitamin D group (56.44%) than with placebo group (42.09%) (P = .039). A comparable proportion in the vitamin D group and placebo group (52.2% vs 59.5%) experienced modest response to treatment (EASI < 50). On contrast, different patterns were notable between supplemented patients and those allocated to placebo group regarding percentage of patients who achieved EASI 50 or EASI 75. Notably, about 38.6% of supplemented patients achieved EASI 75 vs only 7.1% of patients in the placebo group.
One limitation of the study is that the patients hadlimited ethnic diversity, potentially restricting its generalizability, as well as the lack of data from other domains, such as patient reported outcomes. Also, given the possible seasonal fluctuations that characterize AD, future trials are needed to determine if the benefits of supplementation would sustain in patients with winter‐related severe eczema.
Study background
In line with the results of the present study, Kamanamool et al found that oral vit D supplement reduced the skin colonisation of S aureus and demonstrated clinical improvement in children with moderate eczema. Similarly, oral Vit D supplementation has been shown to improve winter‐related AD symptoms.
The observed improvement in disease severity from vitamin D supplementation has strong biological plausibility as 1,25 (OH)D contributes to hallmark features of AD: altered barrier function, immune dysregulation, and inadequate bacterial defense. This might explain the positive impact of supplementation recorded in the present study.
Source: Pharmacology Research and Perspective
Salah. E.M., et al
“The impact of vitamin D supplementation as an adjuvant therapy on clinical outcomes in patients with severe atopic dermatitis: A randomized controlled trial”