Vitamin D May Ease Symptoms of Severe Atopic Dermatitis in Children

Vitamin D used as an adjuvant therapy in children with severe atopic dermatitis (AD) may improve clinical outcomes, according to a study published in Pharmacology Research & Perspectives.

Previously, vitamin D supplementation has yielded positive outcomes in mild and moderate AD. Currently, conventional AD treatments include immune modulatory agents; however, control of AD remains difficult to achieve in some patients, which “suggests the presence of some other associated factors,” the authors explained, and it has been suggested that a deficiency of vitamin D “may be a factor to be considered in the pathophysiology of AD.”

The researchers conducted a double-blind, randomized, parallel, placebo-controlled trial at the National Hepatology and Tropical Medicine Research Institute in Cairo, Egypt. The study included patients with severe AD between the ages of 5 and 16 from June 6, 2018, to September 1, 2018. A total of 86 patients completed the study and were included in the final analysis.

Patients were randomized to receive either vitamin D3 1600 IU/day or placebo. Both groups also received baseline therapy of topical 1% hydrocortisone cream twice daily for 2 weeks. The group receiving vitamin D showed a significant improvement in 25(OH) D serum levels, a measure of vitamin D deficiency, compared with the baseline (P ≤ 001). In the group receiving placebo, 25(OH)D levels were comparable to the baseline level (P = .47).

The mean change in Eczema Area and Severity Index (EASI) score from baseline was significantly greater among patients in the vitamin D group (56.44%) than patients in the placebo group (42.09%; P = .039). While 38.6% of patients receiving vitamin D achieved an improvement of ≥ 75% in EASI score (EASI75), only 7.1% of patients in the placebo group achieved the same improvement.

However, the authors noted that the percentage of nonresponders between the 2 groups were comparable (59.5% in the vitamin D group vs 52.2% in the placebo group). “This indicates that some supplemented patients might achieve excessive benefit from treatment,” they explained.

They noted that there was a fair correlation between body mass index and percentage change in score for EASI75 responders, but further studies are needed to better understand the relationship.

Some of the highlighted limitations of the study were the limited ethnic diversity among patients, which potential restricts the generalizability of the findings, and a lack of data from other domains such as patient-reported outcomes. The authors also pointed out that seasonal fluctuations also characterize AD, with AD aggravated during the winter.

“We advocate further multicenter studies with larger sample size of ethnic diverse population to validate the potential benefit of vit D on clinical outcomes of severe pediatric eczema,” the authors concluded. “Further studies are also needed to examine whether the positive impact of supplementation would be maintained in pediatrics with winter-related severe eczema.”

Reference

Mansour NO, Mohamed AA, Hussein 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. Pharmacol Res Perspect. Published online November 3, 2020. doi:10.1002/prp2.679