Dermatitis Abstracts 1

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Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study.
            (Amestejani et al., 2012) Download
BACKGROUND:  The role of vitamin D in Atopic Dermatitis (AD) is ambiguous and clinical trials are needed to assess the role of vitamin D in the treatment of AD. The aim of this clinical trial study to evaluate the effect of vitamin D supplementation on patients with AD. MATERIAL AND METHODS:  sixty AD patients were included in a randomized, double-blind, placebo-controlled trial study. They were randomly divided into two groups and treated for 60 days: group vitamin D (n=30), and placebo group (n=30). The two groups were as follows: Group D, 1600 IU cholecalciferol (vitamin D) and second group placebo. The severity of AD was evaluated based on SCORAD (Scoring Atopic Dermatitis) and TIS (Three Item Severity score) value by the same trained physician before and after the trial. RESULTS:  According to SCORAD and TIS value index in the vitamin D group showed significant improvement in patients with mild, moderate and severe AD (P<0.05) and in patients who the intake placebo, this improvement didn't showed (P>0.05). CONCLUSION:  Results mention that supplementation with oral vitamin D dramatically improved disease severity in AD patients.

Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children.
            (Camargo et al., 2014) Download
BACKGROUND:  Epidemiologic and preclinical data, and a small randomized trial in Boston, suggest that vitamin D supplementation may improve winter-related atopic dermatitis (AD). OBJECTIVE:  To determine the effect of vitamin D supplementation on winter-related AD. METHODS:  We performed a randomized, double-blind, placebo-controlled trial of Mongolian children with winter-related AD (clinicaltrials.gov identifier: NCT00879424). Baseline eligibility included age 2 to 17 years, AD score 10 to 72 using the Eczema Area and Severity Index (EASI), and winter-related AD (eg, history of AD worsening during the fall-to-winter transition). Subjects were enrolled in Ulaanbaatar during winter and randomly assigned to oral cholecalciferol (1000 IU/day) versus placebo for 1 month. All children and parents received emollient and patient education about AD and basic skin care. The main outcomes were changes in EASI score and in Investigator's Global Assessment. RESULTS:  The 107 enrolled children had a mean age of 9 years (SD 5), and 59% were male. Their median age of AD onset was 3 months (interquartile range 2 months to 1 year) and mean EASI score at baseline 21 (SD 9). One-month follow-up data were available for 104 (97%) children. Compared with placebo, vitamin D supplementation for 1 month produced a clinically and statistically significant improvement in EASI score (adjusted mean change: -6.5 vs -3.3, respectively; P = .04). Moreover, change in Investigator's Global Assessment favored vitamin D over placebo (P = .03). There were no adverse effects in either group. CONCLUSION:  Vitamin D supplementation improved winter-related AD among Mongolian children, a population likely to have vitamin D deficiency in winter.

Vitamin D supplementation modulates the immune system and improves atopic dermatitis in children.
            (Di Filippo et al., 2015) Download
BACKGROUND:  Vitamin D seems to influence the evolution of atopic dermatitis (AD) in children. METHODS:  We tested the vitamin D serum levels of 39 children with AD (AD group t0) and of 20 nonallergic healthy controls (C group). AD severity was evaluated using the AD scoring system (SCORAD index). Cytokine serum levels (IL-2, IL-4, IL-6, IFN-γ, TNF-α) and atopy biomarkers were also measured. The patients were then treated with vitamin D oral supplementation of 1,000 IU/day (25 mg/day) for 3 months. We then reevaluated the vitamin D serum levels, AD severity and cytokine serum levels in all of the treated children (AD group t1). RESULTS:  The cross-sectional analysis on patients affected by AD (AD group t0) showed that the initial levels of all the tested cytokines except for TNF-α were higher than those of the healthy control group (C group), falling outside the normal range. After 3 months of supplementation the patients had significantly increased vitamin D levels (from 22.97 ± 8.03 to 29.41 ± 10.73 ng/ml; p = 0.01). A concomitant significant reduction of both the SCORAD index (46.13 ± 15.68 at the first visit vs. 22.57 ± 15.28 at the second visit; p < 0.001) and of all the altered cytokines (IL-2, IL-4, IL-6, IFN-γ) was also found. CONCLUSIONS:  This study showed vitamin D supplementation to be an effective treatment in reducing AD severity in children through normalization of the Th1 and Th2 interleukin serum pattern.

Vitamin D Status and Its Association with the SCORAD Score and Serum LL-37 Level in Korean Adults and Children with Atopic Dermatitis.
            (Han et al., 2015) Download
BACKGROUND:  Vitamin D insufficiency could be associated with the prevalence of atopic dermatitis (AD). OBJECTIVE:  To examine vitamin D status and the relations between serum 25-hydroxyvitamin D levels, SCORAD score, serum LL-37 level, and body mass index (BMI) in Korean AD patients, and to explore whether these associations differ between adults and children. METHODS:  Serum 25-hydroxyvitamin D levels, serum LL-37, and clinical features were analyzed in a total of 72 Korean patients with AD (39 adults and 33 children) and 140 healthy control subjects (70 adults and 70 children). RESULTS:  Serum 25-hydroxyvitamin D levels were significantly reduced in children with AD (15.06±4.64 ng/ml) compared with normal children in the control group (16.25±6.60 ng/ml) (p=0.036). Significant inverse correlations were found between BMI and 25-hydroxyvitamin D level (r=-0.315, p=0.007) and between the SCORAD score and serum LL-37 level (r=-0.3, p=0.011) in the total AD patients. CONCLUSION:  The results showed that serum vitamin D levels were lower in children with AD than in healthy children; however, the same relation was not observed between adults with AD and healthy adults. Serum 25-hydroxyvitamin D concentration was not significantly correlated with AD severity or serum LL-37 levels in our study population.

The effects of vitamins e and d supplementation on erythrocyte superoxide dismutase and catalase in atopic dermatitis.
            (Javanbakht et al., 2010) Download
BACKGROUND:  Atopic dermatitis is a public health problem worldwide. Increment of reactive oxygen species (ROS) production may be one of the contributing factors of tissue damage in atopic dermatitis. The present study was designed to determine the effect of vitamins E and/or D on erythrocyte superoxide dismutase and catalase activities in patients with atopic dermatitis. METHODS:  In a randomized, double blind, placebo controlled clinical trial 45 atopic dermatitis patients were divided into four groups. Each group received one of the following supplements for 60 days: group A (n=11) vitamins E and D placebos; group B (n= 12) 1600 international unit (IU) vitamin D3 plus vitamin E placebo; group C (n=11) 600 IU synthetic all-rac-α tocopherol plus vitamin D placebo; group D (n=11) 1600 IU vitamin D3 plus 600 IU synthetic all-rac-α tocopherol. Erythrocyte superoxide dismutase (SOD) and catalase activities, serum 25 (OH) D, plasma α-tocopherol were determined. The data were analyzed by analysis of variance (ANOVA) and paired t-test. RESULTS:  After 60 days vitamin D and E supplementation, erythrocyte SOD activities increased in groups B, C and D (P= 0.002, P= 0.016 and P= 0.015, respectively). Erythrocyte catalase activities increased in groups B and D (P= 0.026 and P= 0.004, respectively). The increment of erythrocyte catalase activity was not significant in group C. There was a positive significant correlation between SOD activity and serum 25 (OH) D (r= 0.378, P= 0.01). CONCLUSIONS:  It is concluded that vitamin D is as potent as vitamin E in increasing the activities of erythrocyte SOD and catalase in atopic dermatitis patients.


 

Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis.
            (Javanbakht et al., 2011) Download
BACKGROUND:  Atopic dermatitis is a chronically relapsing, highly pruritic and inflammatory skin disease. This study was done to assess the effects of vitamins D and E supplementation on the clinical manifestation of atopic dermatitis. METHODS:  Forty-five atopic dermatitis patients were included in a randomized, double-blind, placebo-controlled trial. They were randomly divided into four groups and treated for 60 days: group P (n = 11), vitamins D and E placebos; group D (n = 12), 1600 IU vitamin D(3) plus vitamin E placebo; group E (n = 11), 600 IU synthetic all-rac-α-tocopherol plus vitamin D placebo; and group DE (n = 11), 1600 IU vitamin D(3) plus 600 IU synthetic all-rac-α-tocopherol. Serum 25(OH) vitamin D and plasma α-tocopherol were determined before and after the trial. The clinical improvement was evaluated with SCORing Atopic Dermatitis (SCORAD). Data were analyzed by analysis of variance (ANOVA) and Kruskal-Wallis tests. RESULTS:  SCORAD was reduced after 60 days in groups D, E and DE by 34.8%, 35.7% and 64.3%, respectively (p = 0.004). Objective SCORAD also showed significant improvement. There was a positive correlation between SCORAD and intensity, objective, subjective and extent (p < 0.001). We found a significant negative association between plasma α-tocopherol and SCORAD, intensity, objective and extent (p = 0.02). CONCLUSION:  This study supports the contributing and beneficial effects of vitamins D and E in the treatment of atopic dermatitis.

Vitamin D and atopic dermatitis: A systematic review and meta-analysis.
            (Kim and Bae, 2016) Download
OBJECTIVES:  Despite the evidence supporting the use of vitamin D supplements for managing atopic dermatitis (AD), no meta-analysis providing definite conclusions in this field has been reported. The purpose of the present study was to conduct a systematic review and meta-analysis of all controlled studies of vitamin D for treating AD to elucidate the efficacy of vitamin D for alleviating the symptoms of AD. METHODS:  Literature searches were conducted using Ovid-MEDLINE, EMBASE, Web of Science, Cochrane Library, and Korean and Chinese databases. Search terms used were "vitamin D", "atopic dermatitis", "randomized", "controlled trial", and "clinical trial". Random effects models were used to calculate the mean difference, with 95% confidence intervals to analyze the effects of vitamin D supplementation for severity of AD. RESULTS:  Initial searches yielded 266 citations. Of these original results, nine met specific selection criteria. Four of the randomized controlled trials compared the efficacy of vitamin D with a placebo on severity of AD and were included in the meta-analysis. The vitamin D supplementation interventions showed a higher mean difference in severity of AD symptoms (mean difference = -5.81, 95% CI: -9.03 to -2.59, P = 0.0004, I(2) = 50%). CONCLUSIONS:  Vitamin D has a potentially significant role for improving the symptoms of AD. The results from this study suggest that vitamin D supplementation may help ameliorate the severity of AD, and can be considered as a safe and tolerable therapy. However, larger-scale studies over a longer duration of treatment are needed to confirm this conclusion.

Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children.
            (Peroni et al., 2011) Download
BACKGROUND:  Vitamin D deficiency could be associated with the prevalence of atopic dermatitis (AD). OBJECTIVES:  We carried out a study to see whether deficient/insufficient levels of vitamin D correlate with the severity of atopic skin disease. METHODS:  Using the SCORAD index, we evaluated the severity of disease in 37 children (17 girls and 20 boys) aged between 8 months and 12 years with AD, consecutively enrolled in the study. Serum levels of 25-hydroxyvitamin D [25(OH)D] were determined by a chemiluminescent method. Specific IgE (sIgE) to Staphylococcus aureus enterotoxins and sIgE to Malassezia furfur were assayed by the ImmunoCAP system. anova and the Pearson correlation test were used for statistical evaluation. RESULTS:  We found severe, moderate and mild AD in nine (24%), 13 (35%) and 15 (41%) children, respectively. Mean ± SD serum levels of 25(OH)D were significantly higher (P < 0·05) in patients with mild disease (36·9 ± 15·7 ng mL(-1)) compared with those with moderate (27·5 ± 8·3 ng mL(-1)) or severe AD (20·5 ± 5·9 ng mL(-1)). The prevalence of patients with sIgE to microbial antigens increased in relation to vitamin D deficiency and AD severity. CONCLUSIONS:  These data suggest that vitamin D deficiency may be related to the severity of AD and advocate the need for studies evaluating the use of vitamin D as a potential treatment in patients with this disease.

Serum Vitamin D Levels Not Associated with Atopic Dermatitis Severity.
            (Robl et al., 2016) Download
BACKGOUND/OBJECTIVES:  The objective of the current study was to determine the relationship between serum vitamin D levels and the severity of atopic dermatitis (AD) in a Brazilian population. METHODS:  This was a cross-sectional study of patients younger than 14 years of age seen from April to November 2013. All patients fulfilled the Hanifin and Rajka Diagnostic Criteria for AD diagnosis. Disease severity was determined using the SCORing Atopic Dermatitis index and classified as mild (<25), moderate (25-50), or severe (>50). Serum vitamin D levels were classified as sufficient (≥30 ng/mL), insufficient (29-21 ng/mL), or deficient (≤20 ng/mL). RESULTS:  A total of 105 patients met the inclusion criteria. Mild AD was diagnosed in 58 (55.2%) children, moderate in 24 (22.8%), and severe in 23 (21.9%). Vitamin D deficiency was observed in 45 individuals (42.9%). Of these, 24 (53.3%) had mild AD, 13 (28.9%) moderate, and 8 (17.7%) severe. Insufficient vitamin D levels were found in 45 (42.9%) individuals; 24 (53.3%) had mild AD, 9 (20.0%) moderate, and 12 (26.7%) severe. Of the 15 individuals (14.2%) with sufficient vitamin D levels, 10 (60.7%) had mild AD, 2 (13.3%) moderate, and 3 (20.0%) severe. The mean vitamin D level was 22.1 ± 7.3 ng/mL in individuals with mild AD, 20.8 ± 6.5 ng/mL in those with moderate AD, and 21.9 ± 9.3 ng/mL in those with severe AD. Variables such as sex, age, skin phototype, season of the year, and bacterial infection were not significantly associated with vitamin D levels. CONCLUSION:  Levels of 25-hydroxyvitamin D were deficient or insufficient in 85% of the children, but serum vitamin D concentrations were not significantly related to AD severity.

Randomized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston: a pilot study.
            (Sidbury et al., 2008) Download
Twenty children were screened, of which nine were excluded (Fig. 1). Thus, we enrolled 11 subjects, with a median age of 7 years (range 2–13); they were 55% male and 73% nonwhite. Ten of the 11 subjects had mild AD, with Eczema Area and Severity Index (EASI) scores ranging from 10 to 18.6. The hospital pharmacy randomly assigned subjects to take ergocalciferol 1000 IU or an identical-looking placebo once daily for 1 month. Vitamin D appeared to help some children. IGA score improved by 1 Investigator’s Global Assessment (IGA) category in four (80%) of five subjects on vitamin D vs. one (17%) of six on placebo. The difference in change of mean scores between the two groups was not statistically significant. Mean change for vitamin D = - 4.6 vs. -2.2 for placebo. he child with the highest baseline EASI score (18.6) was on placebo and experienced the largest change in EASI score (–9.9).

The Effects of Oral Vitamin D Supplement on Atopic Dermatitis: A Clinical Trial with Staphylococcus aureus Colonization Determination. Download
            (Udompataikul et al., 2015)
BACKGROUND:  An increase in Staphylococcus aureus skin colonization in atopic dermatitis patients resulted from the reduction of cathelicidin production in these patients. Recently, an in vivo study demonstrated that vitamin D could stimulate cathelicidin production. Oral supplements of vitamin D might be beneficial in atopic dermatitis. OBJECTIVE:  To determine the effects of oral vitamin D supplements on clinical impact including Staphylococcus aureus skin colonization evaluation in atopic dermatitis patients. MATERIAL AND METHOD:  Twenty-four atopic dermatitis patients were included in this double-blind, placebo-controlled study. They were randomly assigned into 2 groups for oral 2,000 IUs/day of vitamin D, supplement and placebo. The lesional swab culture for S. aureus was done at week 0, 2 and 4. Clinical outcomes were assessed by SCORAD score, mexameter for erythema index and konometer for conductance were done at week 0, 2 and 4. Serum vitamin D levels were also determined at week 0 and 4. RESULTS:  Twenty patients completed the protocol. S. aureus skin colonization, SCORAD score and erythema index were significantly reduced from baseline to week 4for vitamin D treated group comparing with placebo (p = 0.022, 0.028 and 0.014, respectively). There was an inverse correlation between serum vitamin D levels with S. aureus skin colonization and SCORAD score (r = -1.0, p < 0.001). CONCLUSION:  Oral vitamin D supplement could reduce skin colonization of S. aureus and demonstrated the clinical improvement of patients with atopic dermatitis.

 


References

Amestejani, M, et al. (2012), ‘Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study.’, J Drugs Dermatol, 11 (3), 327-30. PubMed: 22395583
Camargo, CA, et al. (2014), ‘Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children.’, J Allergy Clin Immunol, 134 (4), 831-835.e1. PubMed: 25282565
Di Filippo, P, et al. (2015), ‘Vitamin D supplementation modulates the immune system and improves atopic dermatitis in children.’, Int Arch Allergy Immunol, 166 (2), 91-96. PubMed: 25791938
Han, TY, et al. (2015), ‘Vitamin D Status and Its Association with the SCORAD Score and Serum LL-37 Level in Korean Adults and Children with Atopic Dermatitis.’, Ann Dermatol, 27 (1), 10-14. PubMed: 25673925
Javanbakht, M, et al. (2010), ‘The effects of vitamins e and d supplementation on erythrocyte superoxide dismutase and catalase in atopic dermatitis.’, Iran J Public Health, 39 (1), 57-63. PubMed: 23112990
Javanbakht, MH, et al. (2011), ‘Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis.’, J Dermatolog Treat, 22 (3), 144-50. PubMed: 20653487
Kim, G and JH Bae (2016), ‘Vitamin D and atopic dermatitis: A systematic review and meta-analysis.’, Nutrition, 32 (9), 913-20. PubMed: 27061361
Peroni, DG, et al. (2011), ‘Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children.’, Br J Dermatol, 164 (5), 1078-82. PubMed: 21087229
Robl, R, et al. (2016), ‘Serum Vitamin D Levels Not Associated with Atopic Dermatitis Severity.’, Pediatr Dermatol, 33 (3), 283-88. PubMed: 26862046
Sidbury, R, et al. (2008), ‘Randomized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston: a pilot study.’, Br J Dermatol, 159 (1), 245-47. PubMed: 18489598
Udompataikul, M, et al. (2015), ‘The Effects of Oral Vitamin D Supplement on Atopic Dermatitis: A Clinical Trial with Staphylococcus aureus Colonization Determination.’, J Med Assoc Thai, 98 Suppl 9 S23-30. PubMed: 26817206