PURPOSE OF THE STUDY.
The purpose of this study was to determine the effect of vitamin D supplementation on atopic dermatitis (AD) that worsened in the winter.
Mongolian children aged 2 to 17 years old (n = 107; 59% male, median age 9 years, interquartile range 4–14 years) with AD for which there was a history of worsening during the fall to winter transition.
Subjects were randomized to receive oral cholecalciferol (vitamin D3) 1000 IU or placebo daily for 1 month. Both groups received instructions about basic skin care, education about AD, and emollients. Eczema Area and Severity Index (EASI) and Investigator’s Global Assessment (IGA) scores were assessed before and after the intervention.
The median age of AD onset was 3 months. Baseline EASI and IGA scores did not differ between groups and indicated that the majority of the study population had moderate AD. One month of vitamin D supplementation produced a clinically and statistically significant improvement in EASI score compared with placebo (–6.5 ± 8.8 vs –3.3 ± 7.6 in the control group, P = .01). Both groups improved over the course of the study, but the intervention group demonstrated an average 29% decrease, whereas the placebo group had an average 16% decrease (P = .02). Children on vitamin D supplementation also showed more improved IGA scores than those on placebo (56% vs 43% of subjects improved, P = .03). Parental assessment showed the groups starting to diverge at 2 weeks. At 1 month, 64% of parents whose children received vitamin D reported improvement, whereas 43% of those whose children received placebo reported improvement (P = .03).
In patients with moderate winter-related AD, oral supplementation with vitamin D 1000 IU daily led to clinically and statistically significant improvement.
There are some limitations to this study. The authors did not check serum vitamin D levels before and after intervention. Therefore, they could not correlate improvement with baseline vitamin D levels. On the basis of previous work in Ulaanbaatar and other northern latitudes (the latitude of Ulaanbaatar is roughly the same as the US-Canadian border in the Midwest), it is reasonable to assume that many, if not most, subjects had deficient (<20 ng/dL) or insufficient (20–29.9 ng/dL) vitamin D levels. Higher doses of vitamin D and/or longer intervention might have resulted in more improvement in this study. Vitamin D is a hot topic these days with numerous intervention studies in many areas of medicine. People living in northern latitudes are at great risk of vitamin D insufficiency or deficiency. Vitamin D supplementation is inexpensive, and at usual doses, it is virtually risk free. Physicians treating patients with moderate-severe AD should consider checking serum vitamin levels before recommending supplementation or consider supplementing empirically.
- Copyright © 2015 by the American Academy of Pediatrics