PURPOSE OF THE STUDY.
Previous studies have identified an association between atopic dermatitis (AD) and vitamin D deficiency. The authors observed the changes in clinical symptoms as well as the Th1/Th2 balance after vitamin D oral supplementation in children with AD.
Thirty-nine children (aged 4 ± 3.15 years) were recruited from an Italian pediatric allergy clinic. They all had a clinical diagnosis of AD, Tanner Stage I of development, no recent history of vitamin D supplementation, and no recent calcineurin inhibitor or systemic antiinflammatory therapy.
This was a single-center, prospective, longitudinal study in which study patients, including 20 healthy controls matched for age and gender, were all enrolled during the winter (November–February) season. The AD group was evaluated at time of recruitment and then after 3 months of daily vitamin D supplementation (1000 IU/day or 25 mg/day). Vitamin D serum levels, AD severity assessed through the SCORAD (Scoring Atopic Dermatitis) index, and cytokine serum concentrations were all assessed. Subjects were encouraged to avoid topical steroids during the study period.
The AD patients all had chronic eczema, with 3 (7.7%) having mild AD, 18 (46.1%) with moderate AD, and 18 (46.1%) with severe AD. Baseline evaluation indicated the children with AD had higher cytokine levels, except for tumor necrosis factor-α, compared with the healthy controls. After 3 months of oral vitamin D supplementation, the AD group’s serum vitamin D levels were significantly higher compared with starting levels (29.41 ± 10.73 vs 22.97 ± 8.03 ng/mL, P = .01). There was a reduction in SCORAD index (46.13±15.68 vs 22.57±15.28, P < .001). There was also a statistically significant reduction of interleukin-2, interleukin-6, and interferon-γ, but not for tumor necrosis factor-α. There was a significant negative correlation between the vitamin D change and the SCORAD change (r = –0.49; P = .02).
Vitamin D supplementation effectively reduces the severity of pediatric AD through apparent normalization of the Th1 and Th2 cytokine serum patterns.
Vitamin D deficiency has been associated with active atopic conditions including asthma, allergic sensitization, and AD. It appears to have immunomodulatory effects on both the innate and adaptive immune systems. With AD being a chronic inflammatory condition, it is no surprise that many affected individuals have below-normal vitamin D serum levels. Although this prospective study had a small sample size, children with mild to severe atopic dermatitis all showed improvement in clinical symptoms. Normalizing serum vitamin D levels through daily supplementation may be an affordable nonsteroidal addition to controlling this challenging and often agonizing condition.
- Copyright © 2015 by the American Academy of Pediatrics