A recent randomized trial has found that vitamin D supplementation in children eased the symptoms of severe atopic dermatitis, or eczema.

Eczema is a chronic relapsing inflammatory skin disease characterized by intermittent flares and potentially debilitating effects on the patient’s quality of life. According to the study authors, it is the most common skin disorder in children, affecting approximately 15% to 20% of children worldwide. Conventional treatments currently include immune modulatory agents, such as topical or oral steroids and topical calcineurin inhibitors.

The 86 patients included were between 5 and 16 years old with a diagnosis of severe atopic dermatitis. They were allocated to receive either vitamin D3 daily or a placebo, plus baseline therapy of topical 1% hydrocortisone cream twice daily for 3 months. The upper tolerable limit of vitamin D3 is 3000 international units per day (IU/d) for children aged 4 to 8 years and 4000 IU/d in adolescents and adults.

According to the serum analysis of 25-hydroxyvitamin D [serum 25(OH) D], the group receiving vitamin D supplementation saw significant improvements compared to baseline, with 93% reaching sufficiency level. The maximum serum 25(OH) D reached in this group was 50 ng/mL, a level at which toxicity has not been observed.

In the placebo group, the levels of 25(OH) D was comparable to baseline levels at the end of the study. At week 12, approximately 74% of the group remained under levels of sufficiency and significantly higher levels were recorded among the supplemented group compared with the placebo group.

At the end of the study, children who supplemented with vitamin D had a significantly greater mean percentage change from baseline in the Eczema Area and Severity Index (56.44% and 42.09%, respectively). Notably, 38.6% of the supplemented patients achieved an index score of 75, compared with only 7.1% of patients in the placebo group.

The authors did find that some of the supplemented patients may have had factors that limited absorption efficacy of oral supplementation, which can include variations in the amount and type of fatty acids, dietary fibers, and the interaction with other fat-soluble micronutrients. The authors added that the study population was comprised of patients with limited ethnic diversity, potentially restricting its generalizability.

The study authors concluded that oral daily vitamin D supplementation might provide clinical improvements in children with severe atopic dermatitis, although further research is needed to reveal factors associated with superior clinical outcomes in some supplemented patients. Other studies could investigate whether the positive impact of supplementation would be maintained in pediatric patients with winter-related severe eczema.

REFERENCE
Mansour N, Mohamed A, Hussein M, Eldemiry E, 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. Pharmacology Research & Perspectives; November 3, 2020. https://bpspubs.onlinelibrary.wiley.com/doi/10.1002/prp2.679. Accessed November 6, 2020.