Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children

Abstract

Research has investigated 25-hydroxyvitamin D (25(OH)D) levels in the Atopic Dermatitis (AD) population, as well as changes in AD severity after vitamin D (VitD) supplementation. We performed an up-to-date systematic review and meta-analysis of these findings. Electronic searches of MEDLINE, EMBASE and COCHRANE up to February 2018 were performed. Observational studies comparing 25(OH)D between AD patients and controls, as well as trials documenting baseline serum 25(OH)D levels and clinical severity by either SCORAD/EASI scores, were included. Of the 1085 articles retrieved, sixteen were included. A meta-analysis of eleven studies of AD patients vs. healthy controls (HC) found a mean difference of −14 nmol/L (95% CI −25 to −2) for all studies and −16 nmol/L (95% CI −31 to −1) for the paediatric studies alone. A meta-analysis of three VitD supplementation trials found lower SCORAD by −11 points (95% CI −13 to −9, p < 0.00001). This surpasses the Minimal Clinical Important Difference for AD of 9.0 points (by 22%). There were greater improvements in trials lasting three months and the mean weighted dose of all trials was 1500–1600 IU/daily. Overall, the AD population, especially the paediatric subset, may be at high-risk for lower serum 25(OH)D. Supplementation with around 1600 IU/daily results in a clinically meaningful AD severity reduction.

The impact of vitamin D supplementation as an adjuvant therapy on clinical outcomes in patients with severe atopic dermatitis: A randomized controlled trial

“…The upper tolerable limit, defined as the highest level of daily vitamin D 3 intake that is safe in the general population, for vitamin D 3 is 3000 IU/d in children ages 4‐8 years, and 4000 IU/d in adolescents and adults 13 . Data from clinical trials indicated that daily supplementation with this dose (1600/d) result in a clinically meaningful AD severity reduction 6 . We assumed that this dose would be safe and effective as well.…”

“…12 Reasons for exclusion were serious skin disorder other than AD, tak- 13 Data from clinical trials indicated that daily supplementation with this dose (1600/d) result in a clinically meaningful AD severity reduction. 6 We assumed that this dose would be safe and effective as well. Treatment assignment was masked from the participants and the investigators.…”

“…Many researches have investigated difference between 25‐dihydroxyvitamin D 25(OH) D levels in AD pediatric patients and matched healthy control. A meta‐analysis of these studies found a mean deference of −16 nmol/L in pediatric AD patients compared to healthy control 6 . There is growing interest in the possible role of vit D deficiency in the development of AD.…”

Vitamin D in Toddlers, Preschool Children, and Adolescents

“…Further randomized, controlled trials and investigation as to whether vitamin D improves β-cell function directly or through its beneficial effect on immune function are warranted. Children with allergic disease, especially asthma and atopic dermatitis, experience decreased exacerbations with vitamin D supplementation [31, 59, 60]. Infectious diseases with high incidence in childhood, such as otitis media, urinary tract infection, pneumonia, influenza, and other acute respiratory infections, all have a number of investigations demonstrating decreased incidence with higher vitamin D status [12].…”

Causal analysis shows evidence of atopic dermatitis leading to an increase in vitamin D levels

“…Treatments currently follow several strategies: restoration of barrier function through topical emollients, reduction of inflammation through immunomodulatory agents, and second-line treatments including phototherapy (Rodenbeck et al 2016). A treatment of ongoing controversy is vitamin D supplementation - the most recent Cochrane review concluded no benefit and warned of toxic effects of high doses (Bath-Hextall et al 2012), but a more recently-performed meta-analysis found a reduction in SCORAD in patients receiving supplementation (Hattangdi-Haridas et al 2019).…”