Effect of Vitamin D Supplementation on Changes in the Severity of

the Clinical Symptoms of Atopic Dermatitis

Nanda Earlia, Mimi Maulida, Vella, Rovy Pratama

Dermatology and Venerology Department Faculty of Medicine, Syiah Kuala University, General Hospital dr. Zainoel

Abidin, Banda Aceh, Indonesia.

Keywords: atopic dermatitis, vitamin D, SCORAD.

Abstract: Background: Vitamin D is a fat-soluble vitamin primarily produced by the skin, and it plays a role in innate

and adaptive immune system regulation mechanisms. Vitamin D is also associated with the production of

antimicrobial peptide by keratinocytes, which are potentially used for the management of atopic dermatitis,

psoriasis, vitiligo, acne and rosacea. Objective: To evaluate the effect of vitamin D supplementation on

changes in the severity of atopic dermatitis. Methods: This study is a double-blind clinical trial study with a

parallel design. A total of 56 subjects were divided into two groups: a group that received vitamin D

supplementation of 600 IU daily for 28 days (treatment group) and a group that did not receive vitamin D

supplementation (control group). Both groups received standard therapy in the form of antihistamines, topical

corticosteroids and moisturisers. The degree of severity of the clinical symptoms of atopic dermatitis was

measured using Scoring Atopic Dermatitis index. Data analysis was conducted by using a general test linear

model with a 95% confidence level. Results: The mean age of the treatment and the control group was9.5 ±

4.3 years and 7.4 ± 5.1 years, respectively. In the admissions group, the mean of 31.9 ± 9.8 improved to 12.8

± 6.2 after 28 days of study. Similar to the treatment group, the average of the control group changed from

28.8 ± 15.1 to 13.9 ± 7.8. The result of the data analysis showed no significant difference in the degree of

clinical symptom between the treatment group and the control group because the p value was equal to 0.165.

Conclusion: Vitamin D supplementation of 600 IU in children for 28 days was not effective in reducing the

severity of atopic dermatitis.

1 INTRODUCTION

Atopic dermatitis or atopic eczema is a chronic skin

disease based on hereditary and environmental

factors, and it is common in infants and children.

Atopic dermatitis is a chronic inflammatory disease

of the skin that occurs in 15%–25% of children and

3% of adults. Approximately 85% of patients with

atopic dermatitis appear in childhood, and 70% of

patients with severe atopic dermatitis develop into

having rhinitis or asthma (Kim, 2012).The prevalence

of dermatitis in children is 18.1% in three to five

years. (Peroni, 2008)

In the last decade, vitamin D deficiency in

developing countries was 30%–80% in the entire

population worldwide, and prevalence was high in

children aged 0–16 years. Children with asthma,

atopic dermatitis, allergic rhinitis, acute urticaria and

food allergies tended to be found with vitamin D

deficiency. (Holick, 2008)

As children now receive very little sun exposure,

many children suffer from vitamin D deficiency.

Research in Jakarta found that 75.9% of children had

vitamin D insufficiency and that only 15% of children

had vitamin D deficiency. Several studies were

conducted on children receiving vitamin D against

atopic dermatitis. Research in Egypt in 2011 reported

a relationship of vitamin D deficiency with the

severity of atopic dermatitis. (Hartmann, 2011). Hata

et al. explained that the provision of a vitamin D diet

could improve the function of innate immunity of

skin affected by atopic dermatitis and provedin vitro

that vitamin D could stimulate the formation of

antimicrobial peptide (AMP) and decrease the

expression of Th2 cytokines in the body. (Hartmann,

2011). (Hata, 2014)Thus, this study aimed to evaluate

the effect of vitamin D supplementation on the

severity of atopic dermatitis in children.

Earlia, N., Maulida, M., Vella, . and Pratama, R.

Effect of Vitamin D Supplementation on Changes in the Severity of the Clinical Symptoms of Atopic Dermatitis.

DOI: 10.5220/0008154302190222

In Proceedings of the 23rd Regional Conference of Dermatology (RCD 2018), pages 219-222

ISBN: 978-989-758-494-7

 2021 by SCITEPRESS – Science and Technology Publications, Lda. All rights reser ved

219

2 METHODS

This work is a double-blind clinical trial study with a

parallel design. The subjects were composed of 56

individuals with atopic dermatitis who passed the

inclusion criteria. The inclusion criteria for this study

were subjects aged 1–17 years and those who did not

use topical corticosteroids, oral or topical antibiotics,

oral antivirals and topical calcineurin inhibitors at

least oneweek before the study. The diagnosis of

atopic dermatitis is made based on anamnesis and

physical examination of the patient. Patients who

have a history of kidney disease, kidney stones,

hyperparathyroidism, sarcoidosis, tuberculosis and

lymphoma and those who received systemic

immunosuppressive therapy, chemotherapy, light

therapy andoral calcineurin inhibitor for 30 days prior

to the visit to the polyclinic were excluded as research

subjects.

Subsequently, the subjects were divided into two

groups: the first group comprised 25 patients who

received vitamin D supplementation (treatment

group), and the second group was composed of 31

patients whodid not receive vitamin D

supplementation (control group). Each group

received standard therapy for atopic dermatitis in the

form of antihistamines, topical corticosteroids and

daily moisturisers. The treatment groupreceived

vitamin D supplementation of 600 IU (15 mcg),

which is the recommended dietary allowance,

consumed once per day for 28 days.

The degree of severity of the clinical symptoms of

atopic dermatitis was measured using the Atopic

Scoring Dermatitis (SCORAD) index. The SCORAD

scoring results have a score range of 1–100 with the

following interpretation: mild <25, moderate 25–50

and severe >50. SCORAD assessment was performed

twice on each subject: the initial diagnosis and after

28 days of the study. After the research data were

collected, data analysis was conducted using a

general test linear model with a 95% confidence level.

3 RESULTS

A total of 56 subjects who passed the inclusion and

exclusion criteria participated in the study. The

treatment group consisted of 11 males and 14

females, and its mean age was 9.5 ± 4.3 years. The

control group comprised 16 males and 15 females,

and its average age was 7.4 ± 5.1 years. The data

characteristics of the research subjects are presented

in Table 1.

Table 1. Data and characteristics of the subjects

Variable

Treatment Group (%)

(n = 25)

Control Group (%)

(n = 31)

P value

Age 0,071*

Mean ± SD 9.5 ± 4.3 7.4 ± 5.1

Range 2–16 1–18

Sex -

Male 11 (44) 16 (51.6)

Female 14 (56) 15 (48.4)

SCORAD 0 day 0.364**

Mean ± SD

31.9 ± 9.8 28.8 ± 15.1

Range

17–49.9 10.2–62.4

Mild 8 (32) 16 (51.6)

Moderate 17 (68) 14 (45.2)

Severe - 1 (3.2)

SCORAD 28 days 0.549**

Mean ± SD

12.8 ± 6.2 13.9 ± 7.8

Range

3.3–28.6 1.7–32.5

Mild 23 (92) 29 (93.5)

Moderate 2 (8) 2 (6.5)

Severe - -

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The severity of atopic dermatitis symptoms was

measured twice using SCORAD, and it was measured

at baseline (0 day) and at the end of the study (28

days). In the treatment group, the mean of 31.9 ± 9.8

improved to 12.8 ± 6.2 after 28 days of study. Similar

to the treatment group, the average of thecontrol

group changed from 28.8 ± 15.1 to 13.9 ± 7.8. The

obtained p value was 0.165 according to the data

analysis that used a general linear test model with a

95% confidence level (Table 2). The results showed

no significant difference in the degree of clinical

symptoms between the treatment group and the

control group because the p value was> 0.05.

Table 2. Results of the general linier model test between the treatment group and the control group.

SCORAD

Vitamin D (+)

mean ± SD

(n = 25)

Vitamin D (-)

mean ± SD

(n = 31)

P value

0 day 31.9 ± 9.8 28.8 ± 15.1 0.165

28 days 12.8 ± 6.2 13.9 ± 7.8

4 DISCUSSION

Vitamin D is a fat-soluble vitamin primarily produced

by the skin. When ultraviolet B exposure occurs, 7-

dehydrocholesterol is converted into vitamin D3

(cholecalciferol). Vitamin D can also be found in

foods and supplements, such as vitamin D2

(ergocalciferol) and vitamin D3. The skin cannot

produce vitamin D2. (Russell, 2012)

Vitamin D increases the absorption of calcium in

the intestine and is associated with bone metabolism.

The deficiency of this vitamin in children causes

rickets.Vitamin D is also important in innate and

adaptive immune system regulation. (Russell, 2012)

(Reinholz, 1946)Current research data prove that

vitamin D plays a role in more than 200 different gene

expressions in the body. (Mesquita, 2013).

Research in the 21st century has proved that

adequate vitamin D levels are associated with reduced

risk of various cancers, type 1 diabetes, metabolic

syndrome, cardiovascular disease, peripheral arterial

disease, hypertension, chronic kidney disease, stroke,

bacterial infections, rheumatoid arthritis, Crohn's

disease, periodontal disease, multiple sclerosis,

asthma, atopic dermatitis, muscle weakness,

cognitive impairment, Alzheimer's disease,

depression and premature death.

Various factors are

involved in the occurrence of atopic dermatitis. Thus,

the current study focused on the role of vitamin D

supplementation in patients with atopic dermatitis. In

addition to its role in calcium homeostasis, vitamin D

in various studies has been demonstrated to act as an

immunomodulator and in cellular differentiation.

Vitamin D is also associated with the production of

antimicrobial peptides or AMP by keratinocytes.

Vitamin D and its analogues play a role in the

management of atopic dermatitis, vitiligo, psoriasis,

acne and rosacea. (Peroni, 2011) (Mutgi, 2013;

Miller, 2011)

In 2011, Peroni etal. proved that serum 25 (OH) D

levels of children with mild atopic dermatitis were

higher than those of children with moderate or severe

atopic dermatitis (p <0.05). This finding proves that

vitamin D deficiency correlates with the severity of

atopic dermatitis.

Similarly, nutritional surveys

conducted on atopic dermatitis (n = 132) and healthy

individuals (n = 132) showed that the group of atopic

dermatitis patients had lower vitamin D levels than

the healthy group despite the fact that the vitamin D

serum levels were not measured. (Solvoll, 2000)

Biologically, evidence supports the link between

serum vitamin D levels and the prevalence of atopic

dermatitis, especially in the severity of the disease.

Vitamin D is involved in the mechanisms of innate

and acquired immune system regulation. Vitamin D

receptors are present in various cells, including

keratinocytes and a number of cells in the immune

system. (Peroni, 2011; Amestejani,2014)

A double-blind, placebo-controlled clinical trial

was conducted on 30 patients with atopic dermatitis

given 1,600 IU/day of vitamin D and 30 others

receiving placebo. After 60 days, the group receiving

vitamin D therapy showed significant improvement

regardless of severity (p <0.05). In the placebo group,

no significant improvement was observed (p> 0.05).

The levels of serum 25 (OH) D in the group that was

given vitamin D increased significantly compared

with the baseline levels (p = 0.001). The study

concluded that vitamin D supplementation could cure

atopic dermatitis. (Amestejani, 2014)

Other studies evaluated the effect of vitamins D

and E supplementation on clinical manifestations of

Effect of Vitamin D Supplementation on Changes in the Severity of the Clinical Symptoms of Atopic Dermatitis

221

atopic dermatitis. A total of 45 subjects were involved

in this double-blind clinical trial with placebo

control,and they were evaluated using SCORAD.

Clinical symptoms decreased significantly after 60

days of vitamin D or E or both (p = 0.004).

(Javanbakht, 2015)

Although many studies have proved the

effectiveness of vitamin D supplementation in

symptom improvement and in the severity of atopic

dermatitis, the use of vitamin D in clinical

applications remains controversial. Agnieska failed to

prove the benefits of vitamin D in reducing the

severity of atopic dermatitis because of the absence

of significant immunologic index differences, such as

the phenotypes CD3, CD4, CD8, CD19, CD4/CD8

and CD16/56; natural killer T cells, anti-CD3 human

leukocyte antigen, lymphocyte percentage;

eosinophils and IgE levels.

Similarly, the current

study proved that vitamin D supplementation for 28

days in the treatment group was no more effective

than that in the control group in reducing the severity

of atopic dermatitis in children (p = 0.165). The

researchers assumed that this finding was due to the

minimal dose and the relatively short

supplementation time.

5 CONCLUSIONS

According to the evaluation of the two study groups,

the vitamin D supplementation of 600 IU for 28 days

in the treatment group was no more effective than that

in the control group in reducing the severity of

clinical symptoms of atopic dermatitis in children.

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