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.

Hattangdi-Haridas Hattangdi-Haridas,Lanham-New Lanham-New,Darling Darling,Wong Wong,Ho Ho

doi:10.3390/nu11081854

Hattangdi-Haridas Hattangdi-Haridas, Lanham-New Lanham-New + Show 3 more

Open Access

https://doi.org/10.3390/nu11081854

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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.

Highlights

Atopic Dermatitis (AD) is a chronic recurrent inflammatory disease of the skin characterised by pruritus and inflamed lesions, involving specific areas of the body and causing generalised xerotic skin.As the disease progresses from acute to subacute, to chronic stages, excoriation from scratching and a propensity to secondary infections leads to oozing lesions and further pruritus
Eighty-five percent of AD is seen in children, of which 30% continue to suffer in their adult years [3]
Our results suggest that the AD paediatric population may be an “at-risk group” for vitamin D (VitD) insufficiency

Summary

Introduction

Atopic Dermatitis (AD) is a chronic recurrent inflammatory disease of the skin characterised by pruritus and inflamed lesions, involving specific areas of the body and causing generalised xerotic skin. As the disease progresses from acute to subacute, to chronic stages, excoriation from scratching and a propensity to secondary infections leads to oozing lesions and further pruritus. Severity of pruritis is associated with quality of life. Scores on the PO-SCORAD (patient oriented SCORAD) questionnaire, which includes a visual analogue scale for pruritis severity, are associated with measures of quality of life [1,2]. Eighty-five percent of AD is seen in children, of which 30% continue to suffer in their adult years [3]. There are an estimated 15 million suffers in the United Kingdom (UK) [4] and in the United

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