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Abstract
Atopic dermatitis (AD) is one of the most common inflammatory skin diseases, with a prevalence of up to 15%-20% in children and 2%-10% in adults. Patients with AD have genetically determined risk factors that affect the barrier function of the skin and immune responses that interact with environmental factors. Recently, there has been increasing awareness of the importance of vitamin D, a potential factor, in the development and progression of atopic diseases including AD. Furthermore, some reports suggested that vitamin D deficiency impairs epithelial integrity, leading to increased and inappropriate mucosal exposure to antigens promoting sensitization. Even though numerous studies favor strong associations of vitamin D deficiency during pregnancy and infancy with allergies, high vitamin D intake might be harmful according to conflicting results of other trials. The growing body of the literature indicates an inverse relationship between the severity of AD and vitamin D levels. Animal studies, case reports, randomized clinical trials, and birth cohort studies have suggested that vitamin D may alleviate the symptoms of AD through immune-modulation of the innate and adaptive immune system. Moreover, some studies have shown that in individuals with AD with low vitamin D level, repletion of vitamin D results in decreased severity of diseases. However, all these results have prompted the question of which time, dose, duration, or mode of application of vitamin D might be appropriate in children with AD. Further large cohort studies and clinical trials are warranted to assess the role of vitamin D in the prevention and treatment of AD in children.
Figures and Tables
Table 1
Summary of relevant observational studies
| Source | Study type | Sample size | Vitamin D measurement | Result |
|---|---|---|---|---|
| Oren et al. (2008)7) | Case-control | 100 Vitamin D-deficient obese adults and 190 vitamin D-replete obese adults | Serum levels | Deficient patients were five times as likely to report AD as replete patients (P = 0.05). |
| Peroni et al. (2011)8) | Cross-sectional | 37 Children with AD: 13 mild, 13 moderate, 9 severe | Serum levels | Vitamin D levels were significantly higher in patients with mild disease than severe disease (P < 0.05). |
| Lee et al. (2013)9) | Cross-sectional | 157 Patients with AD | Serum levels | Not significant correlation between vitamin D levels and SCORAD |
| In 36 patients with food sensitization, vitamin D levels were significantly higher in patients with mild disease than moderate or severe disease (P < 0.05). | ||||
| Chiu et al. (2013)10) | Cross-sectional | 94 Children with AD | Serum levels | Not significant correlation between vitamin D levels and SCORAD |
| Lower serum vitamin D level was significantly associated with age 3 yr or older (P < 0.0001), black race (P < 0.0001), and winter season (P = 0.0084). | ||||
| Baek et al. (2014)11) | Cross-sectional | 226 Infants with AD or food allergy | Serum levels | The SCORAD index was independently related to vitamin D levels after adjusting for the level of sensitization (P = 0.031). |
| Gale et al. (2008)12) | Birth cohort | 440 Infants | Serum levels of mothers in late pregnancy | Children whose mothers had vitamin D level in regnancy > 75 nmol/L had an increased risk of AD at 9 months (OR, 3.26; P = 0.025). |
| Baiz et al. (2014)13) | Birth cohort | 239 Newborns | Cord serum levels | Cord serum vitamin D levels were inversely associated with the risk of transient early wheezing and AD by the age of 5 yr. |
Table 2
Summary of relevant clinical trials
| Author | Study type | Sample size | Intervention | Duration | Vitamin D measurement | Result |
|---|---|---|---|---|---|---|
| Sidbury et al. (2008)14) | DB RCT | 11 Children with winter-related AD | 1,000 IU vitamin D/day | 1 Month | Serum levels | Four of five children treated with vitamin D had improved IGA scores, compared with one of six receiving placebo (P = 0.04). |
| Hata et al. (2008)15) | Controlled clinical trial | 14 Healthy controls and 14 patients with AD | 4,000 IU vitamin D/day | 21 Days | Not applicable | Significant increase in cathelicidin expression in AD lesional skin after treatment (P < 0.01). |
| Buchau et al. (2009)16) | Controlled clinical trial | 14 Individuals with AD: 7 untreated, 7 treated | 4,000 IU vitamin D/day | 21 Days | Not applicable | Increase in AMPs observed after treatment with vitamin D downregulated B-cell lymphoma-3 expression in lesional skin (P = 0.08). |
| Javanbakht et al. (2011)17) | DB RCT | 45 Patients with AD | 1,600 IU vitamin D/day | 60 Days | Serum levels | Significant increase in vitamin D level (P < 0.001); significant decrease in severity from baseline (P = 0.01). |
| Amestejani et al. (2012)18) | DB RCT | 60 Patients with AD | 1,600 IU vitamin D/day | 60 Days | Serum levels | Significant improvement in SCORAD and three Item severity score in mild, moderate, and severe AD (P < 0.05). |
| Hata et al. (2014)19) | DB RCT | 30 Patients with AD, 16 patients with psoriasis, and 30 non-atopic subjects | 4,000 IU vitamin D/day | 21 Days | Serum levels | No significant change in skin cathelicidin, HBD-3, IL-13 or EASI scores. |
| Camargo et al. (2014)20) | DB RCT | 107 Children with winter-related AD | 1,000 IU vitamin D/day | 1 Month | Not applicable | Significant improvement in EASI score (P = 0.04) |
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