Successful Treatment of Severe Atopic Dermatitis with Calcitriol and Paricalcitol in an 8-Year-Old Girl

Abstract

Atopic dermatitis (AD) is a chronic inflammatory disease affecting children and adolescence. The traditional therapeutic options for AD, including emollients topically and immune modulatory agents systemically focusing on reducing skin inflammation and restoring the function of the epidermal barrier, are proven ineffective in many cases. Several studies have linked vitamin D supplementation with either a decreased risk to develop AD or a clinical improvement of the symptoms of AD patients. In this report, we present a girl with severe AD who under adequate supplementation with cholecalciferol was treated with calcitriol and subsequently with paricalcitol. She had significant improvement—almost healing of her skin lesions within 2 months, a result sustained for more than 3 years now. Because of hypercalciuria as a side effect from calcitriol therapy, treatment was continued with paricalcitol, a vitamin D analogue used in secondary hyperparathyroidism in chronic kidney disease. Calcitriol therapy may be considered as a safe and efficacious treatment option for patients with severe AD, particularly for those with refractory AD, under monitoring for possible side effects. Treatment with paricalcitol resolves hypercalciuria, is safe, and should be further investigated as an alternative treatment of atopic dermatitis and possibly other diseases of autoimmune origin.

The treatment of refractory periorbital dermatitis

“…Second-line treatment options include topical corticosteroids (0.1% triamcinolone acetonide, 0.1% betamethasone valerate) with follow-up at 1 and 2 weeks (greater efficacy compared to calcineurin inhibitors for short-term treatment of flares[ 16 ]), and calcitriol 1.5–3 mcg/day—based on few cases. [ 17 , 18 ]…”

Treatment of alopecia totalis/universalis/focalis with vitamin D and analogs: Three case reports and a literature review

“…Using high dose cholecalciferol, calcitriol and paricalcitol, we aimed to exert immunomodulatory effects on T-cells while upregulating the expression of VDR on HF and epidermal keratinocytes. For the safety of the off-label use of calcitriol and paricalcitol we based our approach on the previous experience of our group[ 13 , 14 ] and also on published experience of pediatric patients with chronic kidney disease and hyperparathyroidism[ 18 , 19 ], closely monitoring our patients.…”

Secondary Prevention of Diabetes Type 1 with Oral Calcitriol and Analogs, the PRECAL Study

“…Calcitriol (1,25-Dihydroxyvitamin D), the active metabolite of vitamin D, is literally a hormone and the physiological ligand of the VDR, a nuclear hormone receptor. Apart from its role in maintaining calcium and phosphate homeostasis, in addition to the gut and bone, VDR is present in virtually all tissues, and its natural and synthetic ligands are increasingly recognized for their non-calcemic actions, such as potent antiproliferative, prodifferentiative, and immunomodulatory activities providing a rationale for using VDR ligands for various therapeutic indications, such as rheumatoid arthritis, psoriasis, actinic keratosis, atopic dermatitis [29], autoimmune alopecia [30], osteoporosis, autoimmune diseases (T1D, lupus erythematosus, and multiple sclerosis), as well as several cancers (prostate, colon, breast, leukemia, head, and neck) [31]. Pharmacologic doses of calcitriol have been used to prevent insulitis and T1D in non-obese diabetic (NOD) mice, as well as in other models of T1D, possibly via immune modulation as well as direct effects on β-cell function [32].…”