Vitamin D Supplementation Modulates the Immune System and Improves Atopic Dermatitis in Children

Abstract

Background: Vitamin D seems to influence the evolution of atopic dermatitis (AD) in children. Methods: We tested the vitamin D serum levels of 39 children with AD (AD group t₀) and of 20 nonallergic healthy controls (C group). AD severity was evaluated using the AD scoring system (SCORAD index). Cytokine serum levels (IL-2, IL-4, IL-6, IFN-γ, TNF-α) and atopy biomarkers were also measured. The patients were then treated with vitamin D oral supplementation of 1,000 IU/day (25 mg/day) for 3 months. We then reevaluated the vitamin D serum levels, AD severity and cytokine serum levels in all of the treated children (AD group t₁). Results: The cross-sectional analysis on patients affected by AD (AD group t₀) showed that the initial levels of all the tested cytokines except for TNF-α were higher than those of the healthy control group (C group), falling outside the normal range. After 3 months of supplementation the patients had significantly increased vitamin D levels (from 22.97 ± 8.03 to 29.41 ± 10.73 ng/ml; p = 0.01). A concomitant significant reduction of both the SCORAD index (46.13 ± 15.68 at the first visit vs. 22.57 ± 15.28 at the second visit; p < 0.001) and of all the altered cytokines (IL-2, IL-4, IL-6, IFN-γ) was also found. Conclusions: This study showed vitamin D supplementation to be an effective treatment in reducing AD severity in children through normalization of the Th1 and Th2 interleukin serum pattern.

Estimation of Calcidiol Level in Serum of Atopic Dermatitis Patients before and after NB-UVB Phototherapy in Comparison to Oral Vitamin D Therapy

“…Two studies [29,30] enrolled pediatric patients who had a history of AD, and both studies showed that eczema area and severity index (EASI) was decreased after calcidiol supplementation. Similar findings were shown by the others [9,22,27,28] but with using the SCORAD.…”

“…The consistency of such a finding in a large number of studies [5][6][7][17][18][19][20][21][22], confirms that the low level of calcidiol in such a disease is not a coincidence, and that calcidiol deficiency has a possible role in the pathogenesis of AD. The controversy in the serum level of calcidiol in AD patients is mainly viewed among adult AD patients, where several studies showed the non-significant alteration of calcidiol levels among patient and control groups [8,9].…”

“…This could be of particular value as it overcomes the compliance problem that is commonly faced while using phototherapy [24], and has a higher safety profile when the side effects of phototherapy [25], or even topical steroids [26] are considered. The use of oral calcidiol in the management of AD has been proven before to be successful [9,22,[27][28][29][30]. Two studies [29,30] enrolled pediatric patients who had a history of AD, and both studies showed that eczema area and severity index (EASI) was decreased after calcidiol supplementation.…”

Vitamin D and the Pathophysiology of Inflammatory Skin Diseases

“…Many clinical trials including their meta-analysis have shown that vitamin D supplementation results in significant improvement in AD severity (measured by SCORAD and Eczema Area and Severity Index) [121,135,136,137,138]. Di Filippo et al [138] suggested that vitamin D supplementation exerts its positive effect on AD by normalizing the altered Th1 and Th2 cytokines like IL-2, IL-4, IL-6, and IFN-γ in AD patients. In another study, Drozdenko et al [139] showed that the oral intake of vitamin D increases the frequencies of CD38+ B cells to enhance the B-cell receptor-mediated response and decreases the IFN-γ and IL-17 T-cell cytokine response in vitamin D-deficient individuals.…”

Targeting the T Helper 2 Inflammatory Axis in Atopic Dermatitis

“…Current treatment recommendations include the liberal use of emollients, wet-wrap therapy, vitamin D supplementation, topical calcineurin inhibitors, and topical corticosteroids (TCS) [1,33,34] . When moisturizers alone are not sufficient to control the itch and inflammation, TCS are the mainstay of treatment for AD.…”