COEUR D’ALENE, IDAHO – Vitamin D insufficiency or outright deficiency is extremely common among pediatric atopic dermatitis patients, and it correlates with worse skin disease severity.
Unfortunately, vitamin D supplementation in such patients didn’t outperform placebo in improving their atopic dermatitis severity scores in a double-blind, randomized, prospective clinical trial, Dr. Irene Lara-Corrales reported at the annual meeting of the Society for Pediatric Dermatology.
In the first phase of this two-part study, 77 atopic dermatitis patients aged 1-18 years, with a mean age of 7.4 years and free of potentially confounding comorbid medical conditions, had their serum vitamin D level checked. Only 27 patients, or 35%, had a normal level, defined as greater than 72.5 nmol/L, or 30 ng/mL.
Thirty-six patients were categorized as vitamin D insufficient based upon a serum level of 32.5-72.5 nmol/L, or 15-29 ng/mL. The remaining 14 patients were vitamin D deficient, with a serum level below 32.5 nmol/L or 15 ng/mL, according to Dr. Lara-Corrales of the Hospital for Sick Children in Toronto.
Mean baseline atopic dermatitis severity scores using the SCORAD (Scoring Atopic Disease) system were 19.0 in the group with normal serum vitamin D and significantly worse at 28.8 in those who were vitamin D insufficient and 24.6 in patients who were vitamin D deficient.
In phase II of the study, 41 patients from phase I who had low vitamin D levels were randomized and double blinded to either 2,000 IU of vitamin D administered as cholecalciferol drops or to placebo drops for 3 months. The study hypothesis was that SCORAD ratings would improve markedly with vitamin D supplementation, based upon mounting evidence that serum vitamin D plays a key role in skin immune function.
But the hypothesis did not prevail. Although serum vitamin D levels did indeed increase significantly in response to 3 months of daily oral vitamin D supplementation, and recipients showed a hefty mean 15.35-point improvement in SCORAD scores, the placebo-treated controls demonstrated a near-identical mean 15.13-point SCORAD improvement as well.
Dr. Lara-Corrales noted that the study was completed only recently and that substantial collected data have yet to be analyzed. That includes information on sun exposure, nutritional intake, sunscreen use, and exposure to breast milk in early childhood, which may prove useful in interpreting the study results.
The Society for Pediatric Dermatology and the Canadian Dermatology Foundation supported the study. Dr. Lara-Corrales reported having no financial conflicts.