Oral supplements in atopic dermatitis

Evaluation of the Impact of Serum Vitamin D Levels on the Scoring Atopic Dermatitis Index in Pediatric Atopic Dermatitis

Atopic dermatitis (AD) is a chronic and recurrent inflammatory skin condition characterized by itching, eczematous plaques, and dry skin. Despite ongoing research, its exact cause remains elusive. In this study, we aimed to explore the factors that influence the severity of AD in children and assess the relationship between serum vitamin D levels and the disease's severity. We enrolled 96 AD patients in our investigation, evaluated their clinical condition using the Scoring Atopic Dermatitis (SCORAD) index, and compared them to a group of 90 healthy controls. Our analysis revealed that serum vitamin D levels and eosinophil counts significantly impacted the SCORAD index (p < 0.001). According to standardized regression coefficients, for each incremental unit in serum vitamin D levels, the SCORAD index exhibited a decrease of 0.449 units. Similarly, a one-unit increase in eosinophil count resulted in a 0.009 unit increase in the SCORAD index. It is worth noting that the influence of serum vitamin D levels on disease severity surpasses that of eosinophil counts and atopic conditions. In our patient cohort, we uncovered a negative correlation (r = -0.419, p < 0.001) between serum vitamin D levels and the SCORAD index. Our findings suggest that low serum vitamin D levels may have a more substantial impact on AD severity than atopic conditions and eosinophilia. Furthermore, we observed a negative association between the severity of AD and serum 25(OH)D3 levels.

Single-Strain Probiotic Lactobacilli for the Treatment of Atopic Dermatitis in Children: A Systematic Review and Meta-Analysis

Probiotics are known for their positive effects on the gut microbiota. There is growing evidence that the infant gut and skin colonization have a role in the development of the immune system, which may be helpful in the prevention and treatment of atopic dermatitis. This systematic review focused on evaluating the effect of single-strain probiotic lactobacilli consumption on treating children's atopic dermatitis. Seventeen randomized placebo-controlled trials with the primary outcome of the Scoring Atopic Dermatitis (SCORAD) index were included in the systematic review. Clinical trials using single-strain lactobacilli were included. The search was conducted until October 2022 using PubMed, ScienceDirect, Web of Science, Cochrane library and manual searches. The Joanna Briggs Institute appraisal tool was used to assess the quality of the included studies. Meta-analyses and sub meta-analyses were performed using Cochrane Collaboration methodology. Due to different methods of reporting the SCORAD index, only 14 clinical trials with 1124 children were included in the meta-analysis (574 in the single-strain probiotic lactobacilli group and 550 in the placebo group) and showed that single-strain probiotic lactobacilli statistically significantly reduced the SCORAD index compared to the placebo in children with atopic dermatitis (mean difference [MD]: -4.50; 95% confidence interval [CI]: -7.50 to -1.49; Z = 2.93; p = 0.003; heterogeneity I² = 90%). The subgroup meta-analysis showed that strains of Limosilactobacillus fermentum were significantly more effective than strains of Lactiplantibacillus plantarum, Lacticaseibacillus paracasei or Lacticaseibacillus rhamnosus. A longer treatment time and younger treatment age statistically significantly reduced symptoms of atopic dermatitis. The result of this systematic review and meta-analysis shows that certain single-strain probiotic lactobacilli are more successful than others in reducing atopic dermatitis severity in children. Therefore, careful consideration to strain selection, treatment time and the age of the treated patients are important factors in enhancing the effectiveness of reducing atopic dermatitis in children when choosing probiotic single-strain lactobacilli.

From the Cochrane Library: Dietary Supplements for Established Atopic Eczema

Collapse

Vitamin D: Skin, sunshine, and beyond

Vitamin D is a steroid hormone of importance to the field of dermatology. Skin is unique in that it is the site of vitamin D synthesis upon sun exposure and a target organ for its activity. We explore the physiology and metabolic mechanism of action of vitamin D, as well as its effects on the skin. We also discuss the current evidence of the efficacy and safety of oral and topical vitamin D analogues on skin conditions such as psoriasis, atopic dermatitis, vitiligo, sunburn, actinic keratosis, and fibrosing skin disorders. Based on currently available scientific evidence, the National Academy of Medicine's recommended dietary allowance for vitamin D ranges from 400 IU to 800 IU daily based on age categories.

An overview of drug discovery efforts for eczema: why is this itch so difficult to scratch?

Introduction: Atopic dermatitis (AD) is a type of allergic/inflammatory dermatitis characterized by itch and an impairment in quality of life.Areas covered: Herein, the authors review drug discovery efforts for AD, highlighting the clinical efficacy of novel drugs, with a particular focus on the relief of pruritus. Topical agents include emollients, topical antihistamines, corticosteroids, calcineurin inhibitors and herbs. Recently, topical phosphodiesterase E4 (PDE4) inhibitors like crisaborole have become available and are efficacious for mild to moderate AD with few side effects. For more severe AD, monoclonal antibodies like dupilumab are considered as efficacious subcutaneous treatment options. In severe and recalcitrant AD, systemic treatment can ameliorate AD symptoms.Expert opinion: Many topical and systemic medications have demonstrated therapeutic benefits for AD. Indeed, randomized trials have shown that topical PDE4 inhibitors and subcutaneous dupilumab are safe and efficacious. Objective tools to evaluate itch and gauge treatment efficacy is important, but current methodology relies primarily on clinical scores. AD is a systemic atopic disease with a lot of complicated psychosocial issues. Suboptimal efficacy is often due to poor compliance and unrealistic expectation of curative treatment, rendering treatment difficult despite the existence of effective medications.

A survey in uncharted territory: A collaborative study to explore the approach to atopic dermatitis patient management in allopathy and naturopathy

BACKGROUND

Atopic dermatitis (AD) patients frequently use both conventional and complementary medicines for treatment. Allopathic and naturopathic providers may be unaware of each other's approach to AD diagnosis, skin care, and treatment, affecting patient and provider communication, patient safety, and potential for collaborative studies.

OBJECTIVE

To identify core commonalities and differences in allopathic and naturopathic approach to AD.

METHODS

Thirty allopathic and 21 naturopathic providers completed an 11-question free-text comment survey, covering patient education and evaluation, skin care, and treatment of AD. Qualitative content analysis detected key ideas and concepts, and word cloud analysis provided a quantitative visual representation of recurrent words in each group's responses.

RESULTS

All respondents indicated using similar physical features to diagnose AD. In both allopathic and naturopathic fields, the majority of providers did not perform routine testing for AD diagnosis. Skin care with moisturization and "soak-and-seal" bathing practices were routine in both fields. Naturopathic providers heavily emphasized the role of food and diet in AD pathogenesis, education, and management, while allopathic providers indicated little to no role for food and diet in AD. For treatment, allopathic providers favored topical steroids, phototherapy, and immunomodulators, whereas naturopathic providers recommended botanicals, supplements, and other complementary and alternative methods.

CONCLUSIONS

Providers should be aware of the differences between allopathic and naturopathic providers and their approach to AD management, particularly concerning the role of food and diet. There may be opportunities to harmonize skin care regimens for patients given similar approach in both fields, and to collaborate further on studies of diet in AD and treatments not yet effectively tested.

Use of Natural Components Derived from Oil Seed Plants for Treatment of Inflammatory Skin Diseases

The incidence of inflammatory skin diseases is increasing, so the search for relevant therapeutics is of major concern. Plants are rich in phytochemicals which can alleviate many symptoms. In this review, we concentrate on compounds found in the seeds of widely cultivated plants, regularly used for oil production. The oils from these plants are often used to alleviate the symptoms of inflammatory diseases through synergetic action of unsaturated fatty acids and other phytochemicals most commonly derived from the terpenoid pathway. The knowledge of the chemical composition of oil seeds and the understanding of the mechanisms of action of single components should allow for a more tailored approach for the treatment for many diseases. In many cases, these seeds could serve as an efficient material for the isolation of pure phytochemicals. Here we present the content of phytochemicals, assumed to be responsible for healing properties of plant oils in a widely cultivated oil seed plants and review the proposed mechanism of action for fatty acids, selected mono-, sesqui-, di- and triterpenes, carotenoids, tocopherol and polyphenols.