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Are There Ethnic Differences in Hand Eczema? A Review. J Clin Med 2023; 12:jcm12062232. [PMID: 36983235 PMCID: PMC10056516 DOI: 10.3390/jcm12062232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 03/06/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
Hand eczema is a common disease with economic and social ramifications. This study undertakes a review of certain existing literature to provide insight into contributory factors which may result in the varying prevalence and severity of hand eczema among different ethnic groups, particularly to identify modifiable risk factors, as well as to ascertain knowledge gaps for future research direction. The existing literature suggests that factors including (a) genes, (b) differing skin physiology, (c) cultural practices, (d) dietary habits and associated food preparation, (e) climate, (f) predominant occupations, (g) socioeconomic factors, and (h) dissimilar laws and regulations may account for the disparity in the risk of hand eczema among different ethnicities. Given that endogenous factors cannot be avoided, but certain exogenous aspects can be modified, especially as the environment plays an important role in hand eczema flares, it is helpful from a practical perspective to focus on addressing the modifiable risk factors. These factors pertain to unique cultural practices, customs, and food preparation methods. Healthcare professionals should be well-acquainted with such factors to tailor the treatment approach for patients of different ethnicities accordingly because, with globalization, physicians face increasingly diverse patient populations such that cultural customs no longer remain limited to particular geographic regions.
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Kashinskaya TS, Shakhova NV, Lobanov YF, Kamaltynova EM. Prevalence of Vitamin D Insufficiency/Deficiency and Their Role in Atopic Dermatitis Development and Course in Children. CURRENT PEDIATRICS 2022. [DOI: 10.15690/vsp.v21i4.2435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Various conclusive evidence on the role of vitamin D in the pathogenesis of atopic dermatitis (AD) has been obtained in recent decades. Many studies have shown that patients with AD have low concentration of 25(OH)D in blood associated with high concentration of allergen specific IgE (according to several reports). The analysis of low 25(OH)D concentration prevalence, association of vitamin D deficiency with AD severity and sensitization to allergens, and association of vitamin D disorders with risk of AD development is presented.
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Lucas R, Szklenar M, Mihály J, Szegedi A, Töröcsik D, Rühl R. Plasma Levels of Bioactive Vitamin D and A5 Ligands Positively Correlate with Clinical Atopic Dermatitis Markers. Dermatology 2022; 238:1076-1083. [PMID: 35609515 DOI: 10.1159/000524343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 03/27/2022] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Over the past decade, several controversial studies described a relationship between vitamin D and atopic diseases. Low plasma vitamin D levels or even vitamin D deficiency was associated with an increased incidence of atopic disease, postulating that a higher dietary intake of vitamin D may be a beneficial strategy against atopic diseases such as atopic dermatitis (AD). OBJECTIVE Our aim was to determine the relationship between plasma 25-hydroxyvitamin D3 (25(OH)D3) levels, the levels of the ligand of the vitamin D receptor (VDR) heterodimerization partner as well as the retinoid X receptor (RXR) and the active vitamin A5 derivative 9-cis-13,14-dihydroretinoic acid (9CDHRA) and AD severity. METHODS/RESULTS Samples from AD patients (n = 20) and healthy volunteers (n = 20) were assessed. In our study, the frequently measured VDR ligand precursor 25(OH)D3 in addition to the VDR-ligand 1,25-dihydroxyvitamin D3 (1,25(OH)2D3) and 9CDHRA displayed no different levels when compared with the plasma of AD patients and healthy volunteers. When performing further correlation studies focusing on AD patients, plasma 25(OH)D3 levels showed a negative correlation with eosinophils in blood (EOS) and SCORing Atopic Dermatitis (SCORAD) values, while 1,25(OH)2D3 and 9CDHRA levels correlated positively with plasma IgE, EOS, and SCORAD values. CONCLUSION In consequence, the metabolic activation of vitamin D from 25(OH)D3 towards 1,25(OH)2D3 as well as the co-liganding of the RXR by 9CDHRA may be an important signalling mechanism, an important marker for AD development and severity as well as the basis for novel nutritional and pharmaceutical AD treatment options.
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Affiliation(s)
- Renata Lucas
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | | | - Johanna Mihály
- Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Andrea Szegedi
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Daniel Töröcsik
- Department of Dermatology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
| | - Ralph Rühl
- Paprika Bioanalytics BT, Debrecen, Hungary.,Department of Biochemistry and Molecular Biology, Faculty of Medicine, University of Debrecen, Debrecen, Hungary
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Sanmartin R, Pardos C, Doste D, Aguilera J, Alijarde R, Jesús Agón-Banzo P, García-Malinis AJ, Puzo J, Hernández-Martín Á, Gilaberte Y. The association between atopic dermatitis and serum 25-hydroxyvitamin D in children: Influence of sun exposure, diet, and atopy features-A cross-sectional study. Pediatr Dermatol 2020; 37:294-300. [PMID: 31997408 DOI: 10.1111/pde.14049] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Previous studies have linked low serum vitamin D (VD) or 25-hydroxyvitamin D (25(OH)D) levels with increased severity of atopic dermatitis (AD) in children. OBJECTIVE To investigate the association between serum VD (25(OH)D) levels and AD and AD severity, considering the influence of diet and sun exposure. METHODS We performed a prospective cross-sectional study of healthy controls and children diagnosed with AD. Participants were recruited between January 2011 and December 2012, and the following parameters were assessed: age, sex, body mass index (BMI), AD severity, Fitzpatrick skin type, asthma and rhinitis history, dietary VD intake, daily potential sun-induced VD production, sunscreen use, 25(OH)D and IgE serum levels, and results of the ImmunoCAP Phadiatop Infant test. RESULTS The study population consisted of 105 healthy controls and 134 AD patients. Serum 25(OH)D levels were significantly lower in moderate and severe AD than in mild AD, although this association was only significant for patients with light Fitzpatrick skin type (mean(SD) 36.7 (11.9) ng/mL; moderate 28.8 [11.5] ng/mL; and severe 27.6 [12.1] ng/mL, P = .045). Logistic regression analysis revealed a positive association between severe AD and both positive ImmunoCAP Phadiatop test and BMI. CONCLUSION Our data support an association between VD deficiency and AD severity only in patients with light complexion.
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Affiliation(s)
| | - Carlos Pardos
- Perpetuo Socorro, Primary Care Center, Huesca, Spain
| | | | - Jose Aguilera
- Photobiological Dermatology Laboratory, Department of Dermatology and Medicine, Medical Research Center, Faculty of Medicine, University of Málaga, Málaga, Spain
| | | | | | | | - José Puzo
- Department of Biochemistry, San Jorge Hospital, Huesca, Spain
| | | | - Yolanda Gilaberte
- Department of Dermatology, University Hospital Miguel Servet, IIS Aragón, Zaragoza, Spain
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Hattangdi-Haridas SR, Lanham-New SA, Wong WHS, Ho MHK, Darling AL. Vitamin D Deficiency and Effects of Vitamin D Supplementation on Disease Severity in Patients with Atopic Dermatitis: A Systematic Review and Meta-Analysis in Adults and Children. Nutrients 2019; 11:nu11081854. [PMID: 31405041 PMCID: PMC6722944 DOI: 10.3390/nu11081854] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 08/05/2019] [Accepted: 08/06/2019] [Indexed: 12/16/2022] Open
Abstract
Research has investigated 25-hydroxyvitamin D (25(OH)D) levels in the Atopic Dermatitis (AD) population, as well as changes in AD severity after vitamin D (VitD) supplementation. We performed an up-to-date systematic review and meta-analysis of these findings. Electronic searches of MEDLINE, EMBASE and COCHRANE up to February 2018 were performed. Observational studies comparing 25(OH)D between AD patients and controls, as well as trials documenting baseline serum 25(OH)D levels and clinical severity by either SCORAD/EASI scores, were included. Of the 1085 articles retrieved, sixteen were included. A meta-analysis of eleven studies of AD patients vs. healthy controls (HC) found a mean difference of −14 nmol/L (95% CI −25 to −2) for all studies and −16 nmol/L (95% CI −31 to −1) for the paediatric studies alone. A meta-analysis of three VitD supplementation trials found lower SCORAD by −11 points (95% CI −13 to −9, p < 0.00001). This surpasses the Minimal Clinical Important Difference for AD of 9.0 points (by 22%). There were greater improvements in trials lasting three months and the mean weighted dose of all trials was 1500–1600 IU/daily. Overall, the AD population, especially the paediatric subset, may be at high-risk for lower serum 25(OH)D. Supplementation with around 1600 IU/daily results in a clinically meaningful AD severity reduction.
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Affiliation(s)
- Sonal R Hattangdi-Haridas
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Susan A Lanham-New
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK
| | - Wilfred Hing Sang Wong
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Marco Hok Kung Ho
- Department of Paediatrics and Adolescent Medicine, Queen Mary Hospital, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Andrea L Darling
- Department of Nutritional Sciences, School of Biosciences and Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2 7XH, UK.
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Ahmed Mohamed A, Salah Ahmed EM, Farag YMK, Bedair NI, Nassar NA, Ghanem AIM. Dose-response association between vitamin D deficiency and atopic dermatitis in children, and effect modification by gender: a case-control study. J DERMATOL TREAT 2019; 32:174-179. [PMID: 31296076 DOI: 10.1080/09546634.2019.1643447] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Vitamin D is a regulatory factor for immunity and skin barrier functions. It is hypothesized to be linked to atopic dermatitis (AD) which is characterized by interaction between epidermal barrier dysfunction and dysregulation of skin immune functions. METHODS One hundred AD patients and one hundred and one normal controls were collected from outpatient clinic based on their clinical condition, both had measurement of 25-hydroxyvitamin D [25(OH)D]. We assessed the relationship between 25(OH)D deficiency and AD prevalence using adjusted Poisson regression model. RESULTS Serum 25(OH)D levels were significantly lower in cases than controls (mean 35.1 versus 22.6 ng/mL, p < .001). The unadjusted prevalence ratios (PRs) (95% CI) for AD for comparing participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.11 (1.91, 5.06) and 4.77 (2.99, 7.60), respectively. The association did not materially change after adjusting for potential confounders. In the fully adjusted analysis stratified by gender, PRs for AD for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction <.001). CONCLUSION In this case-control study in children, we found a statistically significant dose-response association between vitamin D deficiency and AD. We also observed a statistically significant effect modification of this association by gender. Further research is recommended to study this association longitudinally, and to examine whether treating vitamin D deficiency may potentially improve AD. Key points Question: Can atopic dermatitis be associated with vitamin D deficiency? Finding: Serum 25(OH)D levels were significantly lower in cases with AD than in controls. Prevalence ratios for comparing male participants with intermediate and deficient vitamin D levels to those with optimal levels were 3.38 (1.21, 9.40) and 5.20 (1.91, 14.13), respectively, whereas in the female participants were 1.32 (0.96, 1.83) and 1.49 (1.04, 2.14), respectively (p-interaction <.001). Meaning: vitamin D deficiency is associated with AD in children, effect modification of this association by gender was also observed.
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Affiliation(s)
- Amal Ahmed Mohamed
- Biochemistry Department, National Hepatology and Tropical Medicine Research Institute, Cairo, Egypt
| | - Eman Mohamed Salah Ahmed
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Youssef M K Farag
- Welch Center for Prevention, Epidemiology, and Clinical Research and Clinical Research and Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Nermeen Ibrahim Bedair
- Department of Dermatology, Andrology, Sexual Medicine and STDs, Faculty of Medicine, Helwan University, Cairo, Egypt
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Droitcourt C, Barbarot S, Maruani A, Darrieux L, Misery L, Brenaut E, Adamski H, Chabbert C, Vermersch A, Weiborn M, Seneschal J, Taïeb A, Plantin P, Maillard H, Phan A, Skowron F, Viguier M, Staumont-Salle D, Nosbaum A, Soria A, Barbaud A, Oger E, Dupuy A. A new phototherapy regimen during winter as an add-on therapy, coupled with oral vitamin D supplementation, for the long-term control of atopic dermatitis: study protocol for a multicentre, randomized, crossover, pragmatic trial - the PRADA trial. Trials 2019; 20:184. [PMID: 30909923 PMCID: PMC6434814 DOI: 10.1186/s13063-019-3276-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2018] [Accepted: 03/01/2019] [Indexed: 12/05/2022] Open
Abstract
Background Atopic dermatitis is a highly prevalent, chronic, relapsing disease in both adults and children. On the severity spectrum, lower-end patients benefit from small amounts of topical anti-inflammatory treatments (TAT), whereas higher-end patients need systemic immunosuppressants; in-between patients are treated with TAT and phototherapy. The major therapeutic challenge in this population is the long-term control of disease activity, and the current TAT-based pro-active strategy does not meet all their needs. Immunosuppressants are used as long-term control add-on treatments, but they are restricted to the most severely affected patients because of safety concerns. In addition, neither immunosuppressants nor other strategies have been properly evaluated in the long term despite long-term control having been acknowledged as one of the most important core outcome domains to be targeted in atopic dermatitis trials. Safe add-on therapies, rigorously evaluated for long-term control of the disease, are therefore needed. Phototherapy and vitamin D supplementation are both good candidates. Methods This is a multicenter, national, randomized, superiority, crossover trial testing add-on phototherapy (one winter under spaced sessions of phototherapy and one winter under observation) among subjects receiving standard care (i.e., TAT). On the same population, we will test the long-term control provided by oral supplementation of vitamin D versus placebo in a randomized, superiority, double-blind, parallel-group trial. The primary outcomes are (1) repeat measures of the PO-SCORAD severity score over 1 year and (2) cumulate consumption of TAT (number of tubes) during the winter. They will be tested following a hierarchical testing procedure. The secondary outcomes will be measures repeated over 2 years of investigator-based severity scores, patient-reported severity and quality of life scores, serum vitamin D levels, weeks during which the disease is well-controlled, inter-visit cumulate consumption of TAT, and synthetic patient-reported satisfaction at the end of each winter. Discussion This study includes two separate 2-year pragmatic trials designed to evaluate the efficacy of vitamin D supplementation and pro-active phototherapy for primary care atopic dermatitis patients receiving TAT on long-term control of disease activity. The experimental design enables the study of both interventions and exploration of the interaction between vitamin D and phototherapy. A pragmatic trial is particularly suited to the assessment of long-term control. This study explores the possibility of new and safe therapeutic strategies for the control of long-term atopic dermatitis, and is an example of efficacy research that is unlikely to be sponsored by industrialists. A potentially effective low-cost therapeutic strategy for long-term control is essential for patients and public health. Trial registration ClinicalTrials.gov Identifier: NCT02537509, first received: 1 September 2015. Electronic supplementary material The online version of this article (10.1186/s13063-019-3276-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Catherine Droitcourt
- Univ Rennes, Rennes, France. .,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France. .,INSERM, CIC 1414, 35000, Rennes, France. .,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France.
| | - Sébastien Barbarot
- Department of Dermatology, University Hospital Center of Nantes, 44000, Nantes, France
| | - Annabel Maruani
- Department of Dermatology, University Hospital Center of Tours, 37000, Tours, France
| | - Laure Darrieux
- Department of Dermatology, Hospital Center of Saint-Brieuc, 22000, Saint-Brieuc, France
| | - Laurent Misery
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Emilie Brenaut
- Department of Dermatology, University Hospital Center of Brest, 29000, Brest, France
| | - Henri Adamski
- Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France
| | - Cécile Chabbert
- Department of Dermatology, Hospital Center of Perigueux, 24000, Perigueux, France
| | - Annie Vermersch
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Marie Weiborn
- Department of Dermatology, Hospital Center of Valenciennes, 62000, Valenciennes, France
| | - Julien Seneschal
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Alain Taïeb
- Department of Dermatology, University Hospital Center of Bordeaux, 33000, Bordeaux, France
| | - Patrice Plantin
- Department of Dermatology, Hospital Center of Quimper, 29000, Quimper, France
| | - Hervé Maillard
- Department of Dermatology, Hospital Center of Le Mans, 72000, Angers, France
| | - Alice Phan
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon-Bron, France
| | - François Skowron
- Department of Dermatology, Hospital Center of Valence, 26000, Valence, France
| | - Manuelle Viguier
- Department of Dermatology, University Hospital Center of Reims, 51000, Reims, France
| | | | - Audrey Nosbaum
- Department of Dermatology, University Hospital Center of Lyon, 69000, Lyon Sud, France
| | - Angèle Soria
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Annick Barbaud
- Department of Dermatology and Allergology, University Hospital Center of Paris-Tenon, 75020, Paris, France
| | - Emmanuel Oger
- Univ Rennes, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
| | - Alain Dupuy
- Univ Rennes, Rennes, France.,Department of Dermatology, University Hospital Center of Rennes, Pontchaillou Hospital, 2 rue Henri le Guilloux, 35000, Rennes, France.,EA 7449 REPERES "Pharmaco-epidemiology and Health Services Research", Univ Rennes, 35000, Rennes, France
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Xiang J, Wang H, Li T. Comorbidity of Vitamin A and Vitamin D Deficiency Exacerbates the Severity of Atopic Dermatitis in Children. Dermatology 2019; 235:196-204. [DOI: 10.1159/000496603] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/29/2023] Open
Abstract
<b><i>Background:</i></b> Several studies have suggested that vitamin D (VD) deficiency (VDD) is associated with atopic dermatitis (AD). However, little is known about the relationship between AD and vitamin A (VA). The interaction between VA and VD on AD requires further study. <b><i>Objective:</i></b> We detected serum levels of VA and VD in children with AD to explore how VA deficiency (VAD) and VDD affect AD severity. <b><i>Methods:</i></b> We assessed the SCORing Atopic Dermatitis (SCORAD) index, total immunoglobin E levels and peripheral blood eosinophil counts. VA and VD levels were determined with high-performance liquid chromatography. Correlations among variables were investigated with Pearson’s correlation analysis. <b><i>Results:</i></b> The VD and VA levels were significantly lower in children with AD than in normal children (p < 0.001, p = 0.0423). Both VD and VA levels were negatively correlated with SCORAD scores. The SCORAD scores were significantly higher in AD patients with both VDD and VAD (co-deficiency) than in other AD patients. Significant inverse correlations were observed between peripheral blood eosinophil counts and serum VA and VD levels. <b><i>Conclusions:</i></b> VA and VD co-deficiency may exacerbate AD symptoms in children, but the specific mechanism underlying this relationship requires further study. These findings may indicate the need for studies evaluating the use of VD and VA as potential treatments for AD patients.
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Huang CM, Lara-Corrales I, Pope E. Effects of Vitamin D levels and supplementation on atopic dermatitis: A systematic review. Pediatr Dermatol 2018; 35:754-760. [PMID: 30284328 DOI: 10.1111/pde.13639] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin condition affecting 5%-20% of children worldwide. Studies suggested both a correlation between serum vitamin D (VD) levels and AD severity and a therapeutic potential role for VD supplementation. OBJECTIVES To determine whether serum VD levels correlate with AD severity and the effects of supplementation for disease improvement in children. DATA SOURCES Ovid MEDLINE, EMBASE, and Cochrane Library databases were searched. STUDY SELECTION Publications with children 0-18 years old with AD and data evaluating effects of VD levels or supplementation on AD severity were included. DATA EXTRACTION Author, year, inclusion criteria, study design, location, age, VD levels, VD supplementation regimens, and baseline and final disease severities were extracted. RESULTS Of the 21 included publications, 15, 5, and 1 evaluated VD level, VD supplementation, and both factors with disease severity, respectively. There were 4 randomized control trials (RCTs), 5 cohort, 6 case-control, and 6 cross-sectional studies. A significant inverse correlation between VD level and severity was described in 62.5% (10/16) of studies. There were 67% (4/6) that reported a significant improvement in AD severity with supplementation. LIMITATIONS Studies meeting inclusion criteria were limited. Furthermore, papers were heterogeneous in terms of location, season, and VD supplementation regimen. Language and publication bias was another potential limitation. CONCLUSION In children, the majority of existing literature confirmed a link between serum VD levels and AD severity. Weak evidence was found supporting improvement of AD with VD supplementation. Future large-scale studies are needed to support our findings.
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Affiliation(s)
| | - Irene Lara-Corrales
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Elena Pope
- Section of Dermatology, Division of Pediatric Medicine, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
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11
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Amon U, Baier L, Yaguboglu R, Ennis M, Holick MF, Amon J. Serum 25-hydroxyvitamin D levels in patients with skin diseases including psoriasis, infections, and atopic dermatitis. DERMATO-ENDOCRINOLOGY 2018; 10:e1442159. [PMID: 29904567 PMCID: PMC5997090 DOI: 10.1080/19381980.2018.1442159] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Accepted: 02/13/2018] [Indexed: 02/07/2023]
Abstract
The pathogenetic role of vitamin D as well as its clinical correlation in inflammatory skin diseases is still uncertain. This study aimed to compare serum levels of 25(OH) vitamin D (calcidiol) in outpatients suffering from different skin diseases using the same laboratory method in one study. In routine serum samples of 1,532 patients from the previous 12 months we identified retrospectively 180 (mean age 49.4 years, 80 female, 100 male) and 205 (mean age 36.3 years, 116 female, 89 male) patients with psoriasis (PSO) and atopic dermatitis (AD), respectively. Clinical disease activity and quality of life was evaluated using Physicians Global Assessment Scores (PGA), Dermatology Life Quality Index (DLQI), and a Visual Analog Scale for pruritus in AD, respectively. The median 25(OH)D serum level of all patients (22.97 ng/mL, range 2.61–96.0, n = 1,461) was significantly lower in comparison to healthy controls (41.6 ng/mL, range 16.9–77.57, p < 0.0001, n = 71). In PSO and AD we measured 21.05 ng/mL (44% < 20 ng/mL) and 22.7 ng/mL (39% < 20 ng/mL), respectively (p = 0.152). Among all subgroups, patients with severe acute or chronic infectious skin diseases had the lowest median 25(OH)D serum levels (17.11 ng/mL, n = 94, 66% <20 ng/mL, p < 0,001 vs. AD, p = 0,007 vs. PSO). For PSO and AD there was no significant correlation between 25(OH)D levels and PGA scores and DLQI values, respectively, or the extent of pruritus in AD. 25(OH)D serum levels in inflammatory skin diseases might correlate more with the type of disease and the degree of inflammation than with clinical activity itself.
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Affiliation(s)
- Ulrich Amon
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Laura Baier
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Raul Yaguboglu
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
| | - Madeleine Ennis
- Centre for Experimental Medicine, Queens University of Belfast, University Road, Belfast, Northern Ireland, United Kingdom
| | - Michael F Holick
- Endocrinology, Nutrition and Diabetes, Department of Medicine, Heliotherapy, Light, and Skin Research Center, Boston University Medical Center, 801 Massachusetts Ave, Boston, MA, USA
| | - Julian Amon
- International Centre for Skin Diseases DermAllegra, Am Markgrafenpark 6, Pommelsbrunn-Hohenstadt, Germany
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12
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Sharma S, Kaur T, Malhotra SK, Rai J, Chaudhari S. Correlation of Vitamin D3 Levels and SCORAD Index in Atopic Dermatits: A Case Control Study. J Clin Diagn Res 2017; 11:WC01-WC03. [PMID: 28893022 PMCID: PMC5583930 DOI: 10.7860/jcdr/2017/27188.10223] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2017] [Accepted: 04/17/2017] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Atopic Dermatitis (AD) is a common chronic inflammatory condition characterized clinically by pruritus and eczematous lesions. An inverse relationship has been suggested between serum 25-hydroxyvitamin D concentration and severity of atopic dermatitis. AIM We carried out this controlled cross-sectional study to evaluate the association between the serum vitamin D3 levels and SCORAD index. MATERIALS AND METHODS For this study, 40 patients with clinical diagnosis of AD based on UK diagnostic criteria were enrolled and 40 patients with minor ailments like superficial bacterial, fungal or viral infections and not suffering from atopic dermatitis were taken as controls. Salient presentations were recorded in a pre-set proforma. Serum 25-hydroxyvitamin D levels were determined through Sandwich-ELISA technique. SCORAD (Scoring AD) index was used to evaluate the severity of the disease. RESULTS Mean value of serum 25-hydroxyvitamin D levels in cases was 30.38 nmol/l whereas in controls, it was 53.46 nmol/l. The decrease in serum levels in cases was statistically highly significant (p-value <0.001). Mean±S.D of serum vitamin D levels in mild disease was 33.29±5.89 nmol/l, in moderate disease was 31.52±6.04 nmol/l and in severe form of disease was 21.24±3.17nmol/l. The correlation between SCORAD and serum 25-hydroxyvitamin D levels was also statistically significant. CONCLUSION The data suggests an inverse relationship between serum levels of vitamin D3 and the SCORAD Index.
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Affiliation(s)
- Saurabh Sharma
- Junior Resident, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Tejinder Kaur
- Associate Professor, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Suresh Kumar Malhotra
- Professor and Head, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
| | - Jaswant Rai
- Professor and Head, Department of Pharnacology, Govt. Medical College, Amritsar, Punjab, India
| | - Sunil Chaudhari
- Junior Resident, Department of Dermatology, Venereology and Leprosy, Govt. Medical College, Amritsar, Punjab, India
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Jang YH, Sim HB, Moon SY, Lee WJ, Lee SJ, Jin M, Kim SH, Kim DW. House Dust Mite Sensitization Is Inversely Associated with Plasma 25-Hydroxyvitamin D3 Levels in Patients with Severe Atopic Dermatitis. Ann Dermatol 2017; 29:400-406. [PMID: 28761286 PMCID: PMC5500703 DOI: 10.5021/ad.2017.29.4.400] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2016] [Accepted: 08/31/2016] [Indexed: 12/23/2022] Open
Abstract
Background The relationship between atopic dermatitis (AD) and low vitamin D levels has been studied. Emerging evidence has implicated vitamin D as a critical regulator of immunity, playing a role in both the innate and cell-mediated immune systems. However, the effect of vitamin D on house dust mite (HDM) sensitization in patients with AD has not been established. Objective We investigated the association between vitamin D levels and HDM sensitization according to AD severity. Methods In total, 80 patients (43 men and 37 women) with AD were included. We classified AD severity using Rajka and Langeland scores. Laboratory tests included serum 25-hydroxyvitamin D3, total immunoglobulin E (IgE), and specific IgE antibody titer against Dermatophagoides farinae and D. pteronyssinus. Results There were no differences in vitamin D levels between the mild or moderate AD and severe AD groups. In the severe AD group, high HDM sensitization group had lower serum vitamin D levels compared to low HDM sensitization group with statistical significance. In addition, a significant negative correlation was found between vitamin D levels and HDM sensitization in the severe AD group. Conclusion Our results demonstrate that low vitamin D levels may link to high HDM sensitization in patients with the severe AD. Further elucidation of the role of vitamin D in HDM sensitization may hold profound implications for the prevention and treatment of AD.
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Affiliation(s)
- Yong Hyun Jang
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Hyun Bo Sim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sun Young Moon
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Weon Ju Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Seok-Jong Lee
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Meiling Jin
- Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Sang-Hyun Kim
- Department of Pharmacology, Kyungpook National University School of Medicine, Daegu, Korea
| | - Do Won Kim
- Department of Dermatology, Kyungpook National University School of Medicine, Daegu, Korea
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The relationship between severity of disease and vitamin D levels in children with atopic dermatitis. Postepy Dermatol Alergol 2017; 34:224-227. [PMID: 28670250 PMCID: PMC5471369 DOI: 10.5114/pdia.2017.66054] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 04/29/2016] [Indexed: 01/09/2023] Open
Abstract
Introduction Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disorder. Vitamin D is a liposoluble vitamin synthesized mainly in the skin. Vitamin D has several effects on the skin. Aim To assess the serum level of vitamin D in children with AD and determine its relation to AD severity. Material and methods Sixty patients with AD were enrolled in the study. We evaluated disease severity using the SCORing Atopic Dermatitis (SCORAD) index. The control group consisted of 37 healthy subjects. Results The mean serum concentration of 25(OH)D3 in patients with AD was not statistically different from control subjects (p = 0.065). The vitamin D level was significantly lower in moderate and severe AD compared with mild AD, and this difference was statistically significant (p = 0.001 and p = 0.004). Vitamin D showed a negative correlation with serum total IgE levels (p = 0.007). There was no significant correlation between total IgE levels and SCORAD scores (p = 0.089). Conclusions This study suggests that a low serum vitamin D level is inversely associated with severity of AD in children. Vitamin D has not been included in the routine treatment of AD because of the conflicting results of various studies. Thus, there is a need for more detailed and prospective studies.
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D'Auria E, Barberi S, Cerri A, Boccardi D, Turati F, Sortino S, Banderali G, Ciprandi G. Vitamin D status and body mass index in children with atopic dermatitis: A pilot study in Italian children. Immunol Lett 2017; 181:31-35. [PMID: 27838470 DOI: 10.1016/j.imlet.2016.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2016] [Revised: 10/27/2016] [Accepted: 11/08/2016] [Indexed: 12/24/2022]
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16
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Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis: A Systematic Review and Meta-Analysis. Nutrients 2016; 8:nu8120789. [PMID: 27918470 PMCID: PMC5188444 DOI: 10.3390/nu8120789] [Citation(s) in RCA: 72] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Revised: 11/10/2016] [Accepted: 11/24/2016] [Indexed: 12/23/2022] Open
Abstract
Recent literature has highlighted the possible role of vitamin D in atopic dermatitis (AD), and that vitamin D supplementation might help to treat AD. This study determined the relationship between vitamin D level and AD, and assessed the efficacy of vitamin D supplementation. We searched the MEDLINE, EMBASE, and Cochrane databases up to May 2015. Observational studies and randomized controlled trials were included based on the available data on the serum 25-hydroxyvitamin D (25(OH)D) level and quantified data available for severity assessed using the Scoring Atopic Dermatitis (SCORAD) index or Eczema Area and Severity Index (EASI) score. Compared with healthy controls, the serum 25(OH)D level was lower in the AD patients of all ages (standardized mean difference = −2.03 ng/mL; 95% confidence interval (CI) = −2.52 to −0.78), and predominantly in the pediatric AD patients (standardized mean difference = −3.03 ng/mL; 95% CI = −4.76 to −1.29). In addition, the SCORAD index and EASI score decreased after vitamin D supplementation (standardized mean difference = −5.85; 95% CI = −7.66 to −4.05). This meta-analysis showed that serum vitamin D level was lower in the AD patients and vitamin D supplementation could be a new therapeutic option for AD.
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Affiliation(s)
- Min Jung Kim
- Department of Dermatology, Konkuk University School of Medicine, Seoul 05030, Korea.
| | - Soo-Nyung Kim
- Department of Obstetrics and Gynecology, Konkuk University School of Medicine, Seoul 05030, Korea.
| | - Yang Won Lee
- Department of Dermatology, Konkuk University School of Medicine, Seoul 05030, Korea.
- Research Institute of Medical Science, Konkuk University, Seoul 05030, Korea.
| | - Yong Beom Choe
- Department of Dermatology, Konkuk University School of Medicine, Seoul 05030, Korea.
- Research Institute of Medical Science, Konkuk University, Seoul 05030, Korea.
| | - Kyu Joong Ahn
- Department of Dermatology, Konkuk University School of Medicine, Seoul 05030, Korea.
- Research Institute of Medical Science, Konkuk University, Seoul 05030, Korea.
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Kim JS, Jung M, Yoo J, Choi EH, Park BC, Kim MH, Hong SP. Protective Effect of Topical Vitamin D3 against Photocarcinogenesis in a Murine Model. Ann Dermatol 2016; 28:304-13. [PMID: 27274628 PMCID: PMC4884706 DOI: 10.5021/ad.2016.28.3.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 07/10/2015] [Accepted: 07/23/2015] [Indexed: 12/26/2022] Open
Abstract
Background Although the incidence of non-melanoma skin cancer is increasing, there are no effective practical preventive measures other than avoiding sun exposure. Objective To elucidate the protective effect of topical application of biologically active vitamin D3 (calcitriol) on skin cancer development caused by exposure to ultraviolet (UV). Methods Groups of hairless mice were topically treated with either calcitriol or vehicle immediately after exposure to UVB and UVA three times weekly for the initial 20 weeks, and without UV exposure in the following 6 weeks. Tumor number was counted and biopsies were done for histopathologic analysis. The changes of cyclobutane pyrimidine dimer (CPD) were evaluated 1 hour and 11 hours after short term of UV exposure and application of calcitriol. For safety evaluation, blood test and body weights were evaluated at 23rd and 25th week. Results Total tumor count and number of tumors less than 3 mm in size tended to be fewer in calcitriol group, and tumors more than 3 mm in size showed significantly lower tumor formation rate in calcitriol group. Single application of calcitriol reduced CPD at 1 hour and 11 hours after UV exposure. Histopathologic analysis showed tumors with lower grade malignancy in calcitriol group which suggested a delay in tumor progression. However, serum levels of calcium and phosphate in calcitriol group were above normal range, and weight loss was found. Conclusion Topical calcitriol may suppress the formation and progression of UV-induced non-melanoma skin cancer by enhancing the repair mechanism of UV damage.
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Affiliation(s)
- Ji Seok Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Minyoung Jung
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Jiyeon Yoo
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Eung Ho Choi
- Department of Dermatology, Yonsei University Wonju College of Medicine, Wonju, Korea
| | - Byung Cheol Park
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Myung Hwa Kim
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
| | - Seung Phil Hong
- Department of Dermatology, Dankook University College of Medicine, Cheonan, Korea
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Quirk SK, Rainwater E, Shure AK, Agrawal DK. Vitamin D in atopic dermatitis, chronic urticaria and allergic contact dermatitis. Expert Rev Clin Immunol 2016; 12:839-47. [PMID: 27014952 DOI: 10.1586/1744666x.2016.1171143] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Vitamin D influences allergen-induced pathways in the innate and adaptive immune system, and its potential immunomodulatory role in allergic skin disorders has been explored. This comprehensive review article provides an overview of the role of vitamin D in three common dermatologic conditions: atopic dermatitis (AD), chronic urticaria, and allergic contact dermatitis (ACD). Whereas the literature regarding vitamin D and AD has resulted in mixed findings, several studies have described an inverse relationship between vitamin D levels and AD severity, and improvement in AD with vitamin D supplementation. Similarly, several studies report an inverse relationship between vitamin D levels and severity of chronic urticaria. Although current research in humans remains limited, an increased likelihood of ACD has been demonstrated in vitamin D-deficient mice. Additional well-designed clinical trials will be necessary to determine whether vitamin D supplementation should be recommended for prevention or adjuvant treatment of these common dermatologic conditions.
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Affiliation(s)
- Shannon K Quirk
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Ellecia Rainwater
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Anna K Shure
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
| | - Devendra K Agrawal
- a Department of Clinical & Translational Science , Creighton University School of Medicine , Omaha , NE , USA
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Abstract
Atopic dermatitis (AD), or eczema, is a chronic inflammatory skin condition characterized by relapsing pruritic, scaly, erythematous papules and plaques frequently associated with superinfection. The lifelong prevalence of AD is over 20 % in affluent countries. When a child with severe AD is not responding to optimized topical therapy including phototherapy, and relevant triggers cannot be identified or avoided, systemic therapy should be considered. If studies show early aggressive intervention can prevent one from advancing along the atopic march, and relevant triggers such as food allergies cannot be either identified or avoided, systemic therapy may also play a prophylactic role. Though the majority of evidence exists in adult populations, four systemic non-specific immunosuppressive or immunomodulatory drugs have demonstrated efficacy in AD and are used in most patients requiring this level of intervention regardless of age: cyclosporine, mycophenolate mofetil, methotrexate, and azathioprine. This article reviews the use of these medications as well as several promising targeted therapies currently in development including dupilumab and apremilast. We briefly cover several other systemic interventions that have been studied in children with atopic dermatitis.
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Affiliation(s)
- Eliza R Notaro
- Dermatology Division, Seattle Children's Hospital, University of Washington School of Medicine, 2480 Birch Ave N #1105, Seattle, WA, 98109, USA.
| | - Robert Sidbury
- Dermatology Division, Seattle Children's Hospital, OC.9.835-Dermatology, 4800 Sand Point Way NE, Seattle, WA, 98105, USA.
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