The Effect of Vitamin D Supplementation on Atopic Dermatitis

Atopic Dermatitis(AD)is recognized as one of the major worldwide health concerns. Despite being first described in the nineteenth century by Besnier, management options continue to be limited and are primarily palliative. AD patients are susceptible to many infections, such as the Herpes simplex virus (HSV), resulting in a more serious clinical subgroup of patients with AD complicated by Eczema Herpeticum (ADEH). Supplementation with vitamiD (VD)has shown positive effects on the clinical outcome of AD in previous randomized controlled trials and clinical studies which could be due, in part, to the up regulation the antimicrobial peptide LL‐37, which has known antimicrobial, immune-­modulatory and wound healing effects. Objective: We sought to determine the level of VD deficiency in AD and ADEH patients in a pediatric dermatology clinic,to investigate whether there was a difference in baseline VD levels between AD and ADEH, to examine skin surface LL-­37 levels in both and to establish whether VD supplementation would result in clinical improvement. Methods: A practice evaluation study was performed at the Sheffield Children’s Hospital. All AD patients were screened for VD deficiency. Those that were found deficient were assessed using SCORAD and POEM. Skin surface cells were collected from lesional and non-­lesional sites using a novel non-invasive technique for LL-­37 evaluation. In addition, serum IgE levels and serum calcium levels were also checked. Supplementation was then commenced for two months after which clinical severity was reassessed and all levels were rechecked. Results: Ninety children (mean age9) were screened for VD deficiency; 83% had low VD levels. VD levels were significantly lower in ADEH children than AD children (p <0.0001). Baseline SCORAD was also significantly higher in ADEH patients (p < 0.0001). Skin surface LL-­37 levels were reduced in ADEH patients in comparison to AD patients (p = 0.46), and were significantly reduced in patients with severe AD (SCORAD>50) in comparison to patients with moderate (SCORAD 25-­‐50) or mild AD (SCORAD <25; p=0.018). Two months of VD supplementation resulted in significant improvement of SCORAD (p <0.0001) and POEM (p < 0.0001) in both groups; LL-­37 levels also increased significantly (p = 0.0004). Conclusions: VD deficiency was found to be common in AD children, and VD supplementation reduced ADEH and AD severity in children. Part of the explanation is through increased LL-­37 production.