Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study. Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children. The Effects of Oral Vitamin D Supplement on Atopic Dermatitis: A Clinical Trial with Staphylococcus aureus Colonization Determination. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. Open trial of supplements of omega 3 and 6 fatty acids, vitamins and minerals in atopic dermatitis Does vitamin D intake during infancy promote the development of atopic allergy? Serum Vitamin D levels and Vitamin D supplementation do not correlate with the severity of chronic eczema in children. Topical vitamin B12—a new therapeutic approach in atopic dermatitis—evaluation of efficacy and tolerability in a randomized placebo‐controlled multicentre clinical trial Increased food allergy and vitamin D: randomized, double-blind, placebo-controlled trial. Evaluation of topical vitamin B(12) for the treatment of childhood eczema. Online video improves clinical outcomes in adults with atopic dermatitis: a randomized controlled trial. Evaluation of a parental training program for the management of childhood atopic dermatitis. A pilot study on the use of wet wraps in infants with moderate atopic eczema The management of moderate to severe atopic dermatitis in adults with topical fluticasone propionate Patient perspectives on the management of atopic dermatitis. Placebo-controlled trial of essential fatty acid supplementation in atopic dermatitis
BACKGROUND The role of vitamin D in Atopic Dermatitis ( AD ) is ambiguous and clinical trials are needed to assess the role of vitamin D in the treatment of AD . The aim of this clinical trial study to evaluate the effect of vitamin D supplementation on patients with AD . MATERIAL AND METHODS sixty AD patients were included in a r and omized , double-blind , placebo-controlled trial study . They were r and omly divided into two groups and treated for 60 days : group vitamin D ( n=30 ) , and placebo group ( n=30 ) . The two groups were as follows : Group D , 1600 IU cholecalciferol ( vitamin D ) and second group placebo . The severity of AD was evaluated based on SCORAD ( Scoring Atopic Dermatitis ) and TIS ( Three Item Severity score ) value by the same trained physician before and after the trial . RESULTS According to SCORAD and TIS value index in the vitamin D group showed significant improvement in patients with mild , moderate and severe AD ( P<0.05 ) and in patients who the intake placebo , this improvement did n't showed ( P>0.05 ) . CONCLUSION Results mention that supplementation with oral vitamin D dramatically improved disease severity in AD patients Abstract Background : Atopic dermatitis is a chronically relapsing , highly pruritic and inflammatory skin disease . This study was done to assess the effects of vitamins D and E supplementation on the clinical manifestation of atopic dermatitis . Methods : Forty-five atopic dermatitis patients were included in a r and omized , double-blind , placebo-controlled trial . They were r and omly divided into four groups and treated for 60 days : group P ( n = 11 ) , vitamins D and E placebos ; group D ( n = 12 ) , 1600 IU vitamin D3 plus vitamin E placebo ; group E ( n = 11 ) , 600 IU synthetic all-rac-α-tocopherol plus vitamin D placebo ; and group DE ( n = 11 ) , 1600 IU vitamin D3 plus 600 IU synthetic all-rac-α-tocopherol .  Serum 25(OH ) vitamin D and plasma α-tocopherol were determined before and after the trial . The clinical improvement was evaluated with SCORing Atopic Dermatitis ( SCORAD ) . Data were analyzed by analysis of variance ( ANOVA ) and Kruskal-Wallis tests . Results : SCORAD was reduced after 60 days in groups D , E and DE by 34.8 % , 35.7 % and 64.3 % , respectively ( p = 0.004 ) . Objective SCORAD also showed significant improvement . There was a positive correlation between SCORAD and intensity , objective , subjective and extent ( p < 0.001 ) . We found a significant negative association between plasma α-tocopherol and SCORAD , intensity , objective and extent ( p = 0.02 ) . Conclusion : This study supports the contributing and beneficial effects of vitamins D and E in the treatment of atopic dermatitis BACKGROUND Epidemiologic and pre clinical data , and a small r and omized trial in Boston , suggest that vitamin D supplementation may improve winter-related atopic dermatitis ( AD ) . OBJECTIVE To determine the effect of vitamin D supplementation on winter-related AD . METHODS We performed a r and omized , double-blind , placebo-controlled trial of Mongolian children with winter-related AD ( clinical trials.gov identifier : NCT00879424 ) . Baseline eligibility included age 2 to 17 years , AD score 10 to 72 using the Eczema Area and Severity Index ( EASI ) , and winter-related AD ( eg , history of AD worsening during the fall-to-winter transition ) . Subjects were enrolled in Ulaanbaatar during winter and r and omly assigned to oral cholecalciferol ( 1000 IU/day ) versus placebo for 1 month . All children and parents received emollient and patient education about AD and basic skin care . The main outcomes were changes in EASI score and in Investigator 's Global Assessment . RESULTS The 107 enrolled children had a mean age of 9 years ( SD 5 ) , and 59 % were male . Their median age of AD onset was 3 months ( interquartile range 2 months to 1 year ) and mean EASI score at baseline 21 ( SD 9 ) . One-month follow-up data were available for 104 ( 97 % ) children . Compared with placebo , vitamin D supplementation for 1 month produced a clinical ly and statistically significant improvement in EASI score ( adjusted mean change : -6.5 vs -3.3 , respectively ; P = .04 ) . Moreover , change in Investigator 's Global Assessment favored vitamin D over placebo ( P = .03 ) . There were no adverse effects in either group . CONCLUSION Vitamin D supplementation improved winter-related AD among Mongolian children , a population likely to have vitamin D deficiency in winter BACKGROUND An increase in Staphylococcus aureus skin colonization in atopic dermatitis patients result ed from the reduction of cathelicidin production in these patients . Recently , an in vivo study demonstrated that vitamin D could stimulate cathelicidin production . Oral supplements of vitamin D might be beneficial in atopic dermatitis . OBJECTIVE To determine the effects of oral vitamin D supplements on clinical impact including Staphylococcus aureus skin colonization evaluation in atopic dermatitis patients . MATERIAL AND METHOD Twenty-four atopic dermatitis patients were included in this double-blind , placebo-controlled study . They were r and omly assigned into 2 groups for oral 2,000 IUs/day of vitamin D , supplement and placebo . The lesional swab culture for S. aureus was done at week 0 , 2 and 4 . Clinical outcomes were assessed by SCORAD score , mexameter for erythema index and konometer for conductance were done at week 0 , 2 and 4 . Serum vitamin D levels were also determined at week 0 and 4 . RESULTS Twenty patients completed the protocol .  S. aureus skin colonization , SCORAD score and erythema index were significantly reduced from baseline to week 4for vitamin D treated group comparing with placebo ( p = 0.022 , 0.028 and 0.014 , respectively ) . There was an inverse correlation between serum vitamin D levels with S. aureus skin colonization and SCORAD score ( r = -1.0 , p < 0.001 ) . CONCLUSION Oral vitamin D supplement could reduce skin colonization of S. aureus and demonstrated the clinical improvement of patients with atopic dermatitis BACKGROUND Subjects with atopic dermatitis ( AD ) have defects in antimicrobial peptide ( AMP ) production possibly contributing to an increased risk of infections . In laboratory models , vitamin D can alter innate immunity by increasing AMP production . OBJECTIVE To determine if AD severity correlates with baseline vitamin D levels , and to test whether supplementation with oral vitamin D alters AMP production in AD skin . METHODS This was a multi-centre , placebo-controlled , double-blind study in 30 subjects with AD , 30 non-atopic subjects , and 16 subjects with psoriasis . Subjects were r and omized to receive either 4000 IU of cholecalciferol or placebo for 21 days . At baseline and day 21 , levels of 25-hydroxyvitamin D ( 25OHD ) , cathelicidin , HBD-3 , IL-13 , and Eczema Area and Severity Index ( EASI ) and Rajka-Langel and scores were obtained . RESULTS At baseline , 20 % of AD subjects had serum 25OHD below 20 ng/mL. Low serum 25OHD correlated with increased Fitzpatrick Skin Type and elevated BMI , but not AD severity . After 21 days of oral cholecalciferol , mean serum 25OHD increased , but there was no significant change in skin cathelicidin , HBD-3 , IL-13 or EASI scores . CONCLUSIONS This study illustrated that darker skin types and elevated BMI are important risk factors for vitamin D deficiency in subjects with AD , and highlighted the possibility that seasonality and locale may be potent contributors to cathelicidin induction through their effect on steady state 25OHD levels . Given the molecular links between vitamin D and immune function , further study of vitamin D supplementation in subjects with AD is warranted Objective : To investigate whether dietary supplementation with polyunsaturated fatty acids ( PUFA ) of the omega 3 series ( n‐3 PUFA : 18:3 , n‐3 ; 20:5 , n‐3 ; and 22:6 , n‐3 ) , the omega 6 series ( n‐6 PUFA : 18:3 , n‐6 ) , vitamins and minerals have a clinical effect on atopic dermatitis . Methods : A total of 19 patients aged 17–43 years with moderate to severe atopic dermatitis participated in an open trial of high oral doses of n‐3 and n‐6 PUFA in dry form ( powder ) or omega 3,6,9 fatty acid capsules , vitamin E tablets ( d‐alpha‐tocopherol ) , zinc solution or tablets , and multivitamin capsules daily for 16 weeks . Results : The mean SCORAD improved in 14 of 17 patients by more than 50 % after 8 weeks and 16 weeks of treatment ( p<0.01 and p<0.001 , respectively ) . Conclusion : The open nature of this trial and the small number of subjects are major limitations of this study . The possible role of dietary omega 3 and 6 fatty acids in the treatment of atopic dermatitis should be tested more extensively in a double‐blind trial using high doses of antioxidants combined with PUFA The active metabolite of vitamin D , 1,25-(OH)2D3 , has immunomodulatory properties in addition to its more established action on bone and calcium metabolism . Recently vitamin D has been proposed as one of several environmental factors responsible for the increase in atopic diseases during the last decades . The objective of this study was to determine whether the estimated dose of dietary vitamin D3 during the first year of life is associated with atopic diseases up to the age of 6 years . In a prospect i ve birth cohort study 123 six-year-old children were investigated for the cumulative incidence of atopic dermatitis , allergic rhinitis or asthma by means of a postal question naire . Their vitamin D3 intake during infancy was recorded in a previous study and the relationship between lower or higher vitamin D3 intake and atopic illness later in childhood was assessed . Atopic manifestations were more prevalent in the group with higher intake of vitamin D3 . Although small , this study supports previous investigations suggesting a role of vitamin D intake during infancy in the development of atopic allergy later in childhood . If these findings are confirmed in prospect i ve controlled clinical trials , prevention through modified vitamin D3 supplementation in infancy could be discussed to reduce the burden of atopic illnesses BACKGROUND Eczema is one of the most common chronic inflammatory skin diseases , affecting about 20 % of children . The pathogenic mechanisms of eczema are still not fully understood , and current treatment of moderate-severe eczema is often difficult . Recently , it has been suggested that Vitamin D plays a key role in this disease , even if mechanisms are only partially known . OBJECTIVE The purpose of our study was to assess the  25-Hydroxyvitamin D serum levels in a pediatric population suffering from chronic eczema ( IgE-mediated and non-IgE-mediated ) , and to correlate these phenotypes with the SCORAD severity and selected clinical and biological parameters . Moreover , we aim ed to evaluate whether a supplementation of Vitamin D3 could affect the same clinical and laboratory parameters . METHODS 89 children with chronic eczema were enrolled in the study . Severity of eczema was assessed with the SCORAD index . Past and present history was taken , and patients were divided into two groups according to the state of sensitization . According to a r and omization schedule , the enrolled children were assigned to the following groups : supplementation group , which received a daily oral Vitamin D3 supplementation ( 2000 IUs ) for 3 months ; control group which received no supplementation . RESULTS  Vitamin D concentrations in patients with moderate and severe eczema were not statistically different from Vitamin D concentration detected in the serum of patients with mild eczema . Furthermore , we did not find any correlation between Vitamin D levels , total IgEs and SCORAD index , both in the Sensitized and in the Not-Sensitized group . The Vitamin D3 supplementation did not influence the SCORAD severity or the total IgEs concentration . CONCLUSION To our knowledge , our study is the first one that shows no correlation between serum levels of Vitamin D , eczema severity and IgE sensitization in a pediatric population suffering from chronic eczema Background Vitamin B12 is an effective scavenger of nitric oxide ( NO ) . As the experimental application of a NO synthase inhibitor , Nω‐nitro‐l‐arginine , led to a clear decrease in pruritus and erythema in  atopic dermatitis , it would be reasonable to assume a comparable effect of vitamin B12 BACKGROUND To eluci date whether maternal vitamin D supplementation during lactation improves infantile eczema and other subsequent allergic disorders , a r and omized , double-blind , placebo-controlled trial was performed . METHODS Mothers ( n = 164 ) of infants with facial eczema at 1 month check-up were r and omly assigned to receive vitamin D3 supplements ( n = 82 ; 800 IU/day ) or placebo ( n = 82 ) for 6 weeks from May 2009 to January 2011 . The primary outcome was infantile eczema quantified on Scoring Atopic Dermatitis ( SCORAD ) index at 3 month check-up , and the secondary outcomes were atopic dermatitis , food allergy , and wheeze diagnosed by doctors up to 2 years of age . RESULTS There was no significant difference in SCORAD at 3 month check-up between the two groups . Doctor-diagnosed food allergy was significantly more common up to age 2 years in the vitamin D group ( 10/39 , 25.7 % ) than in the placebo group ( 3/40 , 7.5 % ; risk ratio ( RR ) , 3.42 ; 95 % confidence interval [ CI ] : 1.02 - 11.77 ; P = 0.030 ) . Moreover , at least one secondary outcome was also significantly more common in the vitamin D group ( 17/39 , 43.6 % ) than in the placebo group ( 7/40 , 17.5 % ; RR , 2.49 ; 95%CI : 1.16 - 5.34 ; P = 0.012 ) . CONCLUSIONS Vitamin D supplementation may not decrease the severity of infantile eczema at 3 months of age , but may rather increase the risk of later food allergy up to 2 years of age . Because a large number of subjects was lost to follow up , further study is needed to confirm the findings OBJECTIVES Topical vitamin B(12 ) is an approach that has been shown to successfully treat atopic dermatitis in adults ; however , there have been no studies in children .  Topical vitamin B(12 ) is thought to decrease the symptoms involved in eczema through reducing nitric oxide production . Atopic dermatitis affects 5%-20 % of children in the United States . Various treatment options are available to treat atopic dermatitis in children , but there are drawbacks to some of these options . Children tend to need a larger dose of medication for body surface area involved and can be more adversely affected by agents such as topical steroids . This study was developed in order to find an alternative eczema treatment for children . DESIGN This double-blinded , r and omized , placebo-controlled study with intraindividual left/right comparison was set up to determine whether topical vitamin B(12 ) would be effective in children with eczema . SUBJECTS Patients from the ages of 6 months to 18 years old were recruited from the Center for Family Medicine and enrolled for 4 weeks . OUTCOME MEASURES Skin checks using a st and ardized scoring system were done at baseline , and 2 and 4 weeks by a single investigator . Twenty-one ( 21 ) patients completed the study . RESULTS Skin treated with topical vitamin B(12 ) improved significantly more than placebo treated skin at 2 and 4 weeks ( p = 0.02 , 0.01 respectively ) . CONCLUSIONS Topical vitamin B(12 ) should be considered as a treatment option in children with eczema BACKGROUND Atopic dermatitis ( AD ) is a chronic inflammatory skin disorder characterized by intense pruritus that causes significant disease and psychosocial burden in patients . Patient education has the potential to improve clinical outcomes and patient knowledge of this condition . OBJECTIVES We sought to assess the effectiveness of online video education at improving AD knowledge and disease severity compared with a written pamphlet , and to determine the usefulness and appeal of the two educational delivery vehicles . METHODS In a r and omized controlled trial , 80 participants were r and omized to receive either online video-based patient education or written pamphlet education about AD and its management . We assessed AD disease severity using the patient-oriented eczema measure ( POEM ) scale . AD knowledge was assessed with st and ardized question naires at baseline and after the 12-week intervention . RESULTS All participants had similar baseline knowledge and AD severity at the beginning of the study . On study completion , improvements in AD knowledge assessed by question naire were significantly greater in the video group than the pamphlet group ( 3.05 vs 1.85 , P = .011 ) . Online video-based education result ed in greater improvement in clinical outcome , as measured by POEM , compared with pamphlet-based education ( POEM score reduction of 3.30 vs 1.03 , P = .0043 ) . Finally , although the usefulness of both interventions was rated equally ( P = .77 ) , the online video was significantly more appealing than the pamphlet ( P = .0086 ) . LIMITATIONS This study is limited to AD in adults . CONCLUSION Online video for patient education is an effective and appealing tool for improving clinical outcomes in adult patients with AD Atopic dermatitis ( AD ) in childhood is a common disease with prevalence rates as high as 20 % . Its early onset in infancy and its chronic relapsing course puts a special burden on families . Supporting parents in dealing with the management of AD presents a challenge for physicians . The objective of this study was to determine the effect of a structured parental training program on managing AD in children . Two-hundred and four families participated in a prospect i ve , r and omized controlled trial . Children ( 5 months to 12 years in age ) had suffered from moderate-to-severe AD for at least 4 months . They were r and omly assigned to either the intervention group or a waiting , control group who could participate in the training program 1 year later . The intervention was an inter-disciplinary , structured educational program which covered medical , nutritional , and psychological issues in six group sessions of 2 h each . The families were assessed at the beginning of the study and 1 year later . Main outcome measures were : severity of eczema ( SCORAD ) ; treatment habits ; treatment costs ; quality of life ; and coping strategies . Significant effects were shown regarding treatment behavior , such as regular use of emollients , use of antiseptics and topical steroids in the event of exacerbation , and a reduction in the use of unconventional therapies . Satisfaction with medical treatment was improved , and rumination as an ineffective coping strategy was reduced . Finally , significant reduction of treatment costs was achieved . We conclude that structured training programs for parents of children with AD is a helpful adjunct to dermatological treatment Wet wrap therapy ( WWT ) is a well‐established treatment for  severe atopic dermatitis ( AD ) . However little evidence exists to justify widespread use in the community for less severe eczema . We compared the efficacy of WWT with a st and ard regime of hydrocortisone , to control moderate AD in children . We carried out a single‐observer , r and omized , controlled pilot study in 19 children under 5 years of age , with AD of 30 % or more body surface area , using only 1 % hydrocortisone ( HC ) prior to the study . Group one applied HC once in the morning for 2 weeks , with wet wraps twice daily for week 1 , but only at night for week 2 . Group two applied HC twice daily without wet wraps . Both applied emollient twice daily and as necessary . The primary outcome measure was the Six Area , Six Sign Atopic Dermatitis ( SASSAD ) severity score , and the secondary outcome measures were the Infants Dermatology Quality of Life Index ( IDQOL ) , the Dermatitis Family Impact ( DFI ) score and the weight of topical steroids and emollients used . Over the 2‐week active therapy period the mean fall in SASSAD was 8 [ 95 % confidence interval ( CI ) , −18 to + 2 ; P = 0.11 ] more in the non‐WWT group , the median change in the IDQOL was 2 for Group one and 7 for Group two ( 95 % CI for difference , −10 to + 3 ; P = 0.24 ) and the median change in DFI score was 2 for Group one and 5 for Group two ( 95 % CI for difference , −14 to + 2 ; P = 0.42 ) . This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe , widespread AD , and provides weak evidence to suggest that it may be more effective . We would not advocate routine use of WWT for moderate eczema without further evaluation This study was design ed to investigate a long‐term therapeutic strategy for the management of  recurring atopic dermatitis ( AD ) in adults using fluticasone propionate ( FP ) ointment ( CutivateTM ) whereby FP could help to prevent a relapse of AD once symptoms were under control . Adult patients with chronic , moderate to severe AD entered this multicentre study . All patients were initially treated with FP 0.005 % ( g/g ) ointment in two different regimens . Patients whose AD had been completely healed by these treatments then entered a long‐term treatment phase applying FP or placebo ointment once daily , two times per week for 16 weeks to ‘ known ’ healed lesions . By the end of the initial treatment period , mean SCORAD values had significantly ( P < 0.0005 ) improved from baseline . Patients who entered the maintenance phase and were treated with intermittent FP for up to 16 weeks , demonstrated its superior efficacy ( P = 0.018 ) over placebo , maintaining the improvements achieved after the initial treatment phase , reducing risk of relapse and delaying time to relapse ( P = 0.013 ) . No significant changes were detected in either treatment group in serum cortisol levels or in skin thickness measurements . Intermittent FP applied two times per week maintained a significant level of control , and delayed relapse of AD by comparison with placebo BACKGROUND Atopic dermatitis ( AD ) is increasingly common , with a point prevalence of more than 30 % in some countries , and is characterized by visible skin lesions and intense itching . OBJECTIVE The International Study of Life with Atopic Eczema ( ISOLATE ) is the first large-scale study to assess the effect of AD on the lives of patients and society , how patients and caregivers manage the condition , and how well patients and caregivers currently believe that AD is controlled . METHODS Two thous and two patients ( > 13 years ) and caregivers of children ( 2 - 13 years ) with moderate-to-severe AD r and omly selected from 8 countries underwent  st and ardized telephone interviews using questions developed in collaboration with national eczema patient groups and physicians . RESULTS During each year , patients spend , on average , 1 of 3 days in flare . The majority of patients receive prescription topical corticosteroids to treat flares ; however , 49 % of respondents are concerned about using these agents . On average , patients and caregivers delay initiating treatment for 7 days after onset of a flare . Only 24 % of patients and caregivers feel confident they can manage AD flares adequately . Seventy-five percent of caregivers and patients feel that being able to effectively control AD would be the single most important improvement to their or their child 's quality of life . The avoidable secondary economic cost of AD is estimated at 2 billion Euro per year across the European Union . CONCLUSION ISOLATE highlights the need to improve patients ' control of AD to reduce the significant effect this condition has on the patient and society . CLINICAL IMPLICATION S ISOLATE shows that patients with AD are untreated for half the time they are in flare , and thus there is an urgent need for physicians to ensure that the patients are educated and confident in using medication as prescribed to gain disease control Treatment of atopic dermatitis with essential fatty acids remains controversial . A double-blind , placebo-controlled , parallel-group study was done to investigate the response of patients with atopic dermatitis to essential fatty acid supplements .  Patients with atopic dermatitis were r and omised to receive evening primrose oil , evening primrose oil and fish oil , or placebo for 16 weeks . Disease activity was monitored by clinical severity scores recorded by the investigator , topical steroid requirement , and symptom scores recorded by subjects . Of 123 subjects recruited , 102 completed the treatment period . No improvement with active treatment was demonstrated . Our study , which avoided the method ological and analytical problems of previous studies , found no effect of essential fatty acid supplementation in atopic dermatitis
Vitamin D has a potentially significant role for improving the symptoms of AD .
The results from this study suggest that vitamin D supplementation may help ameliorate the severity of AD , and can be considered as a safe and tolerable therapy .
OBJECTIVES Despite the evidence supporting the use of vitamin D supplements for managing atopic dermatitis ( AD ) , no meta- analysis providing definite conclusions in this field has been reported .
The purpose of the present study was to conduct a systematic review and meta- analysis of all controlled studies of vitamin D for treating AD to eluci date the efficacy of vitamin D for alleviating the symptoms of AD .