{"id":710,"date":"2015-05-12T11:00:01","date_gmt":"2015-05-12T11:00:01","guid":{"rendered":"http:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/?p=710"},"modified":"2017-08-21T11:50:10","modified_gmt":"2017-08-21T11:50:10","slug":"primary-care-corner-with-geoffrey-modest-md-vitamin-d-and-atopic-dermatitis-in-kids","status":"publish","type":"post","link":"https:\/\/stg-blogs.bmj.com\/bmjebmspotlight\/2015\/05\/12\/primary-care-corner-with-geoffrey-modest-md-vitamin-d-and-atopic-dermatitis-in-kids\/","title":{"rendered":"Primary Care Corner with Geoffrey Modest MD: Vitamin D and atopic dermatitis in kids"},"content":{"rendered":"

By: Dr. Geoffrey Modest<\/strong><\/p>\n

Atopic dermatitis (AD) is pretty common in kids (up to 25%), typically occurring early on (45% of cases begin within first 6 months of life, 60% within first year), and 70% remit spontaneously by adolescence. In those with AD there are significant immunologic changes (increase in Th2 cells and decrease in Th1\u00a0cells in their skin, though there are differences in these T-cell subsets in the acute AD phase, with Th2 cells and their associated cytokines of IL-4, IL-5, IL-13 predominating, but in the chronic phase the Th1 cells and their associated IFN-g,\u00a0IL-5,IL-12 predominate. Vitamin D receptors are all over the body, including in the skin and in the immune system, and a\u00a0small RCT in AD patients randomized to vitamin D 1,600 IU\/d found clinical improvement after 60 days. The current study looked further into the immunologic changes and clinical effects of vitamin D supplementation in AD patients\u00a0(see Arch Allergy Immunol 2015;166:91\u201396\u200b<\/strong>).<\/p>\n

\"Atopic_dermatitis_child\"<\/p>\n

Details:<\/p>\n

–39 children with chronic AD\u00a0(mean age 4, 38% with family history of asthma, 87% family history of allergies, 33% of the kids had asthma and 33% had\u00a0rhinitis; 8% had mild AD\/46% moderate\u00a0and 46% severe; 90% with total IgE increased and\u00a023% had documented food allergy,\u00a021% for inhalants only;\u00a038% tested positive for dust mite allergen and\u00a044% for eggs. overall skin test positivity was present in 79%). These AD patients were compared with 20 nonallergic healthy controls.\u200b<\/p>\n

— baseline cytokine (IL-2, IL-4, IL-6, IFN-g, TNF-a)\u00a0and vitamin D levels were assessed, along with SCORAD (an AD clinical scoring system)\u00a0index.<\/p>\n

–then the patients were treated with vitamin D (1,000 IU\/day) for 3 months.<\/p>\n

–Families of AD patients were asked not to use topical steroids (6 did use them sporadically) or oral steroids (none used)<\/p>\n

Results:<\/p>\n

–all cytokines\u00a0except TNF-a\u00a0were elevated in the AD kids
\n–baseline vitamin D levels in the AD and control patients were similar (23 ng\/ml in AD group and 20 ng\/ml in controls)<\/p>\n

–after vitamin D supplementation, the vit D levels increased from 23 ng\/ml to 29 ng\/ml<\/p>\n

–the altered cytokines\u00a0\u00a0(IL-2, IL-4, IL-6, IFN-g)\u00a0were all statistically significantly and dramatically reduced after the vitamin D supplementation, and were within the range of the normal kids<\/p>\n

–the SCORAD index decreased from 46.13 +\/- 15.68 to 22.57 +\/- 15.28, p<0.001) — a SCORAD index\u00a0of 25-50 reflects moderate AD<\/p>\n

In terms of the role of helper T cell subsets, in brief Th1 cells are moere involved in immunity to intracellular pathogens and in autoimmunity; Th2 more with defense against parasites and with atopic diseases. the balance of Th1\/Th2 may be important in terms of disease progression. People with higher ratios and HIV infection have slower disease progression. The most significant initial cytokine associated with Th1 is IL-12, and also IFN-g. Th2 is most strongly associated with IL-4.<\/p>\n

Although there was no formal control in this study, they did find that those kids who did not adhere to the vitamin D supplementation or did not have much of a bump in their vitamin D levels did not have a significant change in their SCORAD index or cytokine levels. So, given the data that vitamin D may well be important in immune function in general and the results in this and the other study cited above, it certainly seems reasonable to me to check vitamin D levels and supplement in kids with atopic dermatitis.<\/p>\n","protected":false},"excerpt":{"rendered":"

By: Dr. Geoffrey Modest Atopic dermatitis (AD) is pretty common in kids (up to 25%), typically occurring early on (45% of cases begin within first 6 months of life, 60% within first year), and 70% remit spontaneously by adolescence. In those with AD there are significant immunologic changes (increase in Th2 cells and decrease in […]<\/p>\n

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