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Vitamin D Deficient in Atopic Dermatitis ?

Vitamin D deficiency rickets in an adolescent with severe atopic dermatitis.
Borzutzky A. et al. Pediatrics. 2014 Feb;133(2):e451-4. doi: 10.1542/peds.2013-1114. Epub 2014 Jan 27. Free article: http://pediatrics.aappublications.org/content/133/2/e451.long

Atopic dermatitis (AD) is a chronic eczematous condition which affects 10% to 20% of children worldwide.
Its severity may be inversely correlated with 25-hydroxyvitamin D (25OHD) levels. (Peroni et al. : http://www.ncbi.nlm.nih.gov/pubmed/21087229)

In this case report the authors report he case of a 14-year-old Chilean girl with severe AD and fish allergy since early childhood. She lived at high latitude and had less sun exposure and access to fish.
Clinical examination showed generalized acute and chronic eczematous lesions predominantly located on the face, back, and forearms. She had oozing and crusting lesions on the face and scalp. SCORAD score was 92. (Skin prototype was IV (Fitzpatrick))

She was diagnosed as having hypocalcemic rickets due to VD deficiency:
Blood tests showed elevated alkaline phosphatase and parathyroid hormone levels and low serum calcium; her serum 25OHD level was <12 nmol/L.
A radiograph of the wrist showed a radiolucent band in the distal metaphysis of the radius with marginal sclerosis.

Treatment consisted of the following*
Dietary counseling as well as sunexposure recommendations (suberythemal)
Oral Calcium supplements (20 mg/kg per day elemental calcium) and VD3 were prescribed. She received 1 VD3 dose of 150 000 IU, followed by weekly 10 000 IU per week for 6 months.
There is NO mention of topical treatment or skincare advice.

RESULTS
Clinically: dramatic improvement in her AD severity with VD treatment (SCORAD score decreased to 19). dramatic improvement in AD extent and intensity, minimal pruritus, and no sleep disturbance
From the lab: Treatment with VD increased her 25OHD level to 44 nmol/L, with normalization of alkaline phosphatase, parathyroid hormone, and calcium.

CONCLUSION
The authors suggest a high index of suspicion of rickets due to VD deficiency in all children with AD; particularly when growing fast and when presenting risk factors (darker skin, living at high latitude, sun avoidance, and low intake of VD-rich foods.
By studying rare diseases such as rickets and its improvement in AD with VD treatments, this warrants further research for VD ad a potential treatment for AD.

COMMENT
This interesting report shows how an oral supplementation of Vitamin D can improve an AD-like rash accompanied with food allergies. It also highlights the complex interaction between VD deficiency, AD, and food allergy
However this is an extreme case of vitamin deficiency combined with bone involvement
It would be interesting to see this in a prospective study the benefits of vitamin D in children with AD.

Article selection: Prof Dr Jean-Hilaire Saurat – dermatologist. Geneva, Switzerland