Atopic dermatitis and skin disease
Randomized trial of vitamin D supplementation for winter-related atopic dermatitis in children

https://doi.org/10.1016/j.jaci.2014.08.002Get rights and content

Background

Epidemiologic and preclinical data, and a small randomized 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 randomized, double-blind, placebo-controlled trial of Mongolian children with winter-related AD (clinicaltrials.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 randomly 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 clinically 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.

Section snippets

Methods

This randomized, double-blinded, placebo-controlled trial was conducted in Ulaanbaatar, Mongolia (latitude 48° N), in association with the National Dermatology Center, the Health Sciences University of Mongolia, and Harvard University. During February to March 2009, children were recruited from 8 dermatology outpatient clinics and 1 asthma outpatient clinic. Eligibility required winter-related AD, defined as a history of AD worsening during either the fall-to-winter transition or during cold

Results

A total of 148 children were assessed for eligibility, of which 41 were excluded (Fig 1). Most exclusions (38 of 41) were for children who had AD but not winter-related AD. This left 107 children in the trial. The median age of subjects was 9 years (IQR 4 years to 14 years), and 59% were male (Table I). The median age of AD onset was 3 months (IQR 2 months to 1 year). Most children (74%) had used topical corticosteroids previously for their AD, with 19% reporting use in the past week. The

Discussion

In this randomized, double-blind, placebo-controlled trial of 107 Mongolian children with winter-related AD, oral vitamin D supplementation with 1000 IU daily for 1 month produced a clinically and statistically significant improvement in AD severity. These findings build on our 2008 publication showing similar results in 11 Boston children.10 In both RCTs, the subjects were children with a specific subtype of AD (ie, winter-related AD) and, based on their northern location (Boston or Mongolia)

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  • Cited by (0)

    This trial was supported by Massachusetts General Hospital in Boston. Study agents and packaging were provided by Ddrops Company (Toronto, Ontario, Canada). Neither sponsor had any role in the design and conduct of the study; in the collection, analysis, and interpretation of the data; nor in the preparation, review, or approval of the manuscript.

    Disclosure of potential conflict of interest: The authors declare that they have no relevant conflicts of interest.

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