Vitamin D Reduces Atopic Dermatitis SeveritySeptember 2016
By Sharon Mintz
A recent study has confirmed that supplementation with vitamin D significantly reduces the severity of atopic dermatitis in as little as four weeks.1 Atopic dermatitis is a chronic, moderate-to-severe form of eczema, a skin disease that affects almost 18 million Americans of all ages.2
In general, people suffering from this condition have had very few effective treatment options, and these address only the symptoms while doing nothing to combat the disease itself. But now, a better understanding of the underlying causes of atopic dermatitis has opened the door to a targeted treatment that can address a critical factor behind atopic dermatitis flares.
Supporting the Body’s Natural Antibiotic
Symptoms of atopic dermatitis can range from dry, itchy skin and red rashes to severe flare-ups that produce open, weeping or crusted sores that may become infected with bacteria.2,3 These infections can progress to produce eye or eyelid problems, which can lead to sleep disruptions. The most severe cases may even require chronic drug therapy.3
This complex disorder has both genetic and environmental roots and appears to be related to allergic disorders and asthma, both of which involve abnormal immune system responses.4
Scientists have discovered that people with atopic dermatitis have a dangerously high percentage of the common bacteria Staphylococcus aureus on their skin’s surface. Staph organisms abound on human skin surfaces and are normally mixed with (and to some extent controlled by) other, less dangerous bacteria. But in people with atopic dermatitis, S. aureus grows out of control, constituting as much as 90% of the organisms found on the skin.1,5
Studies show that an increase in skin colonization with S. aureus is one of the most powerful triggers for atopic dermatitis “flares,” the period of time when the condition gets worse, which is then followed by a period of remission. In addition, it has been found that areas of affected skin in atopic dermatitis patients contain significantly higher densities of S. aureus.1,6
Typically, the body’s immune system produces its own natural antibiotic called cathelicidin, which targets several microorganisms, including S. aureus.1 But people with atopic dermatitis have low levels of cathelicidin. A key, then, to containing the out-of-control colonization of S. aureus is to boost levels of cathelicidin. One of the best ways to do that is with supplemental vitamin D.
The Role of Vitamin D
Previous studies have shown that vitamin D levels correlate strongly, and inversely, with the severity of atopic dermatitis, so higher levels mean less severe disease, and vice versa.7-9 Studies have also suggested that vitamin D supplementation has beneficial effects on atopic dermatitis symptoms.1,10-12 One of the reasons for these benefits is that the production of cathelicidin is strongly dependent upon vitamin D.13 In fact, supplementation with vitamin D was recently shown to boost cathelicidin levels, both in patients with atopic dermatitis and, to a lesser degree, in those with healthy skin.14
Now, a study published in Journal of the Medical Association of Thailand has confirmed previous findings that vitamin D supplementation significantly reduces S. aureus colonization, providing a key insight into how supplementation may prevent flares of the disease.1
Let’s take a look at the details of this exciting study.
Getting to the Root of Atopic Dermatitis
The patients included in this recent study all had mild-to-moderate atopic dermatitis as determined by a standard Scoring for Atopic Dermatitis (SCORAD) scale. At the beginning of the study, the researchers obtained skin cultures to determine the total number of S. aureus organisms. They also recorded the subjects’ SCORAD score, took automated readings of skin redness and skin moisture, and took digital photographs of skin lesions. Then, for the next four weeks, the patients received either 2,000 IU per day of vitamin D or a placebo.1
The results were impressive.
By the end of the study, the average SCORAD score among supplemented atopic dermatitis patients was about 56% lower compared with baseline.1 Supplemented subjects also experienced reductions in skin redness (erythema index) compared with placebo, although no significant change in skin moisture content was found. Importantly, while the placebo group experienced an increase in colonization with S. aureus, the subjects taking vitamin D had an approximate 46% reduction in S. aureus colonization.1 The decreases of both SCORAD score and skin colonization were shown to be correlated inversely with vitamin D levels: the higher the vitamin D level, the lower the rate of Staph colonization, and the lower (less severe) the SCORAD scores.
This study showed that daily supplementation with 2,000 IU of vitamin D for four weeks significantly reduced the severity of atopic dermatitis symptoms, and also reduced the degree of colonization with S. aureus, an organism known to be a factor in atopic dermatitis flares.
Vitamin D is already known to be safe at the doses used in this study, and no adverse effects were found during the study period.
Atopic dermatitis, a moderate-to-severe form of eczema, persists into adulthood in more than 10% of Americans.15 Treatment options have long been limited to topical creams and oral antihistamines to reduce symptoms, but they do nothing to change the underlying conditions.
The discovery of cathelicidins, vitamin D-dependent natural antibiotics, has led to an improved understanding of atopic dermatitis. It has also led to the realization that vitamin D supplementation might be an appropriate way to control atopic dermatitis.
The study reviewed here adds to that knowledge base by proving that vitamin D supplementation significantly reduces the presence of dangerous S. aureus on skin surfaces. Since increased colonization with that organism is a known contributor to disease severity, the demonstration that vitamin D reduces colonization provides further evidence of how the vitamin interacts with the human immune system to reduce both the symptoms and a critical factor in atopic dermatitis flares.
People who suffer from atopic dermatitis should supplement daily with at least 2,000 IU of vitamin D3 to boost their cathelicidin production, reduce colonization with offending organisms, and improve their skin condition.
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- Udompataikul M, Huajai S, Chalermchai T, et al. The Effects of Oral Vitamin D Supplement on Atopic Dermatitis: A Clinical Trial with Staphylococcus aureus Colonization Determination. J Med Assoc Thai. 2015;98 Suppl 9:S23-30.
- Hanifin JM, Reed ML. A population-based survey of eczema prevalence inthe United States. Dermatitis. 2007;18(2):82-91.
- National Eczema Association. Atopic Dermatitis. 2015; https://nationaleczema.org/eczema/types-of-eczema/atopic-dermatitis-2/. Accessed 30 March, 2016.
- Nutten S. Atopic dermatitis: global epidemiology and risk factors. Ann Nutr Metab. 2015;66 Suppl 1:8-16.
- Hauser C, Wuethrich B, Matter L, et al. Staphylococcus aureus skin colonization in atopic dermatitis patients. Dermatologica. 1985;170(1):35-9.
- Goh CL, Wong JS, Giam YC. Skin colonization of Staphylococcus aureus in atopic dermatitis patients seen at the National Skin Centre, Singapore. Int J Dermatol. 1997;36(9):653-7.
- Antal AS, Dombrowski Y, Koglin S, et al. Impact of vitamin D3 on cutaneous immunity and antimicrobial peptide expression. Dermatoendocrinol. 2011;3(1):18-22.
- Dombrowski Y, Peric M, Koglin S, et al. Control of cutaneous antimicrobial peptides by vitamin D3. Arch Dermatol Res. 2010;302(6):401-8.
- Peroni DG, Piacentini GL, Cametti E, et al. Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children. Br J Dermatol. 2011;164(5):1078-82.
- Amestejani M, Salehi BS, Vasigh M, et al. Vitamin D supplementation in the treatment of atopic dermatitis: a clinicaltrial study. J Drugs Dermatol. 2012;11(3): 327-30.
- Javanbakht MH, Keshavarz SA, Djalali M, et al. Randomized controlled trial using vitamins E and D supplementation in atopic dermatitis. J Dermatolog Treat. 2011;22(3):144-50.
- Sidbury R, Sullivan AF, Thadhani RI, et al. Randomized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston: a pilot study. Br J Dermatol. 2008;159(1):245-7.
- Schauber J, Gallo RL. The vitamin D pathway: a new target for control of the skin’s immune response? Exp Dermatol. 2008;17(8):633-9.
- Hata TR, Kotol P, Jackson M, et al. Administration of oral vitamin D induces cathelicidin production in atopic individuals. J Allergy Clin Immunol . 2008;122(4):829-31.
- Silverberg JI, Hanifin JM. Adult eczema prevalence and associations with asthma and other health and demographic factors: a US population-based study. J Allergy Clin Immunol. 2013;132(5):1132-8.
- Available at: http://www.washingtonpost.com/wp-dyn/content/article/2007/06/25/AR2007062501523.html. Accessed June 6, 2016.
- Available at: http://www.chron.com/news/houston-texas/article/U-S-deaths-from-staph-infections-surpass-AIDS-1794461.php Accessed June 14, 2016.
- Youssef DA, Miller CWT, El-Abbassi AM, et al. Antimicrobial implications of vitamin D. Dermatoendocrinology. 2011;3(4):220-9.