A randomized, double-blind, placebo-controlled clinical trial of the effects of vitamin D supplementation among diagnosed atopic dermatitis patients

Background@#Atopic Dermatitis is an emerging public health concern. Recently, several studies have explored the role of Vitamin D in atopic dermatitis. To date, there is no local study using Vitamin D supplementation as an adjunct in the treatment of atopic dermatitis.@*Objective@#To determine the efficacy of Vitamin D supplementation in improvement of the disease severity in atopic dermatitis patients.@*Methods@#This is a Randomized, double blind, placebo-controlled clinical trial. The participants were newly diagnosed atopic dermatitis patients aged 19 to 50 years old. Participants were randomly assigned to take either 1 capsule of oral Vitamin D supplement (2200 IU/capsule) or a comparable placebo capsule, once daily for 60 days. Vitamin D level and disease severity using SCORAD index was evaluated at the start and end of the study.@*Results@#The mean value of serum Vitamin D levels at the start of treatment was deficient and comparable between the treatment and placebo group. The mean change in the serum Vitamin D levels of patients in the Treatment and Placebo group were 10.4 ng/mL ± 5.8 and -0.4 ng/mL ± 3.5, respectively. The mean change in the SCORAD index scores of patients in the Treatment and Placebo group were -20.2 ± 20.6 and 2.2 ± 6.8, respectively. Result of the two-sample independent t-test showed that the mean change in the SCORAD index scores significantly varied according to treatment group (p<0.0001).@*Conclusion@#The results from this study indicate that vitamin D supplementation may ameliorate clinical signs of the disease and can be considered as a safe and well-tolerated form of therapy.

Concentración sérica de prolactina en la dermatitis atópica y su relación con la gravedad de la enfermedad / Serum prolactin levels in atopic dermatitis and the relationship with disease severity

Antecedentes. La prolactina actúa como modulador neuroendocrino de la proliferación de las células epiteliales de la piel y del sistema inmunitario cutáneo. Objetivo. Evaluar la concentración sérica de prolactina en los pacientes con dermatitis atópica y su relación con gravedad de la enfermedad. Métodos. El estudio se llevó a cabo en 46 pacientes con dermatitis atópica y 100 controles sanos de entre 0,5 y 19,5 años. El diagnóstico de dermatitis atópica se basó en las manifestaciones clínicas y se documentó la gravedad de la enfermedad. Se tomaron muestras de sangre venosa para medir la concentración de prolactina. Resultados. La concentración de prolactina no difirió entre los pacientes con dermatitis atópica y los controles, y no se estableció una relación entre la gravedad de la dermatitis atópica y la concentración sérica de prolactina. La prolactina no participa en la patogenia de la dermatitis atópica. Se necesitan otros estudios con tamaños muestrales más grandes y la medición de la concentración de prolactina en la piel para comprender la función de la prolactina en la patogenia de la dermatitis atópica.

Background. Prolactin performs as a neuroendocrine modulator of skin epithelial cell proliferation and the skin immune system. Objective. The aim was to assess the serum prolactin levels in patients with atopic dermatitis and the relationship with disease severity. Methods. The study was performed on 46 patients with atopic dermatitis and 100 healthy controls aged between 0.5 years and 19.5 years. The diagnosis of atopic dermatitis was based on clinical findings and the severity of the disease was documented. Venous blood sampling was performed in order to measure prolactin levels. Results. Prolactin levels in atopic dermatitis were not different from controls and there was no relationship between the severity of atopic dermatitis and serum prolactin levels. Prolactin may not have a role in the pathogenesis of atopic dermatitis. Further studies with larger sample sizes and measurement of prolactin levels in the skin may help to understand the role of prolactin in the pathogenesis of atopic dermatitis.

Significance of Malassezia-specific IgE in children with dermatitis involving the head and neck

PURPOSE: Even though Malassezia yeast may play an important role in the exacerbation of atopic dermatitis (AD), only a few studies of Malassezia infection have been conducted in children with AD. Thus, we compared each of clinical findings, including the severity of head and neck dermatitis and laboratory results depending on specific IgE against Malassezia furfur. METHODS: This cross-sectional study was carried out on 121 children aged 3 months to 18 years between April and July of 2014. Retrospective data was collected using the medical records, and patients were divided into 2 groups according to the presence of Malassezia sensitization. RESULTS: Specific IgE against Malassezia (group 1) was observed in 28 of all patients (23.1%). Group 1 children were at an older age (9.1+/-6.9 vs. 2.1+/-3.7, P<0.001). Group 1 children had a higher SCORing Atopic Dermatitis (SCORAD) index (46.4+/-21.0 ng/mL vs. 37.2+/-13.4 ng/mL, P=0.001), and total IgE (1,324.2+/-1,166.0 IU/mL vs. 209.5+/-532.5 IU/mL, P<0.001) compared to group 2 children (Malassezia-). In the group 1, the correlation between the Malassezia-specific IgE and 25-hydroxyvitamin D3 was negatively weak (r=-0.106) and not statistically significant (P=0.246). Furthermore, Malassezia-specific IgE and the SCORAD index (r=0.281, P=0.002) or total IgE (r=0.380, P<0.001) were positively correlated. CONCLUSION: The results of this study suggest that specific IgE against M. furfur may be helpful in assessing the severity of prepubertal children and early adolescents with AD involving the head and neck.

Correlation between Severity of Atopic Dermatitis and Sleep Quality in Children and Adults

BACKGROUND: The atopic dermatitis (AD) can limit a patient's physical and psychosocial development as well as lower their overall quality of life (QOL), including sleep quality. OBJECTIVE: The purpose of this study was to evaluate the relationships between clinical disease severity, QOL and sleep quality in children and adults with AD. METHODS: The SCORing atopic dermatitis (SCORAD) was examined to evaluate the severity of AD in fifty adult AD patients and 50 children AD patients. A questionnaire based on the children's sleep habits questionnaire (CSHQ) and the children's dermatology life quality index (CDLQI) were used to evaluate QOL and sleep disturbance in children AD patients. The Pittsburgh sleep quality index (PSQI) and dermatology life quality index (DLQI) were used in adult AD patients. RESULTS: The SCORAD and CSHQ score, the SCORAD and CDLQI score and the CSHQ and CDLQI score demonstrated significant correlations. The SCORAD and PSQI score showed no significant correlation. However, there were significant correlations between the SCORAD and DLQI score and the PSQI and DLQI score. CONCLUSION: Increasing severity of AD affects sleep quality in child AD patients. In adults, even though the total score of the sleep questionnaire is not associated with the severity of AD, two components of sleep questionnaire are associated with the severity of AD. There is a significant correlation between sleep quality and QOL in both children and adults. Therefore, we suggest that evaluating the sleep quality as well as clinical severity of the disease is necessary in the management of AD patients.

The importance of IL-31 in pruritus in patients with atopic dermatitis / Шинэ санаа Шинэ нээлт

Atopic dermatitis is a common, chronic, relapsing, allergic skin disease characterized by stronglypruritic eczematous skin lesions. Pruritus is the hallmark of atopic dermatitis, with a significant impact on quality of life for the patients. Many patients define their disease severity by the intensity of pruritus rather than by the appearance of skin lesions. Although the pruritus is one of the most essential symptoms of atopic dermatitis, its pathophysiology is still unclear. The lack of effect of antihistamines argues against a role of histamine in causing atopic dermatitis–related pruritus. Neuropeptides, proteases, kinins, and cytokines induce itching. In the early stages of atopic dermatitis Th2 cellsplay a significant role. Interleukin-31 is a cytokine produced by T cells that increases the survival ofhematopoietic cells and stimulates the production of inflammatory cytokines by epithelial cells. Our study aim is to investigate the correlation between the serum level of IL-31 and the severity of disease.A total of 80 participants with a diagnosis of atopic dermatitis based on the Hanifin and Rajka criteriaare selected from all patients of the National Dermatology center. A questionnaire consisting of theparticipant’s general information and disease history is obtained. The severity of disease is assessed by using SCORAD (Scoring atopic dermatitis) and patients with AD will be grouped into mild ( 50 points) disease groups. Serum IL-31 is measured using ELISA from peripheral blood.The main symptoms were pruritis (91,3%) and xerosis (78,8%). The serum IL-31 and NGF was higher in severe patients while the pruritus and sleep loss were stronger in those patients. Serum IL-31 was significantly correlated to Scorad index and sleep loss (р<0,05).IL-31 could be itch biomarkers. IL-31 has a role in pathogenesis of pruritus and atopic dermatitis.

Correlation between serum 25-hydroxyvitamin D levels and severity of atopic dermatitis in children

PURPOSE: Vitamin D deficiency has been suggested to play a role in the pathogenesis of atopic dermatitis. In addition, inverse correlationship between serum 25-hydroxyvitamin D concentration and severity of atopic dermatitis has been suggested. METHODS: Clinical and laboratory parameters including serum 25-hydroxyvitamin D level and serum total IgE of 251 patients with atopic dermatitis who were 13 months to 18 years were measured. Severity of atopic dermatitis was assessed with SCORing Atopic Dermatitis (SCORAD) index. Statistical analysis was performed using Pearson correlation coefficient, one-way analysis of variance test and chi-square test. RESULTS: Among 251 patients, vitamin D deficiency (25-hydroxyvitamin D or =30 ng/mL, group 3) was present in 74 (29.5%). There was a statistically significant inverse correlation between serum concentration of 25-hydroxyvitamin D and values of SCORAD index (R=-0.24, P<0.000). Serum concentration of 25-hydroxyvitamin D were inversely correlated with total IgE (R=-0.29, P<0.000), and age (R=-0.49, P<0.000). CONCLUSION: The results from this study indicate that serum concentration of 25-hydroxyvitamin D is inversely correlated with clinical severity of atopic dermatitis in children.

The correlation between the severity of atopic dermatitis classified by SCORing atopic dermatitis index and the laboratory tests

PURPOSE: SCORing atopic dermatitis (SCORAD) index is the best validated scoring system in atopic dermatitis (AD). But this scoring system has limitation to the interobserver and intraobserver variation. This study was designed to evaluate the correlation between the severity of AD classified by the SCORAD index and the laboratory tests. METHODS: We evaluated 67 children admitted in the pediatric allergy and respiratory division of Busan St. Mary's Medical Center from April 1 to 30, 2011. SCORAD index was measured by one same physician. The patients were classified into mild to moderate and severe groups by SCORAD index. We identified sex, age and family history of allergic disease. We checked laboratory tests including mycoplasma immunoglobulin (Ig) M, total IgE, eosinophil count, eosinophil cationic protein, specific IgE, total protein, albumin, IgG, IgA, IgM, IgD, and inflammatory index (lactate dehydrogenase, C-reactive protein, erythrocyte sedimentation rate) and skin culture. RESULTS: There were no statistically significant differences between two groups in age, sex, parental allergic history, skin culture, mycoplasma IgM, specific IgE, immunoglobulin, and inflammatory index. The SCORAD index has statistically significant positive correlations with serum total eosinophil count, and total IgE, and negative correlations with total protein, and albumin. CONCLUSION: Our study suggest that serum total eosinophil count, total IgE, total protein, and albumin can be used to evaluate the severity of AD and make up for the SCORAD index.

Effect of Probiotics on the Treatment of Children with Atopic Dermatitis

BACKGROUND: Atopic dermatitis, a chronic recurrent disease, is frequently encountered in clinical practice. In the last 30 years, the prevalence of atopic dermatitis has rapidly increased due to industrialization. Therefore, there have been attempts in recent years to find new ways of treating and preventing atopic dermatitis. OBJECTIVE: In this double-blind, randomized, placebo-controlled study, a combination of Bifidobacterium bifidum, Lactobacillus acidophilus, Lactobacillus casei, and Lactobacillus salivarius strains were evaluated in the treatment of atopic dermatitis in pediatric patients. METHODS: Forty pediatric patients (23 males and 17 females) aged 1~13 years were enrolled. One eligible individual who was approached declined to participate. The probiotic group was administered a probiotic complex containing B. bifidum, L. acidophilus, L. casei, and L. salivarius for 8 weeks. The placebo group, on the other hand, was administered skim milk powder and dextrose. All of the parameters including serum cytokines, eosinophil cationic protein), SCORing Atopic Dermatitis (SCORAD) index, and total serum immunoglobulin E (IgE) were measured in both the probiotic group and the placebo group at the end of 8 weeks. RESULTS: Probiotic intervention in pediatric atopic dermatitis patients effectively reduced the SCORAD index and serum cytokines interleukin (IL)-5, IL-6, interferon (IFN)-gamma, and total serum IgE levels, but did not reduce levels of serum cytokines IL-2, IL-4, IL-10, ECP, or tumor necrosis factor-alpha (TNF-alpha) compared to the placebo group. CONCLUSION: Our study found probiotics to be effective in reducing atopic dermatitis patients' SCORAD index, serum IL-5, IL-6, IFN-gamma, and total serum IgE levels but not effective in reducing serum IL-2, IL-4, IL-10, ECP, or TNF-alpha levels.

The Correlation between SCORAD Index and Instrumental Assessment in Evaluation of Atopic Dermatitis Severity / 대한피부과학회지

BACKGROUND: Atopic dermatitis is a chronic relapsing inflammatory skin disease characterized by dry skin, pruritus, and typical distribution of the lesions. Because an objective tool for the assessment of disease severity of atopic dermatitis has yet to be agreed upon, many dermatologists are dependent on subjective history and clinical scoring. Recently, instrumental measurements have been used for the assessment of skin barrier function. OBJECTIVE: The purpose of this study was to assess the correlation between SCORAD (scoring of atopic Dermatitis) index and the results of instrumental assessments of disease severity in atopic dermatitis. Additionally, we compared the values of instrumental measurements on normal and lesional skin. METHODS: From February to April 2007, 44 patients with atopic dermatitis were treated with topical steroids, topical calcineurine inhibitors, oral antihistamine agents and systemic steroids. At initial visit, and after 1, 2, 3, and 4 weeks of treatment, the SCORAD index was measured, and instrumental measurements of skin surface hydration (SSH), transepidermal water loss (TEWL), and pH were performed on the antecubital fossa (lesional skin) and flank (normal skin) of the patients by Corneometer(R), Tewameter(R), and skin-pH-meter(R). RESULTS: Significant correlation was found between SCORAD index and SSH (p<0.0001), TEWL (p<0.0001), and pH (p=0.1680). SSH and TEWL improved within 1 week of treatment but pH improved after 2 weeks of treatment. Instrumental assessments showed lesional skin had lower SSH, higher TEWL, and more alkaline pH than normal skin. CONCLUSION: Instrumental measurements showed correlation with SCORAD index. Therefore, we can use instrumental assessments as well as SCORAD index in the assessment of disease severity of AD.

The Effect of Montelukast in the Treatment of Atopic Dermatitis through the SCORAD Index / 대한피부과학회지

BACKGROUND: Atopic dermatitis (AD) is a chronic, relapsing, inflammatory skin disease, with genetic and environmental background. The pathogenesis is complex, and although the dermatitis fades during childhood in most cases, the course is unpredictable. Leukotrienes are potent proinflammatory mediators derived from arachidonic acid through the 5-lipoxygenase pathway. Leukotrienes are likely to play a role in the inflammation seen in AD. It is therefore of interest to attempt to reduce the activity of AD by the use of leukotriene antagonists. Montelukast (Singulair(R)) has shown promising results in the treatment of both children and adults with AD, and the safety profile of this medicament is excellent. OBJECTIVE: The objective of our study was to evaluate the efficacy of montelukast for severe AD. METHODS: Thirteen patients with moderate to severe AD were treated with montelukast. The dose of montelukast was 10 mg/day for 8 weeks. At enrollment and on each follow-up visit, every patient was assessed by a single observer and objectively scored for disease extent and severity using SCORing Atopic Dermatitis (SCORAD). In 6 of 13 patients, we measured serum cysteinyl leukotriene levels before and after treatment using ELISA and checked serologic marker such as total Ig E at the first visit and eosinophil counts at every follow-up visit. RESULTS: Patients with a median (range) age of 18.2 (7~38) years participated in the study. Their median SCORAD scores before treatment, at first follow-up (mean 4 weeks later), and at second follow-up (mean 8 weeks later) were 52.4, 35.7, and 29.5. All components of SCORAD (extent, intensity, symptoms) of all patients and eosinophil counts (n=6) had decreased significantly except the extent. Serum cysteinyl leukotriene levels (n=6) had decreased, but not significantly. CONCLUSION: According to our study, montelukast is an effective medicament in the treatment of severe AD patients. So we can take a montelukast as an alternated agent instead of steroid and immunosuppressant agents in severe AD.

The Effect of Skin-colonizing Staphylococcus aureus and Its Exotoxins on Childhood Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Staphylococcus aureus and its exotoxins have been regarded as having an influence on atopic dermatitis(AD). We aimed to examine the prevalence of S. aureus in the AD lesion, the types of the exotoxins, and the relationship between S. aureus and AD. METHODS: AD patients(n=32) and a normal control group(n=20) were enrolled. The severity of AD was measured by SCORAD index. Through skin culture and PCR, we tried to identify S. aureus and its exotoxins. RESULTS: S. aureus was isolated from 18(56 percent) out of 32 AD patients and its exotoxins were identified from 10(31 percent) out of them. The exotoxin types were as follows; sea in 4, eta in 3, sea+tst-1 in 1, sea+see in 2 patients. On the contrary, S. aureus was isolated from only 1(5 percent) out of 20 subjects of the normal control group, and its exotoxin type was sea. The SCORAD index in the S. aureus(+) group was higher than in the S. aureus(-) group, however it was not significant.(44+/-14.2 vs 38+/-17.1, P= 0.304) The SCORAD index was higher in the exotoxin(+) group than in the exotoxin(-) group(49+/-11.2 vs 38+/-16.2, P<0.05). The prevalence of S. aureus and its exotoxins in the AD group was higher than in the normal control group(P<0.001, P<0.05, respectively). The difference of SCORAD index was significant between the exotoxin(+) group and the exotoxin(-) group, but not between the S. aureus(+) group and S. aureus(-) group.(P<0.05, P= 0.304, respectively) CONCLUSION: The exotoxins of S. aureus were found to influence the severity of AD.

Relationship between Severity of Childhood Atopic Dermatitis and Subject's Characteristics Including Psychological, Behavioral and Familial Problems / 대한피부과학회지

BACKGROUND: Previous studies suggest that children with atopic dermatitis (AD) often exhibit psychological, behavioral and familial problems. OBJECTIVE: This study was to assess the relationship between severity of AD and the subject's characteristics. METHOD: Participants included 31 children, aged 7 to 12 years old, who had been treated for AD. They were examined by dermatologists using the Severity Scoring of AD (SCORAD) index, and also completed questionnaires including State-Trait Anxiety Inventory for Children (STAI-C), coping strategies, and the self-reported Strengths and Difficulties Questionnaire (SDQ-S). Participants' mothers were asked to complete the demographic data, Dermatitis Family Impact questionnaire (DFI) and the Korean version of SDQ (SDQ-Kr). All participants completed the wrap-up questionnaires at the end of the AD Camp. RESULTS: In 27 paired participants, the SCORAD index was associated with the number of friends, number of self-avoiding foods, total scores of DFI, subscales of food preparation, cost related to treatment, exhaustion, emotional distress, and the main carer's life. The associations were different according to gender: boys were associated with anxiety, but girls were associated with weight, and number of foods which their mother had avoided to give them. In multivariate analysis, SCORAD was significantly associated with the number of friends. In girls, the cost related to treatment was associated with SCORAD. CONCLUSION: The results suggest that the psychological and familial dimensions of AD should be taken into account as a part of AD routine management in Korea. Further research is needed to establish the effectiveness of any comprehensive intervention with atopic dermatitis.

Soluble E-selectin as A Clinical Marker of Disease Activity in Atopic Dermatitis / 소아알레르기및호흡기학회지

PURPOSE: Augmentation in the expression of E-selectin on activated vascular endothelial cells regulates leukocyte migration into the tissue. These molecules are also shed into the circulation as a soluble form. The level of soluble forms in the serum has been known to be correlated with those expressed on the endothelial cells, thus it can be used as a marker of inflammation in that tissue. The purpose of this study is to compare the serum levels of soluble E-selectin(sE-selectin) in patients with atopic dermatitis(AD), atopic asthmatics, and healthy non-atopics, and to determine whether sE-selectin levels are correlated with disease activity in patients with atopic dermatitis. METHODS: We examined serum sE-selectin levels, serum total IgE levels, and total eosinophil counts from 18 children with AD, 15 atopic asthmatics and 15 healthy non-atopics. The severity of AD was assessed by clinical scoring(SCORAD index). We compared the sE-selectin levels among the three groups and investigated the correlations with SCORAD index. RESULTS: The children with AD had significantly higher levels of sE-selectin than those of atopic asthmatics(P<0.05) and of healthy non-atopics(P<0.05). There was no difference in the serum sE-selectin levels between the groups of atopic asthmatics and healthy non- atopics. Serum sE-selectin levels were correlated with SCORAD index in patients with AD, (P<0.05) but not significantly correlated with serum total IgE levels and total eosinophil counts. There were no significant correlations among SCORAD index, serum total IgE levels, and total eosinophil counts. CONCLUSION: The serum sE-selectin level is elevated only in patients with AD, not in atopic asthmatics. Therefore, sE-selectin could be considered as a useful marker of the disease activity in AD.