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Eczema

Posted on: June 20, 2018   by  John Cannell, MD

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If I have eczema, should I take vitamin D?

Yes, absolutely. Of all the health conditions helped by vitamin D, few respond as well as eczema. Solid scientific evidence supports that statement as you can read below. In fact, vitamin D’s effects on eczema are so robust, if you don’t respond, it may not be eczema. It usually takes 2-3 months to respond but this will depend on what vitamin D blood level you achieved.

The dose is usually between 5,000 – 15,000 IU (125 – 375 mcg)/day. No two achieve the same blood level after taking vitamin D, which is why the dosage range is so great. First have a vitamin D blood level done, either at your doctors or use one of our in-home test kits. Then, you need to take enough vitamin D for several months to get your vitamin D blood level above 50 ng/ml. You can go to your doctor or purchase one of our in-home vitamin D test kits.

How do you know vitamin D helps eczema?

The best scientific study to decide if a treatment is effective, is a meta-analysis, which is a combination of multiple clinical trials.  There are at least two separate meta-analyses [1],[2],[3]  showing that vitamin D is an effective treatment for eczema (Kim and Bae, 2016, Nutrition) and (Samochocki et al, 2013, J Am Acad Dermatol).

In children, the response to vitamin D is sometimes quicker than adults. Camargo et al (2014, J Allergy Clin Immunol.) found that even 25 mcg/day (1,000 IU) improved eczema within a month. Amestejani et al (2012, J Drugs Dermatol.) were among the first to notice that “vitamin D dramatically improved disease severity in AD patients.” Javanbakht et al (2010, J Dermatolog Treat.) also found 1600 IU of vitamin D helped eczema but they found the vitamin D worked even better when combined with 600 IU of vitamin E.

If you have eczema, you really should try vitamin D, but you must take adequate doses. Take between 125 to 375 mcg/day (5,000 to 15,000 IU).  You should have a vitamin D blood test before you start and again in about two months. Most people will have adequate vitamin D levels with the above dose, but some people will need more, especially if they are overweight.  Once your eczema improves or disappears, remember it will return if you stop the vitamin D.

More about eczema

Eczema, also known as atopic dermatitis, is a chronic skin disorder that causes inflammation and red, dry, rough, and itchy skin. Eczema is most common in infants and young children, but you can also develop the disorder as an adult and continue to have it as an adult. In the United States it is incredibly common, affecting about 10-30% of people.

Scientists are not sure what exactly causes eczema, but they think it’s a combination of genetics and the environment. People with eczema have immune systems and skin barriers that do not function properly.

At least a dozen studies have found that both children and adults with eczema are more likely to have low levels of vitamin D. Research has also found that people who have eczema and low levels of vitamin D are more likely to get infections on their skin.

eczemaWhen you have eczema, there are periods of flare-ups, called exacerbations, when your skin is very itchy and inflamed, and periods of remission, when you don’t experience symptoms of the disease. Remission tends to be more common in the summer.

About half of all children with eczema will also develop asthma. People with eczema can get severe skin infections, sometimes requiring hospitalization. Constant itching and scratching can damage the barrier of the skin and allow bacteria to get past the surface of the skin.

What are the symptoms of eczema?

Symptoms of eczema include:

  • Red or grayish patches on the skin
  • Severe itching
  • Small bumps on the skin, which may leak fluid
  • Cracked and scaly skin
  • Sensitive or raw skin

Usually, eczema causes you to develop itchy patches on your hands, feet, elbows, behind the knees, face, neck, and ankles. However, these patches can occur anywhere on your body. Eczema can even affect your eyes, causing itchy, red, and swollen areas around them.[4]

How common is eczema?

Eczema is very common; about 10-25% of children and 3% of adults have this condition.[5] There are some factors that can increase your risk of developing eczema, including:[6], [7]

  • Socioeconomic status: People with higher socioeconomic status and higher education levels are less likely to develop eczema.
  • Family history: People who have a family member with eczema are more likely to develop it.
  • Gender: Females are more likely to have eczema.
  • Gestational age: Children born to older women are more likely to develop eczema.
  • Location: People who live in urban areas, cold climates, industrialized countries, or northern latitudes are more likely to have eczema.[8]

What causes eczema?

Scientists are not sure what exactly causes eczema, but they think it’s a combination of the genes you are born with and the environment you live in. When you have eczema, there are certain triggers (from association studies) that can make your eczema flare up and become worse, including: 4,[9]

  • Soaps, perfumes and makeup
  • Dust and sand
  • Chlorine
  • Cigarette smoke
  • Air pollution
  • Stress
  • Illnesses or infections
  • Low vitamin D levels

What is the link between vitamin D and eczema?

Vitamin D is an important part of the immune system. When you have eczema, your immune system and skin barrier don’t work properly. A number of studies have found that people with eczema are more likely to have lower levels of vitamin D.[10], [11], [12], [13]

epidermisVitamin D receptors are found on the surface of a cell and genes inside the cell, where they bind activated vitamin D. By attaching themselves to a vitamin D receptor, vitamin D helps direct the way the genes in the cell make their proteins.

Vitamin D also increases amounts of good antimicrobial proteins in the skin, such as cathelicidin, which help destroy invading germs and viruses.

This combination of lowering inflammation and increasing antimicrobial defenses can help your immune system fight infections better. Vitamin D also helps repair the broken barriers of your skin. Having enough vitamin D in your body seems to help prevent skin infection, lower inflammation and improve barrier function in people with eczema.

What does the research say in general about vitamin D and eczema?

Preventing eczema

Not many studies have been conducted that analyze the effect of vitamin D on preventing eczema. A lot of research has shown that people who have low levels of vitamin D are more likely to have eczema. Research has also found that children whose mothers had low levels of vitamin D during pregnancy are at a higher risk of developing eczema.[14]

A study conducted on pregnant mothers and their children found that babies with the lowest level of vitamin D at birth had the highest risk of developing eczema by age 5.[15] Research evaluating Chinese children found that having very low levels of vitamin D was strongly linked to having eczema.[16]

A study published in 2012 in Australia looked at pairs of mothers and their newborn infants. The researchers looked at vitamin D levels in the mothers and newborns and whether the infants developed eczema. They found that:[17]

  • Eczema is incredibly common in infants; about one-third of the infants had eczema.
  • Vitamin D levels at birth were lowest in the infants who developed eczema in their first year of life.
  • Every 4 ng/ml increase in vitamin D levels in the newborns was linked to a 13% lower risk of developing eczema.

A newborn’s vitamin D level is about 2/3 of its mother’s vitamin D level. The researchers concluded that low levels of vitamin D in mothers during pregnancy may be related to their infants developing eczema. Improving vitamin D levels in pregnant women may help prevent eczema in their children.

Treating eczema

Most studies have suggested that vitamin D plays a role in both the cause and treatment of eczema. People with eczema who have low levels of vitamin D tend to have worse symptoms and a graded relationship exists, i.e. the lower 25(OH)D the worse the eczema, which is strong evidence that vitamin D is involved in eczema.

A study done on children with eczema and allergies found that those with the lowest levels of vitamin D had the most severe form of the disease.[18]  In addition, a large meta-analysis found that supplemental vitamin D helps treat eczema. 13

An experiment done in 2012 gave people over age 14 with eczema either 1600 IU of vitamin D (which is a low dose) or a dummy pill daily for 60 days. The researchers looked at eczema severity and symptoms between the 2 groups. They found that:[19]

  • The vitamin D treatment group showed more improvements in eczema symptoms than the dummy pill group.
  • The severity of eczema was much lower after people took vitamin D supplements for 60 days.

Another study gave children either 1,000 IU of vitamin D or a dummy pill for one month. They found that:[20]

  • The IGA (protein involved with the immune system) score improved in 80% of the children taking vitamin D.
  • The IGA score improved in only 17% of children taking the dummy pill.

The researchers also said that worsening eczema symptoms during the winter months for some people may be related to lower vitamin D levels from reduced sunlight exposure.

A study published in Poland gave vitamin D supplements to adults with eczema who also had low levels of vitamin D. The people all received 2,000 IU of vitamin D daily for three months in the wintertime. The researchers looked at eczema severity and symptoms before and after supplementation. They found that:[21]

  • People with the lowest vitamin D levels at baseline had more skin infections.
  • After supplementing with vitamin D, the eczema symptoms and severity score were much lower.
  • People who took vitamin D supplements had significant improvements in infectious skin lesions.

Key points from the research

  • Vitamin D is effective in treating eczema.
  • People who have eczema have lower levels of vitamin D.
  • The lower one’s vitamin D, the worse one’s eczema.
  • Vitamin D helps the immune system reduce levels of inflammation and strengthen skin barriers.
  • People who have eczema and low levels of vitamin D are more likely to develop skin infections.
  • Maintaining healthy levels of vitamin D may be a way to help manage eczema symptoms.

What does this mean for me?

happy familyThis research shows that eczema is helped by adequate doses of vitamin D. Although 2,000 IU (50 mcg)/day may improve eczema, supplementing with 5,000 – 15,000 (125 – 375 mcg)/day may well completely resolve eczema.

Also, most of this research has shown that having high enough levels of vitamin D may reduce your risk of developing eczema. Research has shown that healthy vitamin D levels will help manage eczema. Again, people who take vitamin D supplements have less eczema, lower disease activity and fewer skin infections.

If you have eczema and want to take vitamin D, it’s very unlikely this will make your eczema worse or cause you any harm, as long as you take less than 15,000 IU per day. If you take over 10,000 IU (250 mcg)/day, you should check your vitamin D level.

Dr. Cannell shared his experience with eczema in a recent blog, which can be viewed here. If you have suffered with eczema and take vitamin D, please consider emailing the Vitamin D Council team at info@vitamindcouncil.org to share your story.

Citation

John Cannell, MD. Health Condition: Eczema. The Vitamin D Council Blog & Newsletter,  6/2018.

References

[1] Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis: A Systematic Review and Meta-Analysis. Nutrients. 2016 Dec 3;8(12). pii: E789. Review.

[2] Kim G, Bae JH.Vitamin D and atopic dermatitis: A systematic review and meta-analysis. Nutrition. 2016 Sep;32(9):913-20. doi: 10.1016/j.nut.2016.01.023. Epub 2016 Feb 18. Review.

[3] Samochocki Z, et al.Vitamin D effects in atopic dermatitis. J Am Acad Dermatol. 2013 Aug;69(2):238-44. doi: 10.1016/j.jaad.2013.03.014. 

[4] http://www.mayocliic.org/diseases-conditions/eczema/basics/symptoms/con-20032073

[5] Silverberg JI. Atopic Dermatitis : An Evidence-Based Treatment Update. Am J Clin Dermatol. 2014.

[6] http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/atopic-dermatitis/

[7] http://www.webmd.com/skin-problems-and-treatments/eczema/tc/atopic-dermatitis-topic-overview

[8] Borzutzky A, Camargo. Role of vitamin D in the pathogenesis and treatment of atopic dermatitis. Expert Rev Clin Immunol. 2013;9(8):751–3.

[9] Muehleisen B, Gallo RL. Vitamin D in allergic disease : Shedding light on a complex problem. J Allergy Clin Immunol. 2013;131(2):324–329.

[10] Ehlayel M, Bener A, Sabbah A. Is high prevalence of vitamin D deficiency evidence for asthma and allergy risks? Eur Ann Allergy Clin Immunol. 2011;43(3):81–88.

[11] Cheng HM, Kim S, Park G, Chang E. Low vitamin D levels are associated with atopic dermatitis , but not allergic rhinitis , asthma , or IgE sensitization , in the adult Korean population General characteristics. J Allergy Clin Immunol. 2012;133(4):1048–1055.

[12] Litonjua AA. Vitamin D deficiency as a risk factor for childhood allergic disease and asthma. Curr Opin Allergy Clin Immunol. 2012;12(2):179–185.

[13] Dombrowski Y, Peric M, Koglin S, Ruzicka T, Schauber J. Control of cutaneous antimicrobial peptides by vitamin D3. Arch Dermatol Res. 2010;302:401–408.

[14] Kim MJ, Kim SN, Lee YW, Choe YB, Ahn KJ. Vitamin D Status and Efficacy of Vitamin D Supplementation in Atopic Dermatitis: A Systematic Review and Meta-Analysis. Nutrients. 2016 Dec 3;8(12). pii: E789. Review.

[15] Akan A, Azkur D, Ginis T, Toyran M, Kocabas CN. Vitamin D Level in Children Is Correlated with Severity of Atopic Dermatitis but Only in Patients with Allergic Sensitizations. Pediatr Dermatol. 2013;30(3):359–364.

[16] Baiz N, Dargent-Molina P, Wark J, Souberbielle J-C, Annesi-Maesano I. Cord serum 25-hydroxyvitamin D and risk of early childhood transient wheezing and atopic dermatitis. J Allergy Clin Immunol. 2014;133:147–153.

[17] Peroni DG, Piacentini GL, Cametti E, Chinellato I, Boner AL. Correlation between serum 25 -hydroxyvitamin D levels and severity of atopic dermatitis in children. Br J Dermatol. 2011;164:1078–1082.

[18] Bäck O, Blomquist HKS, Hernell O, Stenberg B. Does vitamin D intake during infancy promote the development of atopic allergy? Acta Derm Venereol. 2009;89(1):28–32.

[19] Jones AP, Palmer D, Zhang G, Prescott SL. Cord blood 25-hydroxyvitamin D3 and allergic disease during infancy. Pediatrics. 2012;130(5):e1128–35.

[20] Amestejani M, Salehi BS, Vasigh M, Sobhkhiz A, Karami M, Alinia H. Vitamin D supplementation in the treatment of atopic dermatitis: a clinical trial study. J drugs dermatology. 2012;11(3):327–330.

[21] Sidbury R, Sullivan A, Thadhani R, Jr CAC. Randomized controlled trial of vitamin D supplementation for winter-related atopic dermatitis in Boston : a pilot study. Br J Dermatol. 2008;159:245–248.

[22] Samochocki Z, Bogaczewicz J, Jeziorkowska R, Al E. Vitamin D effects in atopic dermatitis. J Am Acad Dermatol. 2013;69(2):238–244.

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