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The mixed findings of eczema and vitamin D

Posted on: July 19, 2013   by  John Cannell, MD

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Observational data on vitamin D and eczema, also called atopic eczema, is mixed. Some studies show low 25(OH)D levels are associated with less eczema and some studies show the opposite.

Recently Professor Christian Apfelbacher’s research lab at the University of Regensburg in Germany found that in children and adolescents, higher vitamin D levels were associated with a higher prevalence of eczema in their study population in Germany.

Heimbeck I, Wjst M, Apfelbacher CJ. Low vitamin D serum level is inversely associated with eczema in children and adolescents in Germany. Allergy. 2013 Jul;68(7):906-10.

Certainly, studies are mixed, some showing what Professor Apfelbacher’s group found and some showing the opposite. A recent metanalysis found vitamin D improved eczema.

Mutgi K, Koo J. Update on the role of systemic vitamin d in atopic dermatitis. Pediatr Dermatol. 2013 May-Jun;30(3):303-7.

Furthermore, there has been a randomized controlled trial showing some potential benefit in supplementing with vitamin D in eczema.

Hata TR, Audish D, Kotol P, et al. A randomized controlled double-blind investigation of the effects of vitamin D dietary supplementation in subjects with atopic dermatitis. J Eur Acad Dermatol Venereol. 2013; [Epub ahead of print]

However, this present German study used the largest sample size yet for an observational study, collecting data from 9838 children and adolescents. They did a cross sectional analysis, finding eczema was more prevalent in those with higher vitamin D levels. Weighted eczema prevalence increased with 25(OH)D category, yielding a prevalence of 10.5% in the children with the lowest levels, 14.2% in the second quartile, 14.6% in the third quartile, and 14.8%, in the quartile of children with the highest levels (P < 0.0001). As you can see, there was not much difference in eczema prevalence between the 2nd, 3rd, and 4th quartile. However, perplexingly, children with the very lowest levels, (< 8 ng/ml) had significantly less eczema.

What explains these mixed results?

  1. Lower levels may protect against eczema.
  2. There is some kind of confounding factor where children that don’t get outside much don’t have eczema, for whatever reason.
  3. Natural levels may protect against eczema.
  4. As the authors point out, some have hypothesized a U shaped curve for eczema, with those with high levels and low levels being protected against asthma. The authors did not break down their fourth quartile to see if children with levels above 40 ng/ml had less eczema.
  5. As eczema improves dramatically in the summer, it may be something else in sunshine, besides vitamin D, that helps eczema.

I used to have eczema every winter. I don’t remember if my eczema got better or worse when I first started supplementing on low dose of vitamin D (which I did for a year or so until I learned more about it). However, now my 25(OH)D is around 60 ng/ml and has been for many years and my eczema has disappeared.

I wonder if readers have noted that their eczema got better or worse with higher vitamin D supplementation. Please share your experiences.

7 Responses to The mixed findings of eczema and vitamin D

  1. Rita and Misty

    I don’t have eczema.

    But, I’m prone to psoriasis, along the hairline and through the brow line. It used to be significant, and painful.

    Upon my 25(OH) D level reaching 74 ng/ml, the psoriasis cleared up.

    My level as of January 2013 was 104 ng/ml…and in the spring my psoriasis did return–though in the very mildest pf forms.

    I am overdue to test my blood; however, I have been sunbathing since June–the the psoriasis has once again cleared up.

  2. Ian

    I have mentioned this before on VDC. I started my father (then 75) on vitamin D 100mcg daily. He had suffered severe “dermatitis” mainly of his hands throughout the winter months. There was little improvement at first but the next season saw a significant improvement. It has now been three years since going onto the vitamin D and he now takes 125mcg daily and has no “dermatitis” this winter.

  3. Rita and Misty

    Well, Eczema is considered an autoimmune disease, is it not?
    Vitamin d is powerful with respect to prevention and treatment of autoimmune diseases.

    Here is a link to one of my favorite journal articles regarding sunlight:

    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2290997/

  4. IAW

    To: Dr. Cannell
    First I will say that when my Vitamin D level was checked the first time it was 11ng/ml. Although very low, I did not have any skin issues except dry skin BUT did have a “gazillion” other symptoms/health problems. So for some of us even at low levels we do not exhibit “skin issues”. (This also goes for my husband and children.)

    Although I cannot access the entire study, I find a problem with this study in that it is “observational”. It appears that they used “patient surveys” to determine “skin issues”. I would assume if this study is about eczema, then one of the questions is “Do you have eczema?”

    So a quick check on the internet finds that psoriasis is “autoimmune” and that “eczema” is more allergy related. It also seems like the two can be misdiagnosed one for the other or can even be not either one of those but something else.

    So did the survey just ask do you have “eczema” or did it ask if you have “psoriasis” or even a “skin issue”? Maybe some of the “less than 8 ng/ml” have other skin issues! Were the less than 8 ng/ml perfectly healthy with no health issues?

    In my opinion, I am not sure a lot of these observational studies are going to help anyone. I like your #4, “The authors did not break down their fourth quartile to see if children with levels above 40 ng/ml had less eczema”. Don’t doubt yourself it’s the “D”!

  5. sunguy@localnet.com

    My Mother had bad skin problems on her hands. WE called it eczma, but I don’t know how it was described by her Dr.s. Also, I have had very dry skin [as long as I can remember] with scaly, peeling, itchy knuckles on my hands – particularly in the winter. No topical salve ever helped it to the point of making it go away. Not even cortizone Rx ointments! Last year I started Vd supplements and by Nov. had raised my level to ~47. This past winter I had NO PROBLEM with my hands! For the first time I can remember!

    Probably NOT coincidently, I started having digestive problems as a young child – with my height/weight being quite low compared to my compatriots by the age of 4-5 yo. Between 7& 12, I grew <1/4". At 12 I had a blockage, resolved by removal of 18" of small intestine. 4 yr of strong growth only had me at 4'8" at 16 when I got my drivers license. After that I grew to 5' 6 1/2". 4 more surgeries in college reduced my sm gut length to "<50cm" [Surgeons report] with ~1/3 of colon remaining. Sometime during this period my diagnosis was changed from "congenital malrotation" to Crohn's Disease. Crohns is an autoimmune disorder, most likely exacerbated by low Vd levels. I may have been Vd deficient since [or even B4] birth!

    Because of malabsorption due to my short gut, it took 20,000IU/day to get my level up to 47. After I get my next test this summer, I want to increase my supplements further, hoping to get my levels up to the ~70 region. Significant sun exposure is only possible for me in spring and fall because I can't drink enough to avoid dehydration if I sweat when it is hot.

    Back to skin problems vs Vd – my skin is still very dry, but I now have normal looking knuckles [that don't itch]! I definitely attribute my "cure" to the higher Vd levels.

    Thanks for all your work to promote Vd awareness!

    Wynn

  6. rcbaker200@comcast.net

    I couldn’t find the levels of vitamin D they are talking about from the link. However there may be an explanation that one study has shown a higher vitamin D level with eczema. Although there isn’t much vitamin D in dairy (milk), there is some. Children who drink a lot of milk may have a slightly but significantly higher level of vitamin D, although it’s most likely still low in most children. Eczema is connected to milk. So the eczema may be worse because of a significantly increased milk intake. I can’t prove this since the study didn’t like at these factors, but it’s a likely explanation.

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