Researchers from Pontificia Universidad Católica de Chile in Santiago, Chile, recently reported on an interesting case from their hospital in the journal Pediatrics.
The doctors reported on a 14-year old girl with severe atopic dermatitis. Atopic dermatitis (AD) is a chronic and relapsing inflammatory skin condition, with symptoms like dry itchy skin and hyperresponsiveness to allergens. It affects 10 to 20% of children worldwide.
In this case, the girl had a history of AD since early childhood. When she presented to the doctors, eczema (inflammation of the skin) covered most of her skin. She had a history of poor response to corticosteroids, a typical treatment in AD.
The girl also reported muscular weakness and difficulty walking, but she did not claim to have any bone pain.
She had type IV skin (moderate brown), lived 41 degrees south of the equator in Chile and avoided direct sun exposure since early childhood because of her skin condition. Due to these factors, the researchers suspected she might have vitamin D deficiency.
What they found is that she had severe vitamin D deficiency. When they measured her vitamin D, she had an undetectable level of less than 5 ng/ml.
Due to reported troubles of walking and vague muscle weakness, coupled with this severe vitamin D deficiency, the doctors suspected rickets/osteomalacia.
When they examined markers for rickets, her alkaline phosphatase was 932 U/L (normal range 50-162 U/L) and radiographs of her wrist showed marginal sclerosis, suggesting bone mineralization abnormalities.
So they diagnosed hypocalcemic rickets and administered a dose 150,000 IU of vitamin D, followed by a 10,000 IU/week dose thereafter for 6 months. After 6 months, her vitamin D level rose to 17.6 ng/ml, still low but much better than 6 months prior.
As expected, the rickets resolved.
To the doctors’ surprise, however, is that the girl’s AD also improved significantly on the vitamin D regimen. To quantify the severity of AD, doctors use a scale called the SCORAD, which ranges from 0 (no AD) to 103 (most severe AD). In the 6 months on the vitamin D regimen, the girl’s SCORAD dropped from the mid-60s to just below 20, a threefold decrease in AD severity.
To date, research has shown a relationship between vitamin D deficiency and AD. Observational studies show that people with AD are more likely to have low vitamin D levels, and low vitamin D levels in AD predict an increased risk of skin infections. Some small pilot trials confirm that vitamin D might help in AD, too. However, we need more research to say for sure. Case reports like this one give hope that larger trials may prove vitamin D fairly effective in helping treat AD. It’s important to note the girl’s severe vitamin D deficiency may have left greater room for improvement in AD than normal.
The researchers also caution that clinicians need to suspect bone mineralization abnormalities in children and adults with similar conditions and circumstances. Here, the girl lived at a very high latitude, had darkish skin and avoided exposing her skin to the sun because she didn’t want to show her skin condition.