Alfacalcidol use in complex therapy of atopic dermatitis

Abstract

Aim. To study clinical course of atopic dermatitis and improve dermatosis therapeutic tactics in vitamin D deficiency. Study design - comparative observational open-label study.

Methods. 67 patients with a verified «atopic dermatitis» diagnosis were selected to study. Serum calcidol level below 75 nmol/l was observed in 32 patients what was the basis to division of the observed patients into two groups. Conventional therapy (local glucocorticoids and moistening agents, systemic administration of non-specific anti-inflammatory and desensitizing agents) was administered to all patients. Vitamin D active form - alfacalcidol (Alpha D3-Teva) was administered to patients of the second group as a part of complex therapy.

Results. Good clinical results have been achieved amid the treatment, in 21 days SCORAD index decreased by 86.56% in the first group, in the second - by 93.63%, with the clinical remission achievement in over 75% of patients in both groups. Atopic dermatitis complex therapy using alfacalcidol contributed to the normalization of the vitamin D concentration (from 42.92±2.87 to 79.26±4.92 nmol/l) and total calcium level (from 1.97±0.4 to 2, 21±0,8 mmol/l), reduced TEWL measurement and increased corneometry results. The therapy did not contribute to the sebometry data change in both groups.

Conclusion. Vitamin D deficiency leads to more severe atopic dermatitis course; complex treatment of this disease with alfacalcidol facilitated normalization of serum vitamin D level and tendency to the epidermal barrier recovery, what opens new possibilities in the treatment of atopic dermatitis.

Keywords

atopic dermatitis / palmar hyperlinearity / vitamin D deficiency / corneometry / sebometry / TEWL measurement / alfacalcidol

References

[1] Перламутров Ю.Н., Ольховская К.Б. Атопический дерматит: этиопатогенетические аспекты, клинические особенности течения. Пластич. хир. и косметол. 2010; (4): 643-648.

[2] Реушева С.В., Паничева Е.А., Пастухова С.Ю., Реушев М.Ю. Значение дефицита витамина D в развитии заболеваний человека. Успехи соврем. естествознан. 2013; (11): 27-31.

[3] Стукова Е.И., Кениксфест Ю.В. Патогенетическое значение золотистого стафилококка при атопическом дерматите. Фундаментал. исслед. 2013; (7): 680-687.

[4] Brown S.J., Relton C.L., Liao H. Filaggrin haploinsufficiency is highly penetrant and is associated with increased severity of eczema: further delineation of the skin phenotype in a prospective epidemiological study of 792 school children. Br. J. Dermatol. 2009; 161 (4): 884-889. http://dx.doi.org/10.1111/j.1365-2133.2009.09339.x

[5] Carvalho K., Machado A., Carvalho I. Atopic dermatitis and vitamin D: facts and controversies. An. Bras. Dermatol. 2013; 88: 945-953. http://dx.doi.org/10.1590/abd1806-4841.20132660

[6] Hewison М. Vitamin D and the immune system: new perspectives on an old theme. Endocrinol. Metab. Clin. North Am. 2010; 38: 365-379. http://dx.doi.org/10.1016/j.ecl.2010.02.010

[7] Kaae J., Menné T., Carlsen B.C. et al. The hands in health and disease of individuals with filaggrin loss-of-function mutations: clinical reflections on the hand eczema phenotype. Contact Dermatitis. 2012; 67: 119-124. http://dx.doi.org/10.1111/j.1600-0536.2012.02130.x

[8] Landeck L., Visser M., Kezic S., John S.M. Genotype-phenotype associations in filaggrin loss-of-function mutation carriers. Contact Dermatitis. 2013; 68 (3): 149-155. http://dx.doi.org/10.1111/j.1600-0536.2012.02171.x

[9] Meng L., Wang L., Tang H. et al. Filaggrin gene mutation c.3321delA is associated with various clinical features of atopic dermatitis in the Chinese Han population. PLoS One. 2014; 9: 982-990. http://dx.doi.org/10.1371/journal.pone.0098235

[10] Miller J., Gallo R.L. Vitamin D and innate immunity. Dermatologic Therapy. 2010; 23: 13-22. http://dx.doi.org/10.1111/j.1529-8019.2009.01287.x

[11] Nuti R., Bianchi G., Brandi M.L. et al. Superiority of alfacalcidol compared to vitamin D plus calcium in lumbar bone mineral density in postmenopausal osteoporosis. Rheumatol. Int. 2006; 26: 445-453. http://dx.doi.org/10.1007/s00296-005-0073-4

[12] Orimo H. Clinical application of 1α(OH)D3 in Japan. Akt. Rheumatol. 1994; 19: 27-30. http://dx.doi.org/10.1055/s-2008-1046694

[13] Roider E., Ruzicka T., Schauber J. Vitamin D, the cutaneous barrier, antimicrobial peptides and allergies: Is there a link? Allergy Asthma Immunol. Res. 2013; 5: 119-128. http://dx.doi.org/10.4168/aair.2013.5.3.119

[14] Searing D.A., Leung D.Y. Vitamin D in atopic dermatitis, asthma and allergic diseases. Immunol. Allergy Clin. North. Am. 2010; 30 (3): 397-409. http://dx.doi.org/10.1016/j.iac.2010.05.005

[15] Steinstraesser L., Kraneburg U., Jakobsen F., Al-Benna S. Host defense peptides and their antimicrobial-immunomodulatory duality. Immunobiology. 2011: 216 (3): 322-333. http://dx.doi.org/10.1016/j.imbio.2010.07.003

[16] Valdman-Grinshpoun Y., Ben-Amitai D., Zvulunov A. Barrier-restoring therapies in atopic dermatitis: Current approaches and future perspectives. Dermatol. Res. Pract. 2012; 2012: 923134. http://dx.doi.org/10.1155/2012/923134

RIGHTS & PERMISSIONS

Pestova V.Y.