Eczema Review

DOES VITAMIN D AFFECT ECZEMA RISK?

A recent study found an association between vitamin D levels and the risk for developing atopic dermatitis (AD).

While previous evidence has suggested low vitamin D levels were a potential risk factor for AD, the relationship was unclear.

Using data from the 2005 through 2006 US National Health and Nutrition Examination Survey, the researchers examined the association between AD and serum 25-hydroxyvitamin D (25[OH]D) levels among 3921 adults. Analyses adjusted for patient demographics, lifestyle variables, stress, medical comorbidities, and were stratified by race.

The researchers found that the prevalence of ever-reported AD was 7.94%. Individuals with higher socioeconomic status, depressive symptoms, history of asthma or hay fever, who were female, sampled in summer, and non-Hispanic white were more likely to report having AD.

Analyses showed individuals with vitamin D deficiency, defined as less than 50 nmol/L, had higher odds of AD compared with those with levels greater then 75 nmol/L (odds ratio, 1.81; 95% CI, 1.09-3.01). In addition, the researchers found an inverted U-shaped association between AD and serum 25(OH) D levels. The highest risk for AD was at approximately 45 nmol/L, the researchers wrote, “with decreasing risk in both directions away from this value.”

However, the relationship between vitamin D levels and AD was not found among non-Hispanic black individuals.

“Vitamin D is associated with reports of [AD] in non-Hispanic white population, but not in the non-Hispanic black population in the US,” the researchers concluded.

Reference:

Wei J, Jaleel T, MacLeod AS, Ji JS. Inverted Ushaped relationship between vitamin D and ever- reported eczema in US adults [published online December 27, 2018]. Allergy. doi:10.1111/ all.13708

IS AD A RISK FACTOR FOR SUICIDAL IDEATION?

Patients with atopic dermatitis (AD) have an increased risk for suicidal ideation and suicide attempts, according to the findings of a recent study.

For the systematic review and meta- analysis, the researchers searched PubMed, Embase, PyshcINFO, and Cochrane databases for observational studies published from 1946 to May 25, 2018 on AD and suicide attempts, suicidal ideation, and suicide. The quality of the studies was assessed using the Newcastle- Ottawa Scale for observational studies.

A total of 15 studies were identified that included 310,681 patients with AD and 4,460,086 controls.

Compared with individuals without AD, patients with AD were 44% more likely to exhibit suicidal ideation (pooled odds ratio [OR], 1.44; 95% CI, 1.25-1.65) and 36% more likely to attempt suicide (pooled OR, 1.36; 95% CI, 1.09-1.70). However, the researchers found inconsistent results in studies assessing completed suicides among patients with AD.

“Results of this study suggest that patients with AD are at significantly increased risk of suicidal ideation and suicide attempts,” the researchers concluded. “It is important for dermatology providers to be aware of this risk, screen for suicidality in patients with AD, and make mental health referrals when necessary.”

Reference:

Sandhu JK, Wu KK, Bui T, Armstrong AW. Association between atopic dermatitis and suicidality: A systematic review and meta-analysis [published online December 12, 2018]. JAMA Dermatol. doi:10.1001/jamadermatol.2018.4566

AD LINKED TO CARDIOVASCULAR OUTCOMES

A recent systematic review found significant associations between cardiovascular outcomes and atopic dermatitis (AD) among cohort studies.

In the review, the researchers identified 19 studies using MEDLINE, Embase, and Global Health databases. They calculated pooled estimates and the effect of increasing AD severity on cardiovascular outcomes.

“The effects of atopic eczema reported in cross-sectional studies were heterogeneous, with no evidence for pooled associations with angina, myocardial infarction, heart failure, or stroke,” the researchers wrote.

In analyses of cohort studies, the researchers found AD was associated with an increased risk of myocardial infarction, stroke, ischemic stroke, and heart failure, with wide prediction intervals for myocardial infarction and stroke.

Additionally, the risk for developing cardiovascular outcomes appeared to increase with increasing severity of AD.

“Significant associations with cardiovascular outcomes were more common in cohort studies but with considerable between-study heterogeneity,” the researchers concluded. “Increasing atopic eczema severity was associated with increased risk of cardiovascular outcomes. Improved awareness amongst stakeholders regarding this small significant association is warranted.”

Reference:

Ascott A, Mulick A, Yu A, et al. Atopic eczema and major cardiovascular outcomes: a systematic review and meta-analysis of population-based studies [published online December 18, 2018]. J Allergy Clin Immunol. doi:10.1016/j.jaci.2018.11.030

NOVEL TOPICAL TREATS MILD TO MODERATE AD

A novel topical therapy, PAC-14028, was found to effectively improve symptoms of mild to moderate atopic dermatitis (AD) in a recent study.

“Transient receptor potential vanilloid subfamily, member 1 (TRPV1) may play an important role in pruritus and inflammation induction in atopic dermatitis (AD),” the researchers wrote. However, the efficacy of TRPVI antagonists for treating AD has not been well established.

In the phase 2b, randomized, clinical trial, 194 participants with mild to moderate AD were randomized to receive 0.1%, 0.3%, 1.0% PAC-14028 (a TRPV1 antagonist) cream, or vehicle. Participants applied the treatment or vehicle twice a day for 8 weeks. The Investigator’s Global Assessment (IGA) success rate, defined as percentage of participants who achieved IGA score of 0 or 1 after 8 weeks, was assessed as the primary efficacy outcome. Secondary outcomes included severity Scoring Atopic Dermatitis (SCORAD) index and Eczema Area and Severity Index (EASI) 75/90.

After 8 weeks of treatment, IGA success rates were 14.58% for vehicle, 42.55% for PAC-14028 0.1% cream, 38.30% for PAC-14028 0.3% cream, and 57.45% for PAC-14028 1.0% cream. The researchers found statistically significant differences in IGA success rates between the vehicle group and PAC-14028 groups, with 2-grade improvements in scores.

In addition, the SCORAD index, EASI 75/90, sleep disturbance scores, and pruritus visual analogue scale showed improvements. There were no significant safety issues.

“PAC-14028 cream may be an effective and safe treatment modality for the treatment of patients with mild to moderate AD,” the researchers concluded.

Reference:

Lee YW, Won CH, Jung K, et al. Efficacy and safety of PAC-14028 cream - a novel, topical, nonsteroidal, selective TRPV1 antagonist in patients with mild-to-moderate atopic dermatitis: a phase IIb randomized trial [published online January 8, 2019]. Br J Dermatol. doi:10.1111/bjd.17455