Dermatology in India
Bone mineral density in children with moderate to severe atopic dermatitis.
van Velsen SG, Knol MJ, van Eijk RL, de Vroede MA, de Wit TC, Lam MG, Haeck IM, de Bruin-Weller MS, Bruijnzeel-Koomen CA, Pasmans SG.
J Am Acad Dermatol. 2010 Nov;63(5):824-31.
Atopic dermatitis (AD) particularly in its severe forms requires potent topical (corticosteroids) or even systemic treatment (cyclosporine).
In this study the authors sought to measure bone fragility via Bone Marrow Densitometry (BMD) in 60 children with moderate to severe AD (compared with age and sex matched population).
Results show that only 3 patients had low BMD and one had osteoporosis. This is no different than in the general population.
However vitamin D levels were measured (25-hydroxyvitamin D (25-OH-Vitamin D). Deficiency was defined as less than 50nmol/l and insufficiency as levels between 51 and 74 nmol/l.
Deficiency and Insufficiency of 25-OH-Vitamin D was found respectively in 5 and 25 of the 60 patients. Vitamin D levels are therefore insufficient in 50% of patients.
The authors mention that sunlight exposure is of at least 10 minutes a day but in the winter and in an urban environment, sunlight exposure is a tenth or less than in the summer outside of cities. In our experience, AD tends to worsen in the winter and stress. But isn’t an urban working or studying in the winter more stressful.
Therefore the aggravation of AD could be associated with vitamin D deficiency. BMD only reflect the end result of a prolonged, not cyclical deficiency. Oral supplementation of VitD could be tried in patients not responding to treatment, but this requires strict monitoring for appearance of signs and symptoms due to altered blood calcium levels.
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