Vitamin D deficiency and atopic dermatitis severity in a Bangladeshi population living in East London: A cross-sectional study

Rebecca L McCarthy; Soha S Tawfik; Ioannis Theocharopoulos; Ravinder Atkar; Bryan McDonald; Sasha Dhoat; Aaron Hughes; Bjorn R Thomas; Edel A O'Toole

doi:10.1002/ski2.358

Vitamin D deficiency and atopic dermatitis severity in a Bangladeshi population living in East London: A cross-sectional study

Skin Health Dis. 2024 Mar 12;4(3):e358. doi: 10.1002/ski2.358. eCollection 2024 Jun.

Authors

Rebecca L McCarthy^{1

2}, Soha S Tawfik^{1

2

3}, Ioannis Theocharopoulos², Ravinder Atkar¹, Bryan McDonald¹, Sasha Dhoat¹, Aaron Hughes^{1

2}, Bjorn R Thomas², Edel A O'Toole^{1

2}

Affiliations

¹ Dermatology Department The Royal London Hospital Barts Health NHS Trust London UK.
² Blizard Institute The Faculty of Medicine and Dentistry Queen Mary University of London London UK.
³ Department of Dermatology Venereology and Andrology Faculty of Medicine Alexandria University Alexandria Egypt.

Abstract

Background: Atopic eczema is a common, chronic, inflammatory skin condition with considerable heterogeneity. South Asian people living in the UK frequently have low serum vitamin D3 (25(OH)D₃), and those with atopic disease can present with severe eczema. The association between vitamin D deficiency and eczema severity, and the role of vitamin D supplementation in atopic eczema is inconsistent, and under-researched in people with Asian ancestry.

Objectives: This cross-sectional study investigates the association between serum 25(OH)D₃ and eczema severity in a cohort of South Asian children and young adults living in London.

Methods: Eligible participants were Bangladeshi children and young adults aged 0-30 years with eczema, living in London and participating in the Tower Hamlets Eczema Assessment study. Data was collected via parent/patient self-reporting, clinical history and examination, and hospital databases. 25(OH)D₃ levels were documented retrospectively, if available, from hospital databases. Eczema severity was classified by Eczema Area and Severity Index (EASI) score less than or greater than 10 (clear-mild vs. moderate-severe). Multivariate logistic regression was used to adjust for confounding factors.

Results: 681 participants were included in analyses. 25(OH)D₃ results were available for 49.6% (338/681), 84.3% of which had deficient or insufficient lowest 25(OH)D₃. Lowest 25(OH)D₃ was inversely correlated with EASI score (Spearman's rank R ² = -0.24, p < 0.001). 26.1% (178/681) had EASI >10 and a lower median lowest and nearest 25(OH)D₃. After adjustment for confounding EASI > 10 was significantly associated with a lowest 25(OH)D₃ < 25 (OR 3.21, 95%CI 1.35, 8.60), use of mild-moderate potency topical steroid on the face and neck (OR 3.11, 95%CI 1.86, 5.31), calcineurin inhibitor on the face and neck (OR 2.79, 95% CI 1.26, 6.10) and potent - very potent topical steroid on the face and neck (OR2.23, 95%CI 1.02, 4.77) and body (OR 2.11, 95%CI 1.18, 3.87).

Discussion: Vitamin D plays a role in modulation of proteins required for skin barrier function and regulation of the innate immune system, suggesting 25(OH)D₃ deficiency contributes to skin inflammation. This study demonstrates a relationship between 25(OH)D₃ deficiency and worse eczema severity in a cohort of South Asian children and young adults.