J Clin Res Gov 2 (2013) 66-69
Swedish Science Pioneers
Developing World Journal Series
Journal of Clinical Research & Governance
www.jcrg.sciencepub.se
Research Article
Effect of Oral Vitamin E on Atopic Dermatitis
Shahla Babaye-Nazhad a, Mehdi Amirniaa , Effat Khodaeyania, Pegah Noor Afzaa, Hossein Alikhahb, Sahar Mohammadib,
Mohammad Naghavi-Behzadb,c
a: Department of Dermatology, Tabriz Sina Hospital, Tabriz University of Medical Science, Tabriz, Iran.
b: Students' Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran.
c: Medical Philosophy and History Research Center, Tabriz University of Medical Sciences, Tabriz, Iran.
Correspondence
Mohammad Naghavi-Behzad, Medical
Philosophy and History Research
Center, Tabriz University of Medical
Science, Daneshgah Street, Tabriz,
Eastern Azerbaijan, Iran.
Tell: +989141193466
Email: [email protected]
Keywords:
Atopic dermatitis (AD)
Vitamin E
Topical treatment
Skin disease
Ab s t r a c t
Purpose: To compare the efficacy and satisfaction from vitamin E and common modalities in the treatment of AD.
Methods: This clinical trial was performed on 100 patients with AD, presenting to Dermatology Clinic of Tabriz Sina
hospital (Mar 2008 until Dec 2010). The patients were allocated into two groups using the random sequence
generated by RandList 11 software package. In group I, the patients received 400 IU/day Vitamin E orally, while group
II patients received topical corticosteroid and oral antihistamines. All of the patients were followed up for eight
months.
Results: The results were positive in the 66% of the patients in group I and 62% of the patients in group II. There was
no statistical difference in response to therapy in both groups, but satisfaction was higher in patients receiving
vitamin E. There was an inverse relationship between age and response to therapy in patients using vitamin E. No side
effects were reported from vitamin E uses.
Conclusion: Vitamin E may have the same effect as common treatment with topical corticosteroid and oral
antihistamines in improving the signs and symptoms of AD and the quality of life.
Controlled trial
Randomized clinical trial
Received: 2013-06-01
Accepted: 2013-11-11
DOI: 10.13183/jcrg.v2i2.55
2013 Swedish Science Pioneers, All rights reserved.
Introduction
Atopic dermatitis (AD) is frequent, idiopathic and often a difficult
condition to treat [1]. Despite the increasing treatment options,
the prevalence of this disease is increasing during the last
decades [2- 4].
Vitamin E supplements are widely being used in clinical practice
for the prevention and treatment of different medical conditions
[5, 6]. It has been used for more than 50 years in experimental
and
clinical
dermatology
[7,8]. Advances
on the
pharmacodynamics,
pharmacokinetics,
therapeutic
and
protective effects of vitamin E on human skin, have led to
stablishment of numerous new formulations for vitamin E usage
in cosmetics and skin care products [7- 9].
Although the current use of vitamin E is mostly limited to
cosmetics, controlled clinical studies about diseases such as
AD are needed to evaluate the clinical benefits of vitamin E on
human [7, 8, 10]. While a large number of case reports were
published till now, there are scant controlled clinical studies
providing logical and reliable data about dosage and clinical
indications of vitamin E usage [7,8]. Only a few clinical studies
on the effect of vitamin E have been performed on patients with
AD [6].
This study was aimed to compare the efficacy and satisfaction
from vitamin E and common modalities in the treatment of AD.
Methods
This clinical trial was performed on consecutive patients with
AD referring to Dermatology Clinic of Tabriz Sina EducationalMedical Center, Tabriz, Iran since March of 2008 to December
of 2010. Inclusion criteria were having the diagnosis of AD
according to the Hanifin and Rajka Diagnosis Criteria, and
having tolerance to the recommended therapy. Exclusion
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J Clin Res Gov 2 (2013) 66-69
criteria were having chronic diseases or other dermatologic
diseases and irregular presenting for follow up visits. Of 111
enrolled patients, 11 excluded due to exclusion criteria and the
study was completed with the remaining 100 patients.
All participants have signed a written consent, and the study
protocol was approved by the Ethics Committee of Tabriz
University of Medical Sciences (TUMS), which was in
compliance with Helsinki Declaration.
The patients were divided in two groups by RandList software
each containing 50 patients. In group I, the patients received
oral vitamin E, 400 IU/day; and in group II patients received
topical corticosteroid and oral antihistamines as a common
treatment for AD. The patients in both groups were also treated
by continuous topical Vaseline for skin dryness.
Patients were followed up for 8 months, visiting them monthly
and having phone contacts in case of need. At any visits they
examined regarding symptoms (lesions duration and extension)
and signs (pruritus, sleep quality). At the end of 8 month period
the patients asked to select one of options in Table 1 with
attention to his/her disease status. The patients responses
were regarded as subjective effect of the therapy and
underwent statistical analysis.
According to the changes in symptoms and signs within 8
months, the response to therapy was considered positive
(decrease in lesions duration and extension, pruritus, and
improving sleep quality), or negative (no change or
intensification in symptoms and signs). Statistical analysis was
performed by SPSS software package version 13.0 for windows
(SPSS Inc., Chicago, USA) using Chi Square2 and independent
T-test. Quantitative data were presented as mean standard
deviation (SD). P value less than 0.05 was considered
statistically significant in all steps.
Results
Of all studied patients 52 (52%) were male and 48 (48%) were
female, with the age range of 3 to 40 years. The patients had
the average age of 15.59.2 years in group 1 (range: 3.5 to 40
years) and13.27.7 years in group 2 (range: 3 to 33 years)
(P>0.05).
In group 1, the age of patients with no change in the disease
(34%) was 21.5 years in comparison with 12.4 years of whom
responsed (66%) to the therapy. Which statistically was
significant (P<0.05), indicating a reverse relation between age
and response to the therapy in patients treated with vitamin E.
However, such correlation was not found in group 2.
In group 1, seventeen patients (34%) showed no change and
33 (66%) were responsive to medication. These statistics in
group 2 were 19 (38%) and 31 (62%) (P=0.0677, nonsignificant) indicating no difference between responsiveness of
patients in both groups to medications.
In the first group, nineteen of 29 male patients (65.5%) and 14
of 21 female patients (66.7%) responded to therapy (P=0.933).
In group 2, fourteen of 23 male patients (60.9%) and 17 of 27
female patients (63%) responded to therapy (P=0.879). So
there was not any significant relation between patients sex and
response to the therapy in both groups.
There was significant relation between patients subjective
treatment results throughout studied groups (Table 1). So, the
patients receiving vitamin E were more satisfied than whom
using Steroid with Antihistamine (P=0.039).
There was not any side effect in patients using vitamin E.
Discussion
During present randomized control trial study, the results were
positive in the 66% of the patients in group I and 62% of the
patients in group II. There was no statistical difference in
response to therapy in both groups (P>0/05). Vitamin E has
several important roles in the body, first of all it is a potent
antioxidant which can improve the immune macrophagemediated response, second, it decreases the production and/or
release of prostaglandins in body and also it decreases level of
immunoglobulin E (IgE) in serum in case of atopic subjects [1].
The studies indicate that vitamin E decreases the production
and release of inflammatory mediators, suggesting that vitamin
E might have a possible beneficial effect in inflammatory
diseases [11].
Tsoureli-Nikita et al. compared the effects of placebo and
Vitamin E intake in 96 individuals with AD. Fifty patients were
given orally 400 IU (268 mg) of Vitamin E, once a day for period
of 8 months, and 46 patients took placebo for the same period.
The correlation between Vitamin E intake, IgE levels, and the
clinical manifestations of atopy indicated that Vitamin E can be
an excellent therapeutic tool for AD [1].
Table 1. The subjective results of treatment in both studied
groups
Results
Group1
(Vitamin E)
Group 2 (Steroid+
Antihistamine)
3 (6%)
2 (4%)
No change
14 (28%)
17 (34%)
Little Improvement
7 (14%)
18 (36%)
Fairly improved
13 (26%)
8 (16%)
Completely
improved
13 (26%)
5 (10%)
Inverse result
Inverse result, worsen lesions; Good improvement, controlled
itching with little licnification remained in the limbs; Complete
improvement, complete recovery without any itching and skin
lesions
We compared the efficacy and satisfaction of having vitamin E
and common modalities for treatment of AD. The results
showed that there is more satisfaction in patients receiving
Vitamin E than whom using Steroid with Antihistamine.
Nemelka et al. studied a new topical product containing Vitamin
E. The product has been extensively tested for its effectiveness
and skin tolerability on a selected population of 60 infants and
children with age ranging from 2 months to 14 years, who are
suffering mainly from AD and irritant dermatitis. The topical use
of the product result in a significant improvement in
inflammatory skin conditions, with evident and fast reduction of
inflammation and eczema the investigated pathologies. It was
particularly suitable in the treatment of pediatric dermatitis with
symptoms like eczema, itching, desquamation and xerosis [9].
In a double-blind, placebo-controlled, randomized study of 112
patients with hay fever, patients divided into two groups
received either vitamin E (800 mg/d) or placebo in addition to
their regular antiallergic treatment during the pollen season. The
study showed that vitamin E supplementation is a valuable
addition for treatment of seasonal allergic rhinitis [6]. Oh et al.
showed that AD is associated negatively with intakes of
antioxidant-related nutrients. A similar association was
observed for dietary vitamin E [12]. It was suggested that higher
antioxidant nutritional status reduces the risk of AD. However,
further clinical and basic science studies are needed to
determine the real value of new treatments including vitamin E
[6,13,14]. Shahar et al. [6] suggest that vitamin E
supplementation may be a valuable addition to the treatment of
patients with seasonal allergic rhinitis.
Atopic diseases, for example AD, are characterized by
increased oxidative stress [2,15,16]. Low vitamin E intake in diet
has also been associated with current symptoms of atopic
diseases [2,17,18]. Epidemiologic studies have demonstrated
beneficial effects of vitamin E which is naturally found in
patients diet, on atopy in children and adults [19- 21]. Vitamin E
may have immunomodulatory properties beyond its antioxidant
function [22]. The positive response to vitamin E suggests that
protection from oxidative injury may have a role in the resolution
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J Clin Res Gov 2 (2013) 66-69
of ulcerative dermatitis lesions and offers researchers a new
treatment modality with better compliance [23].
Martindale et al. suggested that maternal use of antioxidant
during pregnancy may decrease the risk of suffering from
wheeze and eczema over early childhood years. However, they
suggested continuing the follow up of the cohort in order to
determine whether mothers diet in pregnancy has an
association with atopic disease later in childs life or not [21].
In children with AD, the homeostasis of vitamin E is changed.
Decreased erythrocyte levels of the vitamin are probably due to
the limited tissue reserve. The role of vitamin E in the
pathogenesis and prevention of AD needs further investigations
[24]. Clinical practice in dermatology indicates that lipophilic
antioxidant vitamin E is beneficial in AD and generally among
skin diseases in which an inflammatory process is activated
[24,25].
Vitamins are a natural constituent of human skin and are an
important part of the antioxidants system which protects the
skin from oxidative stress. Use of natural antioxidants such as
vitamins to improve restoring dermal antioxidant activity has
gained interest. Vitamin E, has been shown to have potent
antioxidant and anti-inflammatory properties [26].
Consumption of vitamin E is increasing rapidly in dermatologic
treatment. Several studies investigated the effects of vitamin E
against oxidative stress [5]. Oral ingestion of ascorbic acid
(2000 mg/d) and vitamin E (1000 IU/d) reduced the sunburn
reaction in human cases [5, 27].
Vitamin E ointment suppresses contact dermatitis by stabilizing
keratinocytes [28]. Studies suggest that topical and oral vitamin
E has antitumorigenic, photoprotective, and skin barrier
stabilizing properties [7, 8]. Evidences from basic science
studies suggest that vitamin E may reduce immune allergic
responses [6].
In past decades there was scant proof of vitamin E's
effectiveness in treating certain dermatologic conditions
including AD [29]. Balabolkin et al. found slight efficacy of
vitamin E detected in AD of children [30]. In our study, there
was no statistical difference in response to therapy in both
groups, but satisfaction was very higher in patients receiving
vitamin E than patients treated by common modalities.
Frequent use of vitamin-E derivatives in skin care products
deserves further investigation about tolerability and suitability of
vitamin E in skin care preparations. Given its antioxidant and
photoprotective properties, vitamin E should remain an
ingredient in skin care products [31].
In conclusion, vitamin E may have the same effect as common
treatment with topical corticosteroid and oral antihistamines in
improving signs and symptoms of AD and quality of life. By
considering the lack of side effects of therapeutic dose of
vitamin E, it can be recommend a suitable therapy for AD.
Conflict of interests: The authors declare no conflict of
interest.
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