Dr. Ron’s Research Review – November 27, 2013

© 2013

This week’s research review focuses on topical vitamin B12 for eczema.

The excretion in the urine of (58)Co after an oral dose of (58)Co vitamin B12 given together with intrinsic factor has been found to be reduced in a number of patients with psoriasis, eczema, and other less common dermatoses. There is a correlation between the abnormality and the extent of the rash. (Marks and Shuster 1970)

Topical vitamin B(12) is thought to decrease the symptoms involved in eczema through reducing nitric oxide production. A double-blinded, randomized, placebo-controlled study with intraindividual left/right comparison was set up to determine whether topical vitamin B(12) would be effective in children with eczema. Skin treated with topical vitamin B12 improved significantly more than placebo treated skin at 2 and 4 weeks (p = 0.02, 0.01 respectively). (Januchowski 2009)

A prospective, randomized and placebo-controlled phase III multicentre trial, involved 49 patients with atopic dermatitis. On the body side treated with the vitamin B12 cream (bid for 8 weeks), the modified Six Area Six Sign Atopic Dermatitis score dropped to a significantly greater extent than on the placebo-treated body side (for the investigational drug 55.34 +/- 5.74 SEM, for placebo 28.87 +/- 4.86 SEM, P < 0.001). At the conclusion of the study, the investigator and patients awarded mostly a 'good' or 'very good' rating to the active drug (58% and 59%, respectively) and a 'moderate' or 'poor' rating to the placebo (89% and 87%, respectively). (Stucker, Pieck et al. 2004)

Dr. Ron


Articles

Evaluation of topical vitamin B(12) for the treatment of childhood eczema

         (Januchowski 2009) Download

OBJECTIVES: Topical vitamin B(12) is an approach that has been shown to successfully treat atopic dermatitis in adults; however, there have been no studies in children. Topical vitamin B(12) is thought to decrease the symptoms involved in eczema through reducing nitric oxide production. Atopic dermatitis affects 5%-20% of children in the United States. Various treatment options are available to treat atopic dermatitis in children, but there are drawbacks to some of these options. Children tend to need a larger dose of medication for body surface area involved and can be more adversely affected by agents such as topical steroids. This study was developed in order to find an alternative eczema treatment for children. DESIGN: This double-blinded, randomized, placebo-controlled study with intraindividual left/right comparison was set up to determine whether topical vitamin B(12) would be effective in children with eczema. SUBJECTS: Patients from the ages of 6 months to 18 years old were recruited from the Center for Family Medicine and enrolled for 4 weeks. OUTCOME MEASURES: Skin checks using a standardized scoring system were done at baseline, and 2 and 4 weeks by a single investigator. Twenty-one (21) patients completed the study. RESULTS: Skin treated with topical vitamin B(12) improved significantly more than placebo treated skin at 2 and 4 weeks (p = 0.02, 0.01 respectively). CONCLUSIONS: Topical vitamin B(12) should be considered as a treatment option in children with eczema.

Vitamin B12 excretion in patients with various skin diseases

         (Marks and Shuster 1970) Download

The excretion in the urine of (58)Co after an oral dose of (58)Co vitamin B(12) given together with intrinsic factor has been found to be reduced in a number of patients with psoriasis, eczema, and other less common dermatoses. There is a correlation between the abnormality and the extent of the rash. A reduced glomerular filtration rate was found in a few of the patients in whom it was measured, and this must have been responsible, at least in part, for the reduced excretion of vitamin B(12) in these patients, but abnormal vitamin B(12) excretion also occurred in the absence of impaired renal function. Our evidence is insufficient to show whether malabsorption or increased tissue utilization of vitamin B(12) was the explanation in other cases. Certainly a number of patients had steatorrhoea, and in these it is most likely that malabsorption was the major factor. In patients without steatorrhoea a lone malabsorption of vitamin B(12) cannot be excluded. A decreased serum concentration of vitamin B(12) was found in only one of the patients.

Topical vitamin B12--a new therapeutic approach in atopic dermatitis-evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial

         (Stucker, Pieck et al. 2004) Download

BACKGROUND: Vitamin B(12) is an effective scavenger of nitric oxide (NO). As the experimental application of a NO synthase inhibitor, N omega-nitro-L-arginine, led to a clear decrease in pruritus and erythema in atopic dermatitis, it would be reasonable to assume a comparable effect of vitamin B(12). OBJECTIVES: The efficacy and tolerability of a new vitamin B(12) cream as a possible alternative to current therapies was examined. METHODS: A prospective, randomized and placebo-controlled phase III multicentre trial, involving 49 patients was conducted. For the treatment duration of 8 weeks, each patient applied twice daily (in the morning and evening) the vitamin B(12)-containing active preparation to the affected skin areas of one side of the body and the placebo preparation to the contralateral side according to the randomization scheme. RESULTS: On the body side treated with the vitamin B(12) cream, the modified Six Area Six Sign Atopic Dermatitis score dropped to a significantly greater extent than on the placebo-treated body side (for the investigational drug 55.34 +/- 5.74 SEM, for placebo 28.87 +/- 4.86 SEM, P < 0.001). At the conclusion of the study, the investigator and patients awarded mostly a 'good' or 'very good' rating to the active drug (58% and 59%, respectively) and a 'moderate' or 'poor' rating to the placebo (89% and 87%, respectively). CONCLUSIONS: Topical vitamin B(12) is a new therapeutic approach in atopic dermatitis. These results document a significant superiority of vitamin B(12) cream in comparison with placebo with regard to the reduction of the extent and severity of atopic dermatitis. Furthermore, the treatment was very well tolerated and involved only very low safety risks for the patients.


References

Januchowski, R. (2009). "Evaluation of topical vitamin B(12) for the treatment of childhood eczema." J Altern Complement Med 15(4): 387-9. [PMID: 19368512]

Marks, J. and S. Shuster (1970). "Vitamin B12 excretion in patients with various skin diseases." Br Med J 3(5723): 618-21. [PMID: 5470089]

Stucker, M., C. Pieck, et al. (2004). "Topical vitamin B12--a new therapeutic approach in atopic dermatitis-evaluation of efficacy and tolerability in a randomized placebo-controlled multicentre clinical trial." Br J Dermatol 150(5): 977-83. [PMID: 15149512]