Efficacy and safety profile of antioxidants in the treatment of atopic dermatitis: A systematic review and meta-analysis of randomized controlled trials

The use of antioxidants in atopic dermatitis (AD) is controversial. We conducted a systematic review and meta-analysis to evaluate the efficacy and safety of antioxidants therapy in AD. Randomized clinical trials were identified from Medline, Embase, and Cochrane library. Changes from baseline in severity and itch score were extracted from individual studies and pooled using random-effects. Eighteen trials including 763 AD patients were eligible. Overall, antioxidants were associated with statistically significant reductions in diseases severity (p < 0.0001), but not with itch score (p = 0.59). No serious adverse events were recorded. Subgroup analyses revealed that antioxidants were associated with a significant reduction in severity score regardless of disease severity at baseline and treatment duration (p < 0.05). However, antioxidants had additional benefit only in children (p = 0.02) but not in adults (p = 0.30). Oral supplementation with vitamin D, combined vitamins D and E, combined vitamins A, D and E and topical vitamin B-12 was associated with significantly lower severity score (p < 0.05). There was significant heterogeneity between studies (I-2 = 50%; p = 0.003). The effect estimates did not change statistically after excluding sources of study heterogeneity. This meta-analysis suggests that antioxidants may be a safe and effective treatment for AD patients, especially when supplemented with oral vitamin D and topical vitamin B-12, as well as in pediatric patients.