Dermatologists need to be aware of how skin conditions can affect sleep regulation


disclosures: Duan does not report any relevant financial disclosures. See the study for all relevant financial disclosures from other authors.

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Results of a literature review published in the Journal of the American Academy of Dermatology showed a complex correlation between chronic inflammatory skin disease, such as atopic dermatitis and psoriasis, and sleep loss.

Grace Y. Duan, BA, a medical student at the Pritzker School of Medicine at the University of Chicago, and colleagues wrote that high-quality sleep is vital to a person’s physical, mental, and emotional well-being, as chronically disturbed sleep can lead to a variety of negative health consequences.

“Given the important health implications of sleep loss, addressing this comorbidity for clinicians who succeed [chronic inflammatory skin disease (CISD)] and patients,” the researchers wrote. “Current evidence suggests that sleep loss and CISD interact bidirectionally; however, the mechanisms underlying this relationship are complex and not fully understood.”

The researchers highlighted the fact that pruritis, a common symptom of CISD, can trigger scratching behavior that can lead to more frequent nocturnal arousal and sleep relief.

In addition, the circadian regulation of inflammation may contribute to enhanced nocturnal pruritis and sleep loss, as pro-inflammatory cytokines such as (interleukin [IL])-1-alpha, IL-2, tumor necrosis factor-alpha, interferon-gamma and IL-6 are elevated in the evening. In contrast, anti-inflammatory cytokines such as IL-4 and IL-10 increase upon awakening.

“The daily cycle of cytokines and cortisol may explain why itchy episodes in [atopic dermatitis] usually occur at night,” the researchers wrote.

They went on to say that sleep deprivation due to CISD can further disrupt the immune system and perpetuate a vicious cycle that can lead to even more insomnia.

In terms of management, Duan and colleagues noted that first-generation antihistamines are commonly prescribed for sleep disorders in patients with CISD, and that systemic immunomodulatory therapies may improve sleep quality in patients with atopic dermatitis.

In addition, strategies that help modulate the circadian rhythm, such as oral melatonin supplementation and bright light therapy, may be helpful for patients.

“We appeal to all guidelines to recommend that sleep problems be regularly assessed and treated in patients with CISD,” Duan and colleagues wrote. “In addition, updated guidelines should delve deeper into current evidence-based pharmacological therapies and include a discussion of non-pharmacological and behavior modification strategies for pediatric and adult patients with CISD.”

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