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Managing Sleep Disturbance in Atopic Dermatitis Patients

According to the National Eczema Organization, more than 18 million adults in the US have atopic dermatitis , the most common form of eczema. Atopic dermatitis (AD) typically presents with erythematous scaling pruritic plaques on the cheeks, arms and legs. The majority of individuals who present with atopic dermatitis present in childhood. Atopic dermatitis is common in families who have allergies, asthma and dry skin. The exact cause of atopic dermatitis is unknown; however, it is thought to be related to abnormalities in the epidermal barrier.

“A recent article in Dermatitis reports up to 80% of children and 87% of adults
with AD experience insomnia, with difficulty both falling and staying asleep.”

Atopic dermatitis has been described as the “itch that rashes” with pruritus significantly affecting the quality of life for individuals who have eczema. For many of these individuals sleep quality can be profoundly affected. A recent article in Dermatitis reports up to 80% of children and 87% of adults with AD experience insomnia, with difficulty both falling and staying asleep. Sleep quality in patients with atopic dermatitis can be diminished due to itching and scratching, interrupting rapid eye movement (REM) and non-REM sleep. Pediatric insomnia has been associated with increased levels of anxiety and depression. Insomnia from atopic dermatitis can “ impair children’s cognitive development, leading to learning disabilities, impulsivity, and daytime behavioral problems”. Providers who treat pediatric patients with AD should consider evaluating sleep quality of these patients.

Environmental and behavioral adjustments are first line for the treatment of AD patients with sleep disturbances. Simple approaches, such as the avoidance of higher wavelength blue light exposure (through tablets and mobile devices) prior to onset of sleep is recommended. Additional factors to consider that may affect sleep are bedtime clothing fabrics, bedtime blankets, bedtime lighting, temperature and caffeine intake. Massage therapy, with moisturizing oils, is an additional approach to help improve sleep.

Pharmaceutical treatments for AD should be prescribed with caution, at the lowest possible dose and with monitoring of side effects. Melatonin is a unique option as it has been found that atopic dermatitis patients have lower circulating melatonin levels during periods of exacerbation of their disease. Additional medications, including their benefit, dosing, risk and appropriateness for specific populations were discussed in the article. The authors of the article conclude “sleep management in pediatric AD is critical to ensure proper physical and cognitive development, decrease behavioral issues, and improve quality of life for both patients and caregivers.”

Byline: Sarah B. W. Patton, MSHS, PA-C
Posted October 30, 2019

Article adapted from original: Hendricks A, Manivannan M, Shi V. Clinical pearls on sleep management in atopic dermatitis. Dermatitis. 2019; 30(5); 287-293.