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

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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 University of Chicago Pritzker School of Medicine, and colleagues wrote that high-quality sleep is essential for an individual’s physical, mental, and emotional well-being, as chronically affected sleep can cause a variety of negative health consequences.

“Given the serious health implications of sleep loss, treating this comorbidity is very interesting for clinicians who manage [chronic inflammatory skin disease (CISD)] and patients, ”the researchers wrote. “Current evidence suggests that sleep loss and CISD interact in two directions; however, the mechanisms underlying this relationship are complex and not fully understood.”

The researchers emphasized the fact that itching, a common symptom of CISD, can cause scratching behaviors that can lead to more frequent nocturnal arousal and relief from sleep.

Moreover, day-night regulation of inflammation may contribute to enhanced nocturnal pruritus and sleep loss, as may 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 after awakening.

“Daily cycling of cytokines and cortisol may explain why pruritus episodes occur [atopic dermatitis] tends to happen at night, “the researchers wrote.

They continued that sleep deprivation due to CISD can further deregulate the immune system and perpetuate a vicious cycle that can lead to even more insomnia.

Regarding administration, Duan and colleagues noted that first-generation antihistamines are often prescribed for sleep disorders among patients with CISD, and that ubiquitous immunomodulatory therapies can improve sleep quality among patients with atopic dermatitis.

Moreover, strategies that help modulate day-night rhythm, such as oral melatonin supplementation and light-light therapy, may be helpful to patients.

“We call on all guidelines to recommend that sleep problems be regularly evaluated and administered in patients with CISD,” wrote Duan and colleagues. “In addition, updated guidelines should deepen current evidence-based pharmacological therapies and include a discussion of non-pharmacological and behavioral modification strategies for pediatric and adult patients with CISD.”

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