Dermatologists should be aware of how skin disorders may affect sleep regulation

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 vital to an individual’s physical, mental and emotional well-being, as chronically impacted sleep can lead to a variety of negative health consequences.

“Given the important health implications of sleep loss, addressing this comorbidity is of great interest to clinicians who manage [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 cause scratching behaviors that can lead to more frequent nighttime arousals and lightening of sleep.

Additionally, 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.

“Diurnal cycling of cytokines and cortisol may explain why pruritic episodes in [atopic dermatitis] tend to occur at night,” the researchers wrote.

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

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

Additionally, strategies that help modulate circadian rhythm, such as oral melatonin supplementation and bright-light therapy, may be of use to patients.

“We call upon all guidelines to recommend that sleep problems be regularly assessed and managed in patients with CISD,” Duan and colleagues wrote. “Furthermore, updated guidelines should elaborate on current evidence-based pharmacological therapies and include discussion on non-pharmacological and behavioral modification strategies for pediatric and adult patients with CISD.”