Itching at night: A review on reducing nocturnal pruritus in children

Abstract

The most common causes of chronic nocturnal itching in children are atopic dermatitis and psoriasis, with lichen simplex chronicus and prurigo nodularis contributing to lesser degrees. Despite the prevalence of nocturnal itching, its pathophysiology remains poorly understood. The most troubling consequence of itching at night is poor quality of sleep. Poor sleep quality in children with nocturnal itching has been linked to adverse neurocognitive, behavioral, and physiologic outcomes, including poor performance in school, attention deficit hyperactivity disorder, short stature, hypertension, obesity, and impaired immune function. There is no consensus on the best management of nocturnal itching in children. We conducted a review of the literature evaluating the efficacy of various treatment options for children with chronic nocturnal pruritus. Our review found three recently conducted randomized controlled trials and one case report demonstrating the efficacy of topical corticosteroids, oral melatonin, and clonidine in reducing nocturnal itching or improving sleep quality in children with nocturnal pruritus. Future research is needed to elucidate the pathophysiology of nocturnal itching to best develop targeted, effective treatment strategies.

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

“…A recent Cochrane Review concluded that there is no consistent evidence for the effectiveness of oral H1 antihistamines 133 . Sedating H1 antihistamines may be tried for a short period in acute exacerbations, when sleep disturbances persist despite TCS and emollient use, 270 but long‐term use is not recommended.…”

Patient Journey in Atopic Dermatitis: The Real-World Scenario

“…not reach consensus, with only 47% of the panelists scoring for agreement. The heterogeneous presentation of AD at diagnosis also applied to risk factors; a lack of consensus regarding the presence of nonatopic comorbidities has been identified elsewhere [5,22]. Such comorbities include psychological disorders and lifestyle behaviors associated with high cardiovascular risk.…”

“…However, no consensus was reached regarding the utilization of an AD school or educational measures to improve specific outcomes such as sleep quality or itching management. The relevance of these educational measures is increasingly being acknowledged, particularly in childhood, where nocturnal itching-and the subsequent sleep disturbance-may affect cognitive development [22].…”

“…A high percentage of the panelists (53%) agreed with the frequent use of the Investigator Global Assessment (IGA) to make decisions about treatment scale-up, although this percentage was below the consensus threshold. To complement the general assessment of AD severity, it has been suggested that quality of life or symptoms with a high impact on the patients' life, such as pruritus, should be explicitly assessed [22,39]. Panel members did not reach a consensus on the need for a systematic assessment of pruritus (53% agreement) or quality of life when deciding whether to scale up treatment (59% disagreed with the frequent use of quality of life measurements such as the Infants' Dermatitis Quality of Life Index, proposed due to its use in routine practice) [40,41].…”

Emerging Research in Chronic Pruritus: From Bedside to Bench and Back Again

“…Several antidepressants have also shown some benefits in treating itch [30][31][32]. Khanna et al performed a systematic review to of the current literature to summarize the efficacy of mirtazapine, a tetracyclic antidepressant, in treating chronic itch [33].…”