Mind and skin: Exploring the links between inflammation, sleep disturbance and neurocognitive function in patients with atopic dermatitis

Abstract

Atopic dermatitis (AD) is a chronic, pruritic and inflammatory, dry skin condition with many known comorbidities. These include airway disease, food allergies, atopic eye disease and autoimmune conditions. Furthermore, there is often significant sleep disturbance as well as increased psychological distress and mental health problems. Severe AD therefore often has a significant impact on the quality of life of both patients and their families. In this review we discuss recent findings on the putative links between AD, its association with itch, sleep disturbance and neuropsychiatric morbidity, including the role of inflammation in these conditions. Itch was thought to predominantly drive sleep disruption in AD. We now understand changes in sleep influence immune cell distribution and the associated inflammatory cytokines, which suggests a bidirectional relationship between AD and sleep. We also increasingly recognize inflammation as a key driver in psychological symptoms and disorders. The link between cutaneous, systemic and possible brain inflammation could at least in part be driven by the sleep deprivation and itch‐driven neuronal proliferation seen in AD.

The Psychology of Atopic Dermatitis

“…However, it remains unclear whether neuropsychiatric comorbidities in AD result from persistent and intense itching, poor sleep, and stigma, or if they are direct consequences of proinflammatory cytokines generated by AD inflammation and accelerated neuroinflammation [ 7 , 15 ]. The contributory role of sleep disturbance and itch in the development of AD psychosocial complications has been studied, but the roles of psychological, neurological, and molecular factors are, to date, largely unquantified [ 16 , 17 ].…”

Paediatric Atopic Dermatitis: The Unexpected Impact on Life with a Specific Look at the Molecular Level

“…The pathophysiological mechanisms underlying the development of this pathology are different. A complex interaction emerges between genetically predetermined skin barrier dysfunction, skin dysbiosis, innate and adaptive immunity dysregulation, and environmental factors [2]. More specifically, an inflammatory response is produced when environmental factors stimulate skin dysfunction, which could lead to allergic sensitization.…”

“…More specifically, an inflammatory response is produced when environmental factors stimulate skin dysfunction, which could lead to allergic sensitization. As a result, a clinical response characterized by persistent itching and scratching, predominantly at night, develops [2]. The chronic and relapsing course of the disease, characterized by periods of remission and exacerbation, economic burden, and the whole family's involvement in the treatment process, in association with the different possible clinical presentations in terms of severity, significantly impacts the quality of life of patients affected and of their family [2].…”

“…As a result, a clinical response characterized by persistent itching and scratching, predominantly at night, develops [2]. The chronic and relapsing course of the disease, characterized by periods of remission and exacerbation, economic burden, and the whole family's involvement in the treatment process, in association with the different possible clinical presentations in terms of severity, significantly impacts the quality of life of patients affected and of their family [2]. In particular, the physical, emotional, mental, and social health and the daily functioning of each patient can be affected [3].…”

“…These conditions have the potential to impact a child's neurocognitive 2 of 12 abilities negatively and can also be related to behavioural problems such as attentiondeficit/hyperactivity disorder (ADHD). Children with atopic dermatitis often perform poorly in school due to behavioural issues and learning challenges exacerbated by the physical discomfort and psychological distress associated with the condition [2]. The diagnosis of AD is primarily based on clinical symptoms and the family history of the patient in whom the condition is suspected; however, it is important to note that there is no gold-standard test available for diagnosis, underscoring the complexity of confirming the presence of atopic dermatitis [4].…”