Pruritus and Atopic Dermatitis

Darsow, Ulf; Pfab, Florian; Valet, M.; Huss‐Marp, Johannes; Behrendt, Heidrun; Ring, Johannes; Ständer, Sonja

doi:10.1007/s12016-010-8230-2

Cited by 51 publications

(34 citation statements)

References 65 publications

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“…IL-31 is an inducer of pruritus found to be correlated with SCORAD index and subjective sleeplessness in children with AD. 46 We found that the serum levels of IL-31 and serotonin, another inducer of pruritus, 47,48 were associated with a change in sleep architecture. Further studies are warranted to substantiate these exploratory findings.…”

Section: Figurementioning

confidence: 88%

Atopic Dermatitis, Melatonin, and Sleep Disturbance

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Sleep disturbance affects 47% to 60% of children with atopic dermatitis and is a leading cause of impaired quality of life for the patients and their family. WHAT THIS STUDY ADDS:Sleep disturbance in children with atopic dermatitis can be predicted by a Scoring Atopic Dermatitis index of $48.7, and lower nocturnal melatonin secretion might play a role in the pathophysiology. abstract BACKGROUND AND OBJECTIVES: Sleep disturbance is common in patients with atopic dermatitis (AD). However, studies have largely been questionnaire-based, and the pathophysiology remains unclear. The aims of this study were to determine objective characteristics of sleep disturbance in children with AD and explore contributing factors and clinical predictors.METHODS: Sleep parameters were measured by actigraphy and polysomnography in 72 patients with AD and 32 controls ages 1 to 18 years. Urinary 6-sulfatoxymelatonin levels, serum cytokines, and total and allergen-specific immunoglobulin E (IgE) levels were also measured. RESULTS:The patients with AD had significantly reduced sleep efficiency, longer sleep onset latency, more sleep fragmentation, and less nonrapid eye movement sleep. Results from actigraphy correlated well with those from polysomnography. The AD disease severity was associated with sleep disturbance (r = 0.5520.7), and a Scoring Atopic Dermatitis index of $48.7 predicted poor sleep efficiency with a sensitivity of 83.3% and a specificity of 75% (area under the curve = 0.81, P = .001). Lower nocturnal melatonin secretion was significantly associated with sleep disturbance in the patients with AD. Other correlates of sleep disturbance included pruritus, scratching movements, higher total serum IgE levels, and allergic sensitization to dust mite and staphylococcal enterotoxins. CONCLUSIONS:Poor sleep efficiency is common in children with AD and can be predicted by the Scoring Atopic Dermatitis index. Melatonin and IgE might play a role in the sleep disturbance. Further studies are required to explore the mechanisms and clinical implications, and actigraphy could serve as a useful evaluating tool. Atopic dermatitis (AD) is a common chronically relapsing pruritic inflammatory skin disease. 1 Disturbed sleep is frequently reported by the patients and their family and is a major factor leading to an impaired quality of life. [2][3][4] Sleep disturbance can have many negative consequences, including impaired neurocognitive function, higher rates of behavioral problems, and changes in mood. 5,6 Therefore, the recognition and proper management of sleep disturbance should be an important issue in AD.The sleep disturbance in AD might be due to the pruritus and scratching movements during sleep, 7-10 but it is likely that other factors are involved. 11 Melatonin is a hormone secreted by the pineal gland that is essential for regulating the circadian rhythm. 12 Dysfunction in the diurnal secretion of melatonin in patients with AD has been reported, 13 but its association with their sleep disturbance has...

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Section: Figurementioning

confidence: 88%

Atopic Dermatitis, Melatonin, and Sleep Disturbance

et al. 2014

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“…The pathophysiology behind pruritus is complex, and both peripheral and central factors are involved. 51 Examples of peripheral factors are irritant entry through a defective epidermal barrier, transepidermal water loss, and protease activity in the skin. 52 Centrally, there is a complex interplay of multiple different mediators, although histamine seems to have a limited role, if any.…”

Section: Itch Controlmentioning

confidence: 99%

Atopic Dermatitis: Skin-Directed Management

Tollefson¹,

Bruckner²,

Dermatology³

2014

Pediatrics

110

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Atopic dermatitis is a common inflammatory skin condition characterized by relapsing eczematous lesions in a typical distribution. It can be frustrating for pediatric patients, parents, and health care providers alike. The pediatrician will treat the majority of children with atopic dermatitis as many patients will not have access to a pediatric medical subspecialist, such as a pediatric dermatologist or pediatric allergist. This report provides up-to-date information regarding the disease and its impact, pathogenesis, treatment options, and potential complications. The goal of this report is to assist pediatricians with accurate and useful information that will improve the care of patients with atopic dermatitis. Pediatrics 2014;134:e1735-e1744Atopic dermatitis (AD), commonly referred to as eczema, is a chronic, relapsing, and often intensely pruritic inflammatory disorder of the skin. A recent epidemiologic study using national data suggested that the pediatric prevalence is at least 10% in most of the United States. 1 AD primarily affects children, and disease onset occurs before the ages of 1 and 5 years in 65% and 85% of affected children, respectively. 1 The number of office visits for children with AD is increasing. 2 Up to 80% of children with AD are diagnosed and managed by primary care providers, often pediatricians. 3 Although medical subspecialists, such as pediatric dermatologists and/or pediatric allergists, may be suited to provide more advanced care for children with AD, lack of a sufficient number of such physicians, particularly pediatric dermatologists, 4 likely means the burden of AD care will continue to fall to primary care providers. Although consensus guidelines and practice parameters regarding the management of AD in children have been published, 5-10 considerable variability persists in clinical practice, particularly regarding the roles that bathing, moisturizing, topical medications, and allergies play in management. Inconsistencies in opinion and treatment approach as well as the chronic and relapsing nature of AD can lead to frustration for the patient, family, and primary care providers when managing AD. STATEMENT OF THE PROBLEMNew data support the theory that AD results from primary abnormalities of the skin barrier, 11 suggesting that skin-directed management of AD is of paramount importance. This clinical report reviews AD and provides an up-to-date approach to skin-directed management that is based on pathogenesis. Effectively using this information to create treatment plans

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“…Those patients in whom first-line treatment fails are often graduated to topical corticosteroids, calcineurin inhibitors or systemic immunomodulatory therapies [127]. Since pruritus is often associated with AD, antihistamines have also been prescribed [128,129].…”

Section: Pde4 Inhibitors In the Treatment Of Atopic Dermatitismentioning

confidence: 99%

Cyclic Adenosine Monophosphate Signalling in Inflammatory Skin Disease

Levy¹,

Zhou²

2015

J Clin Exp Dermatol Res

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The second messenger cyclic adenosine monophosphate (cAMP) regulates numerous key pathways that impact the immune system. Distinct cellular cAMP signaling pathways can lead to both pro-and anti-inflammatory effects depending upon the cell type. When dysregulated, these cAMP pathways can influence the pathogenesis of inflammatory cutaneous diseases, such as atopic dermatitis and psoriasis. In psoriasis and atopic dermatitis, cAMP and/or its effector proteins (e.g., protein kinase A) are downregulated suggesting that elevation of cAMP might be a therapeutic option. cAMP levels are the result of balance between synthesis by adenylyl cyclases and degradation by phosphodiesterases (PDEs). Pharmacologically inhibiting PDEs represents one effective mechanism to raise intracellular cAMP levels perhaps leading to targeted immune suppression. Several drugs have been developed to target PDEs and while some toxicities (e.g., nausea and emesis) exist these drugs are generally well tolerated. Perhaps the best characterized is Apremilast, a PDE4 specific inhibitor, which has been FDA approved for the treatment of psoriasis and shows great promise as a safe and novel immunosuppressive medication. Following on the heels of Apremilast are numerous oral and topical PDE inhibitors in various stages of clinical trials. In this review, we examine the role of cAMP signaling in inflammatory cutaneous diseases and the development of PDE inhibitors as therapeutics.

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Pruritus and Atopic Dermatitis

Cited by 51 publications

References 65 publications

Atopic Dermatitis, Melatonin, and Sleep Disturbance

Atopic Dermatitis, Melatonin, and Sleep Disturbance

Atopic Dermatitis: Skin-Directed Management

Cyclic Adenosine Monophosphate Signalling in Inflammatory Skin Disease

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