Sleep-wake disorders and dermatology

[Quality of life and sleep quality in patients with chronic pruritus]

Pruritus is defined as a symptom that leads to scratching. Clinically, a heterogeneous group of clinical pictures of different etiology must be considered. Pruritus is characterized by varying intensity and duration. Many patients and/or their social environment, which is influenced by this, cite the impact on sleep quality as an accompanying main symptom. The patient's quality of life is affected depending on the severity of the pruritus and often leads to comorbidity such as depressive disorders or sleep disorders as well as to an impact on psychosocial well-being if it becomes chronic. To date, in addition to the medical history, the established examination methods have been the determination of the disease burden by assessing disease activity, e.g., with validated disease-specific scores, plus the assessment of quality of life using a dermatological quality of life index (DLQI). The latest studies show that this is by no means sufficient to determine the severity of disease and, as a result, to identify adequate treatment options.

Investigating Chronotype and Sleep Quality in Psoriatic Patients: Results from an Observational, Web-Based Survey

BACKGROUND

Psoriasis is an inflammatory disease for which the implications and repercussions go far beyond the skin. Psoriasis patients suffer not only due to its skin manifestations and related symptoms but also because of comorbidities and a huge emotional impact.

OBJECTIVE

The objective of this study was to investigate chronotype and sleep quality in a group of Italian psoriatic patients.

MATERIALS AND METHODS

An observational, cross-sectional, web-based study was set up by the Dermatology and Clinical Medicine Sections of the Department of Medical Sciences, University of Ferrara, Italy. The web questionnaire was sent to an email list of an Italian association of psoriatic patients with the aim of recording their main demographic, social, historical, and clinical data. The survey included two questionnaires: the Morningness-Eveningness Questionnaire (MEQ) and the Pittsburg Sleep Quality Index (PSQI).

RESULTS

Two hundred and forty-three psoriatic patients (mean age 52.9 ± 12.8 yrs., 32.5% males and 67.5% females) filled out the questionnaire. A good 63.8% of them were affected with psoriasis for more than 10 years, 25.9% reported having a diffuse psoriasis, and 66.7% were on treatment at the time they completed the questionnaire. With reference to chronotype, the mean MEQ score was 55.2 ± 10.7; furthermore, 44% of the patients were "morning-oriented types", M-types, or "larks", 44.5% were "intermediate-types" or I-types, and 11.5% were "evening-oriented types", E-types, or "owls". No correlations were found between chronotype and psoriasis extension. Based on the PSQI results, 72.8% of the study population was judged to have a low sleep quality. Sleep disturbance was significantly related to female sex, living alone, and the presence of comorbidities.

CONCLUSIONS

Sleep disturbance is very common in psoriatic patients, especially in those with comorbidities, in females, and in patients who live alone. The chronotype in psoriatic patients does not appear different when compared to the general population, nor does it seem to have any link with psoriasis severity.

Sleep deprivation and the skin

Sleep is an under-evaluated symptom when assessing patients with cutaneous disease. Consequently, the relationship between sleep deprivation and disease burden is often not considered. The focus of our review article is to explore the bidirectional relationship between sleep and cutaneous disease investigating the disruption in circadian rhythmicity and skin homeostasis. Management strategies should focus on optimizing disease control coupled with improving sleep hygiene.

Common but neglected problem in chronic spontaneous urticaria: Sleep disturbance

Background: Association of chronic spontaneous urticaria (CSU) with sleep disturbance has not been evaluated in studies that involve a large number of patients. Objective: In this study, we aimed to evaluate the sleep attitude and circadian rhythm in patients with CSU. Methods: As the patient group, recently diagnosed 100 patients with CSU, 100 patients with allergic rhinitis (AR) as the patient control group, and 100 healthy controls (HCs) were included. The Pittsburgh Sleep Quality Index (PSQI) questionnaire, sleep hygiene index (SHI), Epworth Sleepiness Scale (ESS) questionnaire, and the morningness-eveningness questionnaire (MEQ) were filled to assess sleep quality and circadian rhythm. CSU disease activity was evaluated by urticaria activity score-7 (UAS-7). Patients with concomitant diseases, e.g., psychiatric illnesses, that possibly affect sleep status or those who use related medications and at moderate or high risk of obstructive sleep apnea according to the STOP-Bang questionnaire were excluded from the study. Results: PSQI, SHI, and ESS scores were higher, and the MEQ score was lower in patients with CSU and patients with AR than those in the HCs (p < 0.001, for each score). However, the scores were not different among the patients with CSU and the patients with AR. UAS-7 was only correlated with PSQI scores (r = 0.402, p < 0.001). In addition, blood eosinophil counts and the serum C Reactive Protein (CRP) level were correlated with sleep quality (p = 0.02). Conclusion: The poor sleep quality, impaired sleep hygiene, increased daytime sleepiness, and intermediate type of circadian rhythm were observed in the patients with CSU and the patients with AR. Physicians should be aware of sleep problems in patients with CSU that might affect their quality of life and the success of their treatment.

The Melatonin-Mitochondrial Axis: Engaging the Repercussions of Ultraviolet Radiation Photoaging on the Skin's Circadian Rhythm

Sunlight is a vital element in modulating the central circadian rhythm, such as the regulation of the host's sleep-awake state. Sunlight is also considered to have a significant influence on the circadian rhythm of the skin. Over-exposure or prolonged exposure to sunlight can lead to skin photodamage, including hyperpigmentation, collagen degradation, fibrosis, and even skin cancer. Thus, this review will focus on the adverse effects of sunlight on the skin, not only in terms of photoaging but also its effect on the skin's circadian rhythm. Mitochondrial melatonin, regarded as a beneficial anti-aging substance for the skin, follows a circadian rhythm and exhibits a powerful anti-oxidative capacity, which has been shown to be associated with skin function. Thus, the review will focus on the influence of sunlight on skin status, not only in terms of ultraviolet radiation (UVR)-induced oxidative stress but also its mediation of circadian rhythms regulating skin homeostasis. In addition, this article will address issues regarding how best to unleash the biological potential of melatonin. These findings about the circadian rhythms of the skin have broadened the horizon of a whole new dimension in our comprehension of the molecular mechanisms of the skin and are likely to help pharmaceutical companies to develop more effective products that not only inhibit photoaging but keep valid and relevant throughout the day in future.

Sleep quality among psoriasis patients: excluding the immunosuppressive therapy effect

Background

Psoriasis is associated with several comorbidities and different psychological disorders including anxiety and depression. Psoriasis may also affect sleep quality and consequently the quality of life. The use of immunosuppressants used in the treatment of psoriasis were also reported to increase insomnia, so the purpose of the study is to assess the quality of sleep and degree of insomnia in patients with psoriasis not on any systemic or immunosuppressive therapy compared to controls and to examine the relation between sleep quality, insomnia with depressive, and anxiety symptoms. One hundred psoriasis cases, not receiving immunosuppressive therapy, and 80 apparently healthy subjects were recruited as controls. We assessed quality of sleep, insomnia and screened for anxiety and depressive symptoms among psoriasis patients and healthy controls; any patient on immunosuppressant therapy was excluded.

Results

Quality of sleep using Pittsburgh Sleep Quality Index, insomnia using Insomnia Severity Index, depression using Beck Depression Inventory, and anxiety using Taylor Anxiety Manifest Scale were statistically significant higher among psoriasis patients than healthy controls all with p value p < 0.001. Depressive symptoms were significantly positively correlated with Pittsburgh Sleep Quality Index (PSQI) global score (p = 0.045) and subjective sleep quality subscale (p = 0.005). Also, BDI scores was significantly positively correlated with insomnia scores as measured by ISI (p = 0.026).

Anxiety symptoms were significantly positively correlated with global score of PSQI (p = 0.004) and its subscale (subjective sleep quality, sleep latency, sleep disturbance, use of medications and daytime dysfunction) and insomnia (p = 0.001).

Conclusions

Abnormal sleep quality and insomnia were detected in patients with psoriasis not using any immunosuppressive or systemic therapy, and this could be due to the psoriasis disease itself or due to the associated anxiety and depression associated with psoriasis. Screening for psychiatric symptoms specially that of depression, anxiety, and sleep among patients with psoriasis is of utmost importance for better quality of life. Thus, collaboration between dermatologists and psychiatrists may show better life quality for these cases and better treatment outcomes.

Sleep impairment in patients with chronic inflammatory skin diseases: A review of mechanisms and management

BACKGROUND

Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation.

OBJECTIVE

To summarize the complex factors that underlie the relationship between CISD and sleep impairment.

METHODS

We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines.

RESULTS

The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis.

CONCLUSIONS

We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.

Hidradenitis Suppurativa: The Influence of Gender, the Importance of Trigger Factors and the Implications for Patient Habits

Hidradenitis suppurativa (HS) is a debilitating, chronic, inflammatory skin disease primarily affecting apocrine gland-rich areas of the body. On the one hand, the presence of triggering factors-some identified, others only hypothesized-may initiate or perpetuate the pathogenic process of HS. In addition to cigarette smoking and diet, other trigger factors, including choice of clothing, are frequently observed in clinical practice. On the other hand, the presence of disease may influence habits of HS patients. Indeed, high incidences of sexual and sleep impairment have been reported in these patients. Consequently, alcohol and substance abuse may be a coping strategy for the emotional and psychological disease burden. Furthermore, a greater awareness of gender differences in HS may be important for dermatologists in their own clinical practice (i.e., pregnancy and breastfeeding). Consequently, in this loop interaction, comprehensive knowledge of all factors involved is crucial for the management of HS patients. Thus, the objective of this review is to (i) discuss the influence of gender on HS, (ii) summarize the most frequent triggering factors of HS and (iii) analyze the impact of HS on patient habits.

Relationships between quality of life, sleep problems, and sleep quality in patients with chronic idiopathic urticaria

BACKGROUND

In this study, we aimed to evaluate the sleep quality among chronic urticaria patients using the Chronic Urticaria Quality-of-Life Questionnaire (CU-Q2oL), sleep quality assessment tools, and polysomnography and to investigate any relationships between the obtained results.

METHODS

The study included 21 patients diagnosed with chronic spontaneous urticaria and 19 healthy controls. We recorded the patients' sleep quality data, including CU-Q2 oL, Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and polysomnography results.

RESULT

Patients in the chronic urticaria group were more likely to have an ESS score of ≥10 (52.4% vs. 5.3%, p = 0.004) and an apnea-hypopnea index of ≥5 (44.4% vs. 5.3%, p = 0.017) compared to the control group. In the patient group, the CU-Q2 oL total score was positively correlated with sleep latency (r = 0.713, p = 0.004) and PSQI-C1 score (r = 0.726, p = 0.005), while it was negatively correlated with urticaria duration (r = -0.579, p = 0.015), apnea-hypopnea index (r = -0.607, p = 0.021), longest apnea duration (r = -0.583, p = 0.029), total number of respiratory events (r = -0.618, p = 0.018), and apnea count (r = -0.686, p = 0.007).

CONCLUSION

We conclude that sleep-related problems exist among a considerably large proportion of patients with chronic spontaneous urticaria.

The Use of Conductive Lycra Fabric in the Prototype Design of a Wearable Device to Monitor Physiological Signals

Wearable technology has become commonplace for the measurement of heart rate, steps taken, and monitoring exercise regimes. However, wearables can also be used to enable or enhance the lives of persons living with disabilities. This paper discusses the design of a wearable device that aims to facilitate the assessment of physiological signals using conductive Lycra fabric. The device will be applicable for daily use within diverse contexts including the evaluation of emotional experiences of children with Severe Motor and Communication Impairment and the detection of Obstructive Sleep Apnea in children with Down Syndrome. The Lycra fabric sensors are used to acquire electrocardiographic signals, galvanic skin response, and respiratory signals. Articulated design requirements include constraints related to the ability to fit children of all sizes, and meeting medical device standards and biocompatibility, and criteria related to low costs, comfortability, and maintainability. Upon prototyping and preliminary testing, this device was found to offer an affordable, comfortable, and accessible solution to the monitoring of physiological signals. Clinical Relevance- This research provides initial knowledge and momentum towards an affordable wearable device using conductive Lycra to effectively monitor and assess physiological signals in children with disabilities.

Sleep Disorders and Psoriasis: An Update

Psoriasis alters patients’ quality of life. Among the disorders associated with psoriasis, sleep disorders are common, although they are not directly assessed by most quality-of-life scores. Thus, the specific evaluation of sleep disorders using dedicated scores is necessary, especially because such disorders alter patients;’ physical and psychological health. The relationship between psoriasis and sleep disorders has been shown in numerous studies, but has not yet been fully elucidated. The aim of this study was to update knowledge of sleep disorders in patients with psoriasis, through a review of the scientific literature since 1980. This work covers several topics of interest, such as sleep assessment methods, the prevalence of sleep disorders in patients with psoriasis, factors predictive of sleep disorders in patients with psoriasis, the impact of sleep disorders on comorbidities and quality of life, pathogenic mechanisms, obstructive sleep apnoea and restless leg syndromes, and the impact of biotherapy treatments on sleep disorders in patients with psoriasis.

Analysis of the structure and function of the epidermal barrier in patients with ichthyoses - clinical and electron microscopical investigations

BACKGROUND

Ichthyoses are pathogenetically characterised by a pronounced disorder of the epidermal barrier. Clinically, hyperkeratosis, severe scaling and erythroderma are present on the entire integument. The time-consuming therapy includes daily baths and the application of skin care products to restore the epidermal barrier.

OBJECTIVES AND METHODS

To enhance the knowledge about the structure and function of the epidermal barrier in ichthyoses, we conducted clinical, biophysical and electron microscopical measurements on 46 patients with ichthyoses, including autosomal recessive ichthyoses, keratinopathic ichthyoses, X-chromosomal recessive ichthyosis and Netherton syndrome.

RESULTS

The patients displayed a significantly decreased skin hydration along with unexpectedly low transepidermal waterloss values. Electron microscopical examinations demonstrated a severe occlusion of the epidermis by lipid remnants of skin care products in the stratum corneum. We found decreased intercellular lipid lamellae and an increased undulation of the corneocyte membrane of all ichthyoses, mostly pronounced in Netherton syndrome. The lipid profiles of ichthyoses showed decreased esterified Ω-hydroxy-sphingosine (EOS) ceramide levels.

CONCLUSIONS

The results demonstrate the extent of the epidermal barrier disruption in ichthyoses. In combination with the knowledge about pathogenetic causes, individually improved therapeutic options can be derived from our results. In the future, the analyses of the organisation of intercellular lipid lamellae and corneocyte membrane undulation will enable improved investigations of the epidermal barrier in ichthyoses and may be used to study and evaluate possible effects of topical skin preparations.

Functional links between thermoregulation and sleep in children with neurodevelopmental and chronic health conditions

The bi-directional relationship between sleep and wake is recognized as important for all children. It is particularly consequential for children who have neurodevelopmental disorders (NDDs) or health conditions which challenge their sleep and biological rhythms, and their ability to maintain rhythms of participation in everyday activities. There are many studies which report the diverse reasons for disruption to sleep in these populations. Predominantly, there is focus on respiratory, pharmaceutical, and behavioral approaches to management. There is, however, little exploration and explanation of the important effects of body thermoregulation on children's sleep-wake patterns, and associated behaviors. Circadian patterns of sleep-wake are dependent on patterns of body temperature change, large enough to induce sleep preparedness but remaining within a range to avoid sleep disturbances when active thermoregulatory responses against heat or cold are elicited (to maintain thermoneutrality). Additionally, the subjective notion of thermal comfort (which coincides with the objective concept of thermoneutrality) is of interest as part of general comfort and associated behavioral responses for sleep onset and maintenance. Children's thermoregulation and thermal comfort are affected by diverse biological functions, as well as their participation in everyday activities, within their everyday environments. Hence, the aforementioned populations are additionally vulnerable to disruption of their thermoregulatory system and their capacity for balance of sleep and wakefulness. The purpose of this paper is to present hitherto overlooked information, for consideration by researchers and clinicians toward determining assessment and intervention approaches to support children's thermoregulation functions and promote their subjective thermal comfort, for improved regulation of their sleep and wake functions.

The Association between Melatonin Levels and Sleep Quality in Patients with Pruritus: A Potential Biomarker on a Candidate Future Treatment

Background:

Melatonin is a hormone that regulates the sleep–wake cycle and has immunomodulatory and anti-inflammatory roles.

Aims:

The aim of this study is to assess melatonin levels and investigate the association with pruritus severity, sleep quality, and depressive symptoms in dermatoses with nocturnal pruritus.

Methods:

The study was a prospective study with 82 participants, including 41 patients and 41 healthy volunteers. The visual analog scale (VAS), Pittsburg Sleep Quality Index (PSQI), and Beck Depression Inventory (BDI) were recorded for each patient. To assess the melatonin levels, urinary 6-sulfatoxymelatonin levels in the first urine in the morning were measured.

Results:

Melatonin concentrations were significantly lower (P = 0.007), while the BDI (P = 0.001) and PSQI (P = 0.001) scores were significantly higher in the patients with pruritus than in the healthy control subjects. There was an inverse correlation between melatonin levels and PSQI scores (r = −0.355, P = 0.023), and a positive correlation was detected between BDI scores and PSQI scores (r = 0.631, P = 0.001) in the pruritus group.

Conclusion:

Melatonin levels were found to decrease in relation to sleep quality in nocturnal pruritus patients. Low melatonin levels in these patients may be associated with sleep disorders and pruritus.

Bipolar Patients and Bullous Pemphigoid after Risperidone Long-Acting Injectable: A Case Report and a Review of the Literature

Neuropsychiatric disorders are found to be associated with bullous pemphigoid (BP), an autoimmune subepidermal blistering disease. Antipsychotics have emerged as possible inducing factors of BP. However, large sample studies concerning BP associated with antipsychotics, as well as with specific mental disorders, are still lacking. Our review retrieved a few clinical studies and case reports on the topic, producing controversial results. We report for the first time a bipolar patient case presenting BP following five-month therapy with risperidone long-acting injectable (LAI). We hypothesize that the dermatological event is associated with the medication administered. The issue emerged during psychiatric consultation and was confirmed by histological examination, direct and indirect immunofluorescence studies, plus positive plasma and cutaneous BP180 and BP230 IgG. Neurodegeneration or neuroinflammation might represent a primary process leading to a cross-reactive immune response between neural and cutaneous antigens and contributing to self-tolerance failure. Furthermore, the time sequence of the shared biological mechanisms leading to clinical manifestations of the neuropsychiatric disorder and BP remains undefined. BP comorbid with bipolar disorder might occasionally represent a serious health risk and affect patients' physical and psychosocial quality of life. Thus, clinicians treating psychiatric patients should consider BP as a possible adverse effect of psychotropic medications.

Nocturnal pruritus and sleep disturbance associated with dermatologic disorders in adult patients

Nocturnal pruritus (NP) is a relatively common reason for dermatologic consultation. Its pathophysiology is partially understood. Skin conditions such as atopic dermatitis, psoriasis, urticaria, and prurigo nodularis are well-described causes of NP. The most distressing sequela of NP is sleep deficit, which can lead to physical and mental disturbances (e.g., daytime somnolence and fatigue) and negative emotional states that profoundly affect quality of life. However, this aspect of NP is often overlooked by dermatologists. It is essential to assess sleep quality in such patients and adopt appropriate measures to arrest the problem at an early stage. We conducted an evidence-based literature review to highlight the pathogenetic mechanisms of NP, identify dermatologic etiologies, and explore methods that have been used to assess the quality of sleep. Furthermore, we performed a systematic review of studies on sleep disturbance relevant to NP in patients with dermatologic conditions. Finally, we discuss the evidence on treatment options for NP and indicate therapies that may target both NP and sleep disturbance.

The importance of evaluating sleep complaints in children with ichthyoses: a commentary on physical and psychological growth impairment

NONE

Ichthyosis, as a debilitating disease, can cause significant physical and psychological damage to children and their families, which also includes sleep impairment. We call attention to the importance of evaluating sleep complaints in these patients, given the scarcity of studies on this subject. As the disease commonly results in severe skin injury, it can affect social relationships and the life and sleep quality of the individuals, leading to significant psychologic damage that can persist throughout their lives.

Influence of Skin Subjective Symptoms on Sleep Quality in Patients with Cutaneous Disorders: A Study of 2871 Subjects

Introduction

Previous studies showed more sleep disturbance (SD) in patients with cutaneous disorders (CD). During CD, unpleasant subjective symptoms [USS], such as itch, pain and others (tingling, burning, or tightness) have a negative influence on sleep quality. This study aims to evaluate the prevalence of SD in CD patients and to identify the influence of itch, pain and other unpleasant sensations on SD.

Materials and Methods

An international, anonymized real-life survey was conducted with individuals [18−75 years], with physician-confirmed CD, or without CD. The 25 items covered sociodemographic characteristics, feeling of overall sleep quality and skin unpleasant sensations. Severity of SD and unpleasant sensations were assessed using a 10-cm Visual Analogue Scale (VAS).

Results

From 3834 analyzed questionnaires, 2871 (67.3%) were in the CD group and 863 (32.7%) in the control group. Patients with CD had significantly more SD (71.2% vs 32.7% in the control group, p<0.0001). CD patients without any reported unpleasant sensation were at higher risk for SD than control subjects (OR 1,362 [95% CI 1.975–2.405] p=0.0013). SS were highly associated with SD (OR 1.641 [95% CI 1.393–1.933] p<0.0001). Pruritus, pain and intermediate sensations were significant predictors of SD, with odds ratios of 1.670, 1.625 and 1.326, respectively. VAS sleep scores were strongly associated with pruritus (r: 0.25, p<0.0001) and pain (r: 0.25 p<0.0001) severity ratings.

Discussion

SD is a common problem for patients with CD. Patients with subjective symptoms suffer more from SD, suggesting that they are aggravating factors, but are likely not the only reason for SD in CD patients. We found that during CD, intermediate sensations also contribute to SD. Despite some limitations and the potential bias due to the study design, our results confirm for the first time on an international level the influence of subjective symptoms on sleep quality in patients with CD.

Indoor Lighting Workplaces

Office work has so far been carried out in company buildings and was largely based on the use of paper on a horizontal surface. Due to multiple reasons, more workers are working in their homes with electronic devices. As a result, both the working environment and personal tools are changing. Since the discovery about 20 years ago of the non-visual ways of light absorption, it was known that apart from the image forming effects (IF) of light from which the criteria for correct lighting have been developed, non-image forming effects (NIF) of light exist. The discovery of NIF has enhanced researcher belief in the importance of daylighting and has raised new criteria to be taken into account for proper interior lighting. Due to all the factors mentioned above, the parameters to be met by a luminaire and its environment for proper lighting of the workstation have been modified and expanded. The rapid advance in the development of new light-emitting diode (LED) luminaires with which the spectral power distribution (SPD) can be practically created opens the door to a genuine technological revolution comparable to the invention of electric lighting around 150 years ago. The authors of this study will review the latest published studies on the importance of light in our lives, IF and NIF effects of light, the parameters which from these effects are suggested to be taken into account for a correct indoor lighting, the regulations in force on indoor lighting workplaces, and proposals to improve indoor lighting and therefore the quality of life of workers.

Relations between vitamin D3, total and specific IgE for house dust mites in atopic dermatitis patients

Atopic dermatitis (AD) is a chronic recurrent inflammatory skin disease. There are a lot of evidences on the importance of vitamin D and house dust mite (HDM) allergens in the etiology and course of AD. The objectives of this study are to evaluate the relation between vitamin D3 level and house dust mites (HDM) Dermatophagoidspecies sensitization in pathogenesis of atopic dermatitis. Cross-sectional design study was conducted on 50 atopic dermatitis patients. Blood analysis were done to determine level of vitamin D3, total IgE by fluorescent immunoassay & specific IgE for HDM (d1, d2) & other inhalant allergens by ELISA test. There was significant high negative correlation with the specific IgE for HDM (r =  −0. 62, p < 0.001) and vitamin D3. & there was non-significant minimal negative correlation with the specific IgE and other inhalant allergens (r = − 0.10, p > 0.05). There was a statistically significant relation between level of vitamin D3 and atopic dermatitis severity and sensitization to HDM and other allergens.

Blue-Light Levels Emitted from Portable Electronic Devices Compared to Sunlight

Over recent years, a technological revolution has taken place in which conventional lighting has been replaced by light emitting diodes (LEDs). Some studies have shown the possibility that blue light from these artificial sources could have deleterious effects on the retina. Considering that people spend a non-negligible time in front of screens from computers and mobile phones, the eyes receive blue light of different intensities depending on the source. Nevertheless, any study about the visual and non-visual effects of blue light must consider precise measurements taken from actual artificial sources. For this reason, we have analyzed the spectral emission of 10 different electronic devices and weighted them according to the hazard caused by blue light to the eyes, comparing the results with solar radiation simulated with a radiative transfer model. The maximum spectral irradiance of the measured electronic devices at 10 cm from the detector was located between 440 nm and 460 nm. The irradiance for blue light hazard ranged from 0.008 to 0.230 Wm−2 depending on the particular characteristics of each electronic device. In contrast, the solar radiances in the same spectral range are larger both under clear and cloudy conditions.

Holistic dermatology: An evidence-based review of modifiable lifestyle factor associations with dermatologic disorders

BACKGROUND

Holistic dermatology focuses on treating the human body as a whole and implementing lifestyle changes to enhance the treatment and prognosis of skin disease. Understanding the interplay between modifiable lifestyle factors and patients' dermatologic health will help physicians better inform patients on self-care methods to mitigate the burden of their skin disease(s).

OBJECTIVE

To review the current scientific literature on the relationship between modifiable lifestyle factors and the dermatologic outcome of skin disorders.

METHODS

A systematic literature search on PubMed, Cochrane, and Web of Science was conducted to identify research articles examining the relationship between dermatology and 6 major categories of modifiable lifestyle factors: diet, sleep, exercise, stress, alcohol, and smoking.

RESULTS

A substantial amount of evidence supports the relationship between modifiable lifestyle factors and dermatologic outcomes. There were the most studies on diet, stress, alcohol, and smoking, but all lifestyle factors were supported by some degree of scientific evidence.

CONCLUSION

All modifiable lifestyle factors explored in this review play a critical role in modulating the onset and progression of skin disease. We anticipate more research studies in the future and an increasing integration of holistic dermatology into patient care.

Depressive Symptoms and Sleep Disturbance in Female Nurses with Atopic Dermatitis: The Korea Nurses' Health Study

Although the prevalence of atopic dermatitis is high in nurses, there is a lack of research on the relationship between atopic dermatitis and depressive symptoms and sleep disturbance among female nurses. This study aimed to determine the effects of atopic dermatitis on depressive symptoms and sleep disturbance in female nurses. We analyzed the data of the Korea Nurses’ Health Study, a large-scale prospective cohort study. A total of 20,613 female hospital nurses aged 20–45 years who participated in the Module 1 of Korea Nurses’ Health Study between July 2013 and November 2014 were included. The chi-square test, t-test, and multivariate ordinal logistic regression analysis were conducted for statistical analysis. The prevalence of atopic dermatitis among female nurses was 11.6%. The levels of depressive symptoms and sleep disturbance were higher in nurses with atopic dermatitis than those without atopic dermatitis. Nurses with atopic dermatitis were 1.16 times more likely to have depressive symptoms and 1.35 times more likely to have sleep disturbance than those without atopic dermatitis after adjusting for confounding variables. The results of this study suggest that additional support should be considered for nurses with atopic dermatitis to improve the occupational environment for managing and preventing the exacerbation of symptoms.

Exploring the real-world profile of refractory and non-refractory chronic idiopathic urticaria in the USA: clinical burden and healthcare resource use

Introduction: Chronic idiopathic/spontaneous urticaria (CIU/CSU) is a debilitating skin condition that is burdensome for patients and healthcare providers. We aimed to describe clinical characteristics, consultation patterns and healthcare resource utilization in real-world US patients with refractory and non-refractory CIU/CSU. Methods: Data was collected from the Adelphi Real World 2015 Urticaria Disease Specific Programme. Physicians completed patient record forms (PRFs) for the next four patients consulting with non-refractory CIU/CSU and the next six with refractory CIU/CSU; patients were considered refractory if symptomatic and on treatment step ≥2. The same patients were asked to complete patient self-completion (PSC) forms describing how CIU/CSU affected them. Results: Seventeen physicians (15 allergists; 2 dermatologists) completed 184 PRFs (108 refractory CIU/CSU; 76 non-refractory CIU/CSU); 140 patients completed PSC forms (93 refractory CIU/CSU; 47 non-refractory CIU/CSU). Mean time from first consultation to diagnosis was 13.5 (SD 28.3) weeks; mean time from diagnosis to first treatment was 16.0 (SD 37.9) weeks. Patients with refractory CIU/CSU were more likely to initially consult primary care physicians than those with non-refractory CIU/CSU (51% and 28%, respectively). The most common symptoms were itching, sleep problems and anxiety/distress, affecting 75%, 23% and 18%, respectively. Patient-perceived disease severity was greater than physician-perceived severity (refractory CIU/CSU kappa 0.1512; non-refractory CIU/CSU 0.1590). Conclusions: Patients with CIU/CSU in this real-world study - particularly those with refractory CIU/CSU - were slow to receive specialist care and had substantial symptom burdens; patient-physician perception of disease severity was discordant. Earlier diagnosis of CIU/CSU may lead to timely use of CIU/CSU therapies.

Presence and characteristics of senile pruritus among Danish elderly living in nursing homes

Aim:

To explore the pattern of occurrence and characteristics of senile pruritus among elderly living in nursing homes in the Northern region of Denmark.

Materials & methods:

A Danish questionnaire was developed and distributed to six nursing homes from which 46 residents participated.

Results:

The prevalence of chronic itch was 28.9%. Evening–night and autumn–winter with an average daily itch of 30 min were reported. Itch interfered with night sleep and daily activities. Scratching was common with 61.5% accompanying scratch marks. Half of participants reported Xerosis. Cream, cold compress and cold shower were found to be the most effective remedies for itch relief.

Conclusion:

The present study revealed a high prevalence of chronic pruritus including cases of senile pruritus that needs further exploration for treatment or preventive strategies.

Senile pruritus is chronic itch of unknown origin among the elderly. The occurrence and characteristics among Danish nursing home residents was not known. We developed a Danish questionnaire and distributed it to 6 nursing homes, where 46 residents participated. We found a high prevalence of chronic itch (28.9%). Disturbing itch was reported in evening–night and autumn–winter. Itch interfered with night sleep and daily activities. Scratching was common with scratch marks. Showering precipitated itch, while cold shower was a reliever. Further studies are required to enhance the knowledge about senile pruritus and prevention or treatment strategies for elderly living in nursing homes.

Sleep quality among adult patients with chronic dermatoses

Chronic dermatoses, including atopic dermatitis, psoriasis, prurigo nodularis, chronic spontaneous urticaria and hidradenitis suppurativa, as well as accompanying subjective symptoms (itch and pain), have a great impact on patients’ well-being. Skin plays an important role in the physiological sleep process. This review attempts to analyze the association between chronic dermatoses in adults and sleep quality in recent studies. Polysomnography and actigraphy are performed for the objective assessment of sleep quality. Questionnaire-based subjective evaluations of sleep quality, including the Pittsburgh Sleep Quality Index and Medical Outcomes Study Sleep Scale, are useful in clinical studies and clinical practice. Subjective symptoms such as itch and pain have an essential influence on sleep quality and general quality of life in patients with chronic skin diseases.

Sleep disorders in adolescents and young adults: Insights into types, relationship to obesity and high altitude and possible lines of management

A sleep disorder is a medical disorder of the sleep pattern of a person that may be serious enough to interfere with normal physical, mental and emotional functioning. Disruptions in sleep can be caused by a variety of causes, from teeth grinding to night terrors. Sleep disorders are usually prevalent among adolescents and young adults, possibly due to factors related to life style, dietary habits, hormonal and emotional disturbances. Other factors that may precipitate sleep disorders include environmental, psychological and genetic factors. Sleep disorders may lead to serious psychological and mood disorders and may even affect the immune system. Management of sleep disorders depends on amelioration of the precipitating factors and the use of certain drugs that may help to restore the normal sleep-wake cycle. This review sheds light on sleep disorders in adolescents and young adults regarding their types, etiology, dangers and possible lines of management.

Sleep disturbance in psoriasis: a case-controlled study

BACKGROUND

Sleep is essential for daytime functioning and health. Given the physical symptoms of psoriasis, a higher prevalence of sleep disorders can be expected. So far, the studies examining sleep disturbance in psoriasis have been of less-than-optimal methodological quality and with mixed results.

OBJECTIVES

To examine the prevalence of sleep disturbance in patients with plaque psoriasis compared with a control group, to evaluate associations with health-related quality of life (HRQoL) and examine possible disease-related predictors of disturbed sleep.

METHODS

We used a cross-sectional, case-controlled design. Participants included 179 consecutively recruited patients with plaque psoriasis and 105 controls. Measures included psoriasis severity (Psoriasis Area and Severity Index); HRQoL (Dermatology Life Quality Index); insomnia severity [Insomnia Severity Index (ISI)]; sleep quality [Pittsburgh Sleep Quality Index (PSQI)]; stress (Perceived Stress Scale); itch (Itch Severity Scale); and depressive symptoms (Beck Depression Inventory). Analyses included group comparisons and regression analyses to identify predictors of sleep disturbance.

RESULTS

A total of 25% of patients with psoriasis reported clinical insomnia (ISI > 15), compared with 10·5% of controls. In all, 53·6% of patients with psoriasis were poor sleepers (PSQI > 5), compared with 21·9% of controls. Itch was statistically significantly associated with all sleep-related outcomes.

CONCLUSIONS

A higher proportion of patients with psoriasis experience poor sleep than controls from the general population. Itch was the main predictor of impaired sleep. Improved control of psoriasis with decreased itch may improve sleep disturbance in psoriasis.

Associations between atopic dermatitis and other disorders

Atopic dermatitis is a heterogeneous, chronic, and inflammatory skin disease that is associated with a profound symptom burden. Recent studies have demonstrated associations between atopic dermatitis and a number of multi-organ and systemic disorders. The origin of these comorbid conditions is likely multifactorial, with combined effects of skin-barrier disruption, immune dysregulation, intense symptoms, and iatrogenic complications. Some of these comorbid conditions appear to be related to the underlying severity of atopic dermatitis and inadequate disease control. This review will summarize recent developments in the understanding of the comorbid health disorders associated with atopic dermatitis, particularly infections, sleep disturbances, and cardiovascular disease.

Circadian rhythm in atopic dermatitis-Pathophysiology and implications for chronotherapy

Circadian rhythm is a biological clock that controls a wide range of physiological functions throughout the body, including various skin functions. A 24-h diurnal cycle, governed by an endogenous clock in the brain, largely controls cutaneous diurnal rhythm, which external factors, including temperature, humidity, diet, and stress, also modulate locally. Circadian rhythm influences cutaneous blood flow and properties of skin barrier function, such as transepidermal water loss and capacitance, and has important implications in atopic dermatitis (AD). This review explores how aberrations in circadian rhythm may play a role in the pathogenesis of AD and proposes implementation of chronotherapy to improve treatment outcomes in patients with AD.

Frequency and Management of Sleep Disturbance in Adults with Atopic Dermatitis: A Systematic Review

Introduction

Intense nocturnal pruritus as well as the complex pathophysiology of atopic dermatitis (AD) can severely affect sleep and become a major factor in negatively impacting quality of life in adults. However, much of the literature on sleep disturbance in AD patients is on the pediatric population, and it is not well studied in adults. Furthermore, limited studies are available to guide effective management of sleep disturbance in AD in general. We review the literature to present the studies that have investigated the relationship between AD and its effect on sleep in adults and provide an approach for clinicians caring for this population.

Methods

A systematic literature search was conducted through the PubMed and EMBASE databases using the search terms “atopic dermatitis” OR “eczema” AND “sleep.” The articles generated by the search and their references were reviewed.

Results

A high prevalence of sleep disturbance is experienced by adults with AD. The likelihood of sleep disturbance is much higher in patients with AD compared to those without AD. Sleep disturbance appears to worsen with AD severity. Pruritus and scratching appear to be large contributors to sleep disturbance in adult patients with AD.

Conclusion

It is important that clinicians evaluate the severity of AD and ask general questions about itching, sleep, impact on daily activities, and persistence of disease during each patient visit and follow-up with the complaint of sleep disturbance. Management of sleep disturbance in AD should focus on adequate disease control of AD as well as possible medical interventions to help improve sleep. The pathophysiology of sleep disturbance in AD is extremely complex, and further research is needed to better understand the interplay of the immune system, circadian rhythm, and environmental factors implicated in both AD and sleep.

Short- and long-term health consequences of sleep disruption

Sleep plays a vital role in brain function and systemic physiology across many body systems. Problems with sleep are widely prevalent and include deficits in quantity and quality of sleep; sleep problems that impact the continuity of sleep are collectively referred to as sleep disruptions. Numerous factors contribute to sleep disruption, ranging from lifestyle and environmental factors to sleep disorders and other medical conditions. Sleep disruptions have substantial adverse short- and long-term health consequences. A literature search was conducted to provide a nonsystematic review of these health consequences (this review was designed to be nonsystematic to better focus on the topics of interest due to the myriad parameters affected by sleep). Sleep disruption is associated with increased activity of the sympathetic nervous system and hypothalamic-pituitary-adrenal axis, metabolic effects, changes in circadian rhythms, and proinflammatory responses. In otherwise healthy adults, short-term consequences of sleep disruption include increased stress responsivity, somatic pain, reduced quality of life, emotional distress and mood disorders, and cognitive, memory, and performance deficits. For adolescents, psychosocial health, school performance, and risk-taking behaviors are impacted by sleep disruption. Behavioral problems and cognitive functioning are associated with sleep disruption in children. Long-term consequences of sleep disruption in otherwise healthy individuals include hypertension, dyslipidemia, cardiovascular disease, weight-related issues, metabolic syndrome, type 2 diabetes mellitus, and colorectal cancer. All-cause mortality is also increased in men with sleep disturbances. For those with underlying medical conditions, sleep disruption may diminish the health-related quality of life of children and adolescents and may worsen the severity of common gastrointestinal disorders. As a result of the potential consequences of sleep disruption, health care professionals should be cognizant of how managing underlying medical conditions may help to optimize sleep continuity and consider prescribing interventions that minimize sleep disruption.

Psychocutaneous disease: Clinical perspectives

Psychocutaneous disease, defined in this review as primary psychiatric disease with skin manifestations, is commonly encountered in dermatology. Dermatologists can play an important role in the management of psychocutaneous disease because patients visit dermatology for treatment of their skin problems but often refuse psychiatric intervention. This review describes common psychocutaneous syndromes, including delusional, factitious, obsessive-compulsive and related, and eating disorders, as well as psychogenic pruritus, cutaneous sensory (pain) syndromes, posttraumatic stress disorder, and sleep-wake disorders. The updated classification of these disorders in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition is included. Strategies for management are reviewed.

Sleep patterns of young children with newly diagnosed atopic dermatitis

Introduction

Even though atopic dermatitis (AD) most often begins in the first year of life, it is not well known whether sleep disturbances occur following the onset of the disease or whether they develop later.

Aim

To determine the sleep patterns of young children already diagnosed with AD in comparison to a control group by using a validated questionnaire, the Brief Infant Sleep Questionnaire (BISQ).

Material and methods

Forty-six children with a new diagnosis of AD and 60 healthy children, aged 3–36 months, participated in the study. Their sleep behaviors were assessed using the BISQ along with a structured sociodemographic data form.

Results

It was found that when compared with healthy children, children with AD did not have decreased daily total sleep duration (p = 0.1); however, it was found that they woke up more frequently at night (52.2% vs. 40%, p = 0.4) and they stayed awake significantly longer than 60 min when they woke up (41.3% vs. 11.7%, p < 0.05). In addition, mothers of children with AD reported that their children had three times as many sleep problems compared to the reports of mothers of healthy children.

Conclusions

The findings of this study showed that sleep disturbance was more common in young children with already diagnosed AD, and the BISQ provided a practical way to assess the sleep patterns. The use of a screening tool to enable early identification and treatment of childhood sleep problems among patients with AD should be encouraged.

Obstructive sleep apnea and dermatologic disorders

Obstructive sleep apnea (OSA) is present in at least 2% of women and 4% of men, and its prevalence is increasing, because a major predisposing factor for OSA is a high body mass index. Psoriasis has the most strongly substantiated link with OSA, where the relationship may be bidirectional. Dermatologic disorders may be comorbid with OSA due to several factors: (i) the heightened proinflammatory state in OSA, which can occur independent of body mass index, and may exacerbate inflammatory dermatoses; (ii) intermittent hypoxemia may promote neovascularization and tumor growth in certain cancers, such as melanoma; (iii) obesity, present in majority of OSA patients, can be associated with a heightened proinflammatory state; (iv) upper airway obstruction due to local tumors or soft tissue swelling due to physical urticaria or angioedema; (v) acute nasal congestion in the atopic patient with allergic rhinitis; (vi) dermatologic disorders associated with other OSA risk factors (eg, acanthosis nigricans and metabolic syndrome); and (vii) a high sympathetic tone (eg, in atopic dermatitis) and resultant sleep fragmentation contributing to upper airway instability during sleep. In many instances, the dermatology patient with OSA may have other medical and psychiatric comorbidities that are also associated with increased OSA risk.

Domestic dog exposure at birth reduces the incidence of atopic dermatitis

BACKGROUND

While the etiopathogenesis of atopic dermatitis is complex and poorly understood, neonatal exposures are important for disease occurrence. However, the effect of dog exposure on the risk of atopic dermatitis is unresolved.

OBJECTIVE

We investigated whether domestic dog exposure affected the risk of atopic dermatitis in children during the first 3 years of life.

METHODS

Copenhagen Prospective Studies on Asthma in Childhood (COPSAC) are ongoing prospective clinical birth cohort studies. Data from 411 children born to mothers with asthma (COPSAC₂₀₀₀ ) and 700 unselected children (COPSAC₂₀₁₀ ) were analyzed following the same protocols at the same research site. Atopic dermatitis was diagnosed prospectively according to the Hanifin-Rajka criteria. Parental history of asthma, eczema, or rhinitis was defined by self-reported physician diagnosis. In the COPSAC₂₀₀₀ , maternal specific serum IgE against eight inhalant allergens was sampled after the children's birth and at pregnancy week 24 in the COPSAC₂₀₁₀ cohort. Associations between dog exposure and atopic dermatitis were analyzed by Cox proportional hazard regression models and adjusted for lifestyle confounders.

RESULTS

In the COPSAC₂₀₀₀ and COPSAC₂₀₁₀ cohorts, the risk of atopic dermatitis was significantly lower in children with domestic dog exposure (_adjusted HR = 0.46 [0.25-0.87], P = 0.02; and _adjusted HR = 0.58 [0.36-0.93], P = 0.03, respectively). The risk of atopic dermatitis decreased in a dose-dependent manner with increasing number of dogs (_adjusted HR = 0.58 [0.38-0.89], P = 0.01) in the COPSAC₂₀₁₀ . The protective effect was restricted to children born to mothers with atopic disease in the unselected COPSAC₂₀₁₀ cohort (_adjusted HR = 0.39 [0.19-0.82], P = 0.01), as no effect was observed in children born to mothers without atopic disease (_adjusted HR = 0.92 [0.49-1.73], P = 0.79). Paternal atopic status did not affect the risk of atopic dermatitis. We found no significant interaction between the CD14 T/T genotype and domestic dog exposure in either cohort (COPSAC₂₀₀₀ , P = 0.36; and COPSAC₂₀₁₀ cohort, P = 0.42).

CONCLUSION

Neonatal domestic dog exposure was associated with a strongly reduced risk of atopic dermatitis in two independent birth cohorts and in a dose-dependent manner. While the mechanisms involved are unclear, our findings raise the question of whether in utero exposures may affect the risk of atopic dermatitis and emphasize the importance of the early environment for disease trajectory.

The mediating effect of sleep satisfaction on the relationship between stress and perceived health of adolescents suffering atopic disease: Secondary analysis of data from the 2013 9th Korea Youth Risk Behavior Web-based Survey

BACKGROUND

Difficulty in sleep is one disturbing symptom in adolescents with atopic diseases including asthma, allergic rhinitis, and atopic dermatitis. Assuming psychological stress can affect adolescents' health status, impaired sleep quality can be one mediator that negatively impacts the health status of adolescents with atopic disease.

OBJECTIVES

This study aimed to identify the mediating effect of sleep satisfaction on the relationship between stress and perceived health status in Korean adolescents with atopic disease and to examine the differences among three types of atopic disease.

DESIGN

A cross-sectional descriptive study was completed based on secondary analysis of raw data from the 2013 9th Korea Youth Risk Behavior Web-based Survey.

SETTINGS AND PARTICIPANTS

The 21,154 adolescents (29.2%) ever diagnosed and treated for at least one atopic disease regardless of the symptom presence in a recent year were extracted out of 72,435 survey participants. Then, the 13,216 individuals with exclusively single atopic diseases were included in analyzing the mediation model.

METHODS

Variables including demographics, stress, perceived health status, and sleep satisfaction were included. Pearson correlation, one-way ANOVA, path analysis to define direct/indirect effects with bootstrapping analysis, and multi-group variance analysis were conducted.

RESULTS

High levels of stress in adolescents with atopic diseases had a significant and direct effect on their negative health status perception for all atopic disease groups. A significant negative mediating effect of sleep satisfaction was identified on the relationship between stress and perceived health status, irrespective of the type of atopic disease. Total effect and remaining direct effect on the path from stress and perceived health status via sleep satisfaction was high in adolescents with atopic dermatitis and allergic rhinitis compared to those with asthma.

CONCLUSIONS

To improve sleep satisfaction for adolescents with atopic diseases, interventions are needed to enhance the adolescents' perceived health status through stress reduction and sleep quality improvement.

Improvement of sleep in patients with chronic idiopathic/spontaneous urticaria treated with omalizumab: results of three randomized, double-blind, placebo-controlled studies

Background

Patients with chronic idiopathic/spontaneous urticaria (CIU/CSU) report difficulty with sleep.

Methods

We examined the effect of omalizumab on sleep-related outcomes during 3–6 months omalizumab or placebo treatment and a 16-week follow-up period within three Phase III double-blind randomized placebo-controlled pivotal trials in CIU/CSU: ASTERIA I, ASTERIA II, and GLACIAL. Sleep quality was assessed in all three studies using sleep-related questions included in an electronic diary, the Chronic Urticaria Quality of Life Questionnaire, and the Medical Outcomes Study Sleep Scale. Score changes from baseline in the treatment arms were compared with that in the placebo arm and adjusted for baseline score and weight. We also examined correlations of sleep scores at baseline, week 12, and week 24 and the slopes of change between sleep and itch and hive.

Results

Patients treated with omalizumab reported a larger reduction in sleep problems than those in the placebo arm; omalizumab 300 mg demonstrated the greatest improvement on all sleep components among all treatment arms. The largest reduction in sleep problems was reported within the first 4 weeks of therapy. After treatment discontinuation, sleep quality worsened. Sleep scores demonstrated moderate-to-strong correlation between them, and the change in sleep scores was associated with changes in itch and hives.

Conclusions

Improvement in sleep was reported after the first dose of omalizumab. Sleep continued to improve throughout the active treatment period. Patients receiving omalizumab 300 mg achieved greater improvement in sleep than those in other treatment arms.

Trial registration ClinicalTrials.gov, NCT01287117 (ASTERIA I), NCT01292473 (ASTERIA II), and NCT01264939 (GLACIAL)

Electronic supplementary material

The online version of this article (doi:10.1186/s13601-016-0120-0) contains supplementary material, which is available to authorized users.

Measurement, Classification and Evaluation of Sleep Disturbance in Psoriasis: A Systematic Review

BACKGROUND

Psoriasis is a long-term immune-mediated inflammatory disorder mainly, but not only, affecting skin, and is associated with significant medical and psychological morbidity. Evidence suggests that sleep is disrupted in psoriasis, however high quality empirical evidence is lacking. Given the importance of sleep for health, characterisation of sleep disruption in psoriasis is an important goal. We therefore conducted a systematic review of the sleep-psoriasis literature.

METHODS

Searches were conducted in Pubmed, SCOPUS and Web of Science from inception to May 2016. Studies were compared against inclusion/exclusion criteria and underwent a quality evaluation. Given the heterogeneity of studies, we conducted a narrative synthesis of the findings.

RESULTS

Searches revealed 32 studies which met our predetermined inclusion/exclusion criteria. Whilst 93.7% of studies reported sleep disruption in this population, ranging from 0.05% to 85.4%, many had important methodological shortcomings. Over half of all quantitative studies (54.8%; 17/31) relied on non-validated measures, contributing to heterogeneity in study findings. In those that employed valid measures, assessing sleep was often not the primary objective. We frequently found the absence of adequate sample size calculations and poor statistical reporting.

CONCLUSION

This review showed that in psoriasis, reported sleep rates of sleep disturbance varied substantially. Most studies lacked a hypothesis driven research question and/or failed to use validated measures of sleep. We were unable to draw firm conclusions about the precise prevalence and nature of sleep disturbance within the psoriasis population. We offer suggestions to help advance understanding of sleep disturbance in psoriasis.

Mechanism of Sleep Disturbance in Children with Atopic Dermatitis and the Role of the Circadian Rhythm and Melatonin

Sleep disturbance is common in children with atopic dermatitis (AD). It is a major factor leading to impaired quality of life in these patients and could have negative effects on neurocognitive function and behavior. However, the pathophysiology of sleep disturbance in children with AD is poorly understood, and there is no consensus on how to manage sleep problems in these patients. Pruritus and scratching could lead to sleep disruption but is unlikely the sole etiology. The circadian rhythm of cytokines, the immune system, and skin physiology such as transcutaneous water loss and skin blood flow might also play a role. Recent studies have suggested that melatonin could also be involved due to its multiple effects on sleep, immunomodulation, and anti-oxidant ability. Environmental factors should also be considered. In this review, we summarize the current understanding of the pathophysiology of sleep disturbance in children with AD, and discuss possible therapeutic implications.

Adult eczema in Italy: prevalence and associations with environmental factors

BACKGROUND

Studies on the prevalence of eczema and atopic dermatitis (AD), and on the factors associated with these diseases, have been mostly performed in children, whereas studies on adult populations are lacking.

OBJECTIVES

To determine the prevalence of eczema and AD in the Italian adult population, and to investigate risk factors associated with the disease.

METHODS

A postal screening questionnaire was administered to 18 357 randomly selected subjects aged 20-44 years in the Gene-Environment Interaction in Respiratory Diseases study, which involved seven centres distributed across northern, central and southern Italy. The questionnaire included items on the occurrence of doctor-diagnosed eczema, asthma and hay fever, socio-demographic characteristics and environmental exposures.

RESULTS

In all, 10 464 (57.0%) subjects responded to the questionnaire. The prevalence of current eczema was 8.1% (95% CI: 7.6-8.7%), while the prevalence of eczema with asthma and/or hay fever (EAH), which was adopted as proxy of AD, was 3.4% (95% CI: 3.1-3.8%). About 60% of the subjects with current eczema reported the onset of the disease in adulthood. In multi-variable models, the prevalence of eczema was significantly associated with female sex, older age, living close to industrial plants, high levels of heavy traffic near home and living in central-southern Italy.

CONCLUSIONS

Eczema and EAH are highly prevalent in Italian young adults, especially in women. Our results suggest that adult onset is not unusual, and that environmental factors may influence the occurrence of eczema and EAH.

Treatment of atopic dermatitis eczema with a high concentration of Lactobacillus salivarius LS01 associated with an innovative gelling complex: a pilot study on adults

GOALS

To evaluate the efficacy of a highly concentrated Lactobacillus salivarius preparation containing a gelling complex formed by Streptococcus thermophilus ST10 and tara gum in the treatment of atopic dermatitis (AD).

BACKGROUND

Previous studies have demonstrated an improvement in AD symptoms after administration of the probiotic strain L. salivarius LS01. S. thermophilus ST10 and tara gum create a gelling complex that adheres to intestinal mucus and improves barrier function.

STUDY

A prospective, controlled pilot trial was carried out to evaluate how the association of S. thermophilus ST10 and tara gum could improve the activity of L. salivarius LS01 administered at high doses to adults with AD. Twenty-five patients were included into the study: 13 were treated for 1 month with the active formulation, whereas 12 represented the placebo group. Scoring Atopic Dermatitis index was determined before and at the end of probiotic administration. Fecal samples were also collected to evaluate changes in bacterial counts of Staphylococcus aureus and clostridia.

RESULTS

A significant improvement in SCORAD index was observed in the probiotic group after 1 month of treatment, whereas no significant changes occurred in placebo patients. A slight decrease in fecal S. aureus count was observed in probiotic-treated patients.

CONCLUSIONS

Data obtained in this study suggest a potential role for L. salivarius LS01 in the treatment of AD. The addition of tara gum and S. thermophilus ST10 seems to improve the overall efficacy of the probiotic strain, in particular shortening the time required for the onset of the positive effects. Further studies to investigate the activity of this preparation are advisable.