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Jaworek AK, Szepietowski JC, Hałubiec P, Wojas-Pelc A, Jaworek J. Melatonin as an Antioxidant and Immunomodulator in Atopic Dermatitis-A New Look on an Old Story: A Review. Antioxidants (Basel) 2021; 10:antiox10081179. [PMID: 34439427 PMCID: PMC8388892 DOI: 10.3390/antiox10081179] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 12/15/2022] Open
Abstract
Atopic dermatitis (AD) is common inflammatory dermatosis, typically with chronic and recurrent course, which significantly reduces the quality of life. Sleep disturbances are considered to be remarkably burdensome ailments in patients with AD, and are routinely included during assessment of disease severity. Therefore, endogenous substances engaged in the control of circadian rhythms might be important in pathogenesis of AD and, possibly, be used as biomarkers of disease severity or even in development of novel therapies. Melatonin (MT), the indoleamine produced by pineal gland (but also by multiple other tissues, including skin), plays a pivotal role in maintaining the sleep/wake homeostasis. Additionally, it possesses strong antioxidant and anti-inflammatory properties, which might directly link chronic skin inflammation and sleep abnormalities characteristic of AD. The objective of this work is to systematically present and summarize the results of studies (both experimental and clinical) that investigated the role of MT in the AD, with a focus on the antioxidant and immunomodulatory effects of MT.
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Affiliation(s)
- Andrzej Kazimierz Jaworek
- Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
- Correspondence:
| | - Jacek Cezary Szepietowski
- Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, 50-368 Wroclaw, Poland;
| | - Przemysław Hałubiec
- Student Scientific Group, Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Anna Wojas-Pelc
- Department of Dermatology, Jagiellonian University Medical College, 31-501 Cracow, Poland;
| | - Jolanta Jaworek
- Department of Medical Physiology, Faculty of Health Sciences, Jagiellonian University Medical College, 31-126 Cracow, Poland;
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Bawany F, Northcott CA, Beck LA, Pigeon WR. Sleep Disturbances and Atopic Dermatitis: Relationships, Methods for Assessment, and Therapies. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2020; 9:1488-1500. [PMID: 33321263 DOI: 10.1016/j.jaip.2020.12.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 11/25/2020] [Accepted: 12/01/2020] [Indexed: 12/28/2022]
Abstract
Atopic dermatitis is one of the most common chronic inflammatory skin conditions and is associated with sleep disturbances in 47% to 80% of children and 33% to 90% of adults. Herein, we review the literature on sleep disturbances experienced by patients with atopic dermatitis, as well as the mechanisms that may underlie this. We present subjective and objective methods for measuring sleep quantity and quality and discuss strategies for management. Unfortunately, the literature on this topic remains sparse, with most studies evaluating sleep as a secondary outcome using subjective measures. The development of portable, at-home methods for more objective measures offers new opportunities to better evaluate sleep disturbances in atopic dermatitis research studies and in clinical practice.
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Affiliation(s)
- Fatima Bawany
- School of Medicine and Dentistry, University of Rochester Medical Center, Rochester, NY
| | - Carrie A Northcott
- Early Clinical Development, Digital Medicine and Translational Imaging, Pfizer, Inc, Cambridge, Mass
| | - Lisa A Beck
- Department of Dermatology, Medicine and Pathology, University of Rochester Medical Center, Rochester, NY
| | - Wilfred R Pigeon
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY.
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Johansson EK, Ivert LU, Bradley B, Lundqvist M, Bradley M. Weight gain in patients with severe atopic dermatitis treated with dupilumab: a cohort study. BMC DERMATOLOGY 2020; 20:8. [PMID: 32962676 PMCID: PMC7510313 DOI: 10.1186/s12895-020-00103-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Accepted: 09/16/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND Dupilumab, targeting the interleukin-4α receptor and inhibiting the action of interleukin-4 and interleukin-13, was recently approved for treatment of moderate to severe atopic dermatitis. There is limited data on long-term effects and safety among patients with severe atopic dermatitis treated with dupilumab. Weight gain was observed among patients treated with dupilumab in our clinic. The aim was to describe weight change in a cohort study of patients with severe atopic dermatitis treated with dupilumab from baseline to follow-up after 12 months, and to analyze if weight change was associated with effect of treatment, reported appetite, and/or disturbed night sleep due to itching. METHODS All patients with atopic dermatitis receiving systemic treatment at the Unit of Dermatology, Karolinska University Hospital, have been registered and monitored consecutively since January 2017. This cohort constituted all patients who started treatment on dupilumab or methotrexate between 10 January 2017 and 30 June 2019 with at least 6 months of follow-up within the study period. The following variables were monitored at start of and during treatment: Eczema Severity Score Index, Patient-Oriented Eczema Measure, visual analogue scale for pruritus 10 cm, Montgomery-Åsberg Depression Rating Scale, Dermatology Life Quality Index, and weight. Data analyses were performed using two-sample Wilcoxon-Mann-Whitney rank-sum test, or the Wilcoxon matched-pairs sign-rank test with a p-value < 0.05 considered as statistically significant. RESULTS Patients treated with dupilumab (n = 12) gained weight (mean 6.1 kg, range [0.1-18.0], p = 0.002) after 1 year on treatment. The majority of patients showed a good response to treatment with dupilumab (n = 11); at follow-up at 6, 9, or 12 months, they reached EASI-90 (n = 6), EASI-75 (n = 4), or EASI-50 (n = 1). There was no significant association between weight gain and treatment response, reported appetite, or disturbed night-sleep due to itch. Patients treated with methotrexate showed no significant weight change (n = 8). CONCLUSIONS To our knowledge, this is the first report on a possible association between weight gain and dupilumab treatment; the extent of the association is yet to be seen, as is the mechanism behind this finding.
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Affiliation(s)
- Emma Kristin Johansson
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden. .,Dermatological and Venereal Clinic, Södersjukhuset, SE-118 83, Stockholm, Sweden.
| | - Lina Ulrika Ivert
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Baltzar Bradley
- Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Maria Lundqvist
- Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
| | - Maria Bradley
- Dermatology and Venereology Unit, Department of Medicine Solna, Karolinska Institutet, SE-171 77, Stockholm, Sweden.,Department of Dermatology, Karolinska University Hospital Solna, SE-171 76, Stockholm, Sweden
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Chong KW, Wright K, Goh A, Meyer R, Rao R. Growth of children with food allergies in Singapore. Asia Pac Allergy 2018; 8:e34. [PMID: 30402401 PMCID: PMC6209600 DOI: 10.5415/apallergy.2018.8.e34] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Accepted: 12/12/2018] [Indexed: 11/18/2022] Open
Abstract
Background Although it is known that children with food allergies are at risk of impaired growth, this has not been well studied in South-East Asia. Objective The aim of this cross-sectional study is to survey the growth of children with food allergies in Singapore and the factors impacting it. Methods Anthropometric data, demographic data, type of food allergy, foods eliminated, and atopic comorbidities were recorded. Malnutrition was defined using World Health Organization standards (≤-2 z-score for weight-for-height [WH], weight-for-age [WA], and height-for-age [HA]). Results Seventy-four patients (51% male) were recruited over 1 month, with median age at diagnosis of 8 months (interquartile range [IQR], 4–13 months) and at data collection of 25 months (IQR, 14–48 months). Sixty-two (84%) had IgE-mediated allergy, 8 (11%) mixed IgE and non-IgE, and 4 (5%) non-IgE-mediated allergy. Food exclusions: 55% one food, 27% two foods, 8% three to four foods, and 10% ≥5 foods. Only 1% were underweight (WA ≤ -2 z-score) and 3% had WA ≥ +2 z-score. Having a mixed type food allergy significantly reduced WA (p = 0.023). WA was significantly lower for those referred to the dietitian (p = 0.027). 5.4% were stunted (HA ≤ -2 z-score). Factors significantly associated with stunting were underlying eczema (p = 0.03) and having an IgE-mediated (p = 0.03) or mixed type food allergy (p = 0.002). One point four percent (1.4%) were undernourished (WH ≤ -2 z-score) and 1.4% were overweight (WH ≥ +2 z-score). Multivariate regression analysis found that children with mixed type food allergies were significantly shorter (z-score -1 lower). Children had a lower WA if they had skin involvement as part of their symptom presentation. Conclusion This is the first survey documenting growth in children with food allergy in Singapore. Eczema, IgE-mediated and mixed type allergies are associated with poorer growth rates in these children. Early, individualised nutritional intervention is recommended for all children with food allergy.
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Affiliation(s)
- Kok Wee Chong
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Karen Wright
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Anne Goh
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
| | - Rosan Meyer
- Department of Paediatrics, Imperial College, London, United Kingdom
| | - Rajeshwar Rao
- Allergy Service, Department of Paediatric Medicine, KK Women's and Children's Hospital, Singapore 229899
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Sleep disorders and atopic dermatitis: A 2-way street? J Allergy Clin Immunol 2018; 142:1033-1040. [PMID: 30144472 DOI: 10.1016/j.jaci.2018.08.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 08/09/2018] [Accepted: 08/14/2018] [Indexed: 12/12/2022]
Abstract
Sleep disturbance is very common in patients with atopic dermatitis (AD) and is a major factor leading to impaired quality of life. Sleep disturbance is often viewed as one of the symptoms of AD and one of the measures of disease severity. In this review we describe a variety of sleep disorders associated with AD and a wide range of effect that sleep disorders have on patients with AD. We also discuss our current understanding of the mechanism of sleep disturbance in patients with AD. The relationship between sleep disorders and AD might be bidirectional and could form a vicious cycle. Therefore we suggest viewing sleep disorders as a comorbidity of AD for which regular screening and bidirectional management strategies are indicated, with equal focus on maintaining disease control and implementing specific strategies to improve sleep.
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Hon KL, Kung JSC, Tsang KYC, Yu JWS, Cheng NS, Leung TF. Do we need another symptom score for childhood eczema? J DERMATOL TREAT 2018; 29:510-514. [DOI: 10.1080/09546634.2017.1373734] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Affiliation(s)
- Kam Lun Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jeng Sum Charmaine Kung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Kathy Yin Ching Tsang
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Jasmine Wai Sum Yu
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Nam Sze Cheng
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
| | - Ting Fan Leung
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong
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Hon K, Kung J, Wang M, Pong N, Li A, Leung T. Clinical scores of sleep loss and itch, and antihistamine and topical corticosteroid usage for childhood eczema. Br J Dermatol 2016; 175:1076-1078. [DOI: 10.1111/bjd.14660] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K.L. Hon
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
| | - J.S.C. Kung
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
| | - M. Wang
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
| | - N.H. Pong
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
| | - A.M. Li
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
| | - T.F. Leung
- Department of Pediatrics; The Chinese University of Hong Kong; 6/F, Clinical Science Building, Prince of Wales Hospital, Shatin Hong Kong Hong Kong
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Walia HK, Mehra R. Overview of Common Sleep Disorders and Intersection with Dermatologic Conditions. Int J Mol Sci 2016; 17:E654. [PMID: 27144559 PMCID: PMC4881480 DOI: 10.3390/ijms17050654] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2016] [Revised: 04/21/2016] [Accepted: 04/22/2016] [Indexed: 01/12/2023] Open
Abstract
Sleep disorders are very common, often under-recognized and therefore undertreated, are associated with a myriad of medical conditions and could lead to significant impairment of quality of life. This review provides an up-to-date synopsis of common sleep disorders encompassing insufficient sleep syndrome, insomnia, circadian rhythm disorders and obstructive sleep apnea with a brief overview of epidemiology, screening, diagnostic testing and treatment. We also emphasize the emerging area of the intersection of sleep disorders and dermatologic conditions and present compelling data regarding underlying mechanisms including sleep dysfunction in relation to disorders of skin inflammation, aging and skin cancer.
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Affiliation(s)
- Harneet K Walia
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
| | - Reena Mehra
- Center for Sleep Disorders Cleveland Clinic 11203, Stokes Blvd Cleveland, Cleveland, OH 44195, USA.
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Chang YS, Chiang BL. Mechanism of Sleep Disturbance in Children with Atopic Dermatitis and the Role of the Circadian Rhythm and Melatonin. Int J Mol Sci 2016; 17:462. [PMID: 27043528 PMCID: PMC4848918 DOI: 10.3390/ijms17040462] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2016] [Revised: 03/17/2016] [Accepted: 03/22/2016] [Indexed: 02/07/2023] Open
Abstract
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.
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Affiliation(s)
- Yung-Sen Chang
- Department of Pediatrics, Taipei City Hospital Renai Branch, Taipei 106, Taiwan.
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
- School of Medicine, National Yang-Ming University, Taipei 112, Taiwan.
| | - Bor-Luen Chiang
- Graduate Institute of Clinical Medicine, College of Medicine, National Taiwan University, Taipei 100, Taiwan.
- Department of Medical Research, National Taiwan University Hospital, Taipei 100, Taiwan.
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Meltzer LJ, Booster GD. Evaluation of an Ecologically Valid Group Intervention to Address Sleep Health in Families of Children With Allergic Diseases. CLINICAL PRACTICE IN PEDIATRIC PSYCHOLOGY 2016; 4:206-213. [PMID: 28083466 DOI: 10.1037/cpp0000136] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Sleep issues in children with allergic diseases may be a result of illness related factors (e.g., itching, wheezing) and/or poor sleep habits due to disrupted routines and parental permissiveness. However, the ability of parents to attend a multi-session sleep intervention may be limited. Thus we examined the validity of a one-time sleep health group intervention for parents of children with allergic diseases. Ninety-three parents of children who were admitted to a two-week intensive day hospital treatment program completed measures of child sleep habits (Children's Report of Sleep Patterns), parent sleep habits (Sleep Hygiene Inventory), parent sleep quality (Pittsburgh Sleep Quality Index), and parental insomnia symptoms (Insomnia Severity Index) before the group intervention and one-month after program discharge; 54 parents attended the sleep health group. Sleep habits and sleep quality improved for both parents and children at the one-month follow-up. However, improvements were seen regardless of group attendance. Potential reasons for the lack of difference between those who did and did not participate in group are presented, and implications of this study for pediatric psychologist in practice are discussed.
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Affiliation(s)
- Lisa J Meltzer
- Division of Behavioral Health, Department of Pediatrics, National Jewish Health
| | - Genery D Booster
- Division of Behavioral Health, Department of Pediatrics, National Jewish Health
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Fishbein AB, Vitaterna O, Haugh IM, Bavishi AA, Zee PC, Turek FW, Sheldon SH, Silverberg JI, Paller AS. Nocturnal eczema: Review of sleep and circadian rhythms in children with atopic dermatitis and future research directions. J Allergy Clin Immunol 2015; 136:1170-7. [DOI: 10.1016/j.jaci.2015.08.028] [Citation(s) in RCA: 91] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2015] [Revised: 08/07/2015] [Accepted: 08/11/2015] [Indexed: 01/25/2023]
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12
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Hon KL, Tsang YCK, Lee VWY, Pong NH, Ha G, Lee ST, Chow CM, Leung TF. Efficacy of sodium hypochlorite (bleach) baths to reduceStaphylococcus aureuscolonization in childhood onset moderate-to-severe eczema: A randomized, placebo-controlled cross-over trial. J DERMATOL TREAT 2015; 27:156-62. [DOI: 10.3109/09546634.2015.1067669] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Hon KLE, Wang SS, Leung TF. What happens to the severity grading by objective SCORAD if we over- or underestimate disease extent or intensity in patients with atopic dermatitis? Int J Dermatol 2012; 51:295-9. [DOI: 10.1111/j.1365-4632.2011.05004.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Camfferman D, Kennedy JD, Gold M, Martin AJ, Lushington K. Eczema and sleep and its relationship to daytime functioning in children. Sleep Med Rev 2010; 14:359-69. [PMID: 20392655 DOI: 10.1016/j.smrv.2010.01.004] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Revised: 01/14/2010] [Accepted: 01/25/2010] [Indexed: 11/30/2022]
Abstract
Chronic childhood eczema has significant morbidity characterised by physical discomfort, emotional distress, reduced child and family quality-of-life and, of particular note, disturbed sleep characterised by frequent and prolonged arousals. Sleep disturbance affects up to 60% of children with eczema, increasing to 83% during exacerbation. Even when in clinical remission, children with eczema demonstrate more sleep disturbance than healthy children. Notably, disturbed sleep in otherwise healthy children is associated with behavioural and neurocognitive deficits. Preliminary evidence suggests that disturbed sleep in children with eczema is also associated with behavioural deficits while the impact on neuropsychological functioning remains unexplored. In conclusion, a disease which affects up to 20% of children in some countries and may produce long-term behavioural and neurocognitive deficits merits further evaluation using standardised tests of sleep, behaviour and neurocognition.
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Affiliation(s)
- Danny Camfferman
- Discipline of Paediatrics, School of Paediatrics and Reproductive Medicine, University of Adelaide, Adelaide, South Australia, Australia
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Hon KLE, Leung TF, Wong KY, Chow CM, Chuh A, Ng PC. Does age or gender influence quality of life in children with atopic dermatitis? Clin Exp Dermatol 2008; 33:705-9. [PMID: 18681872 DOI: 10.1111/j.1365-2230.2008.02853.x] [Citation(s) in RCA: 65] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Quality of life (QoL) is impaired in children with atopic dermatitis (AD) but the various aspects of QoL may not be equally affected. Aim. To evaluate if age and gender affect some aspects of QoL in children with AD. METHOD The Children's Dermatology Life Quality Index (CDLQI) was used for all children with AD seen at a paediatric dermatology clinic over a 3-year period. Disease severity was assessed using the SCORing Atopic Dermatitis (SCORAD) and Nottingham Eczema Severity Score (NESS) tools. RESULTS We reviewed CDLQI in 133 children (70 male and 63 female; age range 5-16 years) with AD. Itch, sleep disturbance, treatment and swimming/sports were the four aspects of QoL issues that were most commonly affected, in 50%, 47%, 38% and 29% of patients, respectively. Problems with interpersonal issues (friendship, school/holidays, and teasing/bullying) occurred in only a minority of children (<or= 10%). Girls had more problems with issues of clothes and shoes than did boys (OR = 2.86, 95% CI 1.05-8.00; P = 0.038). Significant itch and sleep disturbance affected both genders similarly but were generally more common in children <or= 10 years (itch: OR = 2.31, 95% CI 1.04-5.14; P = 0.039; and sleep: OR = 2.31, 95% CI 1.05-5.13; P = 0.037). CONCLUSIONS Not all aspects of QoL are affected equally in children with AD. The disease seems to affect personal domains of itch and sleep more than the interpersonal issues. Age and gender are relevant factors in QoL, with the issue of clothes/shoes being more troublesome for girls. itch and sleep disturbance seem to be a problem mainly in younger children.
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Affiliation(s)
- K L E Hon
- Department of Paediatrics, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, PR China.
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Bender BG, Ballard R, Canono B, Murphy JR, Leung DYM. Disease severity, scratching, and sleep quality in patients with atopic dermatitis. J Am Acad Dermatol 2008; 58:415-20. [PMID: 18280338 DOI: 10.1016/j.jaad.2007.10.010] [Citation(s) in RCA: 116] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2007] [Revised: 08/28/2007] [Accepted: 10/09/2007] [Indexed: 12/22/2022]
Abstract
BACKGROUND The relationship between sleep quality and disease severity in patients with atopic dermatitis has not been clearly defined. METHODS Sleep efficiency and scratching were measured over 2 nights by polysomnography, actigraphy, and self-report in 20 adults with atopic dermatitis. Tumor necrosis factor, interleukin (IL)-6, and IL-10 were assayed from a subset of 9 participants. RESULTS Sleep measured by actigraphy and polysomnography were strongly associated with each other. Decreased sleep efficiency was associated with increasing disease severity, scratching, and IL-6. Self-reported sleep quality and quality of life were not significantly correlated with either objective sleep measure. LIMITATIONS Results in this pilot study await confirmation in a larger investigation. CONCLUSION Objective measures but not self-report documented that increasing severity of atopic dermatitis results in more scratching and declining sleep quality. Our data also suggest an important relationship between sleep and IL-6.
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Affiliation(s)
- Bruce G Bender
- Department of Pediatrics, National Jewish Medical and Research Center, Denver, Colorado 80206, USA.
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Abstract
Atopic dermatitis is an especially common and frustrating condition, and the prevalence is increasing. The disease can adversely affect the quality of life of patients and caregivers. Significant advances in our understanding of the pathogenesis have led to improvements in therapy. Patient and caregiver education, avoidance of potential triggering factors, optimal skin care, and pharmacotherapy offer the potential for good control for most patients.
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Affiliation(s)
- Alexander K C Leung
- The University of Calgary, The Alberta Children's Hospital, #200, 233-16th Avenue NW, Calgary, AB T2M 0H5, Canada.
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Hon KLE, Kam WYC, Lam MCA, Leung TF, Ng PC. CDLQI, SCORAD and NESS: are they correlated? Qual Life Res 2006; 15:1551-8. [PMID: 16826438 DOI: 10.1007/s11136-006-0019-7] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Quality of life (QOL) and clinical severity scores are important parameters in the evaluation of distress experienced by children with atopic dermatitis (AD). The SCORing Atopic Dermatitis (SCOARD) is a widely used clinical score for assessing AD symptomatology over the preceding 3 days and the Nottingham Eczema Severity Score (NESS) is another score useful for AD symptoms over the preceding 12 months. OBJECTIVE We evaluated if these parameters are correlated with QOL in children with AD. PATIENTS/METHODS We assessed quality of life, clinical scores, total IgE and eosinophil count in peripheral blood in AD patients at our paediatric dermatology clinic over a 14-month period. RESULTS Eighty AD patients (42 males and 38 females; mean [SD] age 11.7 [3.7] years) were recruited. The median (interquartile range, IQR) IgE, eosinophil counts and eosinophil percentage were 2988 (1069-7847) kIU/L; 0.6 (0.4-0.9) x 10(-9)/L; and 9 (6-12)%, respectively. Quality of life as measured with CDLQI (The Children's Dermatology Life Quality Index) generally did not correlate well with both the acute and chronic AD severity scores (objective SCORAD and total CDQLI, rho = 0.17, p > 0.05; total NESS and total CDQLI, rho = 0.29, p < 0.05). Factor analysis further confirmed that the objective indicators (serum total IgE, eosinophil count and objective SCORAD), self-reported scores (NESS and subjective SCORAD) and CDLQI were separate dimensions in the assessment of AD in children. CONCLUSION Quality of life, disease severity scores and laboratory atopic markers represent different domains in AD assessment. They do not necessarily correlate well with each other and all three aspects must be individually evaluated to assess the well-being of these patients.
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Affiliation(s)
- K L E Hon
- Department of Paediatrics, Chinese University of Hong Kong, Shatin, Hong Kong SAR, China.
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Hon KLE, Leung TF, Wong Y, Fok TF. Lesson from performing SCORADs in children with atopic dermatitis: Subjective symptoms do not correlate well with disease extent or intensity. Int J Dermatol 2006; 45:728-30. [PMID: 16796637 DOI: 10.1111/j.1365-4632.2005.02703.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. It is not known how well these symptoms correlate with the extent and intensity of eczematous involvement. We evaluated whether: (i) the level of sleep loss correlates with pruritus and (ii) the level of pruritus correlates with the extent or severity of AD in children according to the SCORing Atopic Dermatitis (SCORAD) index. METHOD Patients with AD younger than 18 years old were recruited from the pediatric dermatology clinic of a university teaching hospital, and AD severity was evaluated by the SCORAD index. RESULTS One hundred and eighty-two Chinese children with AD (107 boys and 75 girls) [mean (SD) age of 9.6 (4.2) years] were recruited. Their mean (SD) overall SCORAD was 30.1 (19.2). Sleep loss was strongly correlated with pruritus (r = 0.57, P < 0.001). However, the two subjective symptoms were only weakly correlated with the objective signs (extent and intensity) of AD. The correlations between pruritus and extent and intensity were 0.42 (P < 0.001) and 0.38 (P < 0.001), respectively, and the correlations between sleep loss and extent and intensity were 0.38 (P < 0.001) and 0.34 (P < 0.001), respectively. CONCLUSION We speculate that the lack of a better correlation was either because pruritus and sleep loss as reported by parents were imprecise, or that mechanisms other than disease extent or severity are responsible for the pathogenesis of these subjective symptoms.
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Affiliation(s)
- K L E Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong SAR, China.
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Hon KLE, Lam MCA, Leung TF, Kam WYC, Lee KCK, Li MCA, Fok TF, Ng PC. Nocturnal wrist movements are correlated with objective clinical scores and plasma chemokine levels in children with atopic dermatitis. Br J Dermatol 2006; 154:629-35. [PMID: 16536804 DOI: 10.1111/j.1365-2133.2006.07213.x] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
BACKGROUND Atopic dermatitis (AD) is a distressing disease associated with pruritus and sleep disturbance. Scratching due to pruritus is an important mechanism in the exacerbation of AD but is difficult to document in the home environment. OBJECTIVES To evaluate whether nocturnal wrist activities, defined as average acceleration in the early hours of sleep, were correlated with components of the SCORing Atopic Dermatitis (SCORAD) index and various AD-associated chemokine markers. METHODS Patients with AD aged under 18 years were recruited and the severity of eczema was assessed with the SCORAD index. Concentrations of plasma AD-associated chemokines [cutaneous T-cell attracting cytokine (CTACK); macrophage-derived chemokine (MDC); thymus and activation regulated chemokine (TARC)], interleukin (IL)-18, serum total IgE, and eosinophil counts were measured in these patients. Healthy children with noninflammatory and nonitchy skin conditions as well as healthy children of staff volunteers were recruited as controls. All children were instructed to wear the DigiTrac monitor on their dominant wrist before sleeping. The monitor was programmed to record limb motion between 22.00 and 08.00 h the following morning. RESULTS Twenty-four Chinese children with AD (mean +/- SD age 12.6 +/- 3.7 years) and 15 normal children (mean +/- SD age 11.9 +/- 3.4 years) were recruited. The median (interquartile range) SCORAD was 54.8 (32.8-70.2). Plasma concentrations in pg mL(-1) of CTACK, MDC, TARC and IL-18 in the patients were 105 (92-172), 1648 (973-4214), 258 (100-850) and 415 (304-539), respectively. When compared with controls, most wrist activities occurred at frequencies between 1 and 3 Hz. These activities were most consistent over the first 3 h of sleeping and correlated significantly with disease severity, extent, intensity, and AD-associated chemokine markers CTACK, MDC and TARC. However, there was no significant correlation between wrist activities and the subjective symptom of pruritus or sleep loss. CONCLUSIONS This is the first study to demonstrate that wrist activities, nonintrusively measured by the DigiTrac monitor at home, are closely correlated with the objective clinical scores and levels of peripheral blood chemokine markers for AD but not with the reported symptoms of pruritus or sleep loss. We propose that wrist activities between 1 and 3 Hz for the first 3 h are a good indicator of AD severity in children and should substitute for the pruritus and sleep-loss components of the SCORAD.
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Affiliation(s)
- K-L E Hon
- Department of Paediatrics, The Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, Hong Kong, China.
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