Dermatologists need to be aware of how skin conditions can interfere with sleep.

The findings of a review of the literature that was printed in the Journal of the American Academy of Dermatology revealed a complicated relationship between sleep loss and chronic inflammatory skin conditions such atopic dermatitis and psoriasis.

High-quality sleep is essential for a person's physical, mental, and emotional well-being, according to research by Grace Y. Duan, BA, a medical student at the University of Chicago Pritzker School of Medicine, and colleagues. Chronically poor sleep can have a number of detrimental effects on one's health.

“Given the important health implications of sleep loss, addressing this comorbidity is of great interest to clinicians who manage [chronic inflammatory skin disease (CISD)] and patients,” the researchers wrote. “Current evidence suggests that sleep loss and CISD interact bidirectionally; however, the mechanisms underlying this relationship are complex and not fully understood.”

The researchers emphasised that scratching habits associated with pruritis, a typical symptom of CISD, can result in more frequent overnight awakenings and lighter sleep.

Additionally, because pro-inflammatory cytokines including (interleukin [IL]]-1-alpha, IL-2, tumour necrosis factor-alpha, interferon-gamma, and IL-6 are raised in the evening, circadian regulation of inflammation may be a component in increased nocturnal pruritis and sleep loss. On the other hand, anti-inflammatory cytokines like IL-4 and IL-10 rise after waking up.

“Diurnal cycling of cytokines and cortisol may explain why pruritic episodes in [atopic dermatitis] tend to occur at night,” the researchers wrote.

They went on to say that CISD-related sleep loss can worsen immune system dysregulation and create a vicious cycle that could result in even more insomnia.

In terms of therapy, Duan and colleagues pointed out that patients with CISD frequently receive first-generation antihistamines for sleep disturbances, and that systemic immunomodulatory medications may enhance sleep in individuals with atopic dermatitis.

Patients may also benefit from methods that influence circadian rhythm, like bright-light therapy and oral melatonin supplements.

“We call upon all guidelines to recommend that sleep problems be regularly assessed and managed in patients with CISD,” Duan and colleagues wrote. “Furthermore, updated guidelines should elaborate on current evidence-based pharmacological therapies and include discussion on non-pharmacological and behavioral modification strategies for pediatric and adult patients with CISD.”