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Clinical Pearls on Sleep Management in Atopic Dermatitis

Hendricks, Aleksi J. BS*; Manivannan, Meenakshi BS; Shi, Vivian Y. MD

doi: 10.1097/DER.0000000000000523

Multiple etiologies contribute to sleep disturbance in atopic dermatitis (AD) patients, including learned scratching behavior and increased monoamines, cutaneous blood flow, inflammatory cell activities, and cytokines, as well as decreased melatonin, anti-inflammatory cytokines, and skin barrier function. Insomnia impairs cognitive development in children with AD, leading to behavioral problems and learning disabilities. Insomnia in adults with AD impedes work productivity. In this article, we discuss pearls on improving insomnia through both nonpharmacologic modalities, such as environmental adjustments and massage therapy, and pharmaceutical approaches including melatonin, antihistamines, tricyclic antidepressants, mirtazapine, and benzodiazepine and nonbenzodiazepine sedatives. Future investigations should further delineate the mechanistic link between insomnia and AD exacerbation and identify strategies to combat sleep-related disease burden.

From the *University of Arizona College of Medicine, Tucson

Texas Tech Health Sciences Center El Paso Paul L. Foster School of Medicine, TX

Division of Dermatology, Department of Medicine, University of Arizona, Tucson.

Address reprint requests to Vivian Y. Shi, MD, Dermatology Division, University of Arizona, 7165 N Pima Canyon Dr, Tucson, AZ 85718. E-mail:

A.J.H. and M.M. contributed equally to this article.

V.Y.S. is a stock shareholder of Learn Health and has served as an advisory board member or investigator and/or received research funding from Sanofi Genzyme/Regeneron, AbbVie, Eli Lilly, Novartis, SUN Pharma, LEO Pharma, Pfizer, Menlo Therapeutics, Burt's Bees, GpSkin, the National Eczema Association, Global Parents for Eczema Research, and the Foundation for Atopic Dermatitis and Skin Actives Scientific. The other authors have no funding or conflicts of interest to declare.

© 2019 American Contact Dermatitis Society
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