Como mejorar el dormir en DA

Published in Dermatology

Journal Scan / Review · October 16, 2019

Clinical Pearls on Sleep Management in Atopic Dermatitis

Dermatitis

TAKE-HOME MESSAGE

• Atopic dermatitis (AD) severely impacts sleep quality in up to 80% of children and 87% of adults and has a multifactorial etiology from both biologic and psychologic origins. This review of 26 publications suggests that, while simultaneously controlling AD severity, the approach to treating insomnia in AD patients begins with nonpharmaceutical environmental interventions such as choice of clothing and bedding, temperature regulation, and massage therapy. Pharmaceutical interventions should be used cautiously.

• Sleep management is a pillar of atopic dermatitis management. Nonpharmaceutical interventions should be maximized before adding pharmaceutical interventions. Most sleep aids are off-label for patients with AD, and proper dosing regimens and safety requires further study.

– Margaret Hammond, MD

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Lacey Kruse MD

This paper offers many valuable insights into the clinical approach to a complex, debilitating problem. Achieving restful, regenerative, meaningful sleep is a huge burden for patients with atopic dermatitis (AD), and, therefore, also for us as their providers. As the authors suggest, I also find that a multimodal approach is most effective in combatting this challenge. First and foremost, this consists of improving the control of the AD itself through optimization of patients' skin care and anti-inflammatory agents. Beyond these basic approaches aimed at improving the underlying disease, evidence-based approaches to improving sleep for patients with AD are lacking. Despite this limitation, we are often able to improve sleep in patients with AD by layering pharmacologic and nonpharmacologic approaches, in addition to their skin care regimens. In my practice, this consists of sedating antihistamines, optimization of sleep hygiene, and, occasionally, melatonin. This paper thoroughly reviews the ancillary options for those refractory patients in whom our traditional approach to sleep improvement may not be enough.

Abstract

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.

Dermatitis

Clinical Pearls on Sleep Management in Atopic Dermatitis

Dermatitis 2019 Sep 01;30(5)287-293, AJ Hendricks, M Manivannan, VY Shi 

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Benjamin Hidalgo-Matlock
Skin Care Physicians of Costa Rica

Clinica Victoria en San Pedro: 4000-1054
Momentum Escazu: 2101-9574

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