Oral melatonin improves both sleep disturbance and skin symptoms in children and adolescents who have atopic dermatitis, according to a report published online November 16 in JAMA Pediatrics.
“Although the magnitude of the benefit is not great, many patients might benefit from this dual effect. Sleep disturbance is highly prevalent in children with AD and . . . leads to impaired quality of life for the patients and their families,” said Dr. Yung-Sen Chang of
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Taipei (Taiwan) City Hospital Renal Branch and associates.
The investigators showed in a previous study that children with AD have longer sleep-onset latency, more sleep fragmentation, less REM sleep, and reduced sleep efficiency than healthy control subjects and that these sleep disturbances are associated with scratching movements, more severe dermatitis, and decreased melatonin secretion. “Worse sleep increases the likelihood that these children will scratch, which will further exacerbate the skin inflammation. . . . We hypothesized that melatonin, with its sleep-promoting and antiinflammatory properties, could break this vicious cycle,” they noted.
Dr. Chang and associates performed a single-center randomized double-blind crossover trial involving 38 patients aged 1-18 years who had AD involving at least 5% of their body surface area and sleep problems that occurred more than 3 days per week. These study participants were randomly assigned to receive oral melatonin (3 mg/day) or a matching placebo at bedtime for 4 weeks, then crossed over to the alternate assignment for a further 4 weeks.
The primary efficacy outcome — AD severity as measured on the Scoring Atopic Dermatitis index — improved with melatonin by a mean of 9.1 points out of a possible 103 points, compared with placebo. Melatonin also significantly reduced sleep-onset latency by more than half (23.4 minutes), compared with placebo, according to objective sleep actigraphy results (JAMA Ped. 2015 November 16 [doi:10.1001/jamapediatrics.2015.3092]).
In addition, more patients and families subjectively reported that dermatitis improved when taking melatonin compared with placebo (47% vs 32%), and more reported that sleep improved when taking melatonin compared with placebo (46% vs 34%).
No adverse effects were reported. Melatonin’s good safety profile is particularly important given that all other medications used for sleep problems in patients with AD, such as antihistamines, benzodiazepines, chloral hydrate, and clonidine, are of limited benefit and carry negative adverse effects.
“We recommend melatonin supplementation for these patients, because it is a potentially safe and effective way to improve their sleep and skin condition simultaneously,” Dr. Chang and associates said.