Pathophysiology of nocturnal scratching in childhood atopic dermatitis: the role of brain-derived neurotrophic factor and substance P

Hon, Kam Lun; Lam, M. C.A.; Wong, Kin Hong; Leung, Ting Fan; Ng, Pak Cheung

doi:10.1111/j.1365-2133.2007.08149.x

Cited by 91 publications

(64 citation statements)

References 21 publications

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“…[7][8][9]31 Our study supports this with finding that more movements in sleep and a higher pruritus score were both associated with lower sleep efficiency. However, it is important to note that arousals caused by limb movement were not significantly correlated with sleep efficiency in our patients (data not shown).…”

Section: Figuresupporting

confidence: 80%

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Atopic Dermatitis, Melatonin, and Sleep Disturbance

et al. 2014

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WHAT'S KNOWN ON THIS SUBJECT: Sleep disturbance affects 47% to 60% of children with atopic dermatitis and is a leading cause of impaired quality of life for the patients and their family. WHAT THIS STUDY ADDS:Sleep disturbance in children with atopic dermatitis can be predicted by a Scoring Atopic Dermatitis index of $48.7, and lower nocturnal melatonin secretion might play a role in the pathophysiology. abstract BACKGROUND AND OBJECTIVES: Sleep disturbance is common in patients with atopic dermatitis (AD). However, studies have largely been questionnaire-based, and the pathophysiology remains unclear. The aims of this study were to determine objective characteristics of sleep disturbance in children with AD and explore contributing factors and clinical predictors.METHODS: Sleep parameters were measured by actigraphy and polysomnography in 72 patients with AD and 32 controls ages 1 to 18 years. Urinary 6-sulfatoxymelatonin levels, serum cytokines, and total and allergen-specific immunoglobulin E (IgE) levels were also measured. RESULTS:The patients with AD had significantly reduced sleep efficiency, longer sleep onset latency, more sleep fragmentation, and less nonrapid eye movement sleep. Results from actigraphy correlated well with those from polysomnography. The AD disease severity was associated with sleep disturbance (r = 0.5520.7), and a Scoring Atopic Dermatitis index of $48.7 predicted poor sleep efficiency with a sensitivity of 83.3% and a specificity of 75% (area under the curve = 0.81, P = .001). Lower nocturnal melatonin secretion was significantly associated with sleep disturbance in the patients with AD. Other correlates of sleep disturbance included pruritus, scratching movements, higher total serum IgE levels, and allergic sensitization to dust mite and staphylococcal enterotoxins. CONCLUSIONS:Poor sleep efficiency is common in children with AD and can be predicted by the Scoring Atopic Dermatitis index. Melatonin and IgE might play a role in the sleep disturbance. Further studies are required to explore the mechanisms and clinical implications, and actigraphy could serve as a useful evaluating tool. Atopic dermatitis (AD) is a common chronically relapsing pruritic inflammatory skin disease. 1 Disturbed sleep is frequently reported by the patients and their family and is a major factor leading to an impaired quality of life. [2][3][4] Sleep disturbance can have many negative consequences, including impaired neurocognitive function, higher rates of behavioral problems, and changes in mood. 5,6 Therefore, the recognition and proper management of sleep disturbance should be an important issue in AD.The sleep disturbance in AD might be due to the pruritus and scratching movements during sleep, 7-10 but it is likely that other factors are involved. 11 Melatonin is a hormone secreted by the pineal gland that is essential for regulating the circadian rhythm. 12 Dysfunction in the diurnal secretion of melatonin in patients with AD has been reported, 13 but its association with their sleep disturbance has...

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Section: Figuresupporting

confidence: 80%

“…The sleep disturbance in AD might be due to the pruritus and scratching movements during sleep, [7][8][9][10] but it is likely that other factors are involved. 11 Melatonin is a hormone secreted by the pineal gland that is essential for regulating the circadian rhythm.…”

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confidence: 99%

Atopic Dermatitis, Melatonin, and Sleep Disturbance

et al. 2014

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“…SP and the NK1 receptor are both widely distributed in the brain and the skin where the SP is a key first responder to most harmful stimuli. Despite SP being best known as mediator of anxiety, pain, and vomiting, there is evidence that, in inflammatory dermatoses with elements of chronicity, including AD, there are high levels of SP associated with increased pruritus [111,112]. Thus, an NK1 antagonist might hold the potential to counter the SP-mediated itching in AD patients [113,114].…”

Section: Nk1 Antagonistsmentioning

confidence: 99%

Emerging Treatment Options in Atopic Dermatitis: Systemic Therapies

Nygaard

Vestergaard

Deleuran³

2017

Dermatology

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The pathogenesis of atopic dermatitis (AD) is multifactorial and intricate, and the clinical presentation of the condition varies greatly. Symptoms and severity depend on individual trigger factors and stage of the disease. The majority of AD patients are sufficiently treated with emollients in combination with existing topical or systemic therapies. Yet treatment failure with existing drugs and treatment options can be a significant clinical problem. New treatments are under development, and the majority of these new drugs focus on targeting a skewed immune response in AD. Novel therapeutic approaches, which target the pathways involved in the pathogenesis of AD, may provide a potentially more effective and less harmful approach to systemic therapy. These pharmaceutical agents are designed to narrowly modify or directly block a specific cellular signal or pro-inflammatory pathway. We review systemic drugs in the pipeline for AD. To make the review as current and pertinent as possible, we selected to focus on AD-related therapies available in the clinicaltrials.gov database with a first received date after January 1, 2014, up until May 31, 2017. We excluded therapies that could be categorized as either traditional Chinese medicine, herbal medicine, probiotics, histamine/leukotriene blockers, immuno-adsorption, or immunostimulants.

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“…In Mausmodellen konnte gezeigt werden, dass Neurokinin-1-Rezeptorantagonisten Juckreiz blockieren, der durch Substanz P hervorgerufen wird. Substanz P ist ein sensorisches Neuropeptid, das nachweislich mit dem Schweregrad von Ekzem-Erkrankungen korreliert [39,40]. Aprepitant in einer Dosierung von 80 mg täglich führte zur wirksamen Linderung von Juckreiz bei Patienten mit Sézary-Syndrom, die mit schwerer pruritusbedingter Schlaflosigkeit und Depression stationär behandelt wurden [42].…”

Section: Aprepitantunclassified

Management von paraneoplastischem Pruritus

Rowe¹,

Yosipovitch²

2018

Kompass Dermatol

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Paraneoplastischer Pruritus tritt als systemische Reaktion auf eine zugrunde liegende maligne Erkrankung auf. Paraneoplastischer Pruritus ist am häufigsten mit malignen lymphoproliferativen Erkrankungen sowie soliden Tumoren, die zu Cholestase führen, assoziiert. Paraneoplastischer Pruritus kann sich sowohl ohne primären Hautausschlag manifestieren als auch in Verbindung mit dermatologischen Erkrankungen wie Erythrodermie, Acanthosis nigricans, Dermatomyositis (DM), transitorischer akantholytischer Dermatose (Morbus Grover) oder eruptiver seborrhoischer Keratose. Die Behandlung des paraneoplastischen Pruritus beruht primär auf der Behandlung der zugrunde liegenden malignen Erkrankung, die ursächlich für die systemische Reaktion ist. Wenn die maligne Erkrankung nicht auf Behandlung anspricht, können andere Therapien beim paraneoplastischen Pruritus wirksam sein, wie selektive Serotonin-Wiederaufnahmehemmer, Mirtazapin, Gabapentin, Thalidomid, Opioide, Aprepitant und Histon-Deacetylase-Inhibitoren. Übersetzung aus Curr Probl Dermatol. Basel, Karger, 2016, vol 50, pp 149-154 (DOI: 10.1159/000446060)

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Pathophysiology of nocturnal scratching in childhood atopic dermatitis: the role of brain-derived neurotrophic factor and substance P

Abstract: Serum levels of BDNF and substance P correlate with the clinical score and quality of life score in patients with AD. The strong correlations with nocturnal wrist movements suggest that they may be the pathogenic factors of the annoying symptoms of scratching.

Cited by 91 publications

References 21 publications

Atopic Dermatitis, Melatonin, and Sleep Disturbance

Atopic Dermatitis, Melatonin, and Sleep Disturbance

Emerging Treatment Options in Atopic Dermatitis: Systemic Therapies

Management von paraneoplastischem Pruritus

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