Acta Dermato-Venereologica 99-2CompleteContent | Page 15

175 CLINICAL REPORT Influence of Itch and Pain on Sleep Quality in Atopic Dermatitis and Psoriasis Karolina KAAZ, Jacek C. SZEPIETOWSKI and Łukasz MATUSIAK Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Wroclaw, Poland Subjective symptoms accompanying atopic derma- titis and psoriasis can negatively influence patients’ well-being. This study assessed the impact of itch and pain on sleep quality among 100 patients with atopic dermatitis and 100 patients with psoriasis, compared with 50 controls. The Athens Insomnia Scale (AIS) and Pittsburgh Sleep Quality Index (PSQI) were used to evaluate a spectrum of sleep disturbances. Co-ex- istence of insomnia was indicated in the majority of patients; atopic dermatitis; 82%, psoriasis; 62%. PSQI total scores for patients with atopic dermatitis 4.2 points) and those with psoriasis (8.1  ±  4.8 (8.3  ±   points) qualified them, in 80% of cases, as poor slee- pers and were significantly higher compared with con- trols (3.1  ±  1.9 points). However, subjects with atopic dermatitis experienced more problems with insomnia and sleep quality than did those with psoriasis. Atopic dermatitis and psoriasis-related itch, but not pain, has a substantial association with insomnia and sleep qua- lity in these patients, and is a crucial subjective symp- tom in these chronic, inflammatory skin diseases. Key words: atopic dermatitis; psoriasis; itch; pain; quality of life; sleep; visual analogue scale. Accepted Oct 11, 2018; E-published Oct 11, 2018 Acta Derm Venereol 2019; 99: 175–180. Corr: Jacek C. Szepietowski, Department of Dermatology, Venereology and Allergology, Wroclaw Medical University, Chałubińskiego 1, PL-50-368 Wrocław, Poland. E-mail: [email protected] A topic dermatitis (AD) and psoriasis (Ps) are chronic, inflammatory and debilitating skin diseases. Their pathogenesis, however distinct, is multifactorial and encompasses a hyperactive immune system, environ- mental factors and genetic predisposition (1). The mean prevalence of AD in the general population worldwide ranges from 2.1% to 4.9% (2). The disease is characte- rized by erythema, lichenified lesions and accompanied by severe itch, which is an essential symptom of AD. Itch is such a “crucial”, symptom that Romeo (3) described AD as “the itch that rashes”. It negatively influences different aspects of well-being in patients with AD (4). Skin lesions in Ps are typically scaly plaques that cover the scalp, elbows and knees, but nails and any other skin area can be also affected (5). The prevalence of psoriasis in adults worldwide ranges from 1% to 3% (6). Itch is a problem for approximately 60–90% of adults with pso- riasis, and similarly to AD, is often characterized as the SIGNIFICANCE Atopic dermatitis and psoriasis are chronic, inflammatory and debilitating skin conditions. As skin conditions can af- fect sleep activity, it is possible that such dermatoses can disturb sleep quality. Moreover, atopic dermatitis- and psoriasis-related subjective symptoms may worsen sleep disturbances. In this study, we demonstrate that patients with atopic dermatitis experience far more problems with insomnia and sleep quality than those with psoriasis. We show that atopic dermatitis and psoriasis-related itch, but not pain, has a substantial association with insomnia and sleep quality, and is a crucial subjective symptom in these two chronic inflammatory diseases. most burdensome symptom of the disease (7). Not only itch, but also pain in the lesioned skin, is a frequently reported accompanying symptom, resulting in profound burden due to the course of these diseases (8, 9). Sleep is a fundamental, restorative, physiological, neurobiological state that engages approximately one- third of our lives. Sleep is carefully regulated by mul- tiple processes, including homeostatic sleep drive and the circadian system (10, 11). Both itch and pain can significantly reduce the quality of life (QoL) and sleep of patients (12, 13). The aim of this study was to better characterize the influence of itch and pain on sleep in patients with AD and Ps. MATERIALS AND METHODS The study was conducted among Caucasians with AD (n = 100), with plaque Ps (n = 100) with no involvement of the joints, and 50 sex- and age-matched healthy controls (detailed characteristics are shown in Table I). AD diagnosis was made according to well- established Hanifin & Rajka criteria (14), while Ps diagnosis was based on clinical manifestation (in doubtful cases biopsies were taken). The mean duration of disease was assessed as 20.3  ±  16.1 years (range 3 months–60 years) and 13.5  ±  12.1 years (range 1 month–50 years) for AD and Ps, respectively. Disease severity was evaluated with SCORing of Atopic Dermatitis (SCORAD) for AD and Psoriasis Area and Severity Index (PASI) for patients with Ps (15, 16). All patients and controls with any itchy/painful skin condition of any type or receiving any antipruritics, or pain-killers (e.g. antihistamines, immunomodulators/immunosuppressants, etc. (> 5 half-lives washout period)) were excluded. None of the pa- tients or controls had a known primary psychological disorder or disease of any type that might have influenced sleep quality (e.g. obstructive sleep apnoea). Only over-the-counter (OTC) sleep drugs were allowed. This is an open access article under the CC BY-NC license. www.medicaljournals.se/acta Journal Compilation © 2019 Acta Dermato-Venereologica. doi: 10.2340/00015555-3065 Acta Derm Venereol 2019; 99: 175–180