Kids with eczema may sleep poorly

(Reuters Health) – Kids with eczema – even mild eczema – may be more likely to have poor quality sleep than children who don’t have this common skin disorder, a UK study suggests.

Eczema, also called atopic dermatitis, can lead to scaly, itchy rashes that keep kids up at night. But researchers don’t have a clear picture of how eczema affects kids’ ability to fall asleep, how often they awaken during the night, or how many total hours of rest they get.

For the current study, researchers examined data on 13,988 kids, including 4,938, or 35 percent, with eczema. All the kids had multiple sleep assessments between ages two and 16.

Eczema didn’t appear to impact the total amount of sleep kids got. But compared to children without eczema, kids with mild eczema flare-ups were 40 percent more likely to have lots of sleep disturbances, and those with severe eczema flare-ups had 85 percent higher odds, the study found.

Even when kids with eczema weren’t having active symptoms, they were still 41 percent more likely to have poor sleep quality throughout childhood than kids without eczema.

“As you might expect, the impairment was stronger among children with more severe disease and (kids who also had) asthma or allergic rhinitis,” said senior study author Dr. Katrina Abuabara of the University of California, San Francisco.

“However, what was somewhat surprising was that the risk remained elevated even among children with mild atopic dermatitis alone (and no other atopic conditions), and it remained elevated even during periods when atopic dermatitis was inactive,” Abuabara said by email.

Children with eczema are more apt to have asthma and allergies than kids without the skin disorder, some previous research suggests.

When kids with eczema also had asthma or allergies, they were 52 percent more likely to have poor quality sleep throughout childhood even when they didn’t have active flare-ups, the study found. And when children had asthma or allergies along with severe eczema flare-ups, they were more than twice as likely to sleep poorly.

To assess sleep quantity, researchers surveyed mothers about what time kids usually went to bed and woke up; in the final survey 16-year-olds answered for themselves. Naptimes were included in total sleep hours until age seven.

Researchers also asked about factors involved in sleep quality including the number of awakenings, difficulty falling asleep, and nightmares.

Kids with inactive eczema reported these sleep problems about as often as children with mild eczema symptoms. And, scratching episodes only accounted for 15 percent of awakenings.

These two findings suggest that flareups aren’t the only thing contributing to poor sleep quality in kids with eczema, researchers conclude in JAMA Pediatrics.

One limitation of the study is that researchers largely relied on parents to report eczema symptoms and assess kids’ sleep. Some previous research suggests that parents tend to overestimate how long kids sleep and underestimate how often children awaken during the night, the study authors note.

Kids also may not realize how eczema affects their sleep, said Dr. Saxon Smith, a dermatologist at Royal North Shore Hospital in Sydney, Australia, who wasn’t involved in the study.

“Children will not always be aware of . . . scratching in their sleep,” Smith said by email.

“This can lead to disrupted sleep in terms of the quality of the sleep, waking multiple times a night,” Smith added. “This in turn leads to manifestations of sleep deprivation including tiredness through the day, impaired concentration, and poorer performance at school (or delayed developmental milestones),” Smith said.

Kids who scratch less may sleep better, Smith said.

Eczema can be treated using moisturizers, avoiding certain soaps and other irritants and with prescription creams and ointments containing corticosteroids to relieve itching.

“Early intervention can lead to breaking of the itch-scratch cycle,” Smith advised.

SOURCE: bit.ly/2NOJEJj JAMA Pediatrics, online March 4, 2019.