Sleep disturbance and atopic dermatitis: A bidirectional relationship?

Atopic dermatitis (AD) is one of the most common pediatric dermatologic disorders and is associated with an increased risk of recurrent bacterial and viral cutaneous infections, such as impetigo, the most common bacterial infection in children. AD may impair patient quality of life in a number of ways, one of which is its impact on sleep. The way that the condition affects sleep has not yet been fully elucidated; it is clear that the symptoms of the disease such as pruritus and scratching can affect sleep but other factors, such as changes in the immunological system related to the disease can also have an effect. We argue that this relationship may be bi-directional, with changes to the skin barrier (barrier dysfunction, alterations in its microbiome and oxidative stress) and immunological function caused by the condition impairing sleep and leading to imbalanced inflammatory pathways that exacerbate AD and other associated conditions such as impetigo. We highlight the need for further studies to investigate this correlation between AD and sleep to make the role of this relationship clearer.