Severe AD Potentially Linked to Longer Sleep Time, Social Jetlag

Phyllis Zee, MD, PhD

A recent investigation presented at the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022 hypothesized that severe atopic dermatitis could be linked to later chronotypes and misalignment between social and biological clocks.

Previous data found that atopic dermatitis worsened and night, and the skin condition has also been associated with sleep disturbance.

Despite this, the exact timing of weekday and weekend sleep and light exposure has not been evaluated for differences contributing to poor sleep quality.

As such, investigators led by Phyllis Zee, MD, PhD, Northwestern Memorial Hospital, evaluated whether misalignment between social and biological clocks induced severe atopic dermatitis.

The Methods

Zee and colleagues utilized secondary data analysis from 2 prospective studies of pediatric patients 5-17 years old with an allergist or dermatologist-assessed mild-to-sever case of atopic dermatitis and healthy controls.

All subjects wore actigraphy watches during the weekdays and at least 1 weekend throughout the studies. Rest and activity were analyzed using descriptive statistics, as was light.

The Findings

A total of 75 patients were included in the study, with the average age of participants being 10 years old.

Among these patients, 27% had mild atopic dermatitis, 32% had moderate cases, and 24% had severe cases. Nearly half (45%) were female patients.

Investigators found that patients with severe atopic dermatitis fell asleep at a similar time to the remaining groups including controls (m6SD(clock-time6minutes)523:52669 vs.23:25689,p50.238) and had similar sleep onset latency(8.268.7 vs.13.8 618.7minutes,p50.224) on weekends.

However, patients with severe atopic dermatitis slept longer (later waketime: 09:12664 vs.08:14674,p50.004) resulting in a later sleep-midpoint(04:32653 vs.03:49:668,p50.017).

For weekdays, patients with severe atopic dermatitis and others showed no differences in sleep timing, though the former group had lower levels of daytime light exposure(mean over all days) than Others(1948.462130.0 vs.10169.3613396.2lux,p<0.001).

Zee and investigators observed that patients with severe atopic dermatitis appeared to be later chronotypes with larger social jetlag.

“The later chronotype may not be directly linked to the AD, since circadian formalisms would predict a later chronotype with overall lower levels of daytime light exposure,” the team wrote. “Prospective studies are needed to determine if low levels of light exposure might be contributing to AD severity, and the potential of bright light as an adjuvant therapy.”