AD keeping your patient awake? Melatonin may help!

March 1, 2016

A nightly 3-mg dose of melatonin can help children with atopic dermatitis (AD) fall asleep more quickly and reduce the severity of their AD.

A nightly 3-mg dose of melatonin can help children with atopic dermatitis (AD) fall asleep more quickly and reduce the severity of their AD. This was the finding of an 8-week trial in Taiwan in 48 youngsters with AD aged from 1 to 18 years.

Participants were divided into 2 groups, 1 of which received melatonin for 4 weeks and then a placebo for another 4 weeks. The second group did the reverse, taking a nightly placebo first and then crossing over to melatonin. Investigators assessed AD severity on the first and last day of the 2 treatment periods, using the Scoring Atopic Dermatitis (SCORAD) index, and used questionnaires to evaluate subjective symptoms.

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Melatonin shortened by 21.4 minutes how long it took participants to fall asleep, compared with placebo. In addition, after melatonin treatment, the SCORAD index decreased by 9.1 (on a best-to-worst scale of 0 to 103) compared with the score after taking placebo. (These 2 melatonin-related improvements did not correlate with one another, however.) Patients themselves thought that melatonin improved their sleep and their AD (Chang YS, et al. JAMA Pediatr. 2016;170[1]:35-42).

Commentary: All the patients included in this study had both AD and a sleep problem involving either delayed sleep initiation or disrupted sleep on 3 or more nights per week for 3 months prior to the study. It may be that sleeplessness leads to more awareness of itching, more scratching, and worsened AD. If so, improved sleep might explain improved AD. Or, it may be that anti-inflammatory properties of melatonin decrease itching, which leads to less scratching and improved AD. Bedtime melatonin may be worth a try! -Michael G Burke, MD 

Ms Freedman is a freelance medical editor and writer in New Jersey. Dr Burke, section editor for Journal Club, is chairman of the Department of Pediatrics at Saint Agnes Hospital, Baltimore, Maryland. The editors have nothing to disclose in regard to affiliations with or financial interests in any organizations that may have an interest in any part of this article.