Druhan L. Howell, MD, addresses sleep disruption in atopic dermatitis

In an interview with Contemporary Pediatrics, Druhan L. Howell, MD, Organon health partner, discussed the critical role of sleep assessment in children with atopic dermatitis (AD) and highlighted new data on treatment-related improvements in sleep outcomes.

From a pediatric care perspective, Howell emphasized that clinicians must look beyond visible skin symptoms and ask detailed questions about sleep quality. This includes how frequently a child wakes during the night, difficulty falling asleep, and how disrupted sleep affects daytime functioning. Irritability, behavioral changes, school performance challenges, and parental work impairment are all downstream effects of poor sleep related to eczema.

To objectively measure this burden, Howell pointed to validated tools such as the Patient-Oriented Eczema Measure (POEM) and the Dermatitis Family Impact (DFI) questionnaire. These instruments assess both patient-reported symptoms and the broader impact on family quality of life, offering clinicians a more comprehensive view of disease burden.

Discussing new study findings, Howell noted that clinically meaningful improvements in sleep were observed as early as week 1 and sustained through week 8 in children 2 years and older treated with once-daily tapinarof cream (Vtama; Organon & Co). Improvements were measured using POEM and DFI scores and paralleled reductions in itch severity, reinforcing the connection between symptom control and sleep restoration. The safety and tolerability profile remained consistent with prior studies.

Howell described newer nonsteroidal topical therapies as part of a broader shift in the AD treatment paradigm. While topical corticosteroids and calcineurin inhibitors have long been standards of care, concerns about adverse effects and black box warnings have sometimes limited their appeal. Nonsteroidal options such as tapinarof provide an alternative that is well tolerated and avoids some of those historical concerns, while offering early and sustained symptom improvement.

For primary care pediatricians, Howell advised referral or therapy escalation when children experience persistent sleep disturbances, behavioral changes, significant family burden, or recalcitrant disease despite appropriate treatment. When counseling families, clinicians can now set realistic expectations, explaining that improvements in itch and sleep may occur within the first week of therapy and continue over time. Ultimately, Howell underscored that treating AD effectively means addressing not only visible skin lesions but also the “invisible burden” of sleep disruption and its impact on the entire family.

Disclosure: Organon & Co

Reference

Boguniewicz M, Eichenfield L, Kwong P, Hebert A. Improvement in sleep and family impact for pediatric patients down to 2 years of age with atopic dermatitis treated with tapinarof cream 1% once daily in two pivotal phase 3 trials. J Allergy Clin Immunol. 2026;157(2). doi:10.1016/j.jaci.2025.12.019