Abstract
Nocturnal pruritus (NP) is a relatively common reason for dermatologic consultation. Its pathophysiology is partially understood. Skin conditions such as atopic dermatitis, psoriasis, urticaria, and prurigo nodularis are well-described causes of NP. The most distressing sequela of NP is sleep deficit, which can lead to physical and mental disturbances (e.g., daytime somnolence and fatigue) and negative emotional states that profoundly affect quality of life. However, this aspect of NP is often overlooked by dermatologists. It is essential to assess sleep quality in such patients and adopt appropriate measures to arrest the problem at an early stage. We conducted an evidence-based literature review to highlight the pathogenetic mechanisms of NP, identify dermatologic etiologies, and explore methods that have been used to assess the quality of sleep. Furthermore, we performed a systematic review of studies on sleep disturbance relevant to NP in patients with dermatologic conditions. Finally, we discuss the evidence on treatment options for NP and indicate therapies that may target both NP and sleep disturbance.
Highlights
Pruritus commonly exhibits nocturnal exacerbation, disturbing normal sleep patterns and quality (Tivoli and Rubenstein, 2009)
Systemic inflammation has been suggested as a possible link between chronic pruritic dermatoses and sleep disturbance (SD) because an increased serum C-reactive protein level was documented in patients with SD (Patel et al, 2021)
Nocturnal pruritus (NP) is prevalent in a wide spectrum of skin disorders and causes impaired sleep quality
Summary
Pruritus commonly exhibits nocturnal exacerbation, disturbing normal sleep patterns and quality (Tivoli and Rubenstein, 2009). Sleep is an active process coupled with the circadian rhythm (CR) that is essential for optimal physical and mental health. Pathophysiologic mechanisms, such as skin barrier dysfunction and altered serum levels of endogenous substances (e.g., cortisol and signaling molecules), may be responsible for NP (Lavery et al, 2016). NP is a common dermatologic complaint, typically associated with sleep deficits and impaired quality of life. Sleep disturbance (SD) is often overlooked in the current assessment instruments of quality of life in skin disorders, which results in a practice gap. Most studies in dermatologic conditions have evaluated sleep as a secondary outcome using subjective methods
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