Melatonin for Childhood Atopic Dermatitis and Sleep Disturbance

Sleep disturbance is common in patients with atopic dermatitis (AD), but effective management is lacking. Reduced nocturnal melatonin has been found to be associated with sleep disturbance and greater AD severity.

Investigators in a Taiwanese tertiary care hospital performed a randomized, double-blind, placebo-controlled, crossover study in children with AD (age, 1–18 years, with AD on >5% body surface area), and sleep problems >3 days/week over 3 months. Children with sleep disorders or taking insomnia or antidepressant medications were excluded. All underwent a 2-week preparation using a sleep diary, a fixed sleep schedule, and caffeine avoidance. Children were then randomized to either 3-mg melatonin or placebo tablets orally once daily, for 4 weeks. After a 2-week washout, the groups switched treatments. AD skin-care regimens were unchanged. On the first and last day of each treatment, blood/urine samples were collected, questionnaires given, and the scoring atopic dermatitis (SCORAD) index was assessed by the same blinded physician. Sleep was assessed by actigraphy in all, and polysomnography in a subgroup of patients.

Compared to placebo, melatonin decreased the SCORAD index from a mean of 49 to 40 (P< 0.001), and sleep onset latency shortened by 21 minutes. More patients reported AD and sleep improvement with melatonin than with placebo. There was no significant difference in sleep stages and limb movement with melatonin versus placebo. No adverse event was reported during the study.