Sleep Hormone and Children with Atopic Dermatitis

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Illustration by Deherba

Atopic dermatitis (AD) is a chronic relapsing inflammatory skin disease with symptoms from mild to severe itchiness. Typically, AD occurs in children with a history of atopic, either to themselves or from their families, in the form of asthma, allergic rhinitis, conjunctivitis, or eczema. AD is caused by abnormalities in the multifactorial inflammatory process of the skin. Oxidative stress stimulates the inflammatory response that causes allergic diseases such as AD, allergic rhinitis, and asthma.

The severe disease accompanied by stress related to the chronicity of the disease and the immune response disorders results in sleep disturbance in AD patients. Sleep disturbance due to itching in AD patients can cause physical and mental fatigue, mood changes, and decreased concentration.

Melatonin, known as the sleep hormone, is an important immunomodulatory molecule in allergic diseases. Melatonin is an endogenous free radical scavenger. It affects an anti-inflammatory agent which is proven in studies in vivo and in vitro. Melatonin also plays a role in several body systems including to regulate circadian rhythms because of its role to cause drowsiness.

The question that often arises is whether the AD patient experiencing itchiness will affect melatonin levels, as the itchiness will affect the sleep cycle of patients with AD. The melatonin serum level has been the object of research in patients with AD in recent years, but only a few studies about the effect of hormone on childhood have been published. In contrast to serum melatonin, research on melatonin urine in pediatric DA patients has not been done much, and the results of these studies were also controversial.

The results of previous studies showed that urine melatonin level could depict serum melatonin level so for research with children as subjects, using urine melatonin as a marker of melatonin level in the body is easier. It prompted us to conduct research to measure the levels of urine melatonin in AD patients compared to control group to determine whether there are differences.

The study was conducted analytically observational using the cross-sectional method. The goal is to compare urine melatonin levels in children with AD with non-atopic pediatric patients. Informed consent was approved by the ethics committee, Dr. Soetomo general hospital. The study was conducted on 44 samples consisting of 22 DA samples and 22 control samples. All samples have been filtered according to the criteria for acceptance and rejection of the sample, and there was consent to use them in the research.

The AD diagnosis is made using specific criteria based on history taking, family history, and physical examination. The AD criteria in this study use the Hanifin and Rajka criteria. The degree of AD disease is determined by the Scoring of Atopic Dermatitis index (SCORAD), which is divided into mild, moderate, and severe AD. The AD samples in this study consisted of 5 patients with mild AD, 11 patients with moderate AD, and 6 patients with severe AD.

The results showed that the average urine melatonin level in the AD group was lower than in the control group, although there was no statistically significant difference. It also shows that urine melatonin levels tend to get lower from greater severity of the disease: the more severe AD, the lower urine melatonin.

It is the mechanism of increasing melatonin compensation to correct sleep disorders in AD patients, and in patients who respond to this compensation reaction will have increasing melatonin levels at the time of examination. Higher levels of melatonin are associated with better sleep efficiency and less severe disease.

Further research is expected to be carried out on the possibility of providing melatonin supplements in AD patients, especially in patients with severe AD. (*)

Author: Iskandar Zulkarnain

Details of this research available at

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