Sleep of Psoriasis Patients Improves with Intensive Topical Treatment

A new study found intensive topical treatment not only curbs the itchy sensation for patients with psoriasis or atopic dermatitis but also improves sleep quality.¹

“After only 2 weeks of intensive topical therapy, there was a significant improvement in deep sleep and REM sleep in both patient groups, more so in [atopic dermatitis] patients than in [psoriasis] patients,” wrote investigators, led by Caroline Mann, MD, department of dermatology at University Medical Center of the Johannes Gutenberg University in Germany.

Many dermatologic conditions are linked with sleep disorders as skin irritation may make it more difficult to fall asleep or stay in deep sleep.² However, not a lot of evidence exists on how therapy for these patients may improve sleep quality.¹

Investigators conducted a study to study the sleep patterns in psoriasis and atopic dermatitis, as well as if therapy improved sleep patterns. The treatment included basic care and anti-inflammatory topicals, such as class II – III steroids, daily for 2 weeks. The team also assessed for the disease activity rating, patient-rated outcomes for itch severity, sleep quality, and polygraphy before and after the therapy.

The team collected 25 participants from the department of dermatology at University Medical Center in Mainz, Germany. Patients (mean age: 49 years) had either psoriasis (n = 14) or atopic dermatitis (females, n = 20; males, n = 15) and were treated with only intensive topical treatment to avoid potential systemic effects. Investigators evaluated sleep quality changes before and 2 weeks after the treatment.

Disease activity was measured through the Eczema Area and Severity Index (EASI) and Psoriasis Area and Severity Index (PASI). Patient-rated outcomes were assessed using the Dermatology Quality of Life Index, the Numeric Rating Scale for pruritus intensity, and the Itchy Quality of Life. Sleep was measured by the Epworth Sleepiness Scale (ESS) and the Insomnia Severity Index (ISI).

Sleep patterns were recorded with polysomnography, which includes sensors for electroencephalogram (EEG), electrooculogram (EOG). In this study, the polygraphy device recorded N3 percentage, REM percentage, and Apnea-Hypopnea Index (AHI) through respiratory monitoring, sleep efficiency, and sleep latency.

Disease activity scores (EASI and PASI) were significantly reduced with topical therapy after 2 weeks (P < .001). The PASI in patients with psoriasis decreased from 10.46 (SD ± 1.30) at the beginning of treatment to 5.65 (SD ± 0.91) after the 2 weeks. The pruritus intensity scale demonstrated a significant improvement in deep sleep, resolved after therapy.

Insomnia severity significantly reduced (r > .50; P < .05) and daytime sleepiness decreased considerably in 40% of patients. Additionally, deep sleep and REM sleep significantly improved with a strong effect (r > .50). The team saw the apnea-hypopnea index reduced in 1 of 4 patients regardless of the individual BMI.

After topical therapy, deep sleep rose from baseline to 2 years for patients with both atopic dermatitis (from 5.98% to 16.83%; P = .003) and psoriasis (from 6.1% to 12.33%; P = .016).

REM SLEEP ALSO improved for patients with atopic dermatitis (5.68% to 11.98; P = .016) and psoriasis (5.19% to 13.36%).

Patients with atopic dermatitis have a decreased Apnea-Hypnea Index (AHI) score after treatment (15.15 to 12.4) but it was not significant (P = .0273). The AHI also reduced for patients with psoriasis (20.16 at baseline to 18.27), and this time, the effect was moderate.

Sleep efficacy and sleep onset latency increased in score but the data was not significant for patients with atopic dermatitis (P = .13; P = .44) and psoriasis (P = .845; P = .969).

Investigators outlined multiple limitations, including not age or gender matching the participants, having different stages of disease activity, and the small sample size.

“The results provide insight into the relevance of itch in [psoriasis] patients and raise questions about other possible factors,” the team concluded. “Itch appears to have a significant effect on deep sleep and therapeutic intervention with topicals may explain the rapid improvement. However, reducing skin inflammation also seems to have a significant impact on sleep, as shown in this pilot study.”

References

1. ^{Mann C, Dreher M, Rothschmidt JN, Staubach P. Burden of impaired sleep and its improvement through topical treatment in psoriasis and atopic dermatitis. J Dtsch Dermatol Ges. Published online April 18, 2024. doi:10.1111/ddg.15373}
2. ^{Andrus, E. Sleep Disorders Associated with Dermatologic Conditions. Dermatology Times. June 6, 2023. https://www.dermatologytimes.com/view/sleep-disorders-associated-with-dermatologic-conditions. Accessed April 24, 2024.}