Sleep impairment in patients with chronic inflammatory skin diseases: A review of mechanisms and management

J Am Acad Dermatol. 2023 Feb;88(2):421-427. doi: 10.1016/j.jaad.2022.06.008. Epub 2022 Jun 11.


Background: Chronic inflammatory skin diseases (CISD), such as atopic dermatitis and psoriasis, are associated with nocturnal sleep disturbances, which may in turn exacerbate inflammation.

Objective: To summarize the complex factors that underlie the relationship between CISD and sleep impairment.

Methods: We conducted a focused review of the published literature, including retrospective, prospective, and interventional studies, clinical trials, reviews, and consensus guidelines.

Results: The results of our literature review identified a complex interplay among various physiological, psychosocial, and behavioral factors mediating the relationship between sleep loss and CISD alongside targeted management strategies. We highlight treatment strategies that target these pathways, providing a practical framework for clinicians managing sleep loss in patients with CISD. Current guidelines by dermatology societies on the management of sleep disturbances in patients with CISD are limited and largely focus mostly on atopic dermatitis and psoriasis.

Conclusions: We recommend that sleep problems must be regularly assessed and managed in patients with CISD. Updated clinician guidelines are needed to better recognize and address the multifactorial nature of sleep loss in patients with CISD.

Keywords: circadian; nighttime; nocturnal; scratch; sleep.

Publication types

  • Review

MeSH terms

  • Chronic Disease
  • Dermatitis, Atopic* / drug therapy
  • Dermatitis, Atopic* / therapy
  • Humans
  • Prospective Studies
  • Psoriasis* / complications
  • Psoriasis* / therapy
  • Retrospective Studies
  • Sleep
  • Sleep Initiation and Maintenance Disorders*
  • Sleep Wake Disorders* / etiology
  • Sleep Wake Disorders* / therapy