Produção Nacional
The importance of evaluating sleep complaints in children with ichthyoses: a commentary on physical and psychological growth impairment
2021; American Academy of Sleep Medicine; Volume: 17; Issue: 6 Linguagem: Inglês
10.5664/jcsm.9208
ISSN1550-9397
AutoresEllen M. S. Xerfan, Anamaria S. Facina, Jane Tomimori, Sérgio Tufik, Mônica L. Andersen,
Tópico(s)Neonatal skin health care
ResumoFree AccessEditorialsThe importance of evaluating sleep complaints in children with ichthyoses: a commentary on physical and psychological growth impairment Ellen M.S. Xerfan, MD, Anamaria S. Facina, MD, PhD, Jane Tomimori, MD, PhD, Sergio Tufik, MD, PhD, Monica L. Andersen, PhD Ellen M.S. Xerfan, MD Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo, São Paulo, Brazil , Anamaria S. Facina, MD, PhD Address correspondence to: Anamaria S. Facina, MD, PhD, Universidade Federal de São Paulo, R. Estado de Israel 192, Vila Clementino, 04022-000 São Paulo/SP, Brazil; Email: E-mail Address: [email protected] Departamento de Dermatologia, Universidade Federal de São Paulo, São Paulo, Brazil , Jane Tomimori, MD, PhD Programa de Pós-Graduação em Medicina Translacional, Universidade Federal de São Paulo, São Paulo, Brazil Departamento de Dermatologia, Universidade Federal de São Paulo, São Paulo, Brazil , Sergio Tufik, MD, PhD Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil , Monica L. Andersen, PhD Departamento de Psicobiologia, Universidade Federal de São Paulo, São Paulo, Brazil Published Online:June 1, 2021https://doi.org/10.5664/jcsm.9208Cited by:1SectionsAbstractEpubPDF ShareShare onFacebookTwitterLinkedInRedditEmail ToolsAdd to favoritesDownload CitationsTrack Citations AboutABSTRACTIchthyosis, as a debilitating disease, can cause significant physical and psychological damage to children and their families, which also includes sleep impairment. We call attention to the importance of evaluating sleep complaints in these patients, given the scarcity of studies on this subject. As the disease commonly results in severe skin injury, it can affect social relationships and the life and sleep quality of the individuals, leading to significant psychologic damage that can persist throughout their lives.Citation:Xerfan EMS, Facina AS, Tomimori J, Tufik S, Andersen ML. The importance of evaluating sleep complaints in children with ichthyoses: a commentary on physical and psychological growth impairment. J Clin Sleep Med. 2021;17(6):1147–1148.INTRODUCTIONIchthyoses consists of a heterogeneous group of both inherited and acquired skin disorders, with genetic pattern and mutations in genes related to skin barrier development and function.1–3 Consequently, cutaneous manifestations are chronically represented by dryness on the whole skin surface, which can be extremely severe and cause formation of widespread scaling and hyperkeratosis.1,4 Erythroderma, blisters, and pain can occasionally occur, and abnormalities may exist in syndromic types.1,4,5 This scenario, since childhood, can highly impair the quality of life of its patients and sleep patterns, because it is a very itchy and uncomfortable condition. In addition, it may lead to physical and psychologic debilitation throughout the years.Hereditary forms of ichthyoses manifested since the neonatal period usually have severe outcomes, whereas hereditary mild types can present at later stages of life.2 Although there is variability in clinical outcomes for this condition,2,4,5 we call attention to its relationship with sleep. Even mild forms of ichthyosis can be a potential cause of sleep impairment. Studies approaching the interaction between this skin disease with sleep are rare. We found some of them evidencing worst effects in quality of life of patients as a whole,5,6 decreased by clinical findings, including severe hyperkeratosis and erythema.6 Herein, we call attention to the sleep distress involved in this context and the importance of evaluating sleep impairment in this disease. Several itchy skin conditions may affect sleep, such as psoriasis and atopic dermatitis.7 Ichthyoses should be considered in further studies as a trigger to worse sleep, leading to a continuous impact on the quality of life.It should be assumed that sleep disturbance in ichthyoses could be secondary for 2 reasons, and both might enhance each other. The first argument is the itchy and uncomfortable sensorial feeling in the skin, typically found in the disease, because of cutaneous dryness.1,2 Nociceptive pruritus occurring at night could be a direct and mechanical reason for sleep impairment and lead to sleep disorder development, including insomnia, sleep deprivation, and circadian rhythm disorders, which are sometimes underdiagnosed in children.8,9 The frequent awakening throughout the night to scratch the skin should be considered a potential trigger for poor sleep. The recovery of the body during sleep is regulated by immunological and inflammatory balance.9 Poor sleep can impair skin barrier recovery because of increased participation in immune and proinflammatory cytokines, such as tumor necrosis factor-α and interleukin-1β.10 It should also be considered a 2-way path and a continuous circle, because skin worsening related to inflammatory substrates might be the cause and consequence of a poor recovery night.9,10The second consideration, and very concerning regarding children, is the psychologic complaints that often follow these patients as they get older. A study evaluated quality of life in a group of 10 patients between 56 and 80 years old diagnosed with congenital ichthyoses through quality-of-life questionnaires. All volunteers confirmed an impaired childhood secondary to the skin infection, and 9 patients noted that the disease affected their entire lives, including their skin (scales, pain, and wounds) and unhappiness as an infant and adolescent.11 These results show the negative influence of the disease in this stage of life and how it could impact their whole existence.We should assume that affected individuals start to face social difficulties since their childhood because of self-perception caused by their skin appearance, which may greatly impair their psychologic development. Children with ichthyoses may suffer social resistance in the convivence with other infants at school and in whole society, including their own family, sometimes. The often-scaled skin appearance, commonly hard to control even with intense and long-term dermatologic treatment including heavy emollients, keratolytic agents, systemic retinoids, and local care with bandages to secondarily hurt and infected skin,2 seems to be a barrier to a healthy social life with another people. All these factors make patients' quality of life and sleep quality difficult and traumatic, as well as those of their parents. It can have severe consequences on their mental and physical growth, regarding poor sleep, because sleep is an important predictor for recovery, especially considering the childhood stage and need for healthy habits.The scarcity of studies regarding sleep complaints in ichthyoses requires more assessment of sleep behavior in these patients in future research. Sleep questionnaires are easily accessed and relevant tools that should be used for outcome assistance in those individuals to provide better comprehension of the self-reported aspects of the sleep. They could provide evidence for how quality of life in these patients is impaired by poor sleep and how it can impair the condition. Because sleep could be worsened by several skin diseases, a better understanding of ichthyosis may improve the quality of life in people who have this disease. More data on this subject may provide new possibilities for sleep improvement and minimizing its negative impact.DISCLOSURE STATEMENTAll authors have seen and approved the manuscript. This study was funded by the Associação Fundo de Incentivo à Pesquisa (AFIP). S.T. and M.L.A. receive fellowships from Conselho Nacional de Desenvolvimento Científico e Tecnológico (CNPq). E.M.S.X. receives a postgraduation grant from Coordenação de Aperfeiçoamento de Pessoal de Nível Superior (CAPES) - Finance Code 001. No sponsorship was received for the publication of this manuscript. The authors report no conflicts of interest.REFERENCES1. Takeichi T, Akiyama M. Inherited ichthyosis: non-syndromic forms. J Dermatol. 2016;43(3):242–251. https://doi.org/10.1111/1346-8138.13243 CrossrefGoogle Scholar2. DiGiovanna JJ, Robinson-Bostom L. Ichthyosis: etiology, diagnosis, and management. Am J Clin Dermatol. 2003;4(2):81–95. https://doi.org/10.2165/00128071-200304020-00002 CrossrefGoogle Scholar3. Gånemo A. Quality of life in Swedish children with congenital ichthyosis. Dermatol Rep. 2010;2(1):e7. https://doi.org/10.4081/dr.2010.e7 CrossrefGoogle Scholar4. Dreyfus I, Taïeb C, Barbarot S, et al.. IQoL-32: a new ichthyosis-specific measure of quality of life. J Am Acad Dermatol. 2013;69(1):82–87. https://doi.org/10.1016/j.jaad.2013.01.022 CrossrefGoogle Scholar5. Oji V, Tadini G, Akiyama M, et al.. 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Volume 17 • Issue 6 • June 1, 2021ISSN (print): 1550-9389ISSN (online): 1550-9397Frequency: Monthly Metrics History Submitted for publicationFebruary 10, 2021Submitted in final revised formFebruary 14, 2021Accepted for publicationFebruary 17, 2021Published onlineJune 1, 2021 Information© 2021 American Academy of Sleep MedicineKeywordsichthyosesquality of lifesleep qualitysleepPDF download
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