It's no secret that kids with atopic dermatitis (AD) or eczema often experience increased itchiness at night. In fact, one study of 100 adult and adolescent patients with AD concluded by self-reports that itching was generally worse in the evening and night*. Additional research has shown that children with AD sleep an average of 46 minutes less than children without AD**. Increased itching typically occurs 1 to 6 hours after a child falls asleep and peaks at 3 hours***. Many times, kids are not even aware of the extent to which they are scratching during the night and this further contributes to skin inflammation**. That said, it is without question that nighttime itching can disrupt sleep and cause extreme discomfort to the child. But why does this increased itchiness occur in the first place?
Reasons Why This Might Happens
1. Cortisol is generally known as the "stress" hormone of the body. In addition to this, it also has an affect on different systems of the body. Here, in particular, it is important to mention that cortisol also functions to regulate the inflammatory response and immune function. Following the circadian rhythm, cortisol levels will be high in the morning and low at night. This drop in cortisol levels may be part of the culprit which makes skin inflammation worse as there is less in circulation to facilitate the inflammatory response and immue function *^.
2. Research shows that a rapid decrease in core body temperature occurs to facilitate sleep*+, however, this also leads to a decrease in blood flow to the skin which can cause dryness, contributing to flaky, itchy skin.
3. When bedtime rolls around, kids are usually bundled up in pajamas and blankets. While this makes for a warm and toasty night, the friction from these clothing items can cause irritation to eczema-prone skin, leading to an increase in itchiness.
4. Trans-epidermal water loss is higher in the evening which is suggestive of insufficient epidermal barrier function. This could possibly lead to the itch and irritations throughout the night**.
What Can Parents Do?
1. Keep your child’s bedroom temperature cool and comfortable to prevent sweating as much as possible.
2. Use gentle, fragrance-free detergents and fabric softeners.
3. Avoid dressing children in scratchy fabrics, such as wool or polyester. Choose coverall pajamas with mittens and footies that are made of natural, breathable fabrics like cotton or silk.
3. Moisturize your child's skin at night with a heavy, emollient cream to keep their skin hydrated. We recommend our 'Goodbye 2 Dry' Dry Skin Relief.
4. Trim your child’s nails to avoid secondary infections.
In conclusion, if your child is suffering from eczema or other skin conditions that cause nighttime itchiness, don’t panic. It is a common problem that children and their families deal with. Also, bear in mind to consult your family doctor, pediatrician or dermatologist before administering any medication to a child or to learn new tips. It is always wise to work together with your healthcare provider to find a skincare routine that suits your child and family's needs.
*Cheng, B. T., Patel, M. S., Xu, M., Tilley, C. C., Zee, P. C., Paller, A. S., & Fishbein, A. B. (2022). Timing of itch among children with atopic dermatitis. Annals of Allergy, Asthma & Immunology, 128(5), 603-605.
**Patel, T., Ishiuji, Y., & Yosipovitch, G. (2007). Nocturnal itch: why do we itch at night?. Acta dermato-venereologica, 87(4), 295-298.
***Fishbein, A. B., Lin, B., Beaumont, J., Paller, A. S., & Zee, P. (2021). Nocturnal movements in children with atopic dermatitis have a timing pattern: a case-control study. Journal of the American Academy of Dermatology, 85(2), 474-476.
*^Thau, L., Gandhi, J., & Sharma, S. (2019). Physiology, cortisol.
*+Murphy, P. J., & Campbell, S. S. (1997). Nighttime drop in body temperature: a physiological trigger for sleep onset?. Sleep, 20(7), 505–511. https://doi.org/10.1093/sleep/20.7.505