Recapping the latest in 2022 eczema treatments under development.
Published On: Feb 25, 2022
Last Updated On: Feb 28, 2022
We all know that melatonin can help you fall asleep. But did you also know that emerging research is exploring whether melatonin may additionally help reduce your nighttime itching to help you stay asleep at night.
Melatonin is a hormone mainly produced in the pineal gland in the brain. “Like other hormones, it circulates throughout the body and interacts with the immune system. This helps to coordinate the timing of immune system activity,” said Dr. Anna Fishbein, associate professor of pediatrics (allergy and immunology) at Northwestern University Feinberg School of Medicine. “Melatonin interacts with the immune system via multiple pathways, such as acting as an antioxidant or acting directly on immune cells via melatonin receptors.” Although our bodies produce melatonin naturally, a melatonin supplement before bed can help provide a sedative effect to fall asleep faster. For people with itchy skin at night, the research shows that the benefits of melatonin may extend beyond simply falling asleep — which could lead to sleeping more soundly, too.
According the March 2020 More Than Skin Deep “Voice of the Patient” report, a collaborative initiative within the eczema community to inform treatment research and development for atopic dermatitis (AD), sleep ranked third among the top three most problematic symptoms in responses to polling and a survey, behind itch and condition/appearance of skin.1 This comes as no surprise since sleep disturbance is reported in 47% to 80% of children with AD and in 33% to 87.1% of adults with AD.1
“I’d wake every few hours, bloody and in tears because I had ripped everything off in my sleep because my skin felt like it was on fire. It burned and itched and the only thing I could do for relief was to scratch and claw at it, rub it feverishly on anything I could reach,” said More Than Skin Deep panelist, Briana Cox.
During sleep, our bodies cycle between four stages: one rapid eye movement (REM) cycle and three non-REM (NREM) cycles.2 It’s common for many people to wake briefly between the cycles. For people with eczema, the pain, dry skin and nighttime itching from a flare is often enough to wake them up and keep them up. This is in part due to the activation of the immune system during a flare, leading to free radical production associated with decreased melatonin levels and depressed antioxidant enzyme activities.3
Temperature can also play a role. At night, our bodies naturally prepare for sleep by cooling our core temperature.4 Melatonin is secreted in a diurnal pattern, or daily cycle, with a steady increase and peak between 2:00 AM and 4:00 AM, followed by a gradual decrease.5
Circadian rhythm influences cutaneous blood flow (which determines the amount of heat lost through the skin), among other properties of skin barrier function, which is associated with greater skin permeability, histamine release and — you guessed it — itching.5 Since the skin barrier is most defective, or permeable, at night, this may explain why itching is usually worse at night.
Melatonin has been tested and documented to help fight free radicals in our bodies and function as a potent anti-inflammatory agent.6 This means melatonin stimulates a series of antioxidative activities within the body, which can help protect skin integrity and maintain a functional skin barrier.6 Since melatonin is a key player in kicking off these anti-inflammatory activities, this is why it’s thought to help reduce eczema flare symptoms that may be keeping you up at night. Melatonin helps regulate our circadian rhythm, which in turn regulates immune function. Levels of proinflammatory cytokines, such as IL-1β, IL-2, TNF-α, IFN-γ, and IL-6, are increased at night and generally promote sleep.6 The production of these specific cytokines coupled with cortisol secretion at night are thought to contribute to reducing the urge to itch and disrupting a sleep cycle.
In a 2016 study for melatonin supplementation for children with atopic dermatitis and sleep disturbance, results were evaluated using the Scoring Atopic Dermatitis (SCORAD) index. After melatonin treatment among the 48 children included in the study, the SCORAD index decreased by 9.1 compared with after placebo.7 The results concluded that melatonin supplementation is a safe and effective way to improve the sleep-onset latency and disease severity in children with atopic dermatitis.7
While more research is still needed determine melatonin’s proven benefits for people with eczema, it “likely works better at managing active flares, as opposed to preventing flares,” said Dr. Fishbein. While melatonin is generally well tried, some common side effects may include nausea, headache, dizziness, or feeling overly tired or groggy. However, long-term sleep deprivation can have more lasting negative effects on attention, performance, productivity and mood swings, in addition to being is associated with higher rates of anxiety, depression and an increased risk for other serious health issues.1
Melatonin is an over-the-counter supplement, available at most drug stores or to order online. There are many different brands and forms of melatonin, or melatonin-containing sleep aids, to choose from. Prices vary depending on quantity and brand, but the most common brands found on sites like Amazon or Walmart typically run for prices ranging between $7–$12 per bottle for a 1–3-month supply.
Since it’s considered a dietary supplement, melatonin is not as strictly regulated by the FDA. Furthermore, many sleep-aid supplements often include additional natural or synthetic sleep-promoting ingredients, so it’s important to check the ingredient listed and look for a tried and trusted brand. You may ask your doctor or pharmacist for a recommendation based on your needs. The key is to ensure you’re taking the correct dose: “Melatonin is typically taken every night, about 30 minutes before bedtime with general dosing of 1 mg in infants, 2.5–3 mg in older children and 5 mg in adolescence/adults,” said Dr. Fishbein.
While more research is still needed to determine how nightly melatonin supplements can help reduce flares, they’ve proven to be helpful for many people with eczema who experience sleep disturbances. “Do not be afraid to ask your [healthcare] provider for a referral to a sleep medicine expert. Good sleep is really important for physical, psychologic and immune health,” said Dr. Fishbein. If you find yourself lying awake at night, unable to stop scratching, just know you’re not alone. Melatonin supplements may be a game changer in improving the quality of your sleep.