Melatonina e Dermatite Atópica: Novos Conhecimentos sobre a Fisiopatologia e o seu Papel nas Perturbações do Sono

Ana Sofia Borges; A. Brasileiro; P. Mendes-Bastos

doi:10.29021/spdv.76.4.965

Ana Sofia Borges Serviço de Dermatovenerologia, Hospital Santo António dos Capuchos, Centro Hospitalar Lisboa Central, Lisboa, Portugal
A. Brasileiro Serviço de Dermatovenerologia, Hospital Santo António dos Capuchos, Centro Hospitalar Lisboa Central, Lisboa, Portugal
P. Mendes-Bastos Centro de Dermatologia, Hospital CUF Descobertas, Lisboa, Portugal

DOI: https://doi.org/10.29021/spdv.76.4.965

Palavras-chave: Criança, Dermatite Atópica, Melatonina/uso terapêutico, Transtornos do Sono-Vigília/fisiopatologia

Resumo

As perturbações do sono são frequentes em crianças com dermatite atópica, com impacto negativo significativo na sua qualidade de vida e com consequências no seu comportamento e desempenho cognitivo. Porém, a fisiopatologia das perturbações do sono associadas à dermatite atópica é ainda pouco compreendida. Inicialmente consideradas consequência direta do prurido e do ato de escoriar associado durante o período noturno, hoje sabe-se que as perturbações do sono resultam de uma complexa interligação entre diversos fatores. Estudos recentes têm sugerido que a melatonina possa estar envolvida, não só pela função primordial de controlo do ciclo circadiano, mas também pelas características anti-inflamatória e antioxidante. Nesta revisão, os autores abordam os novos conhecimentos fisiopatológicos sobre os distúrbios do sono em crianças com dermatite atópica, focando o papel da melatonina e sua possível aplicação terapêutica.

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Referências

Bieber T. Atopic dermatitis. N Engl J Med.

;358:1483–94. doi: 10.1056/NEJMra074081.

Camfferman D, Kennedy JD, Gold M, Martin AJ,

Lushington K. Eczema and sleep and its relationship

to daytime functioning in children. Sleep Med Rev.

; 14:359-69. doi: 10.1016/j.smrv.2010.01.004

Ricci G, Bendandi B, Bellini F, Patrizi A, Masi M. Atopic

dermatitis: quality of life of young Italian children

and their families and correlation with severity

score. Pediatr Allergy Immunol. 2007; 18:245-9. doi:

1111/j.1399-3038.2006.00502.x

Lewis-Jones S. Quality of life and childhood atopic dermatitis:

the misery of living with childhood eczema.Int

J Clin Pract. 2006; 60:984-92. doi: 10.1111/j.1742-

-1241.2006.01047.x

Sadeh A, Gruber R, Raviv A. Sleep, neurobehavioral

functioning, and behavior problems in school-age

children.Child Dev. 2002; 73:405-17.

Touchette E, Petit D, Séguin JR, Boivin M, Tremblay

RE, Montplaisir JY. Associations between sleep duration

patterns and behavioral/cognitive functioning at

school entry. Sleep. 2007; 30:1213-9.

Chang YS, Chou YT, Lee JH, Lee PL, Dai YS, Sun C, et

al. Atopic dermatitis, melatonin, and sleep disturbance.

Pediatrics. 2014; 134:e397-405. doi: 10.1542/

peds.2014-0376.

Bender BG, Ballard R, Canono B, Murphy JR, Leung

DY. Disease severity, scratching, and sleep quality in

patients with atopic dermatitis. J Am Acad Dermatol.

; 58:415-20. doi: 10.1016/j.jaad.2007.10.010.

Hon KL, Lam MC, Wong KY, Leung TF, Ng PC. Pathophysiology

of nocturnal scratching in childhood atopic

dermatitis: the role of brain-derived neurotrophic factor

and substance P. Br J Dermatol. 2007; 157:922-5.

doi:10.1111/j.1365-2133.2007.08149.x

Hon KL, Lam MC, Leung TF, Wong KY, Chow CM, Fok

TF, et al. Are age-specific high serum IgE levels associated

with worse symptomatology in children with

atopic dermatitis? Int J Dermatol. 2007; 46:1258-62.

doi: 10.1111/j.1365-2133.2007.08149.x

Stores G, Burrows A, Crawford C. Physiological sleep

disturbance in children with atopic dermatitis: a case

control study. Pediatr Dermatol. 1998; 15:264-8.

Bender BG, Leung DY. Sleep disorders in patients with

asthma, atopic dermatitis, and allergic rhinitis. J Allergy

Clin Immunol. 2005; 116:1200-1. doi:10.1016/j.

jaci.2005.09.041

Reuveni H, Chapnick G, Tal A, Tarasiuk A. Sleep fragmentation

in children with atopic dermatitis. Arch Pediatr

Adolesc Med. 1999; 153:249-53.

Born J, Lange T, Hansen K, Mölle M, Fehm HL. Effects

of sleep and circadian rhythm on human circulating

immune cells. J Immunol. 1997; 158:4454-64.

Geiger SS, Fagundes CT, Siegel RM. Chrono-immunology:

progress and challenges in understanding links between the circadian and immune systems. Immunology.

; 146:349-58. doi: 10.1111/imm.12525.

Hon KL, Lam MC, Leung TF, Kam WY, Lee KC, Li

MC, et al. Nocturnal wrist movements are correlated

with objective clinical scores and plasma chemokine

levels in children with atopic dermatitis. Br J

Dermatol. 2006; 154:629-35. doi:10.1111/j.1365-

2006.07213.x

Sakami S, Ishikawa T, Kawakami N, Haratani T, Fukui

A, Kobayashi F, et al.Coemergence of insomnia and a

shift in the Th1/Th2 balance toward Th2 dominance.

Neuroimmunomodulation. 2002-2003; 10:337-43.

doi: 10.1159/000071474

Chang YS, Chiang BL. Mechanism of sleep disturbance

in children with atopic dermatitis and the role of the

circadian rhythm and melatonin. Int J Mol Sci. 2016;

:462. doi: 10.3390/ijms17040462.

Lee J, Lee H, Noh S, Bae BG, Shin JU, Park CO, et

al. Retrospective analysis on the effects of house dust

mite specific immunotherapy for more than 3 years in

atopic dermatitis. Yonsei Med J. 2016; 57:393-8. doi:

3349/ymj.2016.57.2.393.

Tam H, Calderon MA, Manikam L, Nankervis H, García

Núñez I, Williams HC, et al. Specific allergen

immunotherapy for the treatment of atopic eczema.

Cochrane Database Syst Rev. 2016; 2:CD008774.

doi: 10.1002/14651858.CD008774.pub2.

Brzezinski A. Melatonin in humans. N Engl J Med.

Jan 16; 336(3):186-95.

Chang YS, Lin MH, Lee JH, Lee PL, Dai YS, Chu KH, et

al. Melatonin supplementation for children with atopic

dermatitis and sleep disturbance: a randomized

clinical trial. JAMA Pediatr. 2016; 170:35-42. doi:

1001/jamapediatrics.2015.3092.

Abdelgadir IS, Gordon MA, Akobeng AK. Melatonin

for the management of sleep problems in children

with neurodevelopmental disorders: a systematic

review and meta-analysis. Arch Dis Child. 2018 (in

press). doi: 10.1136/archdischild-2017-314181.

Acuña-Castroviejo D, Escames G, Venegas C, Díaz-

-Casado ME, Lima-Cabello E, López LC, et al. Extrapineal

melatonin: sources, regulation, and potential

functions. Cell Mol Life Sci. 2014; 71:2997-3025.

doi: 10.1007/s00018-014-1579-2.

Carpentieri A, Díaz de Barboza G, Areco V, Peralta

López M, Tolosa de Talamoni N. New perspectives in

melatonin uses. Pharmacol Res. 2012; 65:437-44.

doi: 10.1016/j.phrs.2012.01.003.

Marseglia L, D'Angelo G, Manti S, Salpietro C, Arrigo

T, Barberi I, et al. Melatonin and atopy: role in

atopic dermatitis and asthma. Int J Mol Sci. 2014;

:13482-93. doi: 10.3390/ijms150813482.

Kim TH, Jung JA, Kim GD, Jang AH, Ahn HJ, Park YS, et

al. Melatonin inhibits the development of 2,4-dinitrofluorobenzene-

induced atopic dermatitis-like skin lesions

in NC/Nga mice. J Pineal Res. 2009; 47:324-9.

doi: 10.1111/j.1600-079X.2009.00718.x.

Chen L, Lin SX, Overbergh L, Mathieu C, Chan

LS. The disease progression in the keratin 14 IL-4-

-transgenic mouse model of atopic dermatitis parallels

the up-regulation of B cell activation molecules,

proliferation and surface and serum IgE. Clin Exp

Immunol. 2005; 142:21-30. doi: 10.1111/j.1365-

-2249.2005.02894.x

Gittler JK, Shemer A, Suarez-Farinas M, Fuentes-Duculan

J, Gulewicz KJ, Wang CQF, et al. Progressive

activation of T(H)2/T(H)22 cytokines and selective epidermal

proteins characterizes acute and chronic atopic

dermatitis. J Allergy Clin Immunol. 2012; 130:1344–

doi: 10.1016/j.jaci.2012.07.012.

Howell MD, Fairchild HR, Kim BE, Bin L, Boguniewicz

M, Redzic JS, et al. Th2 cytokines act on S100/

A11 to downregulate keratinocyte differentiation. J Investig

Dermatol. 2008; 128:2248-58. doi: 10.1038/

jid.2008.74.

Carrillo-Vico A, Lardone PJ, Alvarez-Sánchez N, Rodríguez-

Rodríguez A, Guerrero JM. Melatonin: buffering

the immune system. Int J Mol Sci. 2013; 14:8638-83.

doi: 10.3390/ijms14048638.

García JJ, López-Pingarrón L, Almeida-Souza P, Tres

A, Escudero P, García-Gil FA, et al. Protective effects

of melatonin in reducing oxidative stress and in preserving

the fluidity of biological membranes: a review.

J Pineal Res. 2014; 56:225-37. doi: 10.1111/

jpi.12128.

Fishbein AB, Vitaterna O, Haugh IM, Bavishi AA, Zee

PC, Turek FW, et al. Nocturnal eczema: Review of

sleep and circadian rhythms in children with atopic

dermatitis and future research directions. J Allergy

Clin Immunol. 2015; 136:1170-7. doi: 10.1016/j.

jaci.2015.08.028.

Gupta MA, Gupta AK. Sleep-wake disorders and

dermatology. Clin Dermatol. 2013; 31:118-26. doi:

1016/j.clindermatol.2011.11.016.

Kelsay K. Management of sleep disturbance associated

with atopic dermatitis. J Allergy Clin Immunol.

; 118:198-201.

Brown RE, Stevens DR, Haas HL. The physiology of

brain histamine. Prog Neurobiol. 2001; 63:637-72.

Tsujii T, Yamamoto E, Ohira T, Takahashi T, Watanabe

S. Antihistamine effects on prefrontal cortex activity

during working memory process in preschool

children: a near-infrared spectroscopy (NIRS) study.

Neurosci Res. 2010; 67:80-5. doi: 10.1016/j.neures.

01.010.

Richardson GS, Roehrs TA, Rosenthal L, Koshorek G,

Roth T. Tolerance to daytime sedative effects of H1 antihistamines.

J Clin Psychopharmacol. 2002; 22:511-5.

Motola D, Donati M, Biagi C, Calamelli E, Cipriani

F, Melis M, et al. Safety profile of H1-antihistamines

in pediatrics: an analysis based on data from VigiBase.

Pharmacoepidemiol Drug Saf. 2017; 26:1164-71. doi: 10.1002/pds.4246.

Slominski AT, Hardeland R, Zmijewski MA, Slominski

RM, Reiter RJ, Paus R. Melatonin: a cutaneous

perspective on its production, metabolism, and functions.

J Invest Dermatol. 2018;138:490-9. doi:

1016/j.jid.2017.10.025.