Itch Intensity Worse at Night for Pediatric Atopic Dermatitis Patients

Brian Cheng, MD

New research shows itch intensity peaks in the evening for pediatric patients with atopic dermatitis (AD).

A team, led by Brian Cheng, Northwestern University Feinberg School of Medicine, identified the differences in itch intensity among pediatric patients with atopic dermatitis.

The data was presented during the American Academy of Allergy, Asthma & Immunology Annual Meeting (AAAAI) 2022.

Exploring the Data

In previous research, investigators found itch associated with atopic dermatitis varies greatly by the time of day for adults. However, it is not entirely understood what the variation of itch intensity throughout the day is among pediatric patients with atopic dermatitis.

In the cross-sectional study, the investigators surveyed 240 pairs of parents and children, including 60 infants between 1-4 years and 180 children between 5-17 years with atopic dermatitis in the US.

Each pair was stratified by age, sex, and race. The patient population was 55% male, with a mean age of 8.5 years.

The data was derived from questionnaires where the parents selected the time of day with worst itch and rated the child’s itch intensity on a 0-10 scale during each period.

The investigators then queried the exact time of worst itch, bedtime, minutes to fall asleep, and wake time and assessed differences in itch intensity at specific times of day using paired t-tests.

Higher Intensity at Night

Overall, 83% of the pediatric patients had moderate-to-severe atopic dermatitis based on the Patient-Oriented Eczema Measure.

The investigators found the worst itch most frequently occurred at 7:00 pm on weekdays and 8:00 pm on weekends, with a mean worst itch of 2.7 and 3.0 hours prior to sleep onset on weekdays and weekends, respecitively. Itch intensity was also higher in the evening (mean: 5.6 vs 5.4; t = 2.61; P = 0.01). This was even higher at bedtime (5.8 vs. 5.4; t = 4.58; P <.0001) compared to the itch intensity for all other times of day.

“Worst itch intensity among children with AD commonly occurs in the evening/bedtime,” the authors wrote. “Further studies are needed to better understand potentially targetable circadian mechanisms underlying the skin barrier, AD-induced inflammation, and itch.”

Treatment Options

One treatment option that has recently shown promise in the pediatric population with atopic dermatitis is tralokinumab.

Earlier this month, LEO Pharma announced new 16-week data on tralokinumab-ldrm, stating that it led to significant improvements in itch, sleep interference, anxiety and depression, and overall quality of life among adolescents aged 12-17 years old with moderate-to-severe atopic dermatitis.

Tralokinumab-ldrm was previously approved by the US Food and Drugs Administration (FDA) in December 2021 for the treatment of adults with moderate-to-severe atopic dermatitis. It is the first and only FDA approved biologic that binds to and inhibits the interleukin (IL)-13 cytokine.

A ≥4-point improvement in adolescent Worst Daily Pruritus Numeric Rating Scale (NRS) was seen in 23.2% of patients receiving tralokinumab-ldrm 150 mg (P<0.001), 25.0% of those in the tralokinumab-ldrm 300 mg group (P<0.001), and 3.3% placebo, while a ≥6-point improvement in Children’s Dermatology Life Quality Index (CDLQI) was recorded in 31.0% of patients receiving tralokinumab-ldrm 150 mg (P=0.029), 39.5% tralokinumab-ldrm 300 mg (P<0.001), and 15.9% placebo.

Additionally, a ≥6-point improvement in Patient Oriented Eczema Measure (POEM) was reported in 38.7% of the tralokinumab-ldrm 150 mg group (P<0.001), 46.8% of the tralokinumab-ldrm 300 mg group, (P<0.001), and 10.5% of the placebo group. The biologic was also associated with greater improvement than placebo in eczema-related sleep NRS.

The study, “Timing of Itch Among Children with Atopic Dermatitis,” was published online in the Journal of Allergy and Clinical Immunology.