Exploring the Relationship Between AD, Psychological Stress, Sleep Disturbances, Salivary Biomarkers

This article was originally published by Dermatology Times®. It has been lightly edited.

Understanding the relationships between atopic dermatitis (AD), psychological stress, sleep disturbances, and salivary biomarkers is crucial to develop effective clinical management strategies for patients with AD, according to a study published in the World Journal of Clinical Cases.

The recent comprehensive literature review conducted by Brazilian researchers focused on articles published between January 2012 and October 2022 obtained from databases such as PubMed and Scientific Electronic Library Online. The Health Sciences Descriptors used to find related articles included "atopic dermatitis," "psychological stress," "sleep," and "salivary proteins and peptides."

Investigators wrote that the importance of this literature review lies in the scarcity of research associating AD with salivary biomarkers, stress, and sleep disturbances. They explained that AD adversely affects patients' quality of life and is exacerbated by psychological stress as sleep disorders worsen patients' well-being, academic performance, and family dynamics, further intensifying stress levels.

Patient with AD

Image credit: Ольга Тернавская - stock.adobe.com

AD and Sleep Disturbances

Sleep disorders, observed in up to 60% of patients with AD, negatively impact neurocognitive function, behavior, and mood. Studies indicate that sleep disturbances are linked to greater AD severity and increased scratching. Actigraphy and polysomnography studies revealed altered sleep efficiency, longer latency time to sleep onset, increased fragmentation, and reduced non-rapid eye movement sleep in children with AD.

AD and Psychological Stress

Psychological stress exacerbates AD symptoms, and the severity of stress depends on individual perception and the intensity of stressors. The hypothalamic-pituitary-adrenal (HPA) axis and the autonomic nervous system play critical roles in the stress response. Dysregulation in the HPA axis is observed in patients with AD, resulting in an imbalanced immune response and triggering inflammation.

AD and Salivary Biomarkers

Saliva, a non-invasive biofluid, reflects psychological stress through biomarkers like cortisol, melatonin, chromogranin A, alpha-amylase, and immunoglobulin A (IgA). Studies suggested that these salivary biomarkers may serve as indices for evaluating stress in AD patients. Melatonin, with its immunomodulatory and anti-inflammatory effects, is implicated in AD severity and sleep disturbances.

Conclusion

This narrative review sheds light on the intricate interplay between AD, psychological stress, sleep disturbances, and salivary biomarkers. The severity of AD is not only reflected in physical symptoms but also in the emotional and social well-being of individuals. Salivary biomarkers show promise in assessing stress levels and understanding the complex associations between AD, sleep disturbances, and psychological well-being. Further research is essential to unravel the full scope of these relationships and develop targeted interventions for improved clinical management of AD patients.

Reference

Estefan J, Ferreira DC, Cavalcante FS, Dos Santos KRN, Ribeiro M. Investigation of possible relationship between atopic dermatitis and salivary biomarkers, stress, and sleep disorders. World J Clin Cases. 2023;11(17):3958-3966. doi:10.12998/wjcc.v11.i17.3958