Difficulty sleeping is commonplace for children with atopic dermatitis, a condition similar to eczema that causes itchy inflammation of the skin. It has been found that children suffering from AD have decreased levels of nighttime melatonin. Because melatonin has both sleep-inducing and anti-inflammatory properties, the researchers in this study hypothesized that melatonin may be an effective treatment for pediatric patients suffering from AD.
The researchers used a randomized, double blind, placebo-controlled study involving patients aged 1-18 who had AD affecting at least 5% of their total body surface area. patients received either 3mg daily of melatonin or placebo for four weeks. The primary outcome of AD severity was measured using the SCORAD index, and the secondary outcome of sleep impact was measured using actigraphy and polysomnography, as well as urinalysis of sulfatoxymelatonin, the byproduct of melatonin metabolism.
After treatment, the SCORAD mean score dropped by 9.1, and the sleep-onset time dropped by 21.4 minutes on average. Importantly, no adverse effects were reported during the trial.
This study is interesting for patients looking for an OTC solution to both atopic dermatitis as well as sleep issues. The fact that no adverse events occured helps to support the conclusion that melatonin is not only an effective and cheaper solution to two issues as once, but it is also a safe solution in the pediatric population. This knowledge will be useful for us to know in the future, as over 3 million cases of AD are diagnosed annually(Source: Mayo Clinic)
Chang and colleagues conducted a meta-analysis of all published randomized clinical control trials that have been reviewed to study the use of synbiotics in the prevention/treatment of atopic dermatitis (AD) in pediatric patients. AD is a common condition in children and is more commonly referred to as eczema. It is characterized by dry and scaly red patches, usually occurring on the face of children. Chang and colleagues also describe AD as creating an environment that increases a child’s susceptibility to allergic diseases. Synbiotics are OTC medications that are a mixture of both prebiotics and probiotics. The clinical control trials must have met certain criteria in order to be included in the analysis. 8 of the 257 studies met the criteria of an oral administration intervention of synbiotics, and included the severity of the AD in the children within the trial. Of the studies used, 6 were for treatment of AD and 2 were the prevention. After a complete analysis of the 8 studies, evidence was found that synbiotics can be used to treat AD for children 1 year and older, but no significant evidence was found to support the use of synbiotics for AD primary prevention.
JAMA Pediatr. doi:10.1001/jamapediatrics.2015.3943 (published online 25 January 2016).
Parents have the most concern about newborns and what medications that they are receiving. They are also concerned about any disease that may affect their young children, and are willing to do anything in order to treat their children. This analysis shows that there is an effective oral treatment for AD in children, but do you think that this analysis alone is enough for a parent to agree to use as a treatment for their child’s AD? Pediatric medication use also has very strict guidelines in order to ensure the safety of children. In my opinion, I would be more inclined to give a child a topical medication that only interacts with the affected area before I would suggest an over the counter oral medication.