ISLAMABAD, MARCH 12 (ONLINE): Itching is one of the most distressing and poorly understood symptoms of eczema.
A recent study used animal models, human tissue, and nerve fibers to investigate the condition’s tendency to produce itching.
The researchers concluded that the bacteria Staphylococcus aureus may be an important part of the puzzle.
They hope their findings may eventually lead to treatments for a range of skin conditions.
Eczema, also called atopic dermatitis, is one of the most common skin conditions, affecting an estimated 223 million people globally.
One of the dominant symptoms is itch. While scratching can momentarily relieve the sensation, it can also cause skin damage, increase the risk of skin infections, and exacerbate inflammation.
“Itch plays a big part in the quality of life of people with eczema,” explained Carsten Flohr a professor at Kings College London and a member of the British Association of Dermatologists.
“It impacts both the quality of sleep and the amount of sleep people get. It also affects social and working life for adults, and the enjoyment of school for children,” Flohr told Medical News Today.
Andrew Proctor, the chief executive of the National Eczema, says eczema itching is a constant issue for people with the condition.
“For the millions of children and adults with atopic eczema, relentless itch is one of the most difficult things about living with this complex condition,” Proctor told Medical News Today.
“It often leads to the painful ‘itch-scratch cycle,’” he added, “where you scratch to relieve the itch, then the skin is damaged, and it becomes even more itchy, with even greater temptation to scratch.”
There are few long-term treatments that can reliably soothe this type of itching.
However, a recent study published in the journal Cell investigated how a particular skin microbe might drive itch in eczema. Experts hope the results could lead to new treatments.
Skin, microbiome, and eczema
The skin is considered to be the largest organTrusted Source of the body and plays a myriad of vital roles.
It protects against pathogens, dehydration, mechanical damage, and ultraviolet light. It also carries receptors that provide sensations such as pain, temperature, and touch.
Importantly for eczema, it also contains receptors called pruriceptorsTrusted Source, which produce the sensation of itch.
Like many other parts of the body, the skin is home to a thriving microbial community — the skin microbiome, which contains vast numbers of bacteria, fungi, and other microbes.
Although there is growing interest in the human microbiome, scientists have a long way to go before they understand its complex roles in health and disease.
“Your skin bacteria and skin immune system talk to each other and they talk to the bacteria in your gut. Just like with your gut, having a diverse balance is the key to a happy microbiome,” said Flohr, who wasn’t involved in the recent research.
Understanding how bacteria interact with each other as well as the skin and the immune system may one day help treat various skin conditions.
Medical News Today contacted one of the new study’s authors, Isaac Chiu, an associate professor of immunobiology at Harvard Medical School in Massachusetts. We asked why he decided to study skin microbes and eczema.
“My lab previously found that skin microbes can cause pain when under the skin’s surface. We wondered whether microbes also cause itch,” he said.
So, they investigated.
Staphylococcus aureus bacteria and eczema
S. aureusTrusted Source is a pathogenic bacteria and one of the most common causes of skin infections.
According to Chiu, research has shown that “S. aureus is one of the leading bacteria found on atopic dermatitis lesions.”
Evidence also suggests that S. aureus may help drive the inflammationTrusted Source associated with eczema.
However, until now, its links to itch were unclear.
The recent Cell study looks at this relationship in depth using animal models, human tissue, and nerve fibers.
Details of the study on skin bacteria’s role in eczema
The researchers initially applied S. aureus to the skin of mice, which they said increased the likelihood that the animals would develop dermatitis.
These mice also scratched much more than mice without S. aureus.
Next, the researchers set out to understand how S. aureus could trigger this itch response by focusing on enzymes produced by the bacteria. S. aureus produces 10 proteases, so the scientists focused on these.
Eventually, they identified protease V8 as the primary driver of the itch response: When the scientists injected V8 alone into mice, they started scratching.
As further evidence, the researchers showed that patches of human skin affected by eczema had higher levels of V8 than unaffected skin.
Sensory interactions with eczema
Finally, the scientists said they demonstrated that V8 could stimulate pruriceptor neurons from mice and humans by interacting with a specific receptor.
The receptor in question is proteinase-activated receptor 1 (PAR1). When the team blocked PAR1, it decreased itch and reduced skin damage caused by V8 and S. aureus.
V8 seems to be a particularly useful enzyme for S. aureus. Previous research shows “that V8 is important for many S. aureus processes,” Chiu explained.
“For example, it helps acquire nutrients, neutralizes immune factors, and cleaves proteins in the bloodstream,” he said.
Moving forward with eczema research
The Federal Drug Administration (FDA) has already approved vorapaxar (ZONTIVITY), an oral drug that blocks PAR1 and helps prevent thrombotic cardiovascular events.
“Currently, there are only oral compounds available to block PAR1. There are no current topical formulations of these drugs,” Chiu said.
He hopes scientists will develop topical formulations, which might make a difference to people with eczema and other skin conditions that cause itch. However, he explains that widely available treatments like these will be a “long way” off.
Chiu and his colleagues are continuing to investigate. “We are still looking into the role of V8 in itch and skin inflammation,” he said.
“It’s possible that the scratching could induce inflammation and longer-term consequences, such as immune responses. I am also interested in other proteases from microbes and whether they could cause itch,” Chiu added.
Additionally, he plans to continue investigations into how PAR1 interacts with V8.
Flohr was upbeat about the future implications of these findings:
“This is an exciting discovery because it could open the doors to researchers finding new ways to treat eczema. For example, a drug that can block the enzyme that seems to be involved may be useful to treat itching,” he said
Skin diseases such as eczema can cause sleep disturbances, study finds
Experts say itching and other effects from skin conditions can disrupt a person’s sleep. Lucas Ottone/Stocksy
About 900 million people globally have a skin disease at any given time.
Many skin conditions can be painful or chronically itchy, causing discomfort.
Researchers at the EADV Congress 2023 report that 42% of people around the world with skin disease experience sleep disturbances.
Scientists found these sleep disturbances had far-reaching implications for a person’s overall life, including work productivity and daytime fatigue.
Researchers estimate that about 900 million peopleTrusted Source worldwide have a skin disease at any given time.
There are more than 3,000 known skin diseases. Some of the most common types of skin conditions include acne, contact dermatitis, psoriasis, rosacea, and atopic dermatitis, also known as eczema.
Depending on the type and severity of the skin condition, many can impact a person’s life by causing stress or depressionTrusted Source. Many skin conditions can also be painful or chronically itchy, causing discomfort.
Now, a team of researchers recently presented a study at the European Academy of Dermatology and Venereology (EADV) Congress 2023 stating that 42% of people around the world with skin disease experience sleep disturbances with potential implications on their overall quality of life.
The findings haven’t been published yet in a peer-reviewed journal.
The link between skin disease and sleep disturbance
The research results were taken from a comprehensive international research initiative called the ALL PROJECT, which analyzed information from more than 17,000 adults in 20 countries to assess the impact of skin diseases.
When examining the data, the research team reported that 42% of respondents with skin disease experienced sleep disturbances. The main symptoms impacting respondents’ sleep were itching (60%) and burning sensations or tingling (17%).
Scientists found these sleep disturbances have broader implications on everyday life. For example, 49% of respondents reported reduced productivity at work, compared to 19% of respondents without a skin disease.
Additionally, respondents with skin disease were more likely to experience fatigue as soon as they wake from sleep, periods of drowsiness during the day, tingling sensations in their eyes, and repeated yawning than respondents who did not have a skin disease.
“Moving forward, healthcare providers should be encouraged to integrate sleep disturbance questions into the examinations of patients with skin conditions to foster a more comprehensive understanding of the impact of skin diseases,” said Dr. Bruno Halioua, a dermatologist in private practice in Paris, France, and one of the authors of the study.
“Ultimately, the ALL PROJECT aims to spotlight the impact of skin diseases and associated patient experiences so we can mitigate these adverse effects and improve the quality of life for patients,” he told Medical News Today.
A known correlation between sleep and skin conditions
This is not the first study to tie sleep disturbances to skin conditions such as eczema.
A study published in November 2021 reported a high prevalence of sleep disorders in people with skin disorders, which many times lead to reduced daytime performance, impaired sleep among the patients’ relatives, and increased use of substances.
A literature reviewTrusted Source published in February 2023 noted that sleep disturbances in people with chronic inflammatory skin diseases such as atopic dermatitis and psoriasis may also worsen the condition’s inflammation.
Additionally,, another reviewTrusted Source published in August 2020 examined the correlation between skin disease and obstructive sleep apnea.
In addition, the types of medications a person is taking for a skin disease may also impact their sleep. A reviewTrusted Source published in June 2023 observed that some medications primarily used for skin conditions have been associated with alterations to a person’s sleep-wake cycle.
How skin diseases affect sleep
After reviewing this study, Dr. Alexis Young, a dermatologist with Hackensack University Medical Center in New Jersey, told Medical News Today the research results were not surprising.
“I was not surprised. Itch sensation is carried by the same nerve fiber as pain and as such, can be incredibly disruptive to a patient dealing with a skin disease — like atopic dermatitis — both during the day and at night,” Young explained. “Itch is always worse at night when we have fewer distractions than during the day.”
As a dermatologist who focuses on severe atopic dermatitis, Dr. Peter Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University Feinberg School of Medicine in Illinois and founding director of the Chicago Integrative Eczema Center, told Medical News Today that almost all of his patients report a significant impact on their sleep.
“Most skin problems are associated with some symptoms, such as itch, stinging, and discomfort, and that can certainly affect sleep,” said Lio. “Additionally, there’s a great deal of psychological stress that comes with skin disorders, and it is not surprising that perhaps, even in the absence of symptoms, sleep disturbance can be found.”
Reinforcing a holistic treatment approach
Medical News Today also spoke with Dr. Benjamin Ungar, an assistant professor in the Department of Dermatology and director of the Alopecia Center of Excellence at Mount Sinai in New York, about this study.
Ungar said the findings can help reinforce to doctors that successful treatment of skin disease is holistic, in which improvement is seen beyond just skin manifestations.
“Asking patients about sleep disturbance and educating them that it is an important part of their disease can help to lead to better outcomes by ensuring that it is addressed with treatment,” he noted.
Young agreed.
“While these findings are not surprising, I do think they are incredibly important because they actually measure the detrimental impact on daily activities caused by sleep disruption from skin disease,” she said. “These findings, including loss of productivity in the workplace due to fatigue, decreased concentration, etc. may help with future drug research and innovation, drug approval as well as insurance coverage for these drugs.”
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