Scratching and wound infection have been the major problems for the children with atopic dermatitis. Sleep disturbance is common in children with atopic dermatitis (AD). The previous srudy showed that poor sleep efficiency and longer sleep onset latency, more sleep fragmentation, and less nonrapid eye movement sleep. In addition, lower nocturnal melatonin secretion was found to be associated with sleep disturbance and more severe dermatitis in children with AD. Furthermore, melatonin has both sleep-inducing and anti-inflammatory properties, which might be helpful in the management of AD. We also evaluate the effectiveness of melatonin supplement for improving sleep disturbance and disease severity in children with AD. We preformed a randomized, double-blind, placebo-controlled crossover study. Children with AD aged 1 to 18 years were recruited and randomized to melatonin 3 mg or placebo for 4 weeks. After a 2-week washout period, they crossed over to the alternative treatment. Before and after each treatment period, sleep parameters were measured by actigraphy, AD disease severity was evaluated using the Scoring Atopic Dermatitis (SCORAD) index, and serum immunoglobulin E (IgE) levels were assessed.
　　Forty-eight patients underwent randomization. After melatonin treatment, the sleep onset latency shortened from 44.9±39.5 minutes to 21.6±20.4 minutes (decreased 21.4 minutes more than placebo, 95%CI: -38.6 to -4.2, p=0.015). Moreover, the SCORAD index decreased from 49.1±24.3 to 40.2±20.9 (decreased 9.1 more than placebo, 95%CI: -13.67 to -4.57, p=0.0001). The improvement in the SCORAD index did not significantly correlate with the change in the sleep onset latency. The serum IgE level did not change significantly. No adverse events were reported.
　　Melatonin supplement is a safe and effective way to improve both the sleep onset latency and dermatitis severity in children with AD.