The intersection of severe mental illness, psychotropic pharmacotherapy, and metabolic disorders.

Atopic dermatitis is a chronic, relapsing inflammatory skin disease characterized by epidermal barrier dysfunction, type 2 immune activation, xerosis, and persistent pruritus [-]. Sleep disturbance has traditionally been described as a consequence of itch, but the last decade of research has reframed sleep as a clinically important disease domain [,,]. Pediatric reviews, population-based adult studies, actigraphy and polysomnography studies, psychometric validation papers, and interventional trials all show that disturbed sleep is common, measurable, and closely linked with disease severity and daily functioning [,-]. Atopic dermatitis disrupts sleep in children and adults, and this relationship is supported by epidemiological studies, objective sleep studies, and systematic reviews [,-]. The more clinically relevant question is whether sleep disturbance can also aggravate atopic dermatitis and contribute to a self-reinforcing cycle of itch, scratching, impaired barrier recovery, inflammation, stress, and further sleep fragmentation [,,,,]. This review, therefore, focuses on sleep disturbance not only as a symptom, but as a potential disease-modifying factor in atopic dermatitis [,,,].