Assessing itch in children with atopic dermatitis treated with tacrolimus: Objective versus subjective assessment

This study was undertaken to evaluate the clinical efficacy of tacrolimus for itch reduction in children with atopic dermatitis (AD). Seven children (3 boys and 4 girls) with AD were treated with topical tacrolimus for a consecutive 2-wk period after a 1-wk run-in. The clinical severity of AD was assessed with the SCORing Atopic Dermatitis (SCORAD) scale. Sleep disturbance, as reported by patients, and nocturnal scratching documented by a wrist movement monitor (DigiTrac®), were evaluated at baseline and throughout treatment. The median (interquartile range) objective SCORAD scores before and after treatment were 27.2 (24.8–36.7) and 23.9 (22.6–36.5), respectively (P=.248). Overall SCORAD scores before and after treatment were 36.1 (32.8–45.7) and 29.4 (24.8–45.4), respectively (P=.05). Scores on the itch and sleep disturbance components of the SCORAD were reduced from 5.0 (5.0–6.5) and 4.0 (3.5–5.0) to 4.0 (2.0–5.0) and 3.0 (0.5–4.5), respectively. Total SCORAD was reduced in 6 patients (range, 8%–36% reduction) and remained similar in 1 patient. No significant change in the area or intensity component of the SCORAD was detected 14 d after treatment began (P=.48 andP=.115, respectively). Scratching activity, as documented by the DigiTrac movement recorder, was reduced from 115.0 g/min (64.8–215.5) to 71.5 g/min (51.0–118.0) (P=.028) after 2 wk of treatment. Daily symptom scores (n=6 pairs) for sleep disturbance reported separately each day by patients and parents correlated strongly with each other (intraclass coefficient, 0.60–0.98). The findings of this study show that tacrolimus is effective in relieving itch in children with AD. Investigators suggest that scratching movements, objectively measured with the use of DigiTrac, provide a reliable indicator of AD severity in children.