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Case Reports
. 2025 Jul 29;17(7):e88988.
doi: 10.7759/cureus.88988. eCollection 2025 Jul.

The Visualization of Nocturnal Scratching Behavior in Pediatric Atopic Dermatitis: Facilitating Shared Decision-Making and Assessing the Efficacy of Treatment

Akiko Sugiyama  1 , Hiroshi Matsuzaki  2 , Chikako Motomura  2 , Tetsuya Hiramoto  3 , Takeshi Nakahara  4
Affiliations
Case Reports

The Visualization of Nocturnal Scratching Behavior in Pediatric Atopic Dermatitis: Facilitating Shared Decision-Making and Assessing the Efficacy of Treatment

Akiko Sugiyama et al. Cureus. .

Abstract

Itching is a subjective symptom that is especially difficult to assess in pediatric atopic dermatitis (AD) patients with chronic pruritus since early infancy. This study aimed to assess the utility of the Itch Tracker (Maruho Co. Ltd., Osaka, Japan), a smartwatch application, in visualizing nocturnal scratching and facilitating shared decision-making (SDM) in two pediatric AD cases treated with nemolizumab. Objective monitoring revealed discrepancies between self-reported itch and actual scratching behavior, leading to appropriate treatment initiation and significant improvements in scratching behavior, Eczema Area and Severity Index (EASI), and numerical rating scale (NRS) scores. These results highlight the clinical value of behavioral visualization in enhancing SDM and optimizing management in pediatric AD.

Keywords: atopic dermatitis; itch tracker; nemolizumab; scratching; shared decision-making.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. The Ethics Committee of the National Hospital Organization Fukuoka National Hospital issued approval F5-7. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: Takeshi Nakahara declare(s) personal fees from Takeshi Nakahara has received consulting fees, honoraria, grant support, or lecturing fees from AbbVie, LEO Pharma, Maruho, Mitsubishi Tanabe Pharma, Otsuka Pharma, Sanofi, Sun Pharma, Taiho Pharmaceutical, and Torii Pharmaceutical Co., Ltd . Akiko Sugiyama declare(s) personal fees from Maruho Co., Ltd. Akiko Sugiyama has received honoraria from Maruho Co., Ltd and received the Takagi Clinical Research Development Award from Maruho Takagi Dermatology Foundation. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. Changes in nocturnal scratching behavior before and after nemolizumab administration (case 1)
(A) Daily total scratching time (in seconds) and (B) the number of scratching episodes observed over 28 days before and after the administration of Nemo (nemolizumab). The day of Nemo initiation is designated as Day 0. Scratching behavior decreased after treatment. (C) Box plots showing the total scratching time, (D) the number of scratching episodes, and (E) the average duration per scratching episode before and after Nemo administration. All metrics significantly improved (p<0.0001)
Figure 2
Figure 2. Changes in nocturnal scratching behavior before and after nemolizumab administration (case 2)
(A) Daily total scratching time (in seconds) and (B) the number of scratching episodes observed over 28 days before and 35 days after the administration of Nemo (nemolizumab). The day of Nemo initiation is designated as Day 0. Scratching behavior decreased after treatment. (C) Box plots showing the total scratching time, (D) the number of scratching episodes, and (E) the average duration per scratching episode before and after Nemo administration. All metrics significantly improved (p<0.0001)
Figure 3
Figure 3. Longitudinal changes in EASI and NRS scores following nemolizumab administration
(A) EASI scores and (B) NRS scores over five doses of nemolizumab in two pediatric patients with AD. Although the NRS scores did not reach zero, there was no exacerbation of skin inflammation EASI: Eczema Area and Severity Index; NRS: numerical rating scale
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References

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