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In Reply We thank Mekjavic and Macdonald for providing their insightful comments and theory that peripheral vasodilation might be involved in the mechanism of how melatonin helps improve disease severity in children with atopic dermatitis. Temperature and the circadian rhythm have been found to have much influence on the immune system. Cytokine production is rhythmic, and immune responses differ at different body temperatures and at different times of the day.1- 3 Therefore, it is reasonable to hypothesize that these factors play important roles in the effect of melatonin on atopic dermatitis. However, we did not measure peripheral blood flow or body temperature in our study. Therefore, our study cannot provide enough evidence to prove this theory, but this would be an interesting direction for future studies.
Chang Y, Chiang B. Melatonin-Induced Nocturnal Vasodilatation Contributes to Skin Regeneration–Reply. JAMA Pediatr. 2016;170(6):622. doi:10.1001/jamapediatrics.2016.0138