Neurodermatitis

What is neurodermatitis?

Neurodermatitis is a non-life-threatening skin condition involving itching and scratching, usually on just one or two patches of skin. It is also called lichen simplex chronicus.

The itch can occur anywhere on the body but is most commonly found on the arms, shoulders, elbows, legs, ankles, wrists, hands, back of the neck or scalp. The anal and genital areas and the face might also itch. The itching can be intense, causing frequent scratching, or it might come and go. It is most active when the patient is relaxing or trying to sleep. In some cases, the patient wakes up scratching or rubbing the affected area.

What does neurodermatitis look like?

The itchy patches measure between 3 centimeters by 6 centimeters and 6 centimeters by 10 centimeters. The patches can look:

• Dry.
• Thick.
• Scaly.
• Leathery.
• Differently colored, such as reddish, brownish, yellowish, gray or purple. Older patches can appear white or pale in the center, surrounded by darker colors. Over time, there might be scarring.

Scratching can irritate nerve endings in the skin and worsen the itching, leading to more scratching. The condition can become chronic as the itch-scratch cycle continues.

Who is most likely to get neurodermatitis?

It is estimated that neurodermatitis occurs in about 12% of the population. Research has shown that people between 30 years old and 50 years old are more likely to contract the condition. Women are more likely than men to suffer from neurodermatitis at a ratio of 2:1. Those with anxiety disorders, obsessive-compulsive disorders and family members with histories of other skin diseases, including eczema and contact dermatitis, are more likely to develop neurodermatitis.

Some recent studies have suggested that those with certain personality traits – including poor social skills, lack of flexibility, tendency toward pain avoidance, dependency on other people, people-pleasing and dutifulness – are more likely to have neurodermatitis. However, other studies have found no connection between personality and the condition.

What causes neurodermatitis?

The underlying cause of neurodermatitis is unknown. However, it has been observed that the itch can start during times of extreme stress, anxiety, emotional trauma or depression. The itching sometimes continues even after the mental stress eases or stops.

Other possible neurodermatitis triggers include:

• Nerve injuries.
• Insect bites.
• Dry skin.
• Wearing tight clothing, especially if the material is a synthetic fiber, like polyester or rayon. These factors can cause sensitive skin to overreact and itch.
• Other skin diseases. Neurodermatitis sometimes happens as a result of eczema and psoriasis.

What are the symptoms of neurodermatitis?

In addition to itching, scratching and dry, discolored patches of skin, symptoms of neurodermatitis can include:

• Pain.
• Hair loss if itching and scratching occurs on the scalp.
• Open sores and bleeding, due to repeated scratching.
• Infection, which is indicated by sores with yellow-colored crusts, fluid discharge and/or pus-filled bumps.
• Scarring from scratching.
• Skin lines in the affected skin.

How is neurodermatitis diagnosed?

A dermatologist will exam the itchy area, possibly with a scope. The doctor will first rule out other skin conditions, like eczema and psoriasis. The doctor might take a complete medical history and then ask some questions, such as:

• When did the itch start?
• Is it constant or does it come and go?
• What home remedies have been tried?

What tests can be used to diagnose neurodermatitis?

• Skin swab tests find out if there is an infection.
• Patch testing to learn whether an allergy is the problem.
• Fungal tests to identify skin disorders in the general area and to rule out sexually transmitted infections.
• Skin biopsy to find or rule out psoriasis or mycosis fungoides, which is a form of lymphoma.
• Blood tests.

How is neurodermatitis treated?

Neurodermatitis rarely heals without treatment. A dermatologist will write a treatment plan that is unique for each patient. The main goal is to stop the itching and scratching. Treatments can include medications like:

• Corticosteroids. These medicines can be applied to the itchy patch or injected into the patch. Corticosteroids help reduce redness, swelling, heat, itching and tenderness, and can soften thickened skin.
• Antihistamines. Taken before bedtime, an antihistamine can cut back on itching during sleep. It can also help prevent allergic reactions that would worsen the condition.
• Antibiotics. These are prescribed if the patchy area is infected. Antibiotics can be applied to the skin or taken orally in pill form.
• Moisturizers. These reduce dryness and itching.
• Coal tar preparations. This type of medicine causes the skin to shed dead cells and slows the growth of new cells. Patients can place it directly on their skin or add it to their bath.
• Capsaicin creams. These can relieve both pain and itching.

Your doctor might also suggest:

• Coverings. Using bandages, socks or gloves can prevent night scratching, allowing better sleep. Covering also helps medicine applied to the skin penetrate better. (This is also called occlusion.)
• Cool compresses. These can be placed on the skin about five minutes before applying corticosteroids. The compress softens the skin so the medicine can penetrate easier, and it can also relieve itching.
• Antidepressants and/or therapy. This type of treatment may be suggested if it is believed that anxiety, depression or stress is causing the itch.

If none of these treatments are effective, nontraditional treatments include:

• A solution that mixes aspirin and dichloromethane applied to the itchy area.
• Treatments usually used for atopic dermatitis/eczema (tacrolimus and/or pimecrolimus).
• An injection of botulinum toxin (Botox®), a toxic protein that can cause flaccid paralysis, or muscle weakness in the body. In a study of three neurodermatitis patients, all three itched less after one week of treatment and within four weeks the itchy patches were gone.
• Phototherapy, or light therapy. This approach should not be used on genitals.
• Traditional surgery to remove the itchy patch or cryosurgery to destroy unwanted tissue using intense cold.

What if scratching has caused a wound?

If scratching due to neurodermitis has caused a wound, the doctor may wrap a dressing over the area.

Another potential treatment is negative-pressure wound therapy, which involves vacuuming fluid out of the wound and increasing blood flow there.

Hyperbaric oxygen therapy confines the patient in an oxygen chamber to inhale pure oxygen, which enhances the body’s ability to heal itself. Surgery on the wound is another option.

What can you do to promote healing if you have neurodermatitis?

If you have neurodermatitis, you should follow the treatment plan from your doctor and try to keep calm so anxiety and stress don't trigger a flareup. Also, keep these points in mind:

• Try to stop scratching and rubbing. But, keep your fingernails short so you minimize damage if you do scratch.
• Apply ice, anti-itch medication or a cool compress to the itchy area. Take a cool bath to reduce heat, which will relieve itching. Add colloidal oatmeal, which can also relieve itching, to the bath.
• Keep the body at a comfortable, cool temperature.
• Wear loose clothing, preferably made of cotton.
• Cover the itchy area with clothing, tape with corticosteroid medicine or apply an Unna boot, which is a dressing containing healing ingredients like zinc oxide. The covering can discourage scratching.
• Avoid anything that irritates the skin or causes an allergic reaction.

What is the prognosis for people with neurodermatitis?

With the right treatment plan, neurodermatitis can heal completely. However, the doctor and patient may have to adjust the plan or try different plans. Sticking with the plan is vital, especially if neurodermatitis is on the genitals, where cases of the condition are most stubborn.

Unfortunately, neurodermatitis can return if activated by one of the triggers. Then, the patient must return for treatment. In some cases, a doctor will continue treatment on a patient who has healed to prevent the condition from returning.

Sometimes, neurodermatitis can develop into skin cancers like squamous-cell or verrucous carcinoma. This is perhaps due to continuous scratching and rubbing, which can activate chemicals that cause inflammation, which in turn can transform skin cells to cancerous cells.