What is Neurodermatitis?


Imagine an itch so intense that no amount of scratching brings relief and you have some idea of what it feels like to have neurodermatitis. This common eczema develops when nerve endings in the skin become irritated, triggering a severe itch-scratch-itch cycle. Common causes of nerve irritation include an insect bite and emotional stress. It is also known as Lichen simplex chronicus.


What are Signs and Symptoms?


Once the skin is scratched, a vicious itch-scratch-itch cycle develops. The more the skin is scratched, rubbed, or even touched, the more it itches. The itch can become so intense that it disrupts sleep. Develops on any area of the body the person can scratch or rub. Most commonly appears on the lower legs, ankles, back and sides of the neck, wrists, forearms, and genitals. Constant itch causes nervous tension (anxiety) in some patients. Often develops on skin previously affected by an outbreak of atopic dermatitis or contact dermatitis (two common types of eczema) or psoriasis.


What Scratching Can Cause ?


Small, well-defined, scaly, reddish plaques.
Openings in the skin that cause burning pain and leave the patient more susceptible to infection. Signs of infection include open sores, cracks in the skin, and honey-colored crusts.
Visible scratch marks.
Over time, constant scratching causes the skin to thicken and darken, and lines in the skin to become more prominent.
Affected skin may turn pink, red, or reddish brown. When the skin becomes very thick, it sometimes develops a grayish hue.


Who Gets It?   Neurodermatitis develops more frequently in:


People who have psoriasis, allergic contact dermatitis, or irritant contact dermatitis.
Individuals who have an atopic condition, such as atopic dermatitis, asthma, or hay fever.
Females.
Mid-to-late adulthood, with most cases developing between 30 and 50 years of age.


How Is It Diagnosed?


Since neurodermatitis may occur along with other common skin conditions, such as other types of eczema and psoriasis, it is best to see a dermatologist for a diagnosis. Effective treatment requires that all skin conditions be accurately diagnosed.


Diagnosis Also May Include:


A skin biopsy : Removing a bit of the affected skin so that it can be examined under a microscope may be necessary. This procedure helps diagnose a skin infection or another skin condition.

Patch testing : This test helps determine what substances cause an allergic reaction in the patient.


Treatment


The goal of treatment is to stop the itch. What makes treatment so challenging is that the patient must quit scratching, rubbing, and even touching the affected skin. To help the patient and treat the eczema, a dermatologist may prescribe a:

Topical corticosteroid : A mainstay of treatment, this medication helps reduce inflammation and itch. It is important to apply all corticosteroids as directed to get the full benefit and reduce the risk of side effects.

Topical antibiotic : When the skin is broken, this helps to prevent infection and to treat a mild infection. Oral antibiotic. This helps clear a skin infection.

Topical keratolytic : This helps reduce thick skin. A preparation containing urea, salicylic acid, or lactic acid may be used.

Sedative or tranquillizer : In some cases, this can be helpful in reducing anxiety and help the patient to get restorative sleep.


Risk Factors


The following can irritate the nerves of susceptible people, triggering the intense itch-scratch-itch cycle of neurodermatitis :

Clothing worn tightly and made of synthetic fabric or wool.
Dry skin.
Insect bite.
Period of intense stress or emotional trauma.
Poor blood flow.