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Neurodermatitis: Diagnosis and treatment


How do dermatologists diagnose neurodermatitis?

A dermatologist will examine the itchy area, looking for signs of neurodermatitis. Having a dermatologist examine the area should not worry you. Dermatologists understand that neurodermatitis can develop on the genitals or anus. Your dermatologist may also ask you some questions, such as:

  • When did the itch begin?

  • Does the itch come and go, or it is always there?

  • What are you doing to stop the itch?

If the area looks infected, your dermatologist will swab the area. Testing the sample on the swab can tell your dermatologist whether you have an infection. To diagnose you, your dermatologist may need to remove a small amount of skin. Your dermatologist may also run tests to find out whether an allergic reaction could be causing the itchy reaction. This can be especially important when the neurodermatitis appears on the female genitals.

Why see a dermatologist?

Neurodermatitis can develop along with another skin condition like eczema or psoriasis, so it is best to see a skin doctor for your diagnosis. Effective treatment requires an accurate diagnosis of all of your skin conditions.

How do dermatologists treat neurodermatitis?

Your dermatologist will create a treatment plan based on your individual needs. There are many treatments available. None of these treatments has been approved by the U.S. Food and Drug Administration (FDA) specifically for neurodermatitis. All of the prescription medicines, however, are FDA-approved drugs. A treatment plan for neurodermatitis often includes treatment that can:

Stop the itch: This is the main goal of treatment because for treatment to be effective, you must stop scratching, rubbing, and touching the itchy patch. To stop the itch, your dermatologist may include one or more of the following in your treatment plan:

  • Corticosteroid: You usually apply this medicine to the area as directed. Sometimes, a dermatologist will inject this medicine directly into the itchy area. A corticosteroid helps reduce the redness, swelling, heat, itch, and tenderness. It can also soften thickened skin.

  • Cool compress: Applying a cool compress or soaking the area for 5 minutes before you apply a corticosteroid can help the medicine penetrate thickened skin more easily — and reduce the itchiness.

  • Antihistamine: This can relieve the itch and help you sleep.

  • Moisturizer: This reduces dryness, which can reduce the itch.

  • Coal tar preparation: You may apply this to your skin or add it to your bath.

  • Capsaicin cream or doxepin cream: These may decrease the itch.

You may need to cover the area at night to prevent scratching the area while sleeping. Covering the area can also help the medicine penetrate thickened skin. If the above fail to stop the itch, your dermatologist may try a less-traditional treatment option. The following treatments have been reported in medical journals as effective for some patients with neurodermatitis when a corticosteroid failed to stop the itch:

  • Solution that contains aspirin and dichloromethane, which you would apply to the itchy area

  • Tacrolimus ointment (approved to treat), which you would apply to the itchy area

  • Injection of botulinum toxin: In one study of 3 patients, all the patients had noticeably less itch within 1 week. Within 2 to 4 weeks, everyone’s patches of neurodermatitis had cleared.

Reduce thickened skin: If the skin has become very thick, your dermatologist may recommend a medicine that you apply to your skin that can help reduce the thickness.

Treat an infection: If the area is infected, your dermatologist will prescribe a medicine that you either apply to the area or take for a specific time. If your dermatologist prescribes an oral medicine (pills, tablets, etc.), it is extremely important that you take all of the medicine, even if you are feeling better or the infection seems to have cleared.

Treat a wound: The frequent scratching sometimes causes a wound, which requires treatment. Wounds may be treated with one of the following:

  • Wound dressing

  • Surgical treatment

  • Negative-pressure wound therapy

  • Hyperbaric oxygen therapy

Treat anxiety and stress: When neurodermatitis fails to clear with medicine, it can be helpful to think about what’s going on in your life. Do you have tremendous stress in your life? Are you feeling anxious? Both stress and anxiety can trigger the itch — even when you are treating the itch with medicine. If stress or anxiety is a constant in your life, the following may be necessary to get rid of the itch: 

  • An anti-anxiety medicine

  • Psychotherapy, so you can talk about stress or anxiety and find ways to manage these effectively

Patient success story

An article in a medical journal shows that addressing the psychological issue can be effective. This story begins with a 60-year-old woman who saw a dermatologist because she had an intensely itchy patch on her scalp. At times, her scalp itched so severely that she scratched the area until it bled. After 2 years of scratching, the itchy patch on her scalp was completely bald. Her dermatologist diagnosed her with neurodermatitis and prescribed the following treatment plan:

  • Corticosteroid injections, once weekly for 4 weeks

  • An anti-anxiety medicine

  • Psychotherapy

The woman followed this treatment plan. In three months, all of her symptoms were gone and her hair had regrown. In the third month, she stopped taking the anti-anxiety medicine. At the 6-month follow-up with her dermatologist, she had no signs or symptoms of neurodermatitis.

What is the outcome for a person who has neurodermatitis?

Neurodermatitis can clear completely. Sometimes, it can take time to find a treatment plan that works for you. You may have to try different treatment options. Each time, it is essential that you follow your treatment plan. Neurodermatitis rarely goes away without treatment. Once the neurodermatitis clears, it can return when triggered. Common triggers for neurodermatitis include stress, anxiety, and anything that irritates your skin. If this happens, you will need to treat it again to get clearing. Some people need to treat the area to prevent neurodermatitis from returning.  Your dermatologist will tell you what is right for you.


References
Ambika H, Vinod CS, et. al. “A case of neurodermatitis circumscipta of scalp presenting as patchy alopecia.” Int J Trichology. 2013 Apr;5(2):94-6.

Burgin S. “Nummular eczema and lichen simplex chronicus / prurigo nodularis.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:160-2.

Habif TP, Campbell JL, et al. “Lichen simplex chronicus” (card #7). Dermatology DDxDeck. Mosby Elsevier 2006.

Heckmann M, Heyer G, et. al. “Botulinum toxin type A injection in the treatment of lichen simplex: an open pilot study.” J Am Acad Dermatol. 2002 Apr;46(4):617-9.

Hogan DJ (author), James WD (editor). “Lichen simplex chronicus.” Medscape. Last updated July 2014.

Liao YH, Lin CC, et. al. “Increased risk of lichen simplex chronicus in people with anxiety disorder: A nationwide population-based retrospective cohort study.” Br J Dermatol. 2014 Apr;170(4):890-4.

Roussalis JL. “Novel use of acellular dermal matrix allograft to treat a chronic scalp wound with bone exposure: A case study.” Int J Burn Trauma. 2014 Oct 26;4(2):49-52.

Tan E, Tan A, et. al. “Tacrolimus ointment 0.1% in the treatment of scrotal lichen simplex chronicus: An open-label study.” J Am Acad Dermatol. 2013 Apr;68(4) supp. 1, page AB38. Poster abstract: No commercial support identified.

Yosipovitch G, Sugeng MW, et. al. “The effect of topically applied aspirin on localized circumscribed neurodermatitis. J Am Acad Dermatol. 2001 Dec;45(6):910-3.


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