Neurodermatitis

  • Overview
      neurodermatitis-landing.png
    Neurodermatitis around the anklebone: Scratching an itchy patch around the ankle caused the neurodermatitis to appear.

    Neurodermatitis: Overview

    Neurodermatitis is a skin condition that begins with an itch.

    The itch can develop anywhere on the surface of the body. Most commonly, though, an itchy patch develops on an arm, leg, or the back of the neck. It also commonly develops in the anal and genital areas. When it appears in the genital area, it often appears on the scrotum or vulva.

    The itch can be so intense that a person scratches or rubs the itchy patch frequently. The itch can also come and go. For most people, the area feels itchiest when they are relaxing or sleeping. The itch causes people to scratch or rub the area while sleeping — and it can awaken someone from a sound sleep.

    Quite often, the itch begins during an especially stressful time in someone’s life. Even when the stress subsides, the itch usually continues. Scratching or rubbing can change the appearance of that itchy patch.


    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.
    Doyen J, Demoulin S, et al. “Vulvar skin disorders throughout lifetime: about some representative dermatoses.” Biomed Res Int. Published online Jan 8, 2014.
    Habif TP, Campbell JL, et al. “Lichen simplex chronicus” (card #7). Dermatology DDxDeck. Mosby Elsevier 2006.



    Neurodermatitis
  • Symptoms
      neurodermatitis-symptoms_ankle.png
    Neurodermatitis on the ankle and foot: Scratching can wound the skin, which may scab as it heals.

    Neurodermatitis: Signs and symptoms

    When a person has neurodermatitis, the person is likely to notice several of these signs and symptoms:

    Itch: Neurodermatitis causes an itchy patch on the surface of the body. Unlike eczema, psoriasis, and other itchy skin conditions, people tend to develop just 1 or 2 patches that itch. While rare, neurodermatitis can cause several itchy patches.

    When people develop neurodermatitis, they often find themselves:          

    • Scratching or rubbing the itchy patch(es), either frequently or sporadically
    • Thinking that the patch(es) itches for no apparent reason
    • Feeling itchiest while relaxing
    • Feeling especially itchy when life becomes stressful

     

    Pain: Some people feel pain. One study found that when neurodermatitis appears on the scalp, it may cause pain, itch, or both.

      neurodermatitis-symptoms-scars.png
    Neurodermatitis with scarring (white lines): The constant scratching wears away the skin. As the skin heals, it may scar as shown here.
    Raised, rough patch that is red to violet-colored: As the person continues to scratch or rub the itchy patch, a scaly, reddish to violet-colored patch appears.

    Skin thickens and looks leathery: With frequent scratching or rubbing, the skin can thicken. The patch may look leathery and turn a brownish color. Very thick skin can have a grayish hue.

    Hair loss: The scratching (or rubbing) can cause hair loss on areas like the scalp.

    Open sore that bleeds:
    Repeatedly scratching or rubbing can wound the skin, leading to an open sore that bleeds. If this happens, the person has an increased risk of developing an infection.

    Scarring: If a wound is deep, the skin may scar as it heals.

    Infection: Signs of infection include honey-colored crusts and fluid leaking from the area. You may also see pus-filled bumps.

    Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides.



    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.
    Cohen AD, Andrews ID. “Similarities between neuropathic pruritus sites and lichen simplex chronicus sites.” Isr Med Assoc J. 2014 Feb;16(2):88-90.
    Habif TP, Campbell JL, et al. “Lichen simplex chronicus” (card #7). Dermatology DDxDeck. Mosby Elsevier 2006.



    Neurodermatitis
  • Causes

    Neurodermatitis: Who gets and causes

    Who gets neurodermatitis?

    This skin condition is most likely to develop in someone who has the following traits:

    Age: You’re between 30 and 50 years of age. This condition is rare in children; however, some children who have eczema (atopic dermatitis) develop neurodermatitis.

    Gender: Women are more likely to develop neurodermatitis.

    Medical history: You have a personal or family history of one or more of the following:

    Researchers have discovered that a trigger can increase the risk of developing neurodermatitis. Things that can trigger neurodermatitis include:

    • Injury to a nerve
    • Period of intense stress or emotional trauma
    • Bug bite
    • Tight clothing, especially clothing made of wool or a synthetic fabric like rayon or polyester
    • Dry skin

    Traffic exhaust, allergens, sweat, heat, and poor blood flow can also be a trigger.

    What causes neurodermatitis?

    While researchers have discovered that some people are more likely to get neurodermatitis, the cause is still unknown. This condition may develop when nerves overreact to anything from tight clothing to emotional stress. More research is needed.

    If you think that you might have neurodermatitis, an accurate diagnosis and proper treatment are important. Neurodermatitis rarely goes away without treatment.


    References
    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.
    Doyen J, Demoulin S, et al. “Vulvar skin disorders throughout lifetime: about some representative dermatoses.” Biomed Res Int. Published online Jan 8, 2014.
    Habif TP, Campbell JL, et al. “Lichen simplex chronicus” (card #7). Dermatology DDxDeck. Mosby Elsevier 2006.
    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.



    Neurodermatitis
  • Treatment

    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 atopic dermatitis), 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.



    Neurodermatitis
  • Tips
      neurodermatitis_tips.png
    Neurodermatitis can be very itchy, so dermatologists offer tips that can lessen the itch.

    Neurodermatitis: Tips for managing

    To clear neurodermatitis, you need to do 2 things:

    1. Follow your treatment plan.
    2. Stop scratching, rubbing, and touching the affected area(s).

     

    Even the most effective treatment can fail if you scratch, rub, or touch the area with neurodermatitis. Because this can be difficult, dermatologists offer these tips to help lessen the itch:

    Follow your treatment plan. Your plan includes medicine that can stop the itch. For the medicine to work, you must use it as directed.

    If the itch starts, apply a cool compress or take a cool bath. This reduces the heat, which can reduce or eliminate the itch. Adding colloidal oatmeal (available where you buy health and beauty products) to a cool bath can also help reduce the itch.

    Try to stay calm. Emotional stress and anxiety can cause neurodermatitis to flare.

    Keep your body at a comfortable temperature. Heat and sweat can irritate your skin, causing the itch to flare.

    Wear loose-fitting cotton clothing that feels smooth to the touch. Tight clothing can irritate the skin, causing the area to itch. It’s also best to avoid clothing made of wool or a synthetic fabric like polyester or rayon.

    Avoid what irritates your skin or causes an allergic skin reaction. If you’re uncertain what can do this, ask your dermatologist about triggers.

    Until you feel ready to stop scratching . . .
    If you’ve been scratching the same area for years, it may be difficult to stop. Until you feel that you can avoid scratching, rubbing, and touching the area, the following tips may help.

    Cover the area. Wrapping the area in plastic, covering it with clothing or a corticosteroid tape, or wearing an Unna boot (gauze dressing that contains ingredients like zinc oxide to promote healing) can prevent you from scratching. This can be very helpful if you scratch while sleeping.

    Keep your fingernails very short. If you scratch, very short fingernails tend to cause less damage.



    References:

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



    Neurodermatitis