Eczema types: Neurodermatitis signs and symptoms

Neurodermatitis is a common type of eczema. If you have neurodermatitis, you may notice one or more of these signs and symptoms:

Intense itch

Neurodermatitis begins with an itchy patch of skin. This patch of skin may itch often or from time to time.

As you scratch or rub that itchy patch of skin, the itchy patch often becomes itchier. Dermatologists refer to this itching and scratching as the itch-scratch-itch cycle. This cycle can be difficult to break.

Most people who develop neurodermatitis have one or two itchy patches. It’s also possible to develop several itchy patches, but this is rare.

The itch often becomes more intense while you’re relaxing or sleeping

The itch also tends to worsen when life becomes stressful.

Pain

Some people scratch so much that their skin starts to feel painful. One study found that when neurodermatitis appears on the scalp, people may have both itch and pain.

Raised, rough patch that is violet (in dark skin tones) or red (in light skin tones)

The frequent scratching changes the skin. As you continue to scratch or rub the itchy patch, that patch of skin can turn scaly and look violet to reddish in color.

Neurodermatitis on the back of the neck

Frequent scratching leads to a rough-feeling and discolored patch of skin.

Neurodermatitis is common on the back of the neck

Other common places that neurodermatitis develops are the arms, eyelids, scalp, anus, and genitals.

Open sores that bleed

If you repeatedly scratch or rub the area with neurodermatitis, you may develop open sores that bleed. Open sores increase your risk of developing an infection.

Neurodermatitis on the ankle

Frequent scratching caused this scaly patch of thickened skin and open, bleeding sores.

Infection

Scratching can cause an infection. This happens when germs under your fingernails or on your hands get into your body.

If you see honey-colored crusts, fluid leaking from the itchy area, or pus-filled bumps, call your doctor

These are signs of an infection.

Skin thickens and looks leathery

With frequent scratching or rubbing, the skin tends to thicken in order to protect itself. The itchy patch may look leathery and turn a brownish, gray, or reddish in color. You may also notice that the itchy patch feels dry, rough, and scaly. Even when the skin thickens, the itch continues.

Frequent scratching can cause the skin to thicken

Very thick skin can have a grayish hue.

Hair loss or breakage

If you frequently scratch (or rub) your scalp, it can lead to hair loss. Even on the skin, the frequent scratching can cause a bare patch.

Neurodermatitis often causes round, scaly patches on the scalp

The itchy patches on the scalp can cause lots of flaking, which can be mistaken for dandruff.

Scarring

If scratching causes deep wounds, your skin may scar as it heals.

Neurodermatitis with scarring (white lines)

Skin with scars can itch, too.

What causes this ongoing itching isn’t entirely clear. What scientists have discovered is that some people have a greater risk of developing neurodermatitis.

You can find out if you have a greater risk at, Neurodermatitis: Causes.

Images
Images 1,5,7: Getty Images

Images 2,3,4,6: Images used with permission of the DermNet NZ.

Image 8: Image used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

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.

Juarez MC, Shawn G Kwatra SG. “A systematic review of evidence-based treatments for lichen simplex chronicus.” J Dermatolog Treat. 2020 Mar 6;1-9.

Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018:116-7.

Muylaert BPB, Borges MT, et al. “Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.” An Bras Dermatol. 2018 Jan-Feb;93(1):108-110.

Schoenfeld J. “Lichen simplex chronicus.” In: James WD [editor] Medscape. Last updated August 20, 2020.

Voicu C, Tebeica T, et al. “Lichen simplex chronicus as an essential part of the dermatologic masquerade.” [Open Access] Maced J Med Sci. 2017 Jul 24;5(4):556-7.

Written by:
Paula Ludmann, MS

Reviewed by:
Pearl E. Grimes, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 1/20/21