Neurodermatitis

This image displays scaly skin due to lichen simplex chronicus.

This image displays scaly skin due to lichen simplex chronicus.

Neurodermatitis, also known as lichen simplex chronicus, is an itchy skin disease similar to atopic dermatitis. It tends to result in focal patches—one or many—that are due to frequent rubbing or scratching of the same area over time.

These patches tend to be thick and scaly, and have favored areas on the body, including:

  • Nape of the neck
  • Scalp
  • Shoulders
  • Instep of feet/ankles
  • Wrists
  • Backs of hands

 

Like in atopic dermatitis, the itchy areas can become thickened with enhanced skin markings, and are often discolored. Unlike atopic dermatitis, the specific patches tend to always be present while the rest of the skin remains healthy.

Neurodermatitis - Image: Skinsight.com

Thick, scaly, slightly elevated lesions with pronounced skin lines occur when the skin is repeatedly rubbed.

The cause is unknown, but certain triggers such as an insect bite, stress, or even a simple nervous habit, seem to play a role, and the nerves in the skin appear to be abnormally excitable to send the itch sensation. Sometimes, neurodermatitis can occur with a skin allergy in a particular area as well.

How is Neurodermatitis Treated?

Totally avoiding scratching and rubbing is key to breaking the cycling and healing the skin; however, this can be very difficult. Cutting fingernails very short, and applying ice or an anti-itch preparation instead of scratching can be helpful.

In some situations, performing patch testing to look for allergens can be used to determine a possible allergic cause that can then be eliminated.

Like atopic dermatitis, neurodermatitis benefits from moisturizers to calm and protect the damaged skin barrier. Greasy preparations may also help protect the area from rubbing and scratching. Occlusive measures such as socks, gloves, and even gauze wraps may also help the skin heal by disrupting the itch-scratch cycle. Unna boots (gauze impregnated with zinc oxide paste) are particularly helpful for neurodermatitis.

Like in other forms of eczema, a topical corticosteroid medication can help calm the inflammation and itch. Because the skin tends to be very thick and scaly in neurodermatitis, more potent creams are frequently required and must be used only in brief bursts (up to 2 weeks) to prevent side effects. Sometimes covering the corticosteroid with plastic wrap or an Unna boot can greatly assist in severe or resistant cases.

Neurodermatitis - Image: Skinsight.com

Chronic rubbing or scratching of the same area leads to lichen simplex chronicus, with thickened, rough, and sometimes red, broken skin areas.

In cases where corticosteroids are not appropriate, or when they have been used for a prolonged period, a non-corticosteroid topical medication such as tacrolimus (Protopic) or pimecrolimus (Elidel) may be prescribed. These agents, topical calcineurin inhibitors , are approved for use by adults and children two years of age or older, and they avoid many of the side effects of corticosteroids.

In severe cases, corticosteroids may be injected into the lesions; this is much safer than taking oral preparations of corticosteroids and may allow them to penetrate the thickened skin.

Will it Ever Go Away?

Neurodermatitis tends to be very chronic and often has a habitual scratching component that can even occur during sleep. However, with good treatments and protection of the skin so that it can fully heal, many patients can be cured.

Medical images provided by Skinsight.com.