Neurodermatitis

What is neurodermatitis?

Neurodermatitis is a chronic skin and itch condition that causes intense itching and scratching.¹ Neurodermatitis, also called lichen simplex chronicus (LCS), is a type of eczema. Neurodermitis is usually confined to one or two patches of skin.¹

Since neurodermatitis is known as a chronic itch condition, its characteristic thick, scaly skin patches can develop anywhere on the body that you can itch.¹ It most commonly appears on the feet, ankles, hands, wrists, elbows, shoulders, neck and scalp.¹ The eyelids can also be affected. In addition, neurodermatitis can also affect the genital and anal areas.¹

Some people can have neurodermatitis that is spread across their body (not just in patches) called prurigo nodularis.

Neurodermatitis rarely goes away without treatment, and continued scratching can irritate nerve endings in skin, intensifying both itching and scratching.¹ Over time, chronic scratching causes itchy patches of skin to become dry, leathery and thickened, which is called lichenification.¹

What does neurodermatitis look like?

Neurodermatitis looks like thick, scaly patches of skin called plaques, which can oftentimes include lesions caused by scratching.¹ The scaly patches can often become discolored, ranging from a pink to dark brown color depending on your skin tone.¹ Over time, it can develop a dark border around the patches.

Who gets neurodermatitis?

Neurodermatitis affects about 12% of the population.¹ It most commonly affects middle aged people between 30 and 50 years old.¹ Women have been shown to more commonly develop this type of eczema at a 2:1 ratio to men.^1,2 It is particularly common among elderly, Asian individuals.¹

Like most types of eczema, it is more likely to occur if you have a personal or family history of contact dermatitis or atopic dermatitis.¹ People with psoriasis, allergies and asthma are also at risk for neurodermatitis.¹

If you have a mental health disorder such as an anxiety disorder, obsessive-compulsive disorder (OCD) or depression, you might also be at a higher risk of developing this type of eczema.¹ Conversely, quality of life for people with neurodermatitis might put them at a higher risk for developing these disorders.³

Neurodermatitis is also often triggered by certain lifestyle factors. Neurodermatitis often presents in self-reported “high-achieving” individuals who live stressful or competitive lifestyles, and stress can be a significant trigger for this type of eczema.¹

It is rarely diagnosed in children, however some children with atopic dermatitis have also developed neurodermatitis.

Is neurodermatitis contagious?

No, neurodermatitis is not contagious. You cannot catch it or spread it to others.

Why is it so hard to stop scratching with neurodermatitis?

Researchers have found that people with neurodermatitis find scratching to be highly pleasurable, and brain imaging studies have backed these findings up, showing that scratching lights up the brain’s reward systems.⁴ This contributes to the itch-scratch cycle, where scratching causes damage to the skin barrier, which then activates the need to itch.¹ Stopping the itch-scratch cycle can be difficult and is a primary goal of research on neurodermatitis.

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What causes neurodermatitis?

The exact cause of neurodermatitis is not known or completely understood. Currently, scientists think that it is caused by overreactive nerves.⁵ Environmental triggers, such as an irritant in a cosmetic product or bug bite, or an emotional trigger, such as an intense emotion might cause an itchy feeling. This trigger then causes you to scratch, which leads to skin barrier disruption that exacerbates the itch-scratch cycle.¹

Genetics might also play a role. Researchers have found significant differences of the gene TRPA1 in skin patches of neurodermatitis.¹

Researchers are also studying whether neurodermatitis is caused by neuroimmune interactions on the skin.¹ Neuroimmune interactions are what is commonly called a mind-body reaction. Skin contains many nerves that interact with your immune system.¹ During times of stress and inflammation, the number of these nerves and their connections with the immune system increase, which can lead to an increased itchy feeling for the need to scratch.¹

What are common triggers for neurodermatitis?

A trigger is something that exacerbates your neurodermatitis symptoms. Common triggers for neurodermatitis include:

• Tight clothing, especially wool or synthetic fabric¹
• Bug bites⁶
• Nerve injury⁶
• Dry skin⁶
• Heat^1,4

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What are the symptoms of neurodermatitis?

Common symptoms of neurodermatitis include:

• Intense itchiness¹
• Dry skin
• Thick, leathery patches of skin¹
• Pronounced skin lines
• Scales
• Discolored skin that’s often red, brown or gray¹
• Skin irritation¹
• Skin lesions¹

Itching can come and go or be active all the time. For many people, the itch can feel more intense when trying to sleep or relax.⁵

Where on the body does neurodermatitis occur?

Neurodermatitis can occur anywhere you can reach to scratch, but is most common on the feet, ankles, hands, wrists, elbows, shoulders, back of the neck and scalp.⁵ The eyelids, genital and anal areas can also be affected.⁵

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How is neurodermatitis diagnosed?

To diagnose neurodermatitis, a dermatologist will do a physical exam of your skin, examining the itchy patches of skin. They will also ask about your medical history and ask questions about how your symptoms and itch present. Your dermatologist may take a skin swab to rule out infection. They may also suggest allergy testing to rule out any allergic reactions.

Neurodermatitis can be confused for other types of eczema, such as nummular eczema and contact dermatitis, as well as other skin disorders. It’s important to see a dermatologist to confirm a diagnosis, so you can get proper treatment.

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How is neurodermatitis treated?

When creating a treatment plan for neurodermatitis, it’s best to work closely with a dermatologist. They will most likely recommend multiple treatment types instead of just one option. Treatments for neurodermatitis are aimed at healing skin and ending the itch-scratch cycle.

Treatments may include:

• Steroids: Dermatologists often use corticosteroids to help calm inflammation and itch and soften thickened skin. These are usually potent topical steroids, but if the skin is very thick, your dermatologist may inject a steroid into the patch.¹
• Non-steroidal topicals: Topicals such as calcineurin inhibitors and ointments made with salicylic acid can also be used to control itch caused by this skin disease.
• Occlusive treatments: Wraps that cover the affected area can help control itching and make it harder to scratch. These include applying plastic wrap after putting on topicals or moisturizer. Gauze treated with zinc oxide paste can also be applied to the affected skin.¹
• Medicated skin patches: Dermatologists and other qualified healthcare providers may prescribe medicated patches that contain lidocaine, a numbing agent, and capsaicin, a chili pepper component, to help desensitize the nerve endings causing itch. These should be applied to affected areas of skin.
• Oral medications: Certain oral medications can also help stop the urge to scratch, particularly when it happens during sleep. These include prescription antihistamines, which can cause drowsiness, and low doses of anti-anxiety medications.¹
• Light therapy: Phototherapy, or light therapy, can also be used in certain situations to address neurodermatitis.¹

For people with prurigo nodularis, where neurodermatitis is spread across the body, treatments can include biologics that are FDA approved for this condition, including Nemolizumab and Dupilumab.

How do you manage neurodermatitis symptoms?

With the right treatment plan, neurodermatitis flares can go away. It’s important to note that finding the right treatment for you may take some time as no two cases are the same. Be patient and know that once you have an effective prevention routine and treatment options, flares will go away quicker.

Here are some ways to manage neurodermatitis symptoms:

• Moisturize daily
• Apply cool compresses to itchy areas
• Take a bath with colloidal oatmeal
• Wear loose-fitting, non-irritating clothing
• Try to avoid frequent scratching
• Cover the affected area so it’s harder to scratch it with gauze, plastic wrap or clothing
• Wear gloves when sleeping to reduce chances of scratching unconsciously

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Dr. Peter Lio, clinical assistant professor of dermatology and pediatrics at Northwestern University, and Jim Hewlett, an eczema patient, discuss what patients and doctors can do to help make the most of doctor visits to improve eczema care.

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What are possible complications from neurodermatitis?

Scratching can cause open wounds that bleed, causing infection, scabbing and scarring. Over time, scratching scalp patches can cause hair loss. Quality of life can also suffer, and itching can disrupt sleep and interfere with sexual function.^4,7

Does neurodermatitis affect mental health?

Certain patients may benefit from counseling or cognitive behavioral therapy to help address anxiety and other emotional issues contributing to the itch-scratch cycle.

While your relaxation techniques should be customized to your preferences, there are some which experts recommended because they are particularly effective at lowering the stress-levels of those with eczema. Expert-approved stress reduction tactics include:

• Practice mindful meditation
• Workout 150-300 minutes a week
• Get 7-9 hours of sleep as often as possible
• Spend more time with friends and family and expand your social circle
• Develop a yoga routine for stress relief
• Indulge in a favorite at-home activity like reading, baking, coloring and dancing
• Journal about your feelings
• See a therapist