What is neurodermatitis, how to recognize and treat it?

Neurodermatitis is a skin disease from the group of neurodermatoses (itchy dermatoses). The main symptom of the disease is an intensive, constant, unbearable skin itching.

Neurodermatitis can occur at any age but mostly develops in children as a result of skin eczema or exudative diathesis. The majority of patients have an increased sensitivity to certain foods, for instance, chocolate, citrus fruits, or medicines. The disease frequently occurs in patients with asthma.

Short information about neurodermatitis

Causes of neurodermatitis

The following reasons can provoke the development of this disease:

- Exudative diathesis;
- Hereditary predisposition (the presence of allergies in close relatives);
- Irrational and unbalanced nutrition;
- Intoxication;
- Metabolic disease;
- Weakened immunity;
- Diseases of the gastrointestinal tract (digestive tract) of an allergic nature;
- Constant stress;
- Allergic reaction;
- Bronchial asthma;
- Endocrine disorders (diseases of the thyroid gland, adrenal glands and gonads).

Functional disorders of the central nervous system, which are characteristic of this disease, can be not only the cause of the disease, but also its consequence. A kind of "vicious circle" arises, since the severe course of neurodermatitis exacerbates neurological disorders, and they, in turn, exacerbate the course of the disease.

Types of neurodermatitis

In terms of prevalence, neurodermatitis can be:

- Localized (occurs only on some areas of the skin);
- Diffuse or disseminated (spread to multiple areas of the skin).

In addition, the following types of neurodermatitis are distinguished:

- Hypertrophic - skin manifestations are of a tumor-like nature, the favorite place of localization is the inguinal (between legs) zone;
- Psoriasiform - localized in the head and neck area, the rash is red, dense in consistency and covered with small scales;
- Linear - arises in the areas of natural bends of the limbs (ulnar, knee fossa), looks like linear cracks;
- Depigmented - characterized by complete or partial loss of pigment by tissues in the affected areas;
- Decalvering - manifests itself on areas of the body with hair and accompanies hair loss;
- Follicular – papules have a pointed shape, rashes are located along the mouths of the hair follicles.

Depending on the characteristics of the clinical course, there are three degrees of severity of the disease:

- Mild;
- Moderate;
- Severe.

Symptoms of neurodermatitis

The main symptom of the disease is an intense itching of the skin providing severe discomfort. In addition to itching, the following symptoms are characteristic of neurodermatitis:

- White dermographism – the occurrence of white stripes on the skin due to the vascular response to tactile skin irritation. It can be caused by applying strokes to the skin with a blunt stick, after which white stripes appear on this area.
- Neurological disorders: sleep disorders, irritability, mental lability, depression.
- Pronounced pilomotor reflex, which leads to "goose bumps" occurrence. It occurs due to the contraction of the hair muscles of the skin under the influence of an unfavorable factor (for example, cold).

Signs of diffuse neurodermatitis include:

- Papular rash. A papule is a small nodule that does not have a cavity and rises slightly above the surface of the skin. With diffuse neurodermatitis, flesh-colored papules, in some places, they can merge.
- Multiple excoriations (scratching). Due to severe itching, the patient scratches the skin and violates its integrity.
- Dry and flaky skin.
- Linear cracks that appear in the area of natural folds against the background of infiltration, i.e. accumulation of cellular elements in the tissues of the body with an admixture of blood and lymph.
- The lesions are mainly localized on the face, neck, inner thighs, popliteal cavity ( kneepit )and elbow bend.
- It is characterized by a long course of the disease with periods of remission and exacerbation. Improvement in the condition occurs mainly in the summer, and worsening in the winter.

Symptoms of localized neurodermatitis:

- Develops in a limited area of the skin.
- Itching mainly occurs in the evening or at night.
- Papular rash. At the onset of the disease, the skin is unchanged, but due to constant scratching, rashes of a dense consistency, in places covered with scales, occur. Papules can be pale pink to brownish red in color. With the progression of the disease, individual rashes can merge and form a continuous papular infiltration.
- Over time, the skin pattern becomes more pronounced.

Diagnosis of neurodermatitis

The diagnosis of neurodermatitis is made by a dermatologist or allergist-immunologist on the basis of clinical signs, since there are no specific methods for diagnosing this disease. The criteria for making a diagnosis are:

- Dermatitis with typical localization;
- The presence of papular rashes and dry skin;
- Unbearable, intense itching and scratching of the skin;
- Frequent relapses of the disease;
- The presence of concomitant allergic diseases (allergic rhinitis, bronchial asthma, etc.).

Additional research methods may be prescribed, which indirectly indicate this disease:

- General blood test;
- Detection of allergen-specific immunoglobulin (IgE) in the blood;
- Carrying out skin allergy tests (patch test, skin prick test);
- Skin biopsy.

Methods for the treatment of neurodermatitis

Treatment of neurodermatitis consists of the following measures:

- Hypoallergenic diet.
- Psychocorrectional therapy.
- Drug treatment. Antihistamines (for instance, Periactin (Cyproheptadine), sedatives, sleeping pills, antidepressants, immunomodulators, hormones and vitamins can be prescribed.
- Physiotherapy. Magnetic therapy, phonophoresis, diadynamic therapy, inductothermy, galvanization, electrosleep, cryomassage have a positive effect.

A patient suffering from neurodermatitis is advised to avoid stressful situations, walk a lot in the fresh air and have a good rest. You should also exclude as much as possible the exposure to any allergens that can cause an allergic reaction and worsen the course of the disease. In addition, long-term spa treatment in a dry sea climate is recommended.

The consequences of neurodermatitis

If untreated, neurodermatitis can cause the following undesirable consequences:

- Serious disorders of the psycho-emotional state;
- Addition of a secondary infection, the occurrence of abscesses, chronic Furunculosis (purulent inflammation), abscess or phlegmon of the skin;
- Decreased immunity;
- Transformation of damaged skin into a malignant neoplasm (e.g., skin lymphoma).

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Post by: Kevin Phillips, dermatologist, Bradford, United Kingdom