Article by Dr Manasa S, B.A.M.S
What is neurodermatitis?
Have you ever had an itch that just wouldn’t go away, making you scratch over and over again? That’s what it’s like with neurodermatitis, a skin problem that makes you feel like you need to scratch all the time. It usually happens in certain spots like your arms, legs, scalp, neck, or feet. But the tricky thing is, scratching makes it worse and can even hurt your skin. The itching is so intense that it disrupts day today activities in individuals suffering from neuro dermatitis.
Neurodermatitis used to be called lichen simplex chronicus, but now we know it’s caused by a mix of things like your genes, stuff in your environment, and how you feel emotionally. It’s a stubborn problem that can stick around for months or even years. Neither it is life-threatening nor contagious. Over time, the skin in those itchy spots might get thicker and change colour.
It’s more common in women and tends to pop up when you’re in your twenties to fifties. In the U.S., about 1-3% of people deal with it, especially if they have family members with skin allergies.
What do the lesions of neurodermatitis look like?
Characteristics of itchy patches in neurodermatitis:
Size – ranges from 3cm x 6cm to 6cm x 10cm
– Appearance may include:
– Dryness
– Thickness
– Scaliness
– Leathery texture
– Variation in colour, such as reddish, brownish, yellowish, grey, or purple
– Older patches may exhibit central whitening or paleness surrounded by darker hues
– Progression over time may lead to scarring
Causes of neurodermatitis
The exact cause for neurodermatitis is not yet clear but few triggering factors are noted and they are as below:
– Irritants like tight clothing or insect bites
– Scratching exacerbates the itchiness
Neurodermatitis may coexist with –
– Dry skin, atopic dermatitis, or psoriasis
– Stress and anxiety can also provoke itching symptoms
Symptoms of neurodermatitis
– Pruritic and desquamative skin lesions
– Erosions with hemorrhagic tendencies
– Hyperkeratotic, indurated epidermis
– Altered pigmentation and atrophic changes in genital mucosa
– Exacerbated, erythematous plaques exhibiting lichenification or hyperpigmentation
– Affected areas include accessible sites such as scalp, cervical region, distal upper limbs, lower limbs, perineum, and perianal region. Persistent pruritus may vary in intensity and continuity, leading to excoriation secondary to habitual scratching and nocturnal scratching episodes.
Complications of neurodermatitis
Consequences of persistent scratching include:
– Wound formation
– Bacterial skin infections
– Permanent scarring and alterations in skin pigmentation (post-inflammatory hyperpigmentation or hypopigmentation)
The itch associated with neurodermatitis can impact:
– Sleep patterns
– Sexual function
– Overall quality of life
What are the risk factors for neurodermatitis?
Risk factors for neurodermatitis encompass:
– Age: Predominantly observed in individuals aged 30 to 50 years.
– Pre-existing skin conditions: Those with a history of atopic dermatitis or psoriasis have an elevated risk.
– Family predisposition: Those with relatives affected by hay fever, childhood eczema, or asthma are more susceptible.
– Psychological factors: Anxiety disorders and emotional stress can precipitate neurodermatitis.
When should medical help be needed?
– If home remedies fail to alleviate symptoms after two days
– Experience persistent scratching in one area
– Encounter difficulty sleeping or concentrating due to the itch
Immediate medical attention is necessary if:
– Skin pain or signs of infection arise
– Fever accompanies these symptoms
Diagnosis of neurodermatitis
Diagnostic procedures for neurodermatitis include:
– Skin swab tests: Detecting potential infections in the affected area
– Patch testing: Assessing for allergies as a potential cause
– Fungal tests: Identifying skin disorders and ruling out sexually transmitted infections
– Skin biopsy: Investigating for conditions like psoriasis or mycosis fungoides, a type of lymphoma
– Blood tests: Further evaluation for underlying factors or contributing conditions
Prognosis of neurodermatitis
Neurodermatitis, when managed with an effective treatment plan, has the potential for complete healing. However, adjustments or alternative approaches may be necessary, requiring both diligence and cooperation between the patient and doctor, particularly in cases involving genital areas, where the condition tends to be more persistent. Despite initial recovery, the condition can resurface if triggered by specific factors, necessitating a return to treatment. Some patients may require ongoing treatment to prevent recurrence. Additionally, there’s a risk of neurodermatitis progressing into skin cancers such as squamous-cell or verrucous carcinoma. Continuous scratching and rubbing can induce inflammation-triggering chemicals, potentially leading to the transformation of skin cells into cancerous ones. Vigilance in managing triggers and seeking timely medical attention are crucial aspects of managing neurodermatitis to mitigate such risks.
Management and treatment of neurodermatitis
The treatment for neurodermatitis is aimed at:
– Controlling itching
– Preventing scratching
– Addressing underlying causes
The following are the treatments recommended
– Anti-itch creams: Including stronger corticosteroids or nonsteroidal anti-itch products like tacrolimus (Protopic) or pimecrolimus (Elidel).
– Corticosteroid injections: Administered directly into affected skin areas to promote healing.
– Prescription antihistamines: To alleviate itching, albeit some may cause drowsiness.
– Anti-anxiety drugs: Aimed at managing stress-induced itching.
– Medicated patches: Utilizing lidocaine or capsaicin for persistent itching.
– OnabotulinumtoxinA (Botox) injection: Considered for individuals unresponsive to other treatments.
– Light therapy: Exposure to specific light types for those resistant to conventional therapies.
– Talk therapy: Counselling sessions to address emotional triggers contributing to itching and scratching behaviours.
How to manage the wound in neuro dermatitis?
Treatment options for wounds caused by neurodermatitis include:
– Dressing application by the doctor to protect the area
– Negative-pressure wound therapy: Utilizing vacuum technology to remove fluid and boost blood circulation
– Hyperbaric oxygen therapy: Involves inhaling pure oxygen within a pressurized chamber to aid in self-healing
– Surgical intervention on the wound as a potential solution
Lifestyle and home remedies to manage neurodermatitis include
– Avoiding rubbing and scratching
– Applying cool, wet clothes before medicated cream application
– Using cooling lotions like calamine or menthol-containing lotions
– Trying nonprescription medications like hydrocortisone cream or oral antihistamines
– Covering affected areas with bandages or dressings to prevent scratching, especially during sleep
– Keeping nails trimmed and wearing mittens during sleep to minimize skin damage
– Taking short, warm baths with mild, unscented products and moisturizing afterward
– Identifying and avoiding triggers that exacerbate symptoms, such as stress or specific allergens.
Study – One study showed that neurodermatitis moderately affected the quality of life of the patients.
Study – Another study establishes link between neurodermatitis and emotional tension.
Study – Yet another study tells that neurodermatitis may be associated with sexual dysfunction and patients with neurodermatitis should be evaluated with regard to sexual function to provide a better quality of life.
Ayurveda understanding of neurodermatitis
There is no one particular condition explained in Ayurveda which can be exactly correlated with neurodermatitis. In fact, a spectrum of conditions explained, mainly in the context of Kushta Nidana – chapter dealing with explanation of skin disorders, shall be considered in correlation with neurodermatitis. They include – charma kushta, Kapala, ekakushta, kitibha, vaipadika and vicharchika.
From dosha perspective, neurodermatitis resembles kushta – skin disease caused due to predominant vitiation of vata. All the symptoms clearly appear like those caused by skin afflicted by vata.
Since itching is a predominant symptom of neurodermatitis, it can be considered to be caused due to excessive dryness caused by vata or abnormally increased kapha or by combined vitiation of vata and kapha.
Treatment principles include isolation of causative factors and addressing the vitiated dosha. The skin lesions may be treated on the basis of dosha aggravation and on the principles of treating kushta based on the dosha predominance in that type of kushta.
Related Reading – Neurodermatitis – ‘Ayurveda Understanding’
