There are many types and causes of eczema, or inflammation of the skin. Despite its name, neurodermatitis is not like other types of eczema whereby the inflammatory process actually causes skin lesions and intense itchiness. Rather, the skin lesions in neurodermatitis are the result of chronic scratching due to unrelenting itching.
Causes
The cause of neurodermatitis is actually unknown, although it usually starts with a patch of itchy skin irritation--some causes of which are insect bites, persistent rubbing with tight clothes, dry skin or psoriasis. Paradoxically, as you scratch the area, it becomes even itchier. A chronic itch-scratch cycle precipitates changes in the skin, so that the skin becomes thick, leathery and scaly. These skin changes are called lichenification; another term that doctors use for neurodermatitis is lichen simplex chronicus.
If you are a middle-aged woman, you are more prone to having neurodermatitis. Furthermore, if you have a personal or family history of itchy skin diseases like eczema or psoriasis, you are more likely to develop neurodermatitis.
Signs and Symptoms
The main feature of neurodermatitis is a well-circumscribed patch of exquisitely itchy skin, often affecting the neck, arms, thighs and ankles. Persistent scratching can cause the affected patch of skin to become leathery, scaly, raised and darker than the surrounding normal skin.
The itch in neurodermatitis can become so severe and uncomfortable that you can lose sleep and become unable to perform daily activities at work and at home. While itching typically waxes and wanes, scratching can become part of your daily routine if you scratch just out of habit. It is important to break the itch-scratch cycle to reverse the skin changes associated with neurodermatitis.
Scratching can lead to breaks in the skin, which can become infected with bacteria. Infected lesions are red and painful, drain pus and may ulcerate. Secondary infection can lead to permanent scarring and skin changes.
Treatment
The goal in treating neurodermatitis is to stop the stubborn itch-scratch cycle, so that the skin can recover, heal and possibly return to its once normal appearance. However, even after successful cessation of scratching, there might be permanent skin discoloration or mild scarring, especially if the skin lesions had been infected.
Ending the itch-scratch cycle is not an easy matter. Your doctor can prescribe topical or oral steroids, or oral antihistamines to reduce inflammation and to relieve the itching. A technique that can be employed to improve the absorption of topical medications is to cover the medicated area with moist cotton dressing or an adhesive tape at least once a day. Since stress and anxiety can further fuel itching, counseling can also help by understanding how emotions and behaviors can be harnessed to break the itch-scratch cycle. Infected lesions need to be treated with topical or oral antibiotics.
To prevent incurring wounds from chronic scratching, it will help to cover affected areas with bandages and dressings and to keep your nails short. Avoid further skin irritants by wearing smooth-textured clothing and using mild, unscented soaps.
