Introduction

Neurodermatitis also known as lichen simplex chronicus, is a skin condition that involves itching and scratching. It usually starts on a single patch of the skin and scratching the itchy patch can lead to a rash. The more a person scratches the more itchier it becomes. It's not life-threatening nor contagious which means you can't get it from anyone or pass it to anyone. The common sites of neurodermatitis are the elbows, neck, ankles, eyelids, vulva and the face, which are the most commonly affected areas.¹

Importance of identifying affected areas

It's very important to identify the affected areas of the body. In these areas without treatment, the itch worsens and can wake you up at night, affecting your sleep and quality of life. It usually occurs during stressful times and continues even after the stress is gone. Frequent scratching can lead to skin infections and bleeding. Repeated scratching can cause thickness of the skin, which helps in reducing the bleeding and infections but makes the itch worse. Some people scratch without even realising it. Neurodermatitis rarely goes away on its own. Treatment aims to break the itch-scratch cycle.

What are the commonly affected areas

This condition affects areas you can easily reach, such as the 

• Scalp
• Neck
• Wrists
• Forearms
• Ankle
• Vulva
• scrotum
• Anus 

The itch can be very intense and may come and go or be constant. You might scratch the skin out of habit or while sleeping. The scalp is most commonly affected by neurodermatitis. Unlike other body areas, the scalp shows heavy scaling, hiding the redness underneath.³ Neurodermatitis on the back of the neck mostly affects women. The affected area is usually a small spot around the middle of the neck.⁴ In men ankles are more affected. People often scratch their ankles by reaching down while sitting or by rubbing them against a chair leg. This condition is rare in children and affects women more often than men.⁴ Repeated scratching can cause thickened, discoloured patches. These patches can vary in colour from yellow to deep reddish brown, with the centre often being the darkest.²

Affected population

Lichen simplex chronicus affects about 12% of the population. It is most common in middle to late adulthood, especially between ages 30 and 50, likely due to higher stress levels during this time. This condition is more common in assigned females at birth (AFAB) with a ratio of 2:1 than in assigned males at birth (AMAB).²

What are the causes of neurodermatitis

The exact cause of neurodermatitis is unclear. It can be easily triggered by skin irritants such as tight clothes, dryness, nerve injuries or bug bites. The more you scratch, the more itchier it becomes. It has been observed that the itch can begin during periods of extreme stress, anxiety, emotional trauma, or depression. Sometimes, the itching persists even after the mental stress lessens or ends.⁴

How does the affected skin look like

The itchy patches measure in range from 3x6 cm to 6x10 cm. Continuous scratching of the skin irritates the nerve endings and worsens the itch, leading to more scratching. This cycle can make the condition chronic and their appearance can be

• Dry 
• Thick
• Scaly
• Leathery
• Reddish, brownish, yellowish, grey, or purple. Older patches might be white or pale in the centre with darker edges. Over time, they may become scarred⁵

Symptoms of neurodermatitis

There are various symptoms that you can encounter

• Pain
• Scratching the scalp can lead to hair loss
• Open sores and bleeding from scratching
• Infection, shown by yellow crusts, fluid discharge, or pus-filled bumps
• Scarring from scratching
• Skin lines in the itchy area

Diagnosis of neurodermatitis

To diagnose neurodermatitis, doctors use a 

• physical exam 
• medical history
• dermoscopy
• patient-reported symptoms 
• Patch testing 
• Skin biopsy
• Blood tests may also be done²

What are the treatment options

Treatment for lichen simplex chronicus may include:

• Covering the affected area
• Using topical anti-inflammatory treatments like corticosteroids
• Applying topical emollients
• Taking antibiotics if an infection is likely or present, especially if using immunosuppressant drugs
• Using antihistamines to prevent flare-ups caused by allergies²
• Some patients might find counselling helpful for dealing with anxiety and emotions that make the itch-scratch cycle worse⁶
• To relieve itching, moisturise daily
• Use cool compresses
• Wear loose clothing

Prognosis of the condition

The condition can come back if triggered, so more treatment may be required. Doctors might also keep treating it to prevent it from returning. With proper treatment, neurodermatitis can heal completely, but the plan might need adjustments, especially for stubborn cases on the genitals. It’s important to stick with the treatment. Constant scratching can sometimes lead to skin cancers due to ongoing irritation and inflammation. ²

How to prevent neurodermatitis symptoms

Here are some self-care tips for managing neurodermatitis:

• Try to stop scratching: Avoid scratching to control your condition and prevent the itch from returning
• Applying cool and wet cloths: Soothe the skin and relieve itching by placing a cool, wet cloth on the affected area for a few minutes before applying medicated cream
• Identify and avoid triggers that cause flare-ups. For example, manage stress if it triggers your itching.
• Take short, warm baths and moisturising products: Use mild, unscented soaps and limit baths to once a day for 10 minutes or less. After washing, pat the skin dry and apply unscented moisturiser
• Use cooling lotions: Try applying calamine lotion or lotions with menthol
• Use an anti-itch cream or lotion three times a day for two days: Hydrocortisone cream can provide temporary relief, store them in the fridge for a cooling effect. Nonsteroidal creams with menthol can also help
• Take oral antihistamines and try diphenhydramine (Benadryl) can relieve severe itching and help you sleep
• Cover the affected area: Try using bandages or dressings to protect the skin and prevent scratching, especially if you scratch during sleep
• Keep nails trimmed: This is because short nails can reduce skin damage from scratching. Wearing mittens while sleeping can help

FAQs

Can neurodermatitis heal completely?

Neurodermatitis can heal completely, with the right treatment and looking for the right treatment plan may be time taking. You might need to try various options. It is very important to follow each treatment plan carefully.

What are the chances of remission?

It can come back if the proper treatment plan is not being followed.

Is neurodermatitis life-threatening?

No, it is not life threatening but it affects quality of life.

Summary

Neurodermatitis commonly affects areas of the body that are easily accessible including the scalp, neck, wrists, forearms, ankles, vulva, scrotum, and anus. These locations are prone to the itch-scratch cycle, where intense itching leads to scratching, which in turn worsens the itch. Recognising these common sites is important for early diagnosis and treatment. It can help to break this cycle and prevent further complications such as thickened skin, infections, and scarring. 

Effective management involves a combination of self-care measures, medications, and lifestyle adjustments. They address both the physical symptoms and potential underlying emotional triggers, such as stress and anxiety. Understanding the typical patterns and triggers of neurodermatitis can lead to more effective treatment strategies, improving the quality of life for those affected by this condition.