Neurodermatitis. This chronic yet non life threatening skin condition, is so undervalued and acknowledged that many have not even grasped the impact it has on patients suffering with neurodermatitis. Does this dermatological disease, neurodermatitis, really impact the quality of life of those affected?

In terms of the physiological, emotional and physical impact, the short answer is: YES! The quality of life (QoL) of the affected individuals with neurodermatitis can be disturbed, with possible issues on basic lifestyle choices, to sleep disruption and lacking in confidence, anxiety in terms of self image and relationship complications with friends and finding romantic love. This can lead to self esteem disturbances as well as contributing to a negative impact on health.^{1,2,3,4,5,6,7,8,9,10,11,12,13,14.}

To spread awareness with greater understanding of neurodermatitis and how it may affect us and our loved ones, let us explore together!

As with any researched health-related article, it is advised to gather all the sourced information here and then consult with a healthcare professional to evaluate the best course of action. Stay safe and read on!

What Is Neurodermatitis?

Neurodermatitis is not a rare condition; it is quite common as a skin condition. As stated earlier, it is not life-threatening, which is a relief. However, this type of eczema, sometimes referred to as lichen simplex chronicus, may moderately impact patients and their quality of life (QoL), affecting not only the appearance but also mental health.¹

Prevalence and Demographics Of Neurodermatitis

Through surveys, the prevalence is classified as common, affecting up to 12 in every 100 people of the total population. It is highly stressed that even though neurodermatitis affects both males and females, in general, women are more affected than men.¹

In many dermatology studies conducted, the participants are mostly female. This is taken into consideration, as most health-related decisions and facilities are mostly utilised by 67% of women.² This was indicated by Birdi et al., 2020, where they systematically reviewed 15 studies related to QoL and atopic dermatitis. R. Skoet et al. (2003) concluded that age, length of the duration of the chronic condition, atopic and neurodermatitis, and gender do not make a significant impact on impaired QoL.⁵

It is estimated that 5-20% of children suffer from atopic dermatitis worldwide.⁶ They develop this nonlife-threatening condition within the first year, and it is not common in children.^6,13 It is most common between adults 30–50 years old.¹³

 What is shocking is that certain personality types and anxiety disorders increase the risk of neurodermatitis.¹³ Those that have a stronger tendency to please people, excessively dutiful, or to hold emotions are at greater risk.¹³

Symptoms, clinical presentation and common treatments of neurodermatitis

Itching and excessive scratching is one key characterisation, and as a result, lichenificated plaques are evident in clinical presentation.¹ The most common affected areas where the patient is itchy are the face, eyelids, vulva, chin and neck, elbows, and ankles.¹ Feet, hands, wrists, and scalp are also common.¹³

Now to make the distinction between atopic dermatitis and neurodermatitis, are the areas affected? Atopic dermatitis displays comparable symptoms, but it is more widespread with multiple locations showing feelings of scratchiness and lichenification plaques. Neurodermatitis is typically focused only on one-two patches or areas of skin.²

Treatments Of Neurodermatitis

Treating this type of eczema focuses on healing the skin, allowing one to sleep peacefully, and blocking the itch-scratch cycle that is constantly triggered throughout the day.

Sedating anti-histamines are sometimes prescribed to help the person sleep.¹⁰ To make it clear, antihistamines will not work to reduce the flare-up symptoms and itchiness of this eczema type. Neurogenic itch, where the lightest of touches can trigger an itch. The chemical mediators that stimulate the nerves for an itch are released, and thus, such anti-histamine treatments may not work. The use of emollients frequently to prevent dry skin is a treatment that is recommended by dermatologists.¹⁰ Reducing stress and noticing the triggers of flare-ups and itching episodes may help from psychogenic itches, where the itch is stimulated by psychological factors.¹⁰ Medicated patches containing lidocaine and lidocaine may be prescribed to numb the nerve endings that cause itching.¹³

To help with the inflammation, some dermatologists can prescribe corticosteroids that may also soften thickened skin. Injecting such treatments may be ideal if the skin is too thick. Salicylic acid-based ointments and calcineurin inhibitor topicals may be prescribed to control itchiness.¹³

Dr. Gil Yosipovitch, a professor at the Dr. Phillip Frost Department of Dermatology and Cutaneous Surgery at the University of Miami Miller School of Medicine in Florida, states: “Extremely itchy patches of skin cause patients to scratch even when they don’t realise it, and just telling them to stop isn’t realistic.” He states that scratching and itching becomes a subconscious habit that provides relief and satisfaction. So, advising affected individuals to not itch will not help.¹³

Counseling, cognitive behavioral therapy, relaxing techniques, yoga, and meditations can all aid in reducing anxiety and itch triggers.¹³

Physical Impact Of Patients With Neurodermatitis On Quality Of Life

Studies analysed by Birdi et al., 2020, have identified consistent evidence to indicate an elevated severity of neurodermatitis directly shows poorer QoL.² Dermatology Life Quality Index (DLQI) is a tool used to assess QoL of patients with neurodermatitis, and this showed moderate to severe impact from a 2011 China study at Xi'an Jiaotong University, the first of it’s kind that analysed both males and females.¹ This study also assessed the DLQI of patients with psoriasis. With p< 0.001, the mean DLQI score was 9.34 for 150 neurodermatitis participants (149 in the end), much lower than that for psoriasis of 13.32. The DLQI was much lower for neurodermatitis , except for symptoms and sexual dysfunction.¹ A high DLQI score indicates a lower QoL, so it is evident that the QoL is moderate compared to psoriasis yet, much lower QoL in relation to symptoms (q1) and sexual satisfaction (q9).¹ These two parameters are severely impacted, with significance.

The DLQI tool is applied for assessing patients for 33 different skin conditions.¹ The 10 parameters that are questioned to the patients include the level of embarrassment, treatment availability, sexual difficulties, work/study, symptoms and feelings, daily activities such as running errands and shopping, clothes comfort, and social/leisure activities. This is a standard tool that is used and applied to many dermatology studies regarding QoL, which this article has gained reliable information from.¹ Although patients with neurodermatitis experienced greater education, although not focused in this study, and disease duration is short from the study analysis,¹ This did not translate to the QoL as significantly better for neurodermatitis patients as a whole. The psychological and emotional impact, including symptoms and feelings, is affected.^1,3,14 This does indicate that to improve the quality of life in relation to the symptoms of patients with neurodermatitis, treating itchiness will significantly lower the DLQI, resulting in a better quality of life overall. Refer to the treatments section of this article for the relevant information. Even though DLQI does not take into account diet and Comparing the DLQI score for patients before and after treatment gives an understanding of the ways in which a patient can improve QoL.

A systematic review study (mostly women as participants) that did focus on atopic dermatitis and not only neurodermatitis. However, the similarities between the two eczema types are useful to assess QoL.² Compared to healthy adult controls, patients with atopic dermatitis show worse QoL. The study concluded that the worsening of the dermatitis condition leads to a worsened QoL. The review study data also compared specific characteristics of dermatitis to suggest sleep disturbances may be associated with the skin condition’s predictor on QoL. Sleep disturbances may be associated with neurodermatitis as well as sexual dysfunction.^1,2 From the 15 studies compared, QoL was significantly poorer in dermatitis patients compared to healthy patients. Compared to psoriasis, patients with atopic dermatitis report greater physical and mental functioning. However, the scores were poor in terms of the skin discomfort of dermatitis patients and how it affects everyday life and daily activity limitations. This is due to severe discomfort of itchiness (pruritus).^1,2

Psychological and Emotional Impact Of Patients With Neurodermatitis On Quality Of LIfe

Patients with neurodermatitis have been shown to display weak social skills or interpersonal resources.^11,12,13,14

It has been suggested that patients with neurodermatitis suffer from depression, anxiety and other treatable psychological disorders.¹

Ermertcan et al.'s (2011) findings recommend greatly evaluating female neurodermatitis patients on sexual dysfunction in order to significantly improve their quality of life. Compared to healthy patients, lower scores on the Female Sexual Function Index (FSFI) for neurodermatitis patients with p<0.001 indicate significantly lower desire, lubrication, orgasm, and desire.³ It is also associated with many psychologic issues such as obsessive-compulsive disorder (OCD), demoralisation, anxiety, and even depression.³ DLQI score of 11.95 ± 5.65 in patients with neurodermatitis, indicate low QoL.³ Female neurodermatitis patients in the study may show an association of sexual dysfunction.³ A cross-sectional study on atopic dermatitis (AD) patients and relationships with their spouses/partners via DLQI tests showed sexual dissatisfaction. This may be heartbreaking to identify that 57.5% of 266 patients displayed a decrease in sexual desire.^4,5,6

The impact this contagious skin condition has is not only towards the patients; rather, the low QoL also affects their partners' sexual lives.⁴ The Partners QoL was not as affected; however, 36.5% of the partners admitted that eczema appearance had an impact on their sex life.⁴ Sex life is significantly influenced for both partners. Another study showed neurodermatitis patients have sexual dysfunction and problems with depression.⁹

It is advised that these couples may seek external aid, such as counseling and couple therapy, to ensure sexual satisfaction is met for both the affected patient and their partner.^4,5,6

It can also impact the families around the affected individuals, in particular if the patients are children.^4,5,6 Pediatric atopic dermatitis negatively impacts the family; mothers show a reduction in mental and physical health, so professional intervention is deemed necessary for these such cases in order to understand the child’s needs that can change the daily lifestyle and psychological impact on the QoL. This is significant, as 80% of affected children may develop asthma and/or allergic rhinitis, sensitisation to cow’s milk protein, certain foods avoided, and children crying in pain and frustration due to itchiness of the skin lesions. The parents may not sleep due to the child or toddler’s cries.⁶ Parental and child depression and parental stress are linked to lower patient QoL. This sleep disturbance may progress even to adulthood if the condition of atopic dermatitis or neurodermatitis worsens.⁷ In addition,  QoL may be affected by other factors, including one’s personality, education and employment opportunities, any other health issues, and possible financial and social status.^6,7

Self-image and the lack of self-esteem and confidence may be shown in patients with neurodermatitis, in particular if they have been rejected from obtaining romantic partners.¹⁰ Telling the partner that it is non-contagious and talking openly about the skin condition may improve your self-worth and accept any rejection that may follow. The National Eczema Society is an organisation that aims to elevate the confidence of those affected by neurodermatitis and also improve self-worth.

As A. Lambert states, "People are attracted to many different aspects of a potential partner: eczema is just one part of your story."¹⁰ Alan, aged 43, is an individual affected by a skin condition and developed depression. He advises that the condition is part of the patient but does not define who they are. "Be your own cheerleader and educate those around you.”¹¹

Summary

• Neurodermatitis: 12% prevalence of this non-life-threatening skin condition, mostly women are affected. Non-contagious, may affect QoL significantly
• Symptoms and feelings in the DLQI tool are the two parameters that significantly reduce the quality of life in patients with neurodermatitis
• Neurodermatitis may affect daily lifestyle and activities in a negative way, experiencing skin discomfort and a constant need to itch the areas affected
• Lack of confidence and sexual dysfunction may develop, reducing pleasure and desire for both the patient and their partner
• Impact on families when a member is affected, especially the mother, that may develop depression and lack of mental and psychological stability
• Sleep disturbance from itchiness and triggers
• Other factors may affect QoL, including financial status and social life
• Treatments are intended for itchiness, prevent dry skin, soften thickened skin, and achieve much more peaceful sleep. Treatments for psychological issues are counseling, therapy, couple therapy, talking to experts, and charity organisations