Overview
The terms eczema and dermatitis are often used interchangeably which can be misleading and confusing due to the similarity in their symptoms. To put it simply, eczema is a form of dermatitis but not all dermatitis is eczema.
Neurodermatitis is a type of eczema that affects about 12% of the population.1 In this article we will discuss how we can differentiate neurodermatitis from other common types of eczema. We will also go into detail about the causes, triggers, and the treatment options for different types of eczema.
What is Dermatitis?
Dermatitis (derm = skin and itis = inflammation) is the inflammation of the skin. It is an umbrella term and encapsulates several inflammatory skin conditions, characterised by swelling and irritation of the skin which can often lead to itching, dryness and rash formation.
Types of Dermatitis
Dermatitis can be classified on the basis of cause, clinical appearance and site of occurrence.
Cause
Endogenous
- Atopic dermatitis
- Infantile seborrheic dermatitis
- Neurodermatitis
- Nummular dermatitis
- Stasis dermatitis
Exogenous
- Irritant contact dermatitis
- Allergic contact dermatitis
- Photodermatitis
- Radiation dermatitis
- Infective dermatitis
Clinical appearance
- Discoid dermatitis
- Hyperkeratotic dermatitis
- Pompholyx
Site of occurrence
- Hand dermatitis
- Eyelid dermatitis
- Lower leg dermatitis
- Perioral dermatitis
What is Eczema?
Eczema is a type of dermatitis in which the skin becomes dry, itchy and bumpy. According to statistics for industrialised nations, it affects 15-30% of children and 2-10% of adults. While research is ongoing, a genetic predisposition to eczema has been studied, with two types of genes currently linked to this condition.2 However, in most of the cases a combination of factors contributes to triggering an episode of eczema in an individual.
Atopic dermatitis (or atopy) is the most common type of eczema, affecting 101.27 million adults and 102.78 million children globally.3
It is important to note that atopic dermatitis is a type of eczema and should not be used as an analogous term for eczema, as there are other types of eczema as well.
Types of Eczema
According to the National Eczema Association, there are 7 different types of eczema.4
| Type | Cause | Appearance | Treatment |
| Atopic dermatitis | Genetic mutation, primary immunodeficiency, certain environmental factors5 | Red, crusty, patchy skin with pus that may ooze when scratched. | Moisturizers (emollients), topical corticosteroids, antihistamines, lifestyle changes6 |
| Contact dermatitis | Some irritants like rubber gloves, bleach detergents, solvents, etc Certain allergens like pollen, perfumes, some antibiotics etc.7 | Tapioca-like pearly bumps on the palm of hand, fingers, soles of feet and toes. | Avoiding contact with allergens and irritants. Emollients and topical corticosteroids Oral steroids in rare cases8 |
| Dyshidrotic dermatitis | Certain allergies, stress, sweaty hands and feet9 | Tapioca like pearly bumps on the palm of hand, fingers, soles of feet and toes. | Psychotherapy, anti-itch creams, cold compress, moisturisers.12 |
| Neurodermatitis | Psychological stress, anxiety and depression. | Raised rough patches. Dry, scaly, leathery skin typically on neck, arms, shoulders, elbows, and scalp.11 | Coin-shaped raised spots 14 |
| Nummular eczema | Triggers include insect bites, chemical burns and scrapes.13 | Coin shaped raised spots 14 | Topical corticosteroids and topical antibiotics |
| Seborrheic dermatitis | Malassezia yeast infection, hormonal changes, stress, obesity, alcoholism, parkinsonism, HIV, some medications15 | Itchy, greasy and red patches. Flakey scalp and dandruff in beard, mustache and hairy skin | OTC anti dandruff shampoo, antifungal cream, mild topical corticosteroids16 |
| Stasis dermatitis or varicose eczema | Poor circulation of blood in lower limbs17 | Ulcers are present on lower legs and on the upper side of feet. They may bleed when scratched or rubbed. In severe cases the skin permanently becomes thick, leathery, dark, and bumpy. | Improve blood circulation. Emollients and topical corticosteroids18 |
How is neurodermatitis different from other types of eczema?
Neurodermatitis is also known as lichen simplex chronicus (LSC). It is a distinguishable type of eczema characterised by unique triggers and clinical features.
The term ‘neuro’ means nerves, and the nerve endings beneath the skin stimulate itching in this condition. This response by the nerves is usually triggered by long term extreme stress, anxiety, emotional distress, trauma or depression. As a result, individuals with this condition scratch themselves mindlessly and the itch remains even after the mental load is eased.
Some external factors that may trigger neurodermatitis include
- Nerve damage due to any injury
- Insect bites
- Dry and patchy skin
- Wearing skin-tight, non-breathable clothing made of fabrics like polyester and artificial silk
- Eczema and psoriasis (seborrheic dermatitis)19
What does neurodermatitis look like?
Neurodermatitis patches are typically 3 to 10 centimeters in size. Adopting a raised, rough, and scaly appearance. On lighter skin, these patches present as red coloured blisters, whereas they appear purple or violet (bruise-like) on darker skin.
Diagnosis of neurodermatitis
- Your dermatologist will examine the dry patches on your skin
- They will ask you questions like, when did you notice changes in your skin? How often does the area itch? Does the itch come and go or does it persist? Do you have any known allergies?
- Your doctor may take a swab, which will be tested for any infections
- They may also refer you for an allergy test to determine allergens that trigger this condition20
Risk factors for neurodermatitis
Unlike atopic dermatitis or atopy which is common in children, neurodermatitis is rarely present in children. It mostly affects adults between 30 to 50 years of age. Research also indicates that women are more likely to develop this condition than men.21
People with a history of psoriasis, atopy, and contact dermatitis are at greater risk of developing neurodermatitis.22
Studies suggest that anxiety disorders and chronic stress can also increase the risk of neurodermatitis.23
Quality of life with neurodermatitis
Neurodermatitis is a chronic skin condition and that affects the patient’s quality of life. Fortunately, this condition is not life threatening and can be managed effectively with medications and treatment strategies.
The most common issue faced by individuals with neurodermatitis is emotional distress due to visible skin changes and persistent itching. Feelings of embarrassment, isolation, and low self-esteem are also common.
However, it is important to remember that stress can be a major trigger, potential leading to an episode of aggressive itching and scratching. To break this cycle:
- Consult your psychologist if you’re having negative self image
- Connect with support groups or communities of people going through similar experiences – this sense of shared experiences can be empowering and will help you cope with your condition
Summary
Every type of dermatitis is an uncomfortable, physically and mentally dreadful experience, and understanding the difference between different types of dermatitis is crucial for accurate and effective treatment.
The main difference between neurodermatitis and other forms of eczema is the role of psychological stress. Thus, its treatment also involves psychotherapy along with medical intervention.
Therefore, it is important to get a professional diagnosis as soon as you notice some unusual changes to your skin. Early diagnosis allows for prompt and targeted treatment. Which can significantly improve symptom control and help prevent chronic cycles of itching and scratching, enhancing quality of life in the long run.
References
- Altunay İK, Özkur E, Uğurer E, Baltan E, Aydın Ç, Serin E. More than a skin disease: stress, depression, anxiety levels, and serum neurotrophins in lichen simplex chronicus. An Bras Dermatol [Internet]. 2021 [cited 2024 Jul 12]; 96(6):700–5. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8790192/.
- Biagini Myers JM, Khurana Hershey GK. Eczema in early life: Genetics, the skin barrier, and lessons learned from birth cohort studies. J Pediatr [Internet]. 2010 [cited 2024 Jul 12]; 157(5):704–14. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2957505/.
- Tian J, Zhang D, Yang Y, Huang Y, Wang L, Yao X, et al. Global epidemiology of atopic dermatitis: a comprehensive systematic analysis and modelling study. Br J Dermatol. 2023; 190(1):55–61.
- National Eczema Association [Internet]. 7 Types of Eczema; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/.
- Branch NSC and O. Atopic Dermatitis. National Institute of Arthritis and Musculoskeletal and Skin Diseases [Internet]. 2017 [cited 2024 Jul 12]. Available from: https://www.niams.nih.gov/health-topics/atopic-dermatitis.
- Atopic eczema - Treatment. nhs.uk [Internet]. 2017 [cited 2024 Jul 12]. Available from: https://www.nhs.uk/conditions/atopic-eczema/treatment/.
- Contact dermatitis - Symptoms and causes. Mayo Clinic [Internet]. [cited 2024 Jul 12]. Available from: https://www.mayoclinic.org/diseases-conditions/contact-dermatitis/symptoms-causes/syc-20352742.
- Contact dermatitis - Treatment. nhs.uk [Internet]. 2017 [cited 2024 Jul 12]. Available from: https://www.nhs.uk/conditions/contact-dermatitis/treatment/.
- Dyshidrotic Eczema (Dyshidrosis): Symptoms, Causes, Treatments. Cleveland Clinic [Internet]. [cited 2024 Jul 12]. Available from: https://my.clevelandclinic.org/health/diseases/17728-dyshidrotic-eczema.
- National Eczema Association [Internet]. What is dyshidrotic eczema and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/dyshidrotic-eczema/.
- National Eczema Association [Internet]. What is neurodermatitis and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/neurodermatitis/.
- Eczema types: Neurodermatitis diagnosis and treatment [Internet]. [cited 2024 Jul 12]. Available from: https://www.aad.org/public/diseases/eczema/types/neurodermatitis/treatment.
- National Eczema Association [Internet]. What is nummular eczema and what should you do if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/nummular-eczema/.
- Eczema types: Nummular eczema signs & symptoms [Internet]. [cited 2024 Jul 12]. Available from: https://www.aad.org/public/diseases/eczema/types/nummular-dermatitis/symptoms.
- National Eczema Association [Internet]. What is seborrheic dermatitis and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/seborrheic-dermatitis/.
- Seborrheic dermatitis: Diagnosis and treatment [Internet]. [cited 2024 Jul 12]. Available from: https://www.aad.org/public/diseases/a-z/seborrheic-dermatitis-treatment.
- National Eczema Association [Internet]. What is stasis dermatitis and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/stasis-dermatitis/.
- Varicose eczema. nhs.uk [Internet]. 2017 [cited 2024 Jul 12]. Available from: https://www.nhs.uk/conditions/varicose-eczema/.
- Team ME. Atlas University Medicine Hospital [Internet]. 2022. Lichen Simplex Chronicus (Neurodermatitis); [cited 2024 Jul 12]. Available from: https://medicinehospital.com.tr/en/lichen-simplex-chronicus-neurodermatitis/.
- Eczema types: Neurodermatitis diagnosis and treatment [Internet]. [cited 2024 Jul 12]. Available from: https://www.aad.org/public/diseases/eczema/types/neurodermatitis/treatment.
- National Eczema Association [Internet]. What is neurodermatitis and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/neurodermatitis/.
- National Eczema Association [Internet]. What is neurodermatitis and how do you know if you have it?; [cited 2024 Jul 12]. Available from: https://nationaleczema.org/eczema/types-of-eczema/neurodermatitis/.
- Eczema types: Neurodermatitis causes [Internet]. [cited 2024 Jul 12]. Available from: https://www.aad.org/public/diseases/eczema/types/neurodermatitis/causes.
