What is Neurodermatitis?

Neurodermatitis, also known as lichen simplex chronicus, is a dermatological condition characterised by a persistent, itchy area of skin that causes discomfort for the sufferer. The affected patch of skin often develops a thick, leathery texture. 1 . Neurodermatitis can occur on various parts of the body, including exposed areas such as the forearms, legs, and neck, as well as more intimate areas such as the groin. These affected areas usually lead to more discomfort due to scratching, known as the scratch-itch cycle. 

Treatments have been developed to disrupt this cycle by reducing the itchy sensation of the affected area. Since neurodermatitis may develop alongside other conditions such as psoriasis or eczema, 2 a correct diagnosis is essential to prescribe effective treatment. If left untreated or in its most severe form, neurodermatitis can lead to skin infections, permanent discolouration or hyperpigmentation, trouble sleeping, difficulty performing daily tasks, and sexual dysfunction.

Topical treatments in managing Neurodermatitis

Corticosteroids

Topical treatments such as topical corticosteroids 3 are applied directly to the skin but can also be injected into the affected area to increase the dosage strength. Corticosteroids are primarily used to manage skin itchiness by acting as an anti-inflammatory agents, reducing skin soreness to promote healing of the area. 

For neurodermatitis, healthcare professionals commonly prescribe ointment-based corticosteroids. The specific type of corticosteroid prescribed will depend on a variety of patient-specific factors.

Corticosteroids are available in mild forms over the counter and in stronger forms when prescribed by a healthcare professional. Injections of corticosteroids are also administered by healthcare professionals to treat severe cases of neurodermatitis. 

Despite their widespread use for various dermatological conditions, corticosteroids may cause a range of side effects, both skin-related and systemic, as highlighted by a medical study conducted by Hengge et al. in 2006. The following side effects were identified:

Skin-related side effects:

• Atrophy: Thinning of the epidermis on the skin, striae (stretch marks), and easy bruising
• Telangiectasia: Visible dilated blood vessels, appearing as red or blue clusters under the skin
• Purpura: Increased fragility of blood vessels, leading to bursting and causing purplish discolourations of the skin
• Perioral Dermatitis and Rosacea: Can be caused by improper application to the face
• Impaired Wound Healing

Systemic side effects - occurring after long-term use:

• Hypothalamic-Pituitary-Adrenal (HPA) Axis Suppression: This can suppress the body’s HPA axis, affecting cortisol production and increasing the risk of infection
• Cushing’s Syndrome: Excess cortisol, which can induce metabolic changes such as weight gain.

Calcineurin Inhibitors

Topical treatments may also include calcineurin inhibitors which are not steroid-based but act to reduce skin inflammation. They work by blocking the body’s natural production of calcineurin, thereby decreasing the activity of T-lymphocytes within the immune system and reducing the inflammatory response at the site 5. These topical treatments can be prescribed for multiple diseases, including neurodermatitis, as they reduce redness and itchiness of affected skin areas. They have been shown to effectively treat these symptoms without some of the common side effects associated with corticosteroid treatments, as highlighted by Thaci et al. in their study in 2010. Calcineurin inhibitors were found to significantly reduce skin thickness and itchiness, although they can also cause a burning or stinging sensation when applied. This treatment is usually recommended for patients who require prolonged treatment and need a sustainable option that will not cause skin thinning over time.

Emollients for managing Neurodermatitis

Emollients, more commonly known as moisturisers, reduce itchiness and dryness of the skin by filling in cracks in the skin’s barrier (epidermis) with healthy oils, helping to restore the skin’s barrier. The epidermis is important for trapping moisture in the skin and preventing irritants and bacteria from entering. Keeping the epidermis healthy and hydrated in cases of neurodermatitis is crucial. Restoring this barrier after it has been damaged by scratching is key to alleviating dryness and itchiness in patients. A review conducted by Lodén in 2003 found that emollients were effective at reducing symptoms of neurodermatitis, especially when used in conjunction with corticosteroids. It is recommended to use emollients and corticosteroids 20-30 minutes apart and to leave 2 hours between using emollients and calcineurin inhibitors to prevent the spread of treatment to unaffected areas and to maintain effective concentrations of treatments. Emollients themselves have very few side effects; however, allergic reactions and irritation on particularly sensitive skin are possible. 

FAQs

When should I go and see a doctor?

Neurodermatitis or any dermatological condition should be evaluated by a healthcare professional if there is an area of skin that remains persistently itchy and does not improve within 2 days or if it disrupts your sleep. The sensation may come and go or be intense. Other symptoms, in addition to itchiness and scaly, leathery skin, may include discoloured or wrinkled skin that appears darker, or open sores that may lead to infections. 

How do I know if I have Neurodermatitis or just Eczema?

 A healthcare professional will usually take a skin sample or perform an observational examination to determine whether the affected area is neurodermatitis or another skin condition. If you experience persistent skin discomfort, it is best to see a specialist to obtain a correct diagnosis and receive effective treatment.

What can cause Neurodermatitis?

As with most dermatological conditions, the direct cause of neurodermatitis is not known. However, it is thought that, since it can arise alongside other skin conditions, it must have similar triggers. These triggers can include skin irritants such as chemicals in body soaps or clothing that can cause continuous scratching. Additionally, psychological triggers such as anxiety are thought to play a role in the development of neurodermatitis. Certain risk factors increase your chances of developing neurodermatitis, such as your age (usually develops between 30-50 years of age), having previous skin conditions, or having a family history of dermatological complications.

Summary

Neurodermatitis is a skin condition characterised by itchy, red skin that feels dry and leathery to the touch. It can develop alongside other skin conditions such as eczema and psoriasis, so a healthcare professional should examine the suspected area to confirm whether it is neurodermatitis. This condition can be caused by anxiety, skin irritants, or a history of skin problems. 

 Various treatments are available for this disease such as corticosteroids (steroidal treatments) that are applied to the skin to reduce inflammation and itchiness. While effective at reducing symptoms, corticosteroids may cause side effects, including damage to the epidermis with long-term use. Calcineurin inhibitors work by reducing the inflammatory response in the affected area, decreasing inflammation, heat, and redness, and they typically have fewer side effects in comparison to corticosteroids. 

Finally, emollients can be used to treat neurodermatitis by filling in gaps between flaky skin, restoring the skin barrier, and preventing moisture loss. These treatments can be used in combination for effective management, provided that there is a gap between applications.