Imagine an itch so severe you can’t sleep. Scratching is so excessive it can lead to both physical and mental exhaustion. The skin condition, neurodermatitis, occurs in an estimated 12% of the world population.¹ Although it manifests with skin issues, this can be the influence of psychological factors such as stress that can exacerbate the condition.²

Introduction 

Neurodermatitis, or lichen simplex chronicus (LSC), is a chronic skin condition that begins with an itch. The condition involves an intense itch-scratch-itch cycle usually isolated to one or two patches of skin. Over time and with continuous scratching, the patches become dry, scaly and thick resulting in areas of skin called skin plaques. 

Although not life-threatening, it can lead to sleep disturbance, sexual dysfunction and impact the mental health and well-being of sufferers. It is twice as common in those assigned female at birth (AFAB) than those assigned male at birth (AMAB). Due to the increased stress at this stage of life, it is also more common in mid to late-life adults.¹

Understanding neurodermatitis

Causes and triggers

There can be multiple causes of neurodermatitis and they can be both physical and/or psychological. However, the cause can also be unknown. Physically, itch can be caused by skin conditions like eczema or psoriasis. Environmental factors such as extreme temperature or humidity, tight or irritating clothing, a bug bite or excessive sweating are also responsible for the itch-scratch cycle. Excessively dry skin or nerve damage may also put you at risk of developing neurodermatitis. 

Psychologically, stress and mental health disorders such as depression, anxiety and obsessive compulsive disorder (OCD) are thought to play a role here. If the cycle of itching and scratching is intense enough to result in skin plaques then these physical or psychological factors can lead to neurodermatitis. 

Symptoms

The most common symptoms of neurodermatitis are:

1. Intense itch
2. Scratching leads to skin plaques
3. Discoloured skin
4. Pain

These symptoms can significantly disrupt sleep, sexual function and daily life. Symptoms are often detrimental to a patient’s emotional well-being. Anxiety and stress can trigger flares, which can lead to more anxiety and stress. 

Chronic nature and potential complications

A potential complication can be Infection. Persistent scratching can cause the skin to break and bleed, leading to bacterial skin infections. In rarer cases, neurodermatitis can develop into skin cancer. In this, the activation of inflammatory chemicals by continuous scratching and rubbing transforms skin cells into cancerous ones. However, this is uncommon and the link between neurodermatitis and potential skin cancer development requires more research.³ 

Diagnosis

Doctors can diagnose neurodermatitis by taking a complete medical history and by examining the skin plaques. If there is doubt about the diagnosis, they can also use other diagnostic techniques such as skin scraping or a skin biopsy, to help rule out other conditions.

Due to the many potential causes and complex nature of this condition, it’s important to seek medical advice if you believe you may have neurodermatitis. A medical can help to uncover the underlying cause and ensure you receive effective treatment. 

Psychological impact of neurodermatitis

The psychological impact of neurodermatitis is significant as it may contribute to both the development and persistence of neurodermatitis.⁴ In addition, those with neurodermatitis are at higher risk of experiencing mental health problems such as stress, anxiety and depression.⁵ 

Anxiety and stress

The vicious cycle of itch and anxiety contributes to chronic itch intensity and progression. Stress has also been shown to aggravate the conditions. Many chronic itch patients report that stress is a factor that worsens their itch.⁶ Studies have also shown that patients with neurodermatitis have statistically higher stress scores when compared to healthy individuals.⁵

Depression

Depression is also of significant concern for those with neurodermatitis.⁵ The psychological impact of the condition, combined with physical symptoms of chronic pain and discomfort can severely affect quality of life.

The visible nature of the condition can also lead to feelings of low self-esteem and negative body image, which in turn exacerbate low mood and depression.

Sleep disturbances

Excessive scratching, symptomatic of neurodermatitis can cause and contribute to poor sleep quality.⁷ Poor sleep can harm both neurodermatitis symptoms and mental health. A lack of sleep can lead to irritability and mood disturbance which in itself can contribute to mental health issues. Improving sleep quality can help to alleviate both skin symptoms and mental health concerns in neurodermatitis patients.

Social and emotional well-being

Social isolation

Neurodermatitis can have a significant social and emotional impact on those affected. Chronic skin conditions can negatively affect mood and self-worth leading to the avoidance of social situations and a reduction in daily activities.⁸ The skin affects, how physical and psychosocial factors interact, how we are perceived by others, and can have adverse effects on health.⁹ 

As a result, those with neurodermatitis tend to have poor social skills or interpersonal resources and a lack of flexibility.⁷ The impact on appearance can also greatly affect the patient's self-esteem. Feelings of embarrassment, rejection and sociocultural stigma may also cause a person to retreat further from social interactions and loved ones. 

Impact on relationships

Relationships with partners, family, friends and caregivers may be negatively impacted. This is caused by the chronic nature of the condition which may lead to anger, frustration and an inability to manage emotions effectively. Romantic relationships, and intimacy in particular, may become challenging due to the association between neurodermatitis and sexual dysfunction.¹⁰

A 2011 study found a decrease in sexual satisfaction, orgasm, lubrication, arousal, and desire in those assigned female at birth (AFAB) with neurodermatitis.¹⁰ Another study examining the effects of skin conditions on quality of life found that neurodermatitis was a more sexually problematic condition than some other diseases including psoriasis.⁷ For those assigned male at birth (AMAB), a 2015 study found that patients with neurodermatitis are at greater risk of developing Erectile Dysfunction.¹¹

For all of the above reasons, patients with neurodermatitis must be evaluated concerning sexual function to provide a better quality of life.¹⁰ 

Coping strategies and management

Neurodermatitis is managed by treating the underlying cause and relieving the urge to itch. As mentioned above, causes can be both physical and/or psychological. A multifaceted approach that addresses both the physical and psychological aspects is recommended. 

Physical treatments

• Corticosteroids can be applied to the skin or injected into the affected area to reduce inflammation and itching
• Antihistamines can help ease itching and promote sleep
• Calcineurin Inhibitors such as tacrolimus and pimecrolimus can be effective in the reduction of inflammation and itching
• Capsaicin Cream, a chilli pepper component, can reduce itching by desensitising nerve endings
• Cool compresses, moisturisers and occlusive treatments can all provide relief from itching
• Physiotherapy techniques are increasing in popularity and can be effective at managing symptoms and improving quality of life¹² 
• Acupuncture can help to improve symptoms and reduce recurrence when used as a supplemental treatment method

Psychological support

• Cognitive Behavioral Therapy (CBT) or counselling helps talk about stress and anxiety and learn coping mechanisms and resilience
• Support groups can provide an opportunity to talk to other patients and reduce social isolation

Lifestyle changes

• Stress management techniques can help to manage flares
• Diet and exercise may reduce stress and improve overall health, which could indirectly benefit neurodermatitis symptoms. Certain dietary changes may also help reduce inflammation or identify trigger foods¹⁴

A combination of the dermatological treatments described above along with the recommended psychological support and lifestyle changes should lead to better outcomes for patients. Dermatologists and mental health professionals should work together to create a comprehensive treatment plan that meets both the physical and mental health aspects of neurodermatitis. This integrated approach can help break the itch-scratch cycle and improve the overall quality of life for patients.

Summary 

Neurodermatitis, or lichen simplex chronicus (LSC) is a chronic skin condition resulting in an itch-scratch cycle. Although not life-threatening, it can lead to sleep disturbance, sexual dysfunction and significantly impact the mental health and well-being of sufferers. It includes both physical and/or psychological causes with some unknown factors. The psychological impact of neurodermatitis is significant and psychological factors, such as anxiety, may contribute to both the development and persistence of neurodermatitis. Chronic skin conditions like neurodermatitis can negatively affect mood and self-worth leading to the avoidance of social situations and a reduction in daily activities.

Relationships can be negatively impacted as the chronic nature of the condition may lead to anger, frustration and an inability to manage emotions effectively. Neurodermatitis is managed by treating the underlying cause and relieving the urge to itch. A multifaceted approach of dermatological treatments along with the recommended psychological support and lifestyle changes is recommended.