Introduction

Neurodermatitis, also known as lichen simplex chronicus, is a chronic skin disorder associated with intense itching sensation and thickened, scaling patches. It results from scratching the skin, which leads to a cycle of itching and scratching that worsens over time.^1,2  

It commonly affects adults, mainly those with a history of eczema, psoriasis, allergies, or psychological stress. Neurodermatitis may affect both people assigned male at birth (AMAB) and people assigned female at birth (AFAB), though it is more commonly seen in middle-aged individuals.²

Neurodermatitis management includes both physical and psychological aspects that can help in effective control of the disease, which may result in significant improvements in a patient's quality of life. So, in this article, we are going to discuss the common trigger factors, the symptoms of neurodermatitis, and how it is managed.

Causes of neurodermatitis

The exacerbating and trigger factors associated with neurodermatitis are not defined clearly. For instance, dry skin can sometimes trigger or worsen the condition in case of neurodermatitis. However, some possible causes of exacerbating neurodermatitis include nerve injuries and wearing tight clothing. Sometimes, neurodermatitis occurs as a result of other skin diseases like eczema and psoriasis.⁵ The common causes responsible for exacerbating neurodermatitis are:

• Dry skin: Lack of moisture in the skin can increase itchiness and irritation
• Hormonal changes: These include hormonal fluctuations during menstrual cycles, pregnancy, or menopause
• Infections: Infections like bacterial or fungal can aggravate the condition
• Poor hygiene: Inadequate skin care with unhygienic conditions can worsen symptoms
• Certain foods: Spicy foods, dairy products and sometimes certain food additives can exacerbate neurodermatitis

Skin conditions like neurodermatitis don't heal by themselves and rarely heal without treatment and may occur again. So, it is better to prevent its occurrence and manage them at early stages.

Common triggering factors

The common trigger factors are:

• Stress and anxiety: Emotional stress or mental imbalance such as anxiety, or depression can initiate or worsen symptoms
• Skin irritation: Scratching or rubbing the skin may trigger the itch-scratch cycle
• Environmental factors: These include extreme temperatures, changes in season, humidity and pollution. High humidity and temperature promote the growth of allergens which may trigger itch
• Allergens: Exposure to allergens like pollens, dust mites, and pet dander may trigger skin irritation
• Clothing and fabrics: Rough or synthetic fabrics may irritate the skin

Despite various trigger factors, the underlying cause of neurodermatitis is unknown. Studies report that the itch may start in an extremely stressful condition, emotional trauma, anxiety or depression and may continue even after the removal of underlying causes.⁴ This provokes us to know the causes, which can make the symptoms of neurodermatitis worse.

Symptoms of neurodermatitis  

Neurodermatitis is a non-life-threatening yet common chronic allergic skin condition characterized by the presence of a persistent itch-scratch cycle. It presents with dry, scaly, thickened, and patchy skin as the result of this itch-scratch cycle. A very common type of neurodermatitis is lichen simplex chronicus (LSC); depending on the stage, LSC may present as well as localised or disseminated lesions of the skin.  

Commonly affected areas  

The skin lesions may characteristically affect the following:

• Scalp
• Neck sides 
• Extensor forearms: responsible for the extension of the fingers and the wrist
• Ankles
• Genital areas (vulva, pubis, scrotum, and perianal)

Symptoms 

• Patches of skin that are itchy or dry and scaly 
• Open sores that may bleed
• Thick, leathery skin 
• Discolored or wrinkled skin on the genitals
• Rough, raised patches, or those more often inflamed than surrounding skin  

Prevalence and impact  

Neurodermatitis happens to people of all ages from children to adults its incidence is more frequent in females than in males. Apart from the physical aspects, which a patient with neurodermatitis has to deal with, the patient may be found to be suffering from psychological consequences such as:  

• Compulsive habits and dissociative experiences
• Anxiety and depression
• Sleep disturbances and sexual dysfunction  
• Poor social relationships and reduced quality of life  

Awareness of the triggering and aggravating factors in neurodermatitis will allow physicians to advise the patient about the best management and preventive measures, thus ensuring the patient's overall well-being.

Management of neurodermatitis

Since neurodermatitis does not heal without treatment, a unique treatment plan is recommended by a dermatologist for each patient. The main concern in the treatment is to break the itching and scratching cycle. Usually, the treatment plans proposed  include medications such as:

Antihistamines

It is used to cut the itch and scratch cycle during sleep and can be used to prevent allergic reactions which may worsen the condition.

Antibiotics

These medicines are prescribed when a patchy area is affected by neurodermatitis. Antibiotics can be taken orally in pill form or applied topically to the skin.

Corticosteroids 

They are injected in the patch or may be applied on the itchy patch. Corticosteroids are also helpful in reducing heat, swelling, itching, redness and softening thickened skin.

Moisturisers

They are applied to the skin to reduce dryness and itching.

Capsaicin creams 

These are effective in relieving pain and itching.

Coal tar preparations 

Such medicine helps the skin to shed dead cells and decelerate the growth of new cells. They can be applied directly on the skin of the patient or can also be added to their bath.

Sometimes management of neurodermatitis is challenging and thus requires preventive measures as mentioned below, to stop the recurrence of itching or scratching. Therapies like acupuncture or cupping therapies (a type of acupuncture therapy) along with medications such as topical corticosteroids, antihistamines, antipruritics (itch relieving medications) as antihistamines (Doxepin, Capsaicin, Aspirin), antibiotics etc. are used to treat and control the condition but not to cure it permanently.⁶ 

Preventive strategies for neurodermatitis

While all these treatments may alleviate the symptom for a short term,  they may result in side effects including burning, dryness, erythema and hyperpigmentation which can limit the effects of treatment. Therefore emotional, mental and behavioural changes are also suggested with treatment which include:

• Stress management: Techniques such as mindfulness, meditation, therapy and sometimes antidepressants are advised if it is believed that stress, anxiety or depression is causing the itch
• Sleep deprivation: Poor sleep causing awakening can increase itchiness and slow skin healing. So, it is advised to have adequate sleep and improve its quality
• Dietary habits: A balanced diet with anti-inflammatory and antioxidant-rich foods can help to reduce itchiness
• Proper skin care: Regularly moisturise the skin and use gentle skin care products
• Avoiding triggers: Identify and minimise exposure to known irritants or triggers
• Healthy lifestyle choices: Maintain a balanced diet with consistent water intake, regular exercise, and sleep

Emotions-regulating skills serve a therapeutic role in patients having psychological abnormality with neurodermatitis.⁷ Studies reported that lifestyle-related improvements, including avoiding exposure to allergens, mindfulness-based cognitive hypnotherapy and homoeopathy are beneficial in alleviating the condition. The side effects due to conventional medication for prolonged employment have directed dermatologists as well as patients to seek multifaceted effective measures or treatments to control the chronic and relapsing nature of neurodermatitis.

Summary

Neurodermatitis is a skin condition consisting of an itch-scratch cycle that results in itchy, dry, scaly skin patches or patches. It is difficult to treat for a long period but crucial to prevent causes of neurodermatitis from recurring. It is often referred to as Lichen simplex chronicus (LSC). There are various factors responsible for triggering it, such as emotional stress or mental imbalance, scratching or rubbing the skin caused by irritants or allergens. Environmental factors and clothing or fabrics are also found to initiate itchiness.  Persistent scratching may lead to bacterial skin infections, wounds or permanent scars and may also change skin colour as post-inflammatory hyperpigmentation or hypo-pigmentation. 

The itch caused by neurodermatitis has adverse impacts on sleep quality, daily activities, mental peace, sexual function and quality of life. Conditions like dry skin, infections, poor hygiene and hormonal imbalances can also worsen it. Neurodermatitis does not heal on its own and thus requires consulting healthcare providers or dermatologists for personalised care plans. Although medicines are helpful to control it for a while, they require comprehensive management including combining lifestyle changes and stress management with medical treatments.