What Is Neurodermatitis?

Introduction 

Neurodermatitis, also known as lichen simplex chronicus (LSC), is a skin condition involving an itch-scratch-itch cycle.^1,2 The feeling of the itch makes people scratch, making the area itch even more.³ The constant scratching leads to a thick layer of skin at the scratching site, creating a leathery and potentially discoloured patch of skin.^2,3,4  This condition affects about one in every eight people worldwide.^1,2  In addition to issues with the skin, neurodermatitis can lead to sleep disturbances, sexual dysfunction, as well as psychological and physical problems.^1,2  There are several treatment options available to address this condition. 

Understanding neurodermatitis

Common symptoms of neurodermatitis 

The most common symptoms of neurodermatitis are scratching and areas of thick skin, also known as skin plaques.^2,4 These skin plaques usually appear in the regions that are easy to scratch, such as the scalp, head, neck, arms, hands, legs, and genitals.^1,2,5 The plaques could also have a different colour to your skin, and their colour could range from different shades of yellow to a deep reddish-brown.² The plaques often begin as dark patches on a smooth skin surface and then develop into small raised bumps, making the affected area look rough and bumpy.⁴  Later, the deeper layers of the skin become thicker and more rigid and cause the skin markings to appear exaggerated.⁴  In most cases, the lesions may not have clear boundaries.⁴ 

Neurodermatitis can also cause sleep disturbances due to the desire to scratch even when sleeping.¹ Many patients with neurodermatitis also report increased sexual difficulties.^1,6 Neurodermatitis could lead to infection, especially if the skin breaks.² Additionally, while very uncommon, it is possible that neurodermatitis progresses to cancer of a part of the skin called the epithelium.²

What causes neurodermatitis? 

There are many causes of neurodermatitis. As it describes a cycle of itching and scratching, many causes of itching could precipitate it.² If that initial itching and scratching continue to the point of skin thickening, then it might progress to neurodermatitis.² These causes can also be associated with other skin conditions, such as psoriasis, eczema, or environmental factors, such as tight clothing or a bug bite.^1,2 

Another common cause is stress. Being stressed or having mental health disorders such as depression, anxiety, or obsessive-compulsive disorder (OCD) could lead to constant scratching.1,2,5,7 Other psychological factors are thought to play a causative role, where itching is used to help calm down an emotional disturbance.2,7 Sometimes, the cause is unknown. While it is known that the itching causes the scratching that produces the plaques, the underlying cause may not be clear.²

Who can get neurodermatitis? 

People with a pre-existing skin condition that causes scratching are particularly vulnerable to neurodermatitis.^1,2 Furthermore, people who are stressed, have depression, anxiety, or OCD are more likely to get neurodermatitis.^4,7 

It commonly affects people aged 30-50 and is relatively uncommon in children. Also, it is twice as common among those assigned female at birth (AFAB) than those assigned male at birth (AMAB).²

Diagnosing neurodermatitis 

Seeking medical advice 

It is important to seek medical advice if you believe that you might be suffering from neurodermatitis. Due to the complex nature of this condition and its many possible causes, medical expertise is necessary to successfully treat it and its underlying cause. 

Medical history and physical examination 

Doctors diagnose neurodermatitis mainly based on your history and the findings of a physical examination.⁸  This entails asking you about the events that led you to scratch, how long you have been scratching and when it came about, and other information about you.⁸ This may include questions about your mental health, past medical history, social factors, or family history. 

The physical examination will include the doctor taking a look at the skin plaques and areas where you scratch the most.⁸  They will determine if those patches are characteristic of neurodermatitis - in terms of shape, size, and colour or if they represent another skin condition.⁸

Diagnostic tests for neurodermatitis  

If there is doubt about the diagnosis after taking a history and a physical examination, doctors can use skin scraping or a skin biopsy to be sure.⁸  These tests can also help in figuring out the cause of neurodermatitis, which is essential for treatment.⁸ Skin scraping is a procedure where they take a small sample from the top layers of your skin to examine it. This helps doctors to eliminate the possibility of other conditions, like fungal infections.⁸  The skin biopsy involves removing a tiny piece of your skin and looking at it under a microscope. As mentioned above, there are many possible causes of neurodermatitis. Therefore, further diagnostic tests might be necessary to determine the cause and treat it successfully. These tests will depend on what your doctor suspects the cause is, so these could differ for every individual.   

Managing neurodermatitis 

Treatment options 

The management of neurodermatitis is based on treating the underlying cause.^2,8 However, this is not enough, as the itch-scratch-itch cycle may persist after the initial trigger has been dealt with.^2,8 Ending this cycle is of utmost importance because this can prevent the skin plaques from progressing, reducing the risk of infection and cancer. This could also provide relief, especially at night.^2,8 

Topical medications 

To ease itching, doctors may prescribe creams or ointments with corticosteroids that you apply on the skin.^2,8 After using these, you can cover the area for a while to avoid scratching.^2,8  If these are insufficient, doctors might inject steroids directly into the affected area.⁸

Doctors might also prescribe antibiotics if there is an infection along with the skin plaques.²

Oral medications 

If the itching is causing problems with your sleep, they might give you antihistamines or certain antidepressants that can help reduce itching and make you feel sleepier.^2,8 

Different treatments can help you feel better if you have psoriasis or eczema. Doctors may prescribe medications that lower your immune system's activity for inflammation and symptoms.⁸ These medications can reduce the redness and swelling on your skin.⁸

Psychotherapy

As mentioned above, these conditions are often linked to how you feel emotionally, and so therapy might be suggested.^2,8 Receiving cognitive behavioural therapy (CBT), can help you change negative thought patterns. Another option is habit reversal therapy, which may help you stop scratching.^2,8  In some cases, antidepressant medications might be given as well to help improve your mood.^2,8

Light therapy 

For severe cases, light therapy (or phototherapy) using UVA and/or UVB rays can be used, except for the genital region.²

Lifestyle changes to help manage symptoms 

Skincare 

Moisturising regularly helps prevent your skin from getting dry, which in turn helps reduce the sensation of itching and makes for healthier skin.⁸ You can get such moisturisers without a prescription. Some of these moisturisers contain colloidal oatmeal, which can protect the skin from some irritants found in the environment.⁸

Furthermore, wearing loose or baggy clothes can help reduce scratching.^2,8 You can also use cool compresses by applying them on the affected areas, which can relieve itching.⁸

Stress management 

As mentioned above, stress is a common cause of neurodermatitis.^1,2,5,7 Therefore, taking measures to reduce or prevent excess stress could help with neurodermatitis.^1,2,5,7

Identifying triggers

Finding what caused your neurodermatitis is one part of solving the puzzle. Another part is finding what exacerbates or triggers the intense itching and scratching.^2,8 These triggers may include certain foods, environments, clothes, or bug bites.^2,8 Once you have identified these triggers, reducing your exposure to them could also provide much-needed relief.^2,8 

Summary

Neurodermatitis, also known as lichen simplex chronicus (LSC), is a skin condition that involves an itch-scratch cycle, where the urge to scratch causes more itching, leading to thick and discoloured patches on the skin.^2,3,4 These patches commonly appear on areas that are easy to scratch.^1,2,5 There are various causes, including other skin conditions, environmental factors, and psychological issues like stress, anxiety, and depression.^2,4,5 To diagnose neurodermatitis, doctors will take a medical history and conduct a physical examination, and in some cases, they might use skin scraping or biopsy.⁸ Treatment involves managing the underlying cause and breaking the itch-scratch cycle.^2,8  Topical and oral medications can help ease itching, and psychotherapy might be recommended for psychological factors.^2,8 In severe cases, light therapy may be used.² Lifestyle changes such as moisturising regularly, wearing loose clothing, and managing stress can also help manage symptoms.⁸ Identifying triggers and reducing exposure to them can provide relief from neurodermatitis.⁸