Imagine an itch so intense that no
amount of scratching brings relief and you have some idea of what it
feels like to have neurodermatitis. This common eczema develops when
nerve endings in the skin become irritated, triggering a severe
itch-scratch-itch cycle. Common causes of nerve irritation include
an insect bite and emotional stress.
Scratching the intensely itchy
skin of neurodermatitis caused these reddish, rough plaques.
With repeated scratching, white scratch marks appeared, and
over time, the patient’s skin thickened and darkened.
with permission of the American Academy of
National Library of Dermatologic Teaching Slides)
Signs and Symptoms
Intensely itchy skin that is usually
itchiest when the person is resting or relaxing.
Once the skin is scratched, a vicious
itch-scratch-itch cycle develops. The more the skin is scratched,
rubbed, or even touched, the more it itches. The itch can become
so intense that it disrupts sleep.
Develops on any area of the body the
person can scratch or rub. Most commonly appears on the lower
legs, ankles, back and sides of the neck, wrists, forearms, and
Constant itch causes nervous tension
(anxiety) in some patients.
Often develops on skin previously
affected by an outbreak of atopic dermatitis or contact dermatitis
(two common types of eczema) or psoriasis.
Scratching can cause:
Small, well-defined, scaly, reddish
Openings in the skin that cause
burning pain and leave the patient more susceptible to infection.
Signs of infection include open sores, cracks in the skin, and
Visible scratch marks.
Over time, constant scratching causes
the skin to thicken and darken, and lines in the skin to become
more prominent. Thickening can cause a cutaneous horn (piling up
of skin cells that resembles an animal’s horn).
Affected skin may turn pink, red, or
reddish brown. When the skin becomes very thick, it sometimes
develops a grayish hue.
Neurodermatitis develops more frequently in:
People who have psoriasis, allergic
contact dermatitis, or irritant contact dermatitis
Individuals who have an atopic
condition, such as atopic dermatitis, asthma, or hay fever
Mid-to-late adulthood, with most
cases developing between 30 and 50 years of age
While the exact cause remains unknown, researchers have found
that for some people exposure to certain triggers can increase the
risk of developing neurodermatitis.
Research indicates that the following can irritate the nerves
of susceptible people, triggering the intense itch-scratch-itch
cycle of neurodermatitis:
Clothing worn tightly and made of
synthetic fabric or wool
While uncommon, these may also
Exhaust from traffic (long-term
Exposure to allergens and skin
irritants. For example, some people develop neurodermatitis after
using a hair dye that contains P-phenylenediamine (PPD).
Period of intense stress or emotional
Poor blood flow
Scar, especially a keloid-type scar
Neurodermatitis remains until it is
Since effective treatment requires
the person to stop scratching, the condition can be a challenge to
Neurodermatitis can return with
exposure to triggers.
Since neurodermatitis may occur along with other common skin
conditions, such as other types of eczema and psoriasis, it is
best to see a dermatologist for a diagnosis. Effective treatment
requires that all skin conditions be accurately diagnosed.
Diagnosis of neurodermatitis involves:
Diagnosis also may include:
A skin biopsy. Removing a bit
of the affected skin so that it can be examined under a microscope
may be necessary. This procedure helps diagnose a skin infection
or another skin condition.
Patch testing. This test helps
determine what substances cause an allergic reaction in the
The goal of treatment is to stop the itch. What makes
treatment so challenging is that the patient must quit scratching,
rubbing, and even touching the affected skin. To help the patient
and treat the eczema, a dermatologist may prescribe a:
Topical corticosteroid. A
mainstay of treatment, this medication helps reduce inflammation
and itch. It is important to apply all corticosteroids as directed
to get the full benefit and reduce the risk of side effects.
Topical antibiotic. When the
skin is broken, this helps to prevent infection and to treat a
Oral antibiotic. This helps
clear a skin infection.
Topical keratolytic. This
helps reduce thick skin. A preparation containing urea, salicylic
acid, or lactic acid may be used.
Sedative or tranquillizer. In
some cases, this can be helpful in reducing anxiety and help the
patient to get restorative sleep.
Occlusion (wrapping the affected
skin) may be used to increase the potency of medications and help
the patient avoid scratching. In addition to applying medication
as directed, dermatologists often recommend that patients:
Cut their fingernails very short
Apply ice to the area when it itches
instead of scratching
Avoid common irritants that can cause
itch, such as wearing wool or tight fitting synthetic clothing,
becoming overheated, and stressful situations
Follow specific bathing guidelines
Clark RAF et al. “The Other Eczemas.” In: Moschella SL et al.
Dermatology (third edition). WB Saunders Co.: Philadephia,
Hogan D et al. “Lichen Simplex Chronicus.” eMedicine. Last
updated June 12, 2006. Last accessed August 2006.
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developed by the American Academy of Dermatology
for neurodermatitis is “lichen simplex chronicus” because the
condition often lasts a long time (chronic) and repeated scratching
causes the skin to thicken and darken (lichenification).