Neurodermatitis

Neurodermatitis is a skin condition that creates an intense itch-scratch cycle, where scratching an itchy patch of skin makes it even itchier, leading to thick, leathery patches that can disrupt sleep, daily activities, and quality of life.

lichen simplex chronicus

Table of contents

• What is neurodermatitis?
• What does neurodermatitis look like?
• Who is most likely to get neurodermatitis?
• What causes neurodermatitis?
• What are the symptoms?
• How is neurodermatitis diagnosed?
• Treatment options
• Possible complications
• Living with neurodermatitis

What is neurodermatitis?

Neurodermatitis is a skin condition that starts with an itchy patch of skin. When you scratch it, the itching becomes worse, leading to more scratching. Over time, this repeated scratching causes the skin to become thick and leathery^[1]. The condition is also known as lichen simplex chronicus^[2].

Unlike other types of skin conditions that can appear in many places at once, neurodermatitis usually shows up as just one or two patches on the body^[4]. The condition is not life-threatening and is not contagious, meaning you cannot catch it from someone else or spread it to others^[1].

However, the itching can be so severe that it disrupts your sleep, affects your daily routines, and reduces your quality of life^[1]. The itch can occur anywhere on the body that you can reach to scratch, but it most commonly appears on the arms, shoulders, elbows, legs, ankles, wrists, hands, back of the neck, or scalp^[2]. The genital and anal areas, as well as the face, may also be affected^[2].

Neurodermatitis rarely goes away without medical treatment^[2]. Breaking the itch-scratch cycle is challenging, and the condition is usually long-term. It may clear up with treatment but often returns^[1].

What does neurodermatitis look like?

The itchy patches in neurodermatitis typically measure between 3 centimeters by 6 centimeters (about the size of a matchbook) and 6 centimeters by 10 centimeters (roughly the size of a deck of playing cards)^[2].

These patches appear as raised, rough areas of skin with a thick, leathery texture^[1]. The skin becomes dry and scaly, with visible lines forming a distinct pattern on the affected area^[15]. The patches can be differently colored depending on your skin tone. They may look reddish, brownish, yellowish, gray, or purple^[2]. On light skin, patches often appear red, while on dark skin they may look violet^[6].

Older patches may appear white or pale in the center, surrounded by darker colors^[2]. Over time, the patches can develop a dark border around their edges^[4]. Scarring may develop from repeated scratching^[2].

If the affected area is on the scalp, you may notice round, scaly patches, and the flakes may look similar to dandruff^[6]. When neurodermatitis affects the scalp, it can also lead to hair loss in those areas^[2].

Who is most likely to get neurodermatitis?

It is estimated that neurodermatitis occurs in about 12% of the population^[2]. The condition most commonly affects people between 30 and 50 years old^[2]. It is rarely diagnosed in children, though some children with atopic dermatitis have also developed neurodermatitis^[4].

Women are more likely than men to develop neurodermatitis, at a ratio of 2:1^[2]. The condition is particularly common among elderly, Asian individuals^[4].

Certain groups of people have a higher risk of developing neurodermatitis. Those with anxiety disorders, obsessive-compulsive disorder, or depression are at increased risk^[2]. People with a personal or family history of other skin diseases are also more likely to develop this condition. This includes those who have or had eczema, contact dermatitis, or psoriasis^[2].

People with allergies and asthma are also at risk^[4]. Additionally, people whose family members have or had hay fever, childhood eczema, or asthma may be more likely to develop neurodermatitis^[5].

Some studies have suggested that individuals with certain personality traits, such as poor social skills, lack of flexibility, or high levels of stress, may be more likely to have neurodermatitis^[2]. The condition often presents in people who live stressful or competitive lifestyles^[4].

What causes neurodermatitis?

The exact cause of neurodermatitis is not fully understood^[2]. Some experts think it is caused by nerves in the skin overreacting^[6]. Once the itch-scratch cycle begins, scratching irritates nerve endings in the skin and worsens the itching, leading to more scratching^[2].

The itch can start during times of extreme stress, anxiety, emotional trauma, or depression^[2]. Sometimes, the itching continues even after the mental stress eases or stops^[2].

Several factors can trigger neurodermatitis or make it worse. These include nerve injuries, insect bites, and very dry skin^[2]. The condition can be triggered by something that irritates the skin, such as tight clothing or a bug bite^[5]. Wearing tight clothing, especially if made from synthetic fibers like polyester or rayon, can cause sensitive skin to overreact and itch^[2].

Neurodermatitis sometimes develops alongside other skin conditions. It can occur as a result of eczema or psoriasis^[2]. Sometimes, it appears together with dry skin or atopic dermatitis^[5].

What are the symptoms?

The main symptom of neurodermatitis is intense itching^[1]. This itching usually begins on a small patch of skin and can be so strong that it causes frequent scratching^[2]. The itching may be constant or may come and go^[1]. It is most active when you are relaxing or trying to sleep^[2]. In some cases, you may wake up scratching or rubbing the affected area without realizing it^[2]. You may also scratch your skin out of habit, even while sleeping^[1].

The skin in the affected area becomes thick and leathery from repeated scratching^[1]. You will notice raised, rough patches that appear inflamed or darker than the rest of the skin^[1]. The patches are typically dry and scaly^[1].

Other symptoms can include pain, though the patch itself may not hurt unless you scratch it intensely^[6]. Open sores and bleeding can occur due to repeated scratching^[2]. If scratching occurs on the scalp, hair loss may develop in those areas^[2].

Infection is another possible symptom. This is indicated by sores with yellow-colored crusts, fluid discharge, or pus-filled bumps^[2]. When the genital area is affected, you may notice discolored, wrinkled skin^[1].

How is neurodermatitis diagnosed?

If you have symptoms of neurodermatitis, you should see a healthcare provider or dermatologist^[6]. To diagnose the condition, your provider will examine your skin and talk with you about your symptoms^[9]. They may examine the itchy area, possibly with a magnifying instrument^[2].

The doctor will first rule out other skin conditions, such as eczema and psoriasis^[2]. They will take a complete medical history and may ask questions such as when the itch started, whether it is constant or comes and goes, and what home remedies you have tried^[2].

Several tests may be used to confirm the diagnosis or rule out other conditions. A skin swab test can find out if there is an infection^[2]. Patch testing may be performed to determine if there are accompanying allergies^[16]. Fungus tests can help identify general skin disorders^[16].

To rule out other conditions, your healthcare provider may take a small sample of the affected skin to have it examined under a microscope in a laboratory. This test is called a skin biopsy^[9]. A biopsy can help detect or exclude other conditions such as certain forms of skin disease^[16]. Blood tests may also be performed^[16].

Treatment options

Treatment for neurodermatitis focuses on controlling the itching, preventing scratching, and addressing underlying causes^[9]. Even with successful treatment, the condition often returns^[9]. The main goal is to stop the itch-scratch cycle^[16].

Your healthcare provider may suggest one or more of the following treatments:

Anti-itch creams are often the first line of treatment. If over-the-counter corticosteroid cream is not helping, your healthcare provider may prescribe a stronger corticosteroid^[9]. Alternatively, they may prescribe a nonsteroidal anti-itch product with a calcineurin inhibitor, such as tacrolimus or pimecrolimus. A calcineurin inhibitor may be especially helpful in easing itching in sensitive areas such as the genitals^[9].

Corticosteroid injections may be given directly into the affected skin to help it heal^[9]. This treatment involves the doctor injecting the medication into the itchy patch^[16].

Medicine to ease itching includes prescription antihistamines, which help relieve itching in many people with neurodermatitis^[9]. Some of these drugs may cause drowsiness and help prevent scratching while you sleep^[9].

Anti-anxiety drugs may be prescribed because anxiety and stress can trigger neurodermatitis. These medications may help prevent the itchiness^[9].

Medicated patches containing lidocaine or capsaicin may be suggested for stubborn itching^[9]. These patches are applied directly to the affected area.

OnabotulinumtoxinA injection, commonly known as Botox, may be helpful for people who have not had success with other treatments^[9].

Light therapy is another option that may be helpful for people who have not had success with other treatments^[9]. This technique uses specific types of light to treat the affected skin.

It is important to identify and eliminate factors that worsen your symptoms, such as dry skin^[1]. Your healthcare provider can help you develop strategies to break the itch-scratch cycle.

Possible complications

Persistent scratching can lead to several complications. These include wounds from intense scratching^[7] and bacterial skin infections^[7]. An infection may cause sores with yellow-colored crusts, fluid discharge, or pus-filled bumps^[2].

Permanent scars and changes in skin color can develop from repeated scratching^[7]. The affected area may become permanently darker or lighter than the surrounding skin. Over time, scarring may appear on the affected patches^[2].

The itch of neurodermatitis can significantly affect your sleep, sexual function, and overall quality of life^[7]. The condition can have a psychological impact and may cause significant stress, anxiety, and sleep disturbances^[22].

Living with neurodermatitis

Neurodermatitis is a long-term condition that can be challenging to manage^[1]. The itching, dryness, and discoloration rarely clear up without medical treatment^[2]. Breaking the itch-scratch cycle is difficult, and the condition may clear up with treatment but often returns^[1].

Researchers have found that people with neurodermatitis find scratching to be highly pleasurable. Brain imaging studies have shown that scratching activates the brain’s reward systems^[4]. This contributes to the itch-scratch cycle, where scratching causes damage to the skin barrier, which then triggers more itching^[4].

You should see your healthcare provider if home remedies have not helped after two days and you catch yourself repeatedly scratching the same patch of skin, or if the itch prevents you from sleeping or focusing on your daily routines^[7].

You should seek immediate medical care if your skin becomes painful or looks infected and you have a fever^[7]. Signs of infection include yellow-colored crusts on sores, fluid discharge, or pus-filled bumps^[2].