How to Get Rid of Neurodermatitis
Dealing with the Itch Scratch Cycle of Lichen Simplex Chronicus
Mar 4, 2009
Certain insights to the itch scratch cycle will provide the patients with specific tips on how to get rid of neurodermatitis. Neurodermatitis is characterized by intense itching and lichenification where the skin is thickened, pigmented and the skin markings accentuated.
Causes of Neurodermatitis
There are two types of lichen simplex chronicus (LSC), depending upon the cause.
- Primary Neurodermatitis. Here the exact cause is unknown; the incessant rubbing and scratching is thought to be triggered by emotional stress and anxiety in predisposed individuals.
- Secondary Lichenification. In chronic dermatitis, where the skin becomes thickened and lichenified due to chronic rubbing and scratching, even after the initial eliciting event is long gone, the patient continues with the itching, sustaining the neurodermatitis.
Whatever the cause, once the skin becomes sensitized, the nerve endings beneath the skin surface become hyperactive and irritable, producing severe itching sensations, to which the patient responds with violent bouts of scratching and rubbing.
This itch scratch cycle becomes a habit, further causing lichenification of the skin and thickening of the underlying nerve endings.
Any emotional stress, anxiety or depressive episodes sends nerve signals to the skin and the individual, knowingly and unknowingly start the itch scratch cycle.
Signs and Symptoms of Neurodermatitis
Itching or pruritus is the predominant symptom in neurodermatitis. Sometimes the itching is out of proportion to the clinical appearance of the skin. The itching comes in paroxysms of heightened intensity, with the scratching providing a certain amount of mental satiety to the patient. But when the scratching continues, the skin becomes sore and irritated.
The acute stage of oozing, swelling and bright red color is conspicuous by their absence in lichen simplex chronicus. Initially the skin may be a little red and mildly swollen with the normal skin lines exaggerated.
Neurodermatitis is more common between the ages of 30 and 50; women are affected more often than men. Single or multiple areas of involvement may be there. The usual sites of involvement are the lateral aspect of the legs, ankle, nape and sides of neck, scalp, upper thighs, the vulva in females and scrotum in males and the outer aspect of forearms and arms.
Lichen simplex chronicus has to be differentiated from chronic contact dermatitis, lichenified plaque psoriasis, lichen planus and hypertrophic chronic ring worm infestation.
Treatment of Neurodermatitis
Neurodermatitis, as the name indicates, is not a simple itchy skin rash. Most often it has got deep psychological ramifications, which have to be addressed if one is to get rid of lichen simplex chronicus.
- Patient education. Affected individuals should be made to understand that it is the scratching and rubbing that sustains the skin thickening and itching. The psychological issues have to be brought out and sorted out.
- Psychological support. In intractable neurodermatitis, the individual should get a psychology consultation. Psychotherapy, hypnosis, biofeedback techniques and relaxation therapies have all helped patients.
- For very thick lichenified plaques of lichen simplex chronicus, intralesional injection of triamcinolone at a concentration of 10-20 mg/ml will provide dramatic results.
- Moderate thickness neurodermatitis patches will respond well to super potent and potent topical steroids, especially under plastic occlusion in the early stages of treatment.
- Tar or steroid impregnated tapes are useful for prolonged use. Care should be taken to reduce the strength of the steroid once the thickness is reduced. At this stage, steroid sparing applications like tacrolimus or pimecrolimus may be used.
- Topical 5% doxepin has been used as a maintenance therapy in some patients.
- Sedating antihistamines like hydroxyzine and minor anxiolytic medications are also useful adjunctives in the management of lichen simplex chronicus.
Reference
Disclaimer
The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.
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