Neurodermatitis

Overview

This skin disease, also called atopic dermatitis, is characterised by severe itching, dry and leathery skin, and eczema in differing degrees of severity. Based on a hereditary disposition, neurodermatitis is caused by an immune reaction in the skin. Various factors influence the disease. It is important to avoid these and to apply good skincare.

Synonyms

neurodermatitis, atopic eczema, atopic dermatitis, endogenous eczema

Symptoms

Main symptoms

• Eczema: chronic inflammation of the skin, intermittent in nature
• The main symptom is itching
• Dry skin owing to impaired secretion of sebum and fat
• Acute stage
  • Oozing eczema, swollen body part
  • Blisters, scales and crusts
  • Often worse in late autumn, winter or spring
• Chronic stage
  • Red, raw and dry skin
  • Skin quickly forms small and painful tears
  • Leathery and thickened skin (“rhino skin”, lichenification) caused by chronic inflammation, scratching and infections
• Typical locations
  • Children and young people: crook of the arm, back of the knee, neck, eyelids, side of the face
  • Adults: hands, neck, forehead and eyelids, ears or feet
• Consequences, complications
  • Eczema can become infected by bacteria, viruses or fungi
  • Particularly susceptible to bacteria that cause pus ('pyogenic') and the herpes virus

Causes and treatment

Causes

• Genetic factors (family predisposition)
• Immune reaction of the skin
• Chronic inflammation, deficient sebum production and dry skin
• Factors that can trigger the disease, e.g.
  • Stress, tension, stressful events
  • Skin irritants: chemicals, cleaning agents, cosmetics, physical or mechanical friction (wool, excessive skin cleansing, sweating, heat exhaustion)
  • Climate (cold, very dry or very humid air)
  • Hormones: thyroid disorders, pregnancy
  • Lifestyle: overweight, tobacco, alcohol
  • Allergies to pollen, animal hair, house dust, food
  • Infections (e.g. cold)

Further treatment by your doctor / in hospital

Possible tests

• Blood and allergy tests
• Skin examination

Possible therapies

• Topical external application
  • Preparations containing tar, urea, zinc or possibly cortisone
  • Ointments containing tacrolimus (to avoid the side-effects of cortisone)
  • Anti-inflammatory ointments (for purulent discharge or blisters)
• Systemic application (“internal”, affects the entire system)
  • Anti-itching medication (usually antihistamines)
  • Cortisone tablets (anti-allergic effect)
• Psychological support, neurodermatitis training
• Light and climate therapy
• Acupuncture or acupressure
• Sometimes antibiotics are needed

What can I do myself?

• Don’t scratch
  • Worsens the skin symptoms
  • Increases the risk of infection
  • Only improves the itching for a short while
• Relieve itching
  • Stroke gently with a soft brush
  • Menthol powder or camphor solutions
• Wear linen or cotton clothing; cotton and synthetic blends
  • Avoid woollen and synthetic-only fabrics
• Skincare
  • Sparing use of skin-friendly soap
  • Cistus wash solution
  • Moisturising oil baths (1 tbsp olive oil mixed with 2 cups milk)
  • Lukewarm water for bathing and hand washing rather than hot
  • Use ointments and moisturising emulsions without additives, don't apply too generously, rather apply small amounts several times a day
  • Wet compresses, apply calendula salve
• Lifestyle
  • Pursue a low-stress, regular and balanced lifestyle
  • Find strategies for coping better with the itching (relaxation, autogenic training)
• Dietary measures
  • As a rule, strict “neurodermatitis diets” aren't useful (abstention from sugar, meat, etc.)
  • It might be useful to avoid spicy foods and alcohol
• For known allergies: avoid the triggers as far as possible
• Don’t smoke
• Change in climate (beach or mountains) often has a positive effect
• Breastfeed children with a genetic predisposition for a long time
  • This can reduce the possibility of the child developing neurodermatitis or allergies

When to see a doctor?

• Skin rash causing much suffering
• Purulent eczema
• Substantial worsening of eczema
• Eczema accompanied by fever

Further information

aha! Swiss Allergy Centre (aha! Allergiezentrum Schweiz) www.aha.ch

CSS has joined forces with the aha! Swiss Allergy Centre to offer courses for children and parents, as well as holiday camps for children with neurodermatitis. Children will learn in a fun, interactive way how to cope better with their condition. You, as parents, will learn more about neurodermatitis, and gain practical tips for dealing with it in everyday life.