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NEURODERMATITIS


Neurodermatitis is a skin condition that falls under the category of atopic disorders. Those disorders also include hay fever, allergic asthma and food allergies. Neurodermatitis is a chronic inflammatory disease that is also known as atopic dermatitis or atopic eczema, and more rarely as endogenous eczema or Besnier’s prurigo.

Who can get neurodermatitis?


Neurodermatitis can occur at any age, sometimes even in infants. Certain individuals have an inherited genetic predisposition to it. Its course is always episodic, with symptom-free periods of varying duration. The condition’s extent, symptoms and degree of suffering can vary. A very mild form may hardly impair a person’s daily life, while a severe form can cause severe impairment with great suffering and an enormous amount of mental and physical stress, for example due to avoidance of social contact and sleep deficits. Typical symptoms of neurodermatitis include very dry, flaking, reddened skin and pronounced itching. Long-term atopic eczema also causes rough skin with areas of thickening (lichenification).

How does neurodermatitis manifest in children and adults?


Atopic eczema can occur even in small children, sometimes even in babies. Neurodermatitis is not curable, meaning that some individuals continue to suffer from it when they are adults. Atopic eczema in adults often takes a more severe course than it does in young people. Neurodermatitis affects different parts of the body more or less extensively at different ages.


Atopic eczema in infants

This chronic form of eczema does not occur before the age of three months and tends to be characterized by diffuse distribution, primarily on the face, scalp and neck as well as on the outsides of arms and legs. This form is usually accompanied by excruciating itching that prevents infants and therefore parents from getting any rest, especially at night. The skin is also very dry all over. Often, the diaper area remains clear. An additional bacterial super-infection can complicate treatment.


Atopic eczema in children

In children, the patches of eczema gradually shift to areas with skin creases, primarily the hollows of the knees and elbows.
These areas eventually become heavily lichenified, with severe drying, thickening and flaking. The skin is also very dry all over. At this age, troublesome eczema of the hands also develops, and the face and neck are frequently affected. Here too, bacterial super-infections can lead to a significant deterioration in the appearance of the skin. The affected areas of skin are more susceptible to viral infections; for example, molluscum contagiosum or bacterial impetigo contagiosa may occur. In addition, activities like swimming lessons in chlorinated water can further dry out the skin and cause the existing neurodermatitis to grow worse.


Atopic eczema in adults

Atopic dermatitis can occur in a wide range of types and extents in adults. For example, there are mild versions that occur only on eyelids, hands, neck and genitals, but also extremely pronounced forms that involve generalized redness of the skin everywhere. One very common variant is nummular eczema, which is accompanied by circular (nummular, or coin-shaped) to oval flaky or crusty plaques that are often more pronounced around the edges. The skin is generally dry and sensitive, requires consistent daily replenishing care and tends to be itchy.


EXPERT TIP

Avoid irritating, drying substances, allergens and intensive contact with water. Start a consistent basic treatment plan using replenishing skin-care products adapted to your skin’s degree of dryness.


What are the causes of neurodermatitis?


Many factors can cause neurodermatitis. Genetic predisposition plays a big role here. The probability of a child developing atopic dermatitis is 50% if one parent has hay fever, allergic asthma or neurodermatitis; if both parents are affected, that percentage increases to 75%. This predisposition leads to a disturbance of the skin’s ability to function as a barrier, causing the skin to dry out and become more sensitive. In addition, this disturbance of the barrier function allows substances and allergens that would not get past healthy skin to penetrate into the skin.

The “hygiene hypothesis” provides another explanation for the genesis of neurodermatitis. It posits that in the modern world, people’s excessive hygiene measures keep them from being confronted with enough microbes, leading the immune system to react disproportionately to those it does encounter.


What are the causes of neurodermatitis?


Many factors can cause neurodermatitis. Genetic predisposition plays a big role here. The probability of a child developing atopic dermatitis is 50% if one parent has hay fever, allergic asthma or neurodermatitis; if both parents are affected, that percentage increases to 75%. This predisposition leads to a disturbance of the skin’s ability to function as a barrier, causing the skin to dry out and become more sensitive. In addition, this disturbance of the barrier function allows substances and allergens that would not get past healthy skin to penetrate into the skin.

The “hygiene hypothesis” provides another explanation for the genesis of neurodermatitis. It posits that in the modern world, people’s excessive hygiene measures keep them from being confronted with enough microbes, leading the immune system to react disproportionately to those it does encounter.

What triggers atopic eczema?


Having a genetic predisposition does not necessarily mean that a person will develop atopic eczema. However, there are various things that can trigger it. The following are examples of such trigger factors:

  • Allergens: House dust mites, grass pollen, animal hair and -- in infants -- often foods as well.
  • Dry skin: Dry climate conditions as well as skin-care mistakes can likewise create conditions favorable to atopic dermatitis.
  • Skin-irritating materials and fabrics: Woolen fabrics, skin-irritating cosmetics or cleaning products are among the potential triggers of neurodermatitis in affected individuals and can also worsen existing cases of neurodermatitis.
  • Infections: There are two ways in which infections play a significant role in neurodermatitis. An infection like a cold can jump-start atopic eczema, but it is also possible for bacteria, viruses and fungi to cause an existing case of neurodermatitis to get worse.
  • Climate: Temperature fluctuations and extreme climate conditions, as well as humidity and the sweating that goes along with it, are factors that can promote the development of atopic eczema.
  • Hormonal fluctuations: Atopic eczema can be triggered by hormonal adjustments within the body. During pregnancy, menstruation or menopause, an outbreak or worsening of atopic dermatitis is more likely.
  • Mental health: Stress can also cause neurodermatitis to get significantly worse.

What can be done for neurodermatitis?


Because a predisposition to atopic eczema, or the presence of atopic diathesis, cannot be eliminated, neurodermatitis itself is not curable. There are of course therapies than can alleviate symptoms and improve quality of life. However, the affected individual has to take the initiative. Doing so can help prolong symptom-free periods and ensure that outbreaks remain mild.   

Avoid triggers

Because there are numerous things that can trigger neurodermatitis, it is important to conscientiously avoid them. If affected individuals are not sure what the triggers are, it is often helpful to document complaints and their possible triggers over a period of several weeks in a symptom diary.

Basic skin care

Atopic eczema requires very mild, gentle cleansing and conscientious replenishing, protective basic skin care that is adapted to an individual’s particular skin. Individuals should test lotions, such as those containing botanical oils (evening primrose oil), dexpanthenol, zinc or urea, before use. Long hot showers, multiple daily showers and long baths should be avoided, as should any kind of irritation.


What can be done for neurodermatitis?


Because a predisposition to atopic eczema, or the presence of atopic diathesis, cannot be eliminated, neurodermatitis itself is not curable. There are of course therapies than can alleviate symptoms and improve quality of life. However, the affected individual has to take the initiative. Doing so can help prolong symptom-free periods and ensure that outbreaks remain mild.   

Avoid triggers

Because there are numerous things that can trigger neurodermatitis, it is important to conscientiously avoid them. If affected individuals are not sure what the triggers are, it is often helpful to document complaints and their possible triggers over a period of several weeks in a symptom diary.

Basic skin care

Atopic eczema requires very mild, gentle cleansing and conscientious replenishing, protective basic skin care that is adapted to an individual’s particular skin. Individuals should test lotions, such as those containing botanical oils (evening primrose oil), dexpanthenol, zinc or urea, before use. Long hot showers, multiple daily showers and long baths should be avoided, as should any kind of irritation.



Drug therapy

Topical corticosteroids and calcineurin inhibitors weaken the inflammatory reaction by causing the immune system’s response to become milder. This can be supported by applying tannin-containing substances, for example compresses made with black tea, externally. Systemic therapies are used in severe cases. Light and climate therapies can also bring about good responses.

Desensitization

If neurodermatitis is accompanied by an allergy, desensitization can be performed in order to weaken the immune system’s over-reaction to the allergens.

Supportive measures

There are other measures that can help make symptoms milder during an outbreak of neurodermatitis. These include therapeutic measures that treat the often excruciating itching or directly attack bacterial super-infections.



Psychological treatment and relaxation exercises

Professional psychological treatment and relaxation techniques help many people with atopic eczema deal with both psychosocial aspects of the condition and quality of life restrictions due to the excruciating itching and visible rash. In addition, this can help the individual discover and avoid triggers that may have psychological origins.

Nutrition

Here too, keeping a diary of complaints is advisable in order to find potential connections between worsening or triggering of atopic eczema and intake of certain foods. Infants often experience worsening of neurodermatitis due to food allergies. In such a case, the relevant foods should be avoided, at least temporarily.

Drug therapy

Topical corticosteroids and calcineurin inhibitors weaken the inflammatory reaction by causing the immune system’s response to become milder. This can be supported by applying tannin-containing substances, for example compresses made with black tea, externally. Systemic therapies are used in severe cases. Light and climate therapies can also bring about good responses.

Desensitization

If neurodermatitis is accompanied by an allergy, desensitization can be performed in order to weaken the immune system’s over-reaction to the allergens.

Supportive measures

There are other measures that can help make symptoms milder during an outbreak of neurodermatitis. These include therapeutic measures that treat the often excruciating itching or directly attack bacterial super-infections.

Psychological treatment and relaxation exercises

Professional psychological treatment and relaxation techniques help many people with atopic eczema deal with both psychosocial aspects of the condition and quality of life restrictions due to the excruciating itching and visible rash. In addition, this can help the individual discover and avoid triggers that may have psychological origins.

Nutrition

Here too, keeping a diary of complaints is advisable in order to find potential connections between worsening or triggering of atopic eczema and intake of certain foods. Infants often experience worsening of neurodermatitis due to food allergies. In such a case, the relevant foods should be avoided, at least temporarily.


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