Neurodermatitis

Neurodermatitis is a skin condition that starts with an itchy patch of skin. Scratching makes it itch more. With more scratching, the skin becomes thick and leathery. You may develop several itchy spots, typically on the neck, wrists, forearms, legs or groin area.

Neurodermatitis — also known as lichen simplex chronicus — is not life-threatening or contagious. But the itching can be so intense it disrupts your sleep, sexual function and quality of life.

Breaking the itch-scratch cycle of neurodermatitis is challenging, and neurodermatitis is usually a long-term condition. It may clear up with treatment but often returns. Treatment focuses on controlling the itching and preventing scratching. It also may help to identify and eliminate factors that worsen your symptoms, such as dry skin.

Symptoms of neurodermatitis include:

• An itchy, scaly skin patch or patches
• Open sores that bleed
• Thick, leathery skin
• Discolored, wrinkled genital skin
• Raised, rough patches that are inflamed or darker than the rest of the skin

The condition involves areas that can be reached for scratching — the scalp, neck, wrists, forearms, ankles, vulva, scrotum and anus. The itchiness, which can be intense, may come and go or be nonstop. You may scratch your skin out of habit and while sleeping.

When to see a doctor

See your health care provider if home remedies haven't helped after two days and:

• You catch yourself repeatedly scratching the same patch of skin
• The itch prevents you from sleeping or focusing on your daily routines

Seek immediate medical care if your skin becomes painful or looks infected and you have a fever

The exact cause of neurodermatitis isn't known. It can be triggered by something that irritates the skin, such as tight clothing or a bug bite. The more you scratch, the more it itches.

Sometimes, neurodermatitis goes along with other skin conditions, such as dry skin, atopic dermatitis or psoriasis. Stress and anxiety also can trigger itching.

Factors that can increase the risk of neurodermatitis include:

• Age. The condition is most common among people between 30 and 50 years of age.
• Other skin conditions. People who have or had other skin conditions, such as atopic dermatitis or psoriasis, are more likely to develop neurodermatitis.
• Family history. People whose blood relatives have or had hay fever, childhood eczema or asthma may be more likely to develop neurodermatitis.
• Anxiety disorders. Anxiety and emotional stress can trigger neurodermatitis.

Persistent scratching can lead to a wound, a bacterial skin infection, or permanent scars and changes in skin color (postinflammatory hyperpigmentation or hypopigmentation). The itch of neurodermatitis can affect your sleep, sexual function and quality of life.

To see if you have neurodermatitis, your health care provider will look at your skin and talk with you about your symptoms. To rule out other conditions, your health care 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.

Treatment for neurodermatitis focuses on controlling the itching, preventing scratching and addressing underlying causes. Even with successful treatment, the condition often returns. Your health care provider may suggest one or more of the following treatments:

• Anti-itch creams. If corticosteroid cream that you can by at a store isn't helping, your health care provider may prescribe a stronger corticosteroid or a nonsteroidal anti-itch product with a calcineurin inhibitor, such as tacrolimus (Protopic) or pimecrolimus (Elidel). A calcineurin inhibitor may be helpful in easing itching in sensitive areas such as the genitals.
• Corticosteroid injections. Your health care provider may inject corticosteroids directly into the affected skin to help it heal.
• Medicine to ease itching. Prescription antihistamines help relieve itching in many people with neurodermatitis. Some of these drugs may cause drowsiness and help prevent scratching while you sleep.
• Anti-anxiety drugs. Because anxiety and stress can trigger neurodermatitis, anti-anxiety drugs may help prevent the itchiness.
• Medicated patches. For stubborn itching, your health care provider may suggest lidocaine or capsaicin (kap-SAY-ih-sin) patches.
• OnabotulinumtoxinA (Botox) injection. This technique may be helpful to people who haven't had success with other treatments.
• Light therapy. This technique also may be helpful to people who haven't had success with other treatments. It involves exposing the affected skin to certain types of light.
• Talk therapy. Talking with a counselor can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching. Your counselor might suggest some behavioral techniques to try.

These self-care measures can help you manage neurodermatitis:

• Stop rubbing and scratching. The itching may be intense, but avoiding rubbing and scratching is key to controlling your condition and preventing the itch from coming back.
• Apply cool, wet cloths. These may soothe the skin and relieve the itch. Put a cool, wet cloth on the affected skin for a few minutes before you apply a medicated cream. This helps the cream soak into the skin.
• Try cooling lotions. Apply calamine lotion or a lotion that contains camphor or menthol.

• Try nonprescription medications. Apply an anti-itch cream or lotion to the affected area. Do this three times a day for two days. A hydrocortisone cream can temporarily relieve the itch. If you keep the cream in the refrigerator, it's cool and soothing when you use it. Or try a nonsteroidal cream with menthol or pramoxine (CeraVe, Sarna, others) to help ease the itch.

  An oral antihistamine, such as diphenhydramine (Benadryl), can relieve severe itching and help you sleep. Some people have success with capsaicin cream, but it may sting at first.

• Cover the affected area. Bandages or dressings can help protect the skin and prevent scratching. These may be especially useful if you scratch during your sleep.
• Keep your nails trimmed. Short nails may do less damage to the skin, especially if you tend to scratch while you're asleep. You might try wearing mittens when you sleep too.

• Take short, warm baths and moisturize your skin. Prepare your bath with warm — not hot — water. Sprinkle in an oatmeal-based, also called colloidal, bath product (Aveeno). Use mild soaps without dyes or perfumes. Limit bathing time and frequency. Ideally, shower or bathe no more than once a day, and try to limit the shower or bath to 10 minutes or less.

  After washing, pat your skin dry and apply unscented moisturizer.

• Avoid triggers. Notice what seems to bring on a recurrence and avoid it. For example, if a stressful event triggered itching, try learning stress management techniques.

You may start by seeing your primary care provider. Or you may be referred to a doctor who specializes in skin conditions called a dermatologist.

Here's some information to help you get ready for your appointment.

What you can do

Before your appointment, make a list of:

• Symptoms you've been having and for how long
• Key personal information, including any major stressors or recent life changes
• All medications, vitamins and supplements you take, including the doses
• Questions to ask your health care provider

For neurodermatitis, some basic questions to ask your health care provider include:

• What's the most likely cause of my itching?
• Are there other possible causes?
• Do I need any tests?
• Will the itching ever stop?
• What treatments do you recommend?
• What side effects can I expect from treatment?
• What else might help?
• How long will it take for my skin to get better?
• I have other health conditions. How can I best manage them together?

What to expect from your doctor

Your health care provider is likely to ask you questions, such as:

• Do your symptoms come and go, or are they fairly constant?
• What products do you use on your skin, including soaps, lotions and cosmetics?
• What steps have you taken to manage the itchiness?
• Have any of these measures helped?
• Have you been stressed or anxious lately?
• How much do your symptoms affect your quality of life, including your ability to sleep?