What Are The First Symptoms Of Neurodermatitis & How Do You Test For It?

Neurodermatitis is a chronic skin condition that is characterized by lichenification plaque secondary to excessive itching. Therefore, it is also known as lichen simplex chronicus. It affects about 12% of the total population with a higher predilection for women than men. Although neurodermatitis is not life-threatening, it can have a major impact on the quality of life of a person along with psychosocial burden. The patients with neurodermatitis commonly have an underlying psychological disorder, mainly anxiety or depression. Since patients with neurodermatitis have psychological disorders; they also have complaints of sleeping disorders, sexual dysfunction, and poor social skills. These underlying conditions greatly reduce the quality of life of patients suffering from neurodermatitis.(1)

What Are The First Symptoms Of Neurodermatitis?

What Are The First Symptoms Of Neurodermatitis?

The first and predominant symptom of neurodermatitis is severe itching and it can be so intense that repeated itching and rubbing of the skin can lead to a lesion that resembles a circumscribed scaly patch. The margins of the patch are sharp with thickening of the affected skin with exaggeration of the normal markings of the skin known as lichenification. It can be further divided into localized (circumscribed) and generalized (disseminated) types with the primary or secondary origin. The disseminated type is almost always atopic dermatitis.(2)

Some patients may have only a single affected area, while others may have affected multiple areas. Neurodermatitis appears in areas that are accessible to itching. The commonly affected sites include the nape of the neck, lower legs, and ankles, side of the neck, scalp, upper thighs, vulva, pubic area, and scrotum in men, forearms, and wrists. In women, the most commonly affected area is the nape of the neck where the lesion may extend to the scalp and may be confused with psoriasis. In men, the most commonly affected area is the ankles due to personally scratching or using the chair leg as a scratch board. The disease is not found in children, only adults more so females are affected.(2)

How Do You Test For Neurodermatitis?

Emotional stress plays an important role in perpetuating the lichenification of the lesion in predisposed people with pruritus dermatoses. However, the prefix ‘neuro’ has made the diagnosis of neurodermatitis synonymous to any anxiety-related dermatoses and it has been labeled to any emotionally related lesion. Therefore, to overcome this misunderstanding it is important to carefully examine the morphology, configuration, and distribution of the lesion and not only depend on the history for proper diagnosis of this lesion. Neurodermatitis may commonly be confused with psoriasis of the scalp and neck, chronic trichophyton rubrum infection of feet, legs, groin, and perianal areas, lichen planus, chronic contact dermatitis and dry skin eczema in winters.(2)

To reach a confirmatory diagnosis of neurodermatitis, other skin conditions should be ruled out. Laboratory studies can be carried out and an elevated serum immunoglobulin E level supports the diagnosis of atopic dermatitis. Potassium hydroxide test and fungal cultures are done to exclude the diagnosis of tinea cruris or candidiasis in patients with genital neurodermatitis. Patch testing can be done to rule out allergic contact dermatitis as an underlying primary dermatosis (for example, allergic contact dermatitis to nickel with secondary neurodermatitis) or as a chronic factor (for example, allergic contact dermatitis to topical corticosteroids used for the treatment of neurodermatitis). Skin biopsy can also be performed to rule out other skin conditions, such as psoriasis or mycosis fungoides (cutaneous T-cell lymphoma) in adult patients.(3)

The management of neurodermatitis is aimed at reducing the severity of itching and rubbing and the extent of the lesion. Topical steroid is the treatment of choice as it leads to a reduction in inflammation and itching as well as softening of the hyperkeratotic lesion. Intralesional steroid injection is given for refractory lesions, whereas disseminated lesions may require total body phototherapy. Antianxiety medications and antihistamines may be considered in some patients, whereas, antibiotics may be needed for infected lesions.(3)

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