Neurodermatitis also is known as lichen simplex chronicus is a skin condition that starts due to repeated scratching and rubbing of the skin. The mechanical trauma caused by repeated scratching the area leads to lichenification, thickening, and scaling of the skin. Approximately 12% of the adult general population is affected by neurodermatitis. It is more commonly found in females than in males. Lichen nuchae is a form of neurodermatitis that is seen on the mid-posterior nape of the neck, which is only found in females. Individuals aged 30-50 years are more commonly affected with neurodermatitis.(1)
What Are The Ways To Prevent Neurodermatitis?
The first and foremost way to prevent neurodermatitis is to stop and avoid the urge to scratch or rub the affected area. It is also important to take anti-itch medicines as directed by the physician. As stress and anxiety can cause neurodermatitis flares, it is important to stay calm and relaxed. If the itch starts to appear, then one can use a cold compress or take a cold shower to reduce the heat and reduce the itch. Colloidal oatmeal addition to a cold bath can help in reducing the itch. The optimal temperature should be maintained as a hot and humid climate can exacerbate pruritus. Tight clothing can rub against the skin and irritate the skin, making the skin prone to itching; therefore, it is best to avoid tight clothes and to wear loose and comfortable clothes. All the allergens should be avoided that might trigger pruritus. Keeping fingernails short and trim also reduce unnecessary damage to the affected skin. Since neurodermatitis is a chronic condition, it can be difficult to stop the urge to itch; therefore, the affected area can be covered with plastic, clothing, corticosteroid tape, or gauze dressing to prevent scratching. This method is particularly helpful to avoid scratching while sleeping.(2)
Does Neurodermatitis Recur?
The questions whether neurodermatitis recurs or not depends totally on the patients resolve to avoid and stop scratching and patients who do not comply with the instructions of a doctor are more likely to have a recurrence of neurodermatitis. Extreme hot temperatures, humidity, stress, and exposure to the previous allergen also lead to the recurrence of neurodermatitis. Therefore, while maintaining all the precautions, i.e. hot temperatures, humid environment, stress and exposure to the allergen is important to avoid recurrence. It is also important to discuss various ways to change habitual scratching of the affected area to prevent recurrence of neurodermatitis.(1)
Neurodermatitis is mostly found in areas that are accessible to scratching and rubbing. Although scratching is aggravated by pruritus, the underlying pathophysiology of neurodermatitis is still unknown. Neurodermatitis is commonly seen in individuals with atopic dermatitis and atopic diathesis. It is also closely related to psychiatric conditions such as anxiety, depression, and obsessive-compulsive disorder. Other possible reasons for neurodermatitis are insect bites, traumatic scars, post-herpes zoster, xerosis, acne keloidalis nuchae, venous insufficiency, and asteatotic eczema.(1)
Treatment Of Neurodermatitis
The main objective of the treatment of neurodermatitis is to reduce or minimize the existing lesions. The location, extent, and morphology of the lesion also play a significant role in the management of neurodermatitis. Currently, the treatment of choice is topical steroids as they work on reducing the inflammation and pruritus along with softening hyperkeratosis. Low potency topical steroids are used for thin skin areas such as vulva, face, scrotum, and axilla; whereas, mid-potency steroid is used for the treatment of large and active lesions. High potency topical steroids are used for areas where the skin is thick. For the lesions that are refractory, Intralesional corticosteroid injections are given. The patients with anxiety may be given anti-anxiety drugs (doxepin, clonazepam) and antihistamines (diphenhydramine, hydroxyzine) may also be given to relieve itching and mild inflammation. Antibiotics are given for infected lesions. Patients who are not responsive to topical corticosteroids can be given topical tacrolimus, while disseminated lesions need to be treated with systemic medications and total body phototherapy.(1)
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