Neurodermatitis

Neurodermatitis is a common type of eczema. If you have neurodermatitis, you may notice one or more of these signs and symptoms:

Intense itch

Neurodermatitis begins with an itchy patch of skin. This patch of skin may itch often or from time to time.

As you scratch or rub that itchy patch of skin, the itchy patch often becomes itchier. Dermatologists refer to this itching and scratching as the itch-scratch-itch cycle. This cycle can be difficult to break.

Most people who develop neurodermatitis have one or two itchy patches. It’s also possible to develop several itchy patches, but this is rare.

The itch often becomes more intense while you’re relaxing or sleeping

The itch also tends to worsen when life becomes stressful.

Pain

Some people scratch so much that their skin starts to feel painful. One study found that when neurodermatitis appears on the scalp, people may have both itch and pain.

Raised, rough patch that is violet (in dark skin tones) or red (in light skin tones)

The frequent scratching changes the skin. As you continue to scratch or rub the itchy patch, that patch of skin can turn scaly and look violet to reddish in color.

Neurodermatitis on the back of the neck

Frequent scratching leads to a rough-feeling and discolored patch of skin.

Neurodermatitis is common on the back of the neck

Other common places that neurodermatitis develops are the arms, eyelids, scalp, anus, and genitals.

Open sores that bleed

If you repeatedly scratch or rub the area with neurodermatitis, you may develop open sores that bleed. Open sores increase your risk of developing an infection.

Neurodermatitis on the ankle

Frequent scratching caused this scaly patch of thickened skin and open, bleeding sores.

Infection

Scratching can cause an infection. This happens when germs under your fingernails or on your hands get into your body.

If you see honey-colored crusts, fluid leaking from the itchy area, or pus-filled bumps, call your doctor

These are signs of an infection.

Skin thickens and looks leathery

With frequent scratching or rubbing, the skin tends to thicken in order to protect itself. The itchy patch may look leathery and turn a brownish, gray, or reddish in color. You may also notice that the itchy patch feels dry, rough, and scaly. Even when the skin thickens, the itch continues.

Frequent scratching can cause the skin to thicken

Very thick skin can have a grayish hue.

Hair loss or breakage

If you frequently scratch (or rub) your scalp, it can lead to hair loss. Even on the skin, the frequent scratching can cause a bare patch.

Neurodermatitis often causes round, scaly patches on the scalp

The itchy patches on the scalp can cause lots of flaking, which can be mistaken for dandruff.

Scarring

If scratching causes deep wounds, your skin may scar as it heals.

Neurodermatitis with scarring (white lines)

Skin with scars can itch, too.

What causes this ongoing itching isn’t entirely clear. What scientists have discovered is that some people have a greater risk of developing neurodermatitis.

You can find out if you have a greater risk at, Neurodermatitis: Causes.

Images
1,5,7: Getty Images

2,3,6: Images used with permission of the DermNet NZ.

4, 8: Images used with permission of the American Academy of Dermatology National Library of Dermatologic Teaching Slides

References
Burgin S. “Nummular eczema and lichen simplex chronicus / prurigo nodularis.” In: Wolff K, Goldsmith LA, et al. Fitzpatrick’s Dermatology in General Medicine (seventh edition). McGraw Hill Medical, New York, 2008:160-2.

Habif TP, Campbell JL, et al. “Lichen simplex chronicus” (card #7). Dermatology DDxDeck. Mosby Elsevier 2006.

Juarez MC, Shawn G Kwatra SG. “A systematic review of evidence-based treatments for lichen simplex chronicus.” J Dermatolog Treat. 2020 Mar 6;1-9.

Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018:116-7.

Muylaert BPB, Borges MT, et al. “Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.” An Bras Dermatol. 2018 Jan-Feb;93(1):108-110.

Schoenfeld J. “Lichen simplex chronicus.” In: James WD [editor] Medscape. Last updated August 20, 2020.

Voicu C, Tebeica T, et al. “Lichen simplex chronicus as an essential part of the dermatologic masquerade.” [Open Access] Maced J Med Sci. 2017 Jul 24;5(4):556-7.

Written by:
Paula Ludmann, MS

Reviewed by:
Pearl E. Grimes, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 1/20/21

All content solely developed by the American Academy of Dermatology

Who is most at risk of developing neurodermatitis?

What causes this skin disease isn’t entirely clear. What researchers do know is that some people have a greater risk of developing this disease.

Findings from research studies suggest that you have a greater risk if you have one of these conditions that makes the skin itch:

• Atopic dermatitis

• Contact dermatitis

• Extremely dry skin

• Psoriasis

• Stasis dermatitis

• A condition inside your body that leads to itchy skin, like kidney disease

You may also have a higher risk if you have obsessive-compulsive disorder (OCD) or an anxiety disorder.

OCD, according to the International OCD Foundation, is a mental health disorder that causes unwanted ideas and thoughts that a person cannot stop. Having these thoughts and ideas leads to a great deal of stress or anxiety. To get relief from these thoughts, people often feel the need to repeat certain behaviors. One example is checking to see that doors are locked over and over again.

You also have a greater risk if you are:

• Between 30 and 50 years of age

• Female

• African American or Asian

Neurodermatitis is rare in children. A few children who have eczema (atopic dermatitis) develop neurodermatitis.

When does neurodermatitis usually begin?

The itchiness often begins when someone is going through a difficult period in life. You’re more likely to develop neurodermatitis when you feel intense:

• Anxiety

• Stress

• Depression

Even when life improves, the itch of neurodermatitis often continues.

What causes neurodermatitis?

While researchers have discovered that some people have an increased risk of getting neurodermatitis, what causes this disease is not entirely understood.

It may be that this disease develops when nerves in your skin overreact. This could explain why neurodermatitis often begins when a person feels an intense emotion like stress, anxiety, or depression. These may cause a mind-body reaction.

Nerves may also overreact when you have:

• An allergy

• A bug bite

• An injured nerve

• Excessively dry skin

• Atopic dermatitis or psoriasis (skin diseases)

• Poor blood flow

Dermatologists often refer to the above as “triggers.” This means that for the disease to begin, something must set it off (or trigger it).

Other possible triggers for neurodermatitis include:

• Wearing tight clothing, especially if made of wool, rayon, or polyester

• Being exposed to lots of traffic exhaust

• Sweating or heat

If you think that you may have neurodermatitis, it’s important to find out. Without treatment, the itch can be intense and long lasting. Seeing a dermatologist can help you get an accurate diagnosis. To find out what’s involved in diagnosing and treating neurodermatitis, go to, Neurodermatitis: Diagnosis and treatment.

Image
Getty Images

References
High WA. “Lichenoid skin eruptions.” In: Fitzpatrick JE, et al. Dermatology Secrets Plus (5th ed.), Elsevier. China, 2016:113.

Juarez MC, Shawn G Kwatra SG. “A systematic review of evidence-based treatments for lichen simplex chronicus.” J Dermatolog Treat. 2020 Mar 6;1-9.

Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018:116-7.

Plaza JA, Prieto VG. “Inflammatory skin conditions.” In: Modern Surgical Pathology (2nd ed.), 2009. p. 1843+.

Schoenfeld J. “Lichen simplex chronicus.” In: James WD [editor] Medscape. Last updated August 20, 2020.

Written by:
Paula Ludmann, MS

Reviewed by:
Pearl E. Grimes, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 1/20/21

All content solely developed by the American Academy of Dermatology

How do dermatologists diagnose neurodermatitis?

To find out if you have neurodermatitis, your dermatologist will:

• Examine the itchy patches of skin: This allows your dermatologist to look for signs of neurodermatitis.

• Ask you questions: It’s important for your dermatologist to have some information about you, including when the itch began, whether the area itches all the time or the itch comes and goes, and what you do to relieve the itch.

• Take a swab (if the skin looks infected): This helps tell your dermatologist if you have an infection, so you can receive the right treatment.

• Perform (or refer you for) allergy testing: If your dermatologist thinks the itch could be due to an allergic reaction, this can help find what you’re allergic to.

Knowing where you have itchy skin allows your dermatologist to give you an accurate diagnosis and proper treatment.

If your dermatologist thinks that you may have a second skin condition like psoriasis, you may need a skin biopsy to find out.

Your dermatologist can perform a skin biopsy during your office visit. During a skin biopsy, you remain awake while your dermatologist removes a small amount of skin.

Why see a dermatologist to diagnose neurodermatitis?

Neurodermatitis can develop along with another skin condition, like eczema or psoriasis. For this reason, it is best to see the medical doctor who has in-depth training and experience in diagnosing skin conditions.

Effective treatment requires an accurate diagnosis of all of your skin conditions.

How do dermatologists treat neurodermatitis?

If you have neurodermatitis, treatment is important. Neurodermatitis rarely clears without treatment.

Your dermatologist will create a treatment plan based on your individual signs, symptoms, and needs. Your customized plan may include treatment to:

Stop the itch: For treatment to be effective, you must stop scratching, rubbing, and touching the itchy skin. To relieve the itchy skin, you may need to use one or more of the following:

• Corticosteroid: You usually apply this medicine to the affected area as directed. Sometimes, a dermatologist will inject this medicine directly into the itchy area. A corticosteroid helps reduce the swelling, heat, itch, and tenderness. It can also soften thickened skin.

• Cool compress: Applying a cool compress or soaking the area in water for 5 minutes before you apply a corticosteroid can help the medicine penetrate thickened skin more easily — and reduce the itchiness.

• Antihistamine that makes you drowsy: This can relieve the itch and help you sleep.

• Moisturizer: This reduces dryness, which can reduce the itch.

• Coal tar preparation: You may apply this to your skin or add it to your bath.

• Capsaicin cream or doxepin cream: These may decrease the itch.

You may need to cover the area before you go to bed. This helps to protect your skin from damage caused by scratching while you sleep.

Covering the area can also help the medicine penetrate thickened skin.

If the above treatment fails to stop the itch, your dermatologist may try a less-traditional treatment option. The following treatments, when prescribed or given by your dermatologist, have been reported in medical journals as effective for some patients with neurodermatitis.

• Solution that contains aspirin and dichloromethane, which you would apply to the itchy area

• Tacrolimus ointment or pimecrolimus cream, which you would apply to the itchy area

• Injection of botulinum toxin

While you many think of botulinum toxin as a treatment for wrinkles, it can also help reduce itch. In one study of 3 patients with neurodermatitis, all the patients had noticeably less itch within 1 week after treatment with botulinum toxin. Within 2 to 4 weeks, everyone’s patches of neurodermatitis had cleared.

Heal injured skin: The skin has an outer layer that needs to heal. If it doesn’t heal, an exposed nerve could continue to trigger your desire to scratch. To help your skin heal, your dermatologist may include:

• Soaks: This can be especially helpful for neurodermatitis on the genitals or anus. Soaking can help relieve the itch, irritation, or pain in these areas.

• Moisturizer: Applying this after a soak helps to seal in much needed moisture.

Once the skin starts to heal, moisturizer alone may be all you need. Be sure to use the moisturizer that your dermatologist recommends. Some moisturizers can irritate the sensitive skin, which could worsen neurodermatitis.

Reduce thickened skin: If the skin has become very thick, your dermatologist may recommend a medication that you apply to your skin that can help reduce the thickness.

Treat an infection: If the area is infected, your dermatologist will prescribe a medication that you either apply to the area or take by mouth for a specific time.

Heal a wound: The frequent scratching sometimes causes a wound, which requires treatment. Wounds may be treated with one of the following:

• Wound care that you do at home

• Surgical treatment

• Negative-pressure wound therapy (can do at home)

• Hyperbaric oxygen therapy (requires visits to a hospital)

Alleviate anxiety and stress: When neurodermatitis fails to clear with medication, it can be helpful to think about what’s going on in your life.

Do you have tremendous stress in your life? Are you feeling anxious? Both stress and anxiety can trigger the itch — even when you are treating the itch with medication. If stress or anxiety is a constant in your life, the following may be necessary to get rid of the itch:

• An anti-anxiety medication

• Psychotherapy, so you can talk about stress or anxiety and find ways to manage these effectively

Patient success story

A story printed in a medical journal shows that addressing the psychological issue can be effective. This story begins with a 60-year-old woman who had an intensely itchy patch on her scalp.

The patch had been there for years. At times, the woman’s scalp itched so severely that she scratched the area until it bled. After two years of scratching, the itchy patch on her scalp was completely bald.

By seeing a dermatologist, this woman learned that she had neurodermatitis. Her dermatologist prescribed the following treatment plan:

• Corticosteroid injections, once weekly for 4 weeks

• An anti-anxiety medication

• Psychotherapy

The woman followed this treatment plan. In three months, all her symptoms were gone, and her hair had regrown. In the third month, she stopped taking the anti-anxiety medication. At her six-month follow-up with her dermatologist, she had no signs or symptoms of neurodermatitis.

No one treatment plan works for everyone who has neurodermatitis. That’s why dermatologists continue to study treatment options for neurodermatitis.

If you continue to itch, tell your dermatologist. Other options may be available to you.

A few patients have had success with biofeedback. This is a technique that you would learn. It helps people to control certain responses, such as the desire to scratch.

TENS is another option. It’s short for transcutaneous electrical nerve stimulation (TENS) and consists of using a device to send electrical impulses to your skin. The electrical impulses may reduce itch.

In a small study of 22 patients with neurodermatitis who failed to get relief from corticosteroid medication, TENS helped. At the end of 4 weeks, 80% of the patients had significantly less itch.

Light treatments may be another option. To get light treatments, you need to go to a hospital or medical office that offers this therapy.

What is the outcome for a person who has neurodermatitis?

Neurodermatitis can clear completely. However, it can take time to find a treatment plan that works. You may have to try different treatment options. Each time, it is essential that you follow your treatment plan.

Neurodermatitis rarely goes away without treatment. Once neurodermatitis clears, it can return when triggered. Common triggers for neurodermatitis include stress, anxiety, and anything that irritates your skin. If you get a flare-up, you will need to treat the neurodermatitis again.

Some people find that they need to treat the area to prevent neurodermatitis from returning. Your dermatologist will tell you what is right for you.

Self-care also plays an important role in clearing neurodermatitis. Find out what you can do on your own at, Neurodermatitis: Self-care.

Image
Getty Images

References
Ambika H, Vinod CS, et al. “A case of neurodermatitis circumscipta of scalp presenting as patchy alopecia.” Int J Trichology. 2013 Apr;5(2):94-6.

Engin B, Tufekci O, et al. The effect of transcutaneous electrical stimulation in the treatment of lichen simplex: A prospective study.” Clin Exp Dermatol. 2009; 34(3):324-8.

Heckmann M, Heyer G, et al. “Botulinum toxin type A injection in the treatment of lichen simplex: an open pilot study.” J Am Acad Dermatol. 2002 Apr;46(4):617-9.

Juarez MC, Shawn G Kwatra SG. “A systematic review of evidence-based treatments for lichen simplex chronicus.” J Dermatolog Treat. 2020 Mar 6;1-9.

Legat FJ, Weisshaar E, et al. “Pruritus and dysesthesia.” In: Bolognia JL, et al. Dermatology. (4th edition). Elsevier, China, 2018:116-7.

Liao YH, Lin CC, et al. “Increased risk of lichen simplex chronicus in people with anxiety disorder: A nationwide population-based retrospective cohort study.” Br J Dermatol. 2014 Apr;170(4):890-4.

Lotti T, Buggiani G, et al. “” Prurigo nodularis and lichen simplex chronicus.” Dermatol Ther. Jan-Feb 2008;21(1):42-6.

Muylaert BPB, Borges MT, et al. “Lichen simplex chronicus on the scalp: exuberant clinical, dermoscopic, and histopathological findings.” An Bras Dermatol. 2018 Jan-Feb;93(1):108-110.

Schoenfeld J. “Lichen simplex chronicus.” In: James WD [editor] Medscape. Last updated August 20, 2020.

Tan E, Tan A, et. al. “Tacrolimus ointment 0.1% in the treatment of scrotal lichen simplex chronicus: An open-label study.” J Am Acad Dermatol. 2013;68(4) supp. 1, page AB38. Poster abstract: No commercial support identified.

Yosipovitch G, Sugeng MW, et al. “The effect of topically applied aspirin on localized circumscribed neurodermatitis.” J Am Acad Dermatol. 2001;45(6):910-3.

Written by:
Paula Ludmann, MS

Reviewed by:
Pearl E. Grimes, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 1/20/21

All content solely developed by the American Academy of Dermatology

10 tips dermatologists give their patients who have neurodermatitis

To clear neurodermatitis, you must stop scratching, rubbing, and touching your itchy skin.

Dermatologists understand that this can sound impossible. That’s why they offer their patients with neurodermatitis the following tips.

1. Follow your treatment plan. Your plan includes medication that can stop the itch. For this medication to work, you must use it as directed.
   
   Even when you use the medication as directed, your skin can itch for a while. When the itch starts, you can get temporary relief by doing one of the following:

   • Apply a cool compress to the itchy area. To make a cool compress, run cold water over a clean towel, then apply the cool, damp towel to the area for 10-15 minutes a few times daily.
   • Take a cool bath in colloidal oatmeal. This product is available at your local drugstore.
   • Take an antihistamine that contains diphenhydramine. You can buy these without a prescription. It’s important to know that you will feel sleepy after taking this medication. Only antihistamines that cause drowsiness can ease the itchy feeling.

2. Moisturize. Neurodermatitis makes your skin extremely dry. Apply a fragrance-free moisturizer at least once a day and after every bath or shower. Applying moisturizer while your skin is still damp after washing makes the moisturizer more effective.
   
   Continue to apply moisturizer after your skin heals. Moisturizer can help prevent another flare-up of neurodermatitis.

3. If you cannot stop scratching, rubbing, or touching the skin with neurodermatitis, cover it. Some people have scratched for so long that they don’t realize that they’re scratching. Others scratch while asleep.
   
   You can cover your skin by wrapping it with loose-fitting clothing or an elastic bandage or by applying a corticosteroid tape.

4. Ask your dermatologist about wearing an Unna sleeve or Unna boot if covering your skin fails to protect it. If you scratch while sleeping (or cannot stop scratching), this device can protect the skin on your arm or leg, allowing it to heal.
   
   Should this be an option for you, a nurse or other medical professional will apply the Unna boot or Unna sleeve. These are made of gauze dressing that contains ingredients like zinc oxide to promote healing. The gauze goes on wet and dries hard. You will need to return to your dermatologist to have an Unna sleeve or Unna boot removed.

5. Keep your fingernails very short. When fingernails are very short, they tend to cause less damage if you scratch.

   Getting treatment for neurodermatitis can stop the itch

   ---

   And that can help you feel more comfortable in your own skin.

6. Find ways to reduce stress. When you feel stressed or anxious, neurodermatitis can flare up. Even after your skin clears, stress could cause a new patch of itchy skin.
   
   If you’re unsure how to reduce stress, talk with your dermatologist or primary care doctor. A mental health professional can also provide helpful techniques.

7. Try to stay a comfortable temperature. Heat and sweat can irritate your skin, causing your skin to itch.

8. Wear loose-fitting cotton clothing that feels smooth to the touch. Tight clothing can irritate the skin, causing the area to itch. It’s also best to avoid clothing made of wool or a synthetic fabric, like polyester or rayon.
   
   If you have neurodermatitis in your groin area, wear loose-fitting satin underwear. Silk and synthetic materials like polyester can irritate your sensitive skin. You also want to avoid wearing shapewear. The tight fit can rub and irritate your skin, causing the area to itch.

9. Avoid what triggers your neurodermatitis. Common triggers include becoming overheated and sweating, feeling stressed, and having extremely dry skin. If you’re uncertain about what to avoid, ask your dermatologist.

10. Keep your dermatology appointments. Follow-up appointments will help you get the most out of your treatment plan. For example, your dermatologist may prescribe a medication that you would apply for a few weeks. After that, you’d get a prescription for another medication.
    
    Sometimes, a treatment fails to work. If this happens, keep your appointment. Dermatologists understand that this can happen and work with their patients to find treatment that will help them.
    
    If you’re having trouble following your treatment plan, your dermatologist can also help you sort it out.

Neurodermatitis rarely clears without medical treatment

While you may want to treat the itchy patches of skin on your own, neurodermatitis usually requires prescription medication to clear. Some patients also need help figuring out how to avoid scratching so that their skin can heal.

If you have itchy patches on your skin, take time out to see a dermatologist. Many skin conditions can cause itchy skin. A board-certified dermatologist can figure out what’s causing your itchy skin and create a treatment plan tailored to your needs.

Find a dermatologist

References
Kunin A. "Eczema: Protect your skin, reclaim control.” In: The DERMAdoctor Skinstruction Manual. Simon & Schuster. United States, 2005:98-9.

Schoenfeld J. “Lichen simplex chronicus.” In: James WD [editor] Medscape. Last updated August 20, 2020.

Written by:
Paula Ludmann, MS

Reviewed by:
Pearl E. Grimes, MD, FAAD
Ivy Lee, MD, FAAD

Last updated: 1/20/21

All content solely developed by the American Academy of Dermatology