HEALTH GUIDE: Neurodermatitis

What is neurodermatitis?

At the time when a doctor diagnoses this disease, those affected are likely to ask themselves the question: “What is neurodermatitis?” The chronic, non-contagious skin condition is regarded as a disease of affluence triggered by western civilisation-type lifestyle. It occurs in acute, subacute or chronic stages, each of which requires individual treatment. The acute form of neurodermatitis is characterized by the formation of a new eczema on an existing one lasts up to four weeks. These new skin changes lead to a worsening of older skin damage, frequently resulting in inflammatory changes. The chronic form, in most cases, persists for several years with different skin changes occurring at any one time. With the subacute form, the inflammations last for several months.

Causes of neurodermatitis

The actual causes are still not fully understood. Though what is certain is that a predisposition or susceptibility to neurodermatitis is hereditary, though the disease itself is not. This means that the most common cause is genetic predisposition. Besides the latter, there are theories relating to other causative circumstances such as environmental influences and psychological factors. In addition to this, clinical observations have shown that many suffering from neurodermatitis do not have a healthy intestinal flora. Other possible triggers for the ailment include:

  • Allergies
  • Specific foods
  • Climatic (too high outdoor temperatures, dry air)
  • Stress and limited social contact

Paradoxically, experts point to excessive hygiene as a reason for the prevalence of the disease. It seems both a healthy human body and a body with neurodermatitis need contact with germs and dirt, as it appears that the body is able to distinguish between harmless and less harmless intruders that need a protective response.

Symptoms of neurodermatitis

Neurodermatitic symptoms, which appear in different parts of the body and in varying degrees, include severe itching and dry skin. Those affected experience episodic reddening of the skin and inflammatory eczema which is prone to periodic discharge. The phases, which are interspersed by symptom-free periods, vary in intensity and length. The appearance of eczema is typically found on the elbows, the back of the knees, the neck as well as other areas and can be attributed to a lack of certain fats as well as the skin's reduced ability to store moisture. For this reason, the skin tends to flake. Furthermore important skin functions such as barrier development against external influences, perspiration and temperature regulation are not maintained. This is accompanied by deficient blood circulation. The altered germ configuration in the skin of neurodermatitic patients is likely to aggravate the disease because and, due to the skin lacking a protective function, germs are able to penetrate it more easily causing infections. The itching that is characteristic of neurodermatitis, and the natural reflex to scratch, for many affected people leads to a vicious circle – the so-called itch-scratch cycle. This means that sufferers harm themselves when scratching, resulting in unaffected areas becoming inflamed.

Diagnosis of neurodermatitis

Doctors diagnose neurodermatitis by means of its typical symptoms – not through specific examinations. Other diagnostic criteria take into account a family history of neurodermatitis and also whether white streaks occur after scratching the skin instead of red ones. Those affected frequently itch when sweating. Moreover paleness is seen around the mouth as well as dark circles under the eyes. Those with neurodermatitis also develop more frequent skin infections than people without the disease.

Once a doctor has diagnosed the condition, the next step is to determine what triggers it. This is where the affected person comes in. The more precisely the patient documents the course of the disease, the more likely she or he will to be able to discover the triggers.

What helps against neurodermatitis? Therapy and treatment

There is no cure for neurodermatitis and likewise no standardized therapy regimen. Nevertheless consistent therapy is essential in order to alleviate symptoms or even achieve symptom-free conditions. What is more, different treatment of neurodermatitis needs to be carried out depending on the stage of the disease. The severe itching is the greatest problem for those affected and, in order to relieve this, it is essential to treat the eczema. Exactly which therapy will prove successful depends on the triggers and is best determined on an individual basis. This requires a lot of patience!

One option is phototherapy, where a healthcare professional shines UV light at the eczema enabling it to heal. This form of treatment is recommended for severe cases although it is not suitable for children under age twelve. In all other cases, the doctor will need to individualize therapy for each patient.

Lipid-rich neurodermatitis creams are suitable for cracked and very dry skin. With discharging skin, it is recommended to use moist compresses with boiled water or a saline solution. So-called shake lotions are also suitable. Preparations containing cortisone may be used for the treatment of acute itching (neurodermatitic itching), but not for long-term therapy.

Another neurodermatitic treatment is the use of immunosuppressive creams that weaken the function of the immune system. Acting more selectively on the skin's immune system than cortisone, these are able to inhibit inflammation and subsequently heal eczema. However the European Medicines Agency has limited the use of neurodermatitic creams, meaning that doctors may only use them when cortisone does not work or cortisone treatment is not an option. In all other cases, their utilization is not permitted.

Neurodermatitis in babies and children

This disease frequently appears in infancy or childhood, often disappearing at school age. It has been estimated that ten to fifteen percent of children in Europe are affected by it. infantile eczema – a rash on the face and top of the head – often indicates dermatitis in babies. In occasional cases, the symptoms spread to the face, neck, legs and buttocks.

From age one to two, so-called childhood eczema (neurodermatitis in children) often develops. It is characterized by dry skin which itches a lot. In older children and adolescents, neurodermitic skin changes frequently appear all over the body.

Neurodermatitis prevention using diet

What foods should those affected avoid? If one has neurodermatitis, it is best to eat a healthy and balanced diet and one should keep a food diary. Doing this helps people discover individual reactions to foods. Many individuals have intolerance to cow's milk, nuts and other foodstuffs. Ready-made products should also be avoided.

Since patients with neurodermatitis often suffer from allergies, allergy tests are recommended as a preventive measure. This enables substances to be identified that can trigger the disease or aggravate its course.

Helping to combat neurodermatitis – based on current knowledge

Recent research has shown that extracts from oats and cistus (rockrose) as well as other plants help relieve neurodermatitis. Their ingredients have an antibacterial effect, relieving inflammation and itching. Furthermore they have a positive effect on the hypersensitive immune system.

Clinical evidence shows that using four or more different skin care products for the various skin conditions and stages of the disease is ideal when trying to achieve satisfactory results. This is necessary because the skin becomes accustomed to a skin care product after prolonged use. It is worth noting that skin care products should ideally have a balanced pH value, be free of allergenic substances and soothe irritations. A dermatological test for skin tolerance is also vital.