Eczema types: Neurodermatitis diagnosis and treatment

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.

Did your dermatologist prescribe pills to treat an infection?

It is extremely important that you take all the medication, even if you are feeling better or the infection seems to have cleared.

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.

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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