About Neurodermatitis

A patch of skin itches, so you scratch it. But scratching can make the area itchier, so you keep scratching. Eventually you may scratch simply out of habit. This cycle of chronic itching and scratching is a symptom of neurodermatitis, a stubborn skin condition that can cause the affected skin to become thick and leathery.

Neurodermatitis — also known as lichen simplex chronicus or scratch dermatitis — isn’t serious, but breaking the itch-scratch cycle is challenging. Successful treatment of neurodermatitis depends on identifying and eliminating factors that may be aggravating the problem. Over-the-counter and prescription creams can help. Once the scratching stops, it can take months for the skin to return to normal.

Symptoms

Signs and symptoms of neurodermatitis include:

  • Itchy skin in a single, limited area
  • Leathery or scaly texture to the skin
  • Raised, rough patch that is red or darker than the rest of your skin

The primary symptom of neurodermatitis is itchy skin — often a single patch on the neck, wrist, forearm, thigh or ankle. Sometimes neurodermatitis affects genital areas, such as the vulva or scrotum.

The itchiness tends to come and go. It may be most noticeable when you’re at rest — watching TV or sleeping, for example — and disappear when you’re active. Anxiety or stress can make the itchiness worse. Eventually you may scratch simply out of habit.

The itching can be very intense. As you rub or scratch the area, it gets itchier. And the more it itches, the more you scratch. Breaking this itch-scratch cycle can be challenging.

Causes

The exact cause of neurodermatitis isn’t known. Sometimes neurodermatitis begins with something that simply rubs or irritates the skin, such as tight clothing or a bug bite. As you rub or scratch the area, it gets itchier. The more you scratch, the more it itches.

In some cases, neurodermatitis is associated with other skin conditions — such as dry skin, eczema or psoriasis. Stress and anxiety can trigger itching, too. Allergies don’t seem to be a factor.

Neurodermatitis is most common between ages 30 and 50. Women are affected more often than are men. You’re more likely to develop neurodermatitis if you have a personal or family history of eczema, psoriasis or similar skin conditions.

Diagnosis

Diagnosis is typically based on your skin’s appearance and a history of itching and scratching. Your doctor may recommend one of the following tests to rule out other causes or to confirm the diagnosis.

  • Patch testing. A patch test (contact delayed hypersensitivity allergy test) can rule out other causes of itchy skin, such as allergic contact dermatitis. During a patch test, small quantities of potential allergens are applied to small patches, which are then placed on your skin. The patches remain on your skin for two days, and then your doctor checks for a reaction. If you’re allergic to a particular substance being tested, you develop a raised bump or a reaction limited to the skin just beneath the patch.
  • Punch biopsy. During a punch biopsy test, the doctor uses a circular tool to remove a small section of your skin’s deeper layers. A punch biopsy extends about 1/4 inch (6 millimeters) deep. You’ll likely receive stitches to close the wound.

Persistent scratching can lead to a bacterial skin infection and permanent scars or changes in skin color.

Treatment

To stop the stubborn itch-scratch cycle, you must stop scratching the affected area. It’s bound to be tough, but you can do it. And your doctor can help.

Your doctor may recommend one or more of the following treatments:

  • Prescription medication. Oral corticosteroids and antihistamines may be necessary to reduce the inflammation and relieve the intense itching. Antidepressants or anti-anxiety medications may be helpful for some people. If you develop a bacterial infection in the rash, your doctor may prescribe an antibiotic lotion or oral antibiotics.
  • Wet dressings. This involves applying medicated cream to affected areas and then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the medicated cream. Plastic tape with medication in the adhesive, which is changed every 24 hours, also may be used.
  • Counseling. A counselor can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching. Counseling may also help you learn stress management techniques.

Even after successful treatment, mild scarring or changes in skin color could remain.

Self-care

The following are ways you can lessen the itch and irritation caused by neurodermatitis.

  • Try over-the-counter (nonprescription) creams or medications. Apply an anti-itch cream or lotion to the affected area. A nonprescription hydrocortisone cream, containing at least 1 percent hydrocortisone, can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe.
  • Cover the affected area with cool, wet compresses. Bandages or dressings can help protect the skin and prevent scratching. This may be especially important if you scratch during your sleep.
  • Take a comfortably cool bath. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others).
  • Wear smooth-textured cotton clothing. This will help you avoid irritation.
  • Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body. And after washing, apply a moisturizer to protect your skin.
  • Keep stress under control. Stress and anxiety can trigger itching.