Neurodermatitis

Aka: Neurodermatitis

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II. Epidemiology

  1. More common in Atopic Patients (Atopic Dermatitis)

III. Pathophysiology

  1. Response to chronic Atopic Dermatitis

IV. Symptoms

  1. Bouts of intense itching
    1. Rash does not appear until after scratching starts
    2. Rash may appear spontaneously
  2. Itching awakens person from sound sleep
    1. Scabies and Rhus Dermatitis prevent getting to sleep
  3. Associated with emotional stress or depressed mood

V. Signs

  1. Characteristics
    1. Red Papules and Plaques
    2. Overlying lichenification
  2. Sites of involvement
    1. Occiput and Neck (Lichen Simplex Nuchae)
      1. Usually occurs in women
    2. Outer lower portion of leg (more often in men)
    3. Ankle
    4. Wrists and extensor elbow
    5. Perineum and anus
    6. Scrotum or vulva
    7. Upper Eyelids and peri-auricle
    8. Scalp (Scalp-picker's Nodules)

VI. Differential Diagnosis

  1. See Pruritus Causes
  2. Neurotic Excoriation

VII. Complications

  1. Impetigo

VIII. Management

  1. See Pruritus Management
  2. Maximize management of Atopic Dermatitis
  3. Frequent application of Skin Lubricants
    1. Replaces the habit of scratching
  4. Bedtime Antihistamines
    1. Doxepin (Sinequan) 10 to 30 mg qhs
  5. Topical antipruritics
    1. Zonalon (topical doxepin)
      1. Risk of drowsiness if widespread use
      2. Risk of contact allergy
    2. Menthol and Phenol (Sarna lotion)
    3. Pramoxine (PrameGel, Pramosone)
  6. Topical Corticosteroids
    1. For inflammatory rash
    2. Occlusion helpful for lichenified areas
  7. Intralesional steroids
    1. Consider in scalp-picker's Nodules
  8. Systemic Steroids
    1. Consider in severe refractory cases
    2. Prednisone 20 mg qd for 14 days
  9. Occlusion
    1. Medicated gauze bandages (Unna Boot)
    2. Dressing with impregnated steroid (Cordran Tape)

IX. References

  1. Habif (1996) Clinical Dermatology, Mosby, p. 69

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Ontology: Neurodermatitis (C0027822)

Definition (NCI) Skin findings arising from repeated rubbing, picking or scratching of a real or imagined irritation of the skin.(NICHD)
Definition (MSH) An extremely variable eczematous skin disease that is presumed to be a response to prolonged vigorous scratching, rubbing, or pinching to relieve intense pruritus. It varies in intensity, severity, course, and morphologic expression in different individuals. Neurodermatitis is believed by some to be psychogenic. The circumscribed or localized form is often referred to as lichen simplex chronicus.
Concepts Disease or Syndrome (T047)
MSH D009450
SnomedCT 156383005, 267854005
English Neurodermatitides, Neurodermatitis, neurodermatitis, neurodermatitis (diagnosis), Neurodermatitis [Disease/Finding], Lichen Simplex Chronicus, Neurodermatitis (disorder)
Swedish Neurodermatit
Japanese ｼﾝｹｲﾋﾌｴﾝ, 苔癬-慢性単純, 神経皮膚炎-限局性, 慢性単純苔癬, 限局性神経皮膚炎, 神経皮膚炎
Czech neurodermatitida, Neurodermatitida
Finnish Neurodermatiitti
Russian NEIRODERMATIT, NEIRODERMIT, НЕЙРОДЕРМАТИТ, НЕЙРОДЕРМИТ
Polish Neurodermit, Świerzbiączka ogniskowa, Liszaj przewlekły
Hungarian Neurodermatitis
Norwegian Nevrodermatitt
Croatian NEURODERMATITIS
Spanish neurodermatitis (trastorno), neurodermatitis, Neurodermatitis
Dutch neurodermatitis, Dermatitis, neuro-, Neurodermatitis
French Neurodermite, Névrodermite
German Neurodermitis
Italian Neurodermatite
Portuguese Neurodermatite
Derived from the NIH UMLS (Unified Medical Language System)

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