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Neurodermatitis
Aka: Neurodermatitis
- See Also
- Lichen Simplex Chronicus
- Epidemiology
- More common in Atopic Patients (Atopic Dermatitis)
- Pathophysiology
- Response to chronic Atopic Dermatitis
- Symptoms
- Bouts of intense itching
- Rash does not appear until after scratching starts
- Rash may appear spontaneously
- Itching awakens person from sound sleep
- Scabies and Rhus Dermatitis prevent getting to sleep
- Associated with emotional stress or depressed mood
- Signs
- Characteristics
- Red Papules and Plaques
- Overlying lichenification
- Sites of involvement
- Occiput and Neck (Lichen Simplex Nuchae)
- Usually occurs in women
- Outer lower portion of leg (more often in men)
- Ankle
- Wrists and extensor elbow
- Perineum and anus
- Scrotum or vulva
- Upper Eyelids and peri-auricle
- Scalp (Scalp-picker's Nodules)
- Differential Diagnosis
- See Pruritus Causes
- Neurotic Excoriation
- Complications
- Impetigo
- Management
- See Pruritus Management
- Maximize management of Atopic Dermatitis
- Frequent application of Skin Lubricants
- Replaces the habit of scratching
- Bedtime Antihistamines
- Doxepin (Sinequan) 10 to 30 mg qhs
- Topical antipruritics
- Zonalon (topical doxepin)
- Risk of drowsiness if widespread use
- Risk of contact allergy
- Menthol and Phenol (Sarna lotion)
- Pramoxine (PrameGel, Pramosone)
- Topical Corticosteroids
- For inflammatory rash
- Occlusion helpful for lichenified areas
- Intralesional steroids
- Consider in scalp-picker's Nodules
- Systemic Steroids
- Consider in severe refractory cases
- Prednisone 20 mg qd for 14 days
- Occlusion
- Medicated gauze bandages (Unna Boot)
- Dressing with impregnated steroid (Cordran Tape)
- References
- Habif (1996) Clinical Dermatology, Mosby, p. 69