Neurodermitis

Introduction

Neurodermatitis - also known as atopic dermatitis or atopic eczema - is one of the most common skin diseases. It causes chronic inflammatory reactions of the skin that occur in phases. The causes of the disease are not known - however, hereditary predispositions as well as environmental substances or psychological factors can favour the development of atopic dermatitis. The typical symptoms are severe itching and dry, sometimes scaly skin.

Neurodermatitis is treated with regular skin care and medication; the skin disease is not contagious.
Atopic dermatitis is particularly common in children: In Switzerland, 15 to 30 per cent are affected. However, in 75 per cent of cases, the symptoms disappear on their own by the age of ten. Children with atopic dermatitis have an increased risk of hay fever, allergic asthma and food allergies. Adults are less likely to suffer from atopic dermatitis. However, if adults suffer from atopic dermatitis, the skin disease is usually more severe.

Symptoms

The typical symptoms of atopic dermatitis are very itchy and dry skin. The skin of patients with atopic dermatitis is drier than normal skin. In atopic dermatitis, the skin's barrier function and other functions such as perspiration and blood circulation are impaired, causing the skin to lose moisture. The symptoms and the affected areas of the body change as the disease progresses.

Symptoms of neurodermatitis in infants with weeping eczema usually appear on the face, scalp and the outside of the arms and legs (usually from the second month of life). Due to the humid climate, the nappy area is usually left out.

Flexural eczema: In children and adolescents, the skin is often reddened and dry due to inflammation on the hands, neck, elbows, bends of the knees and neck. Over the years, the skin can thicken - this change is called lichenification.

In adults, a special form of atopic dermatitis - the so-called prurigo form - can occur. This involves the appearance of very itchy lumps all over the body.

Course

Atopic dermatitis occurs in episodes of varying length and severity. Atopic dermatitis often begins in childhood. The disease can heal itself, but a third of all children with atopic dermatitis also develop atopic eczema in adulthood - at least temporarily. Atopic dermatitis is not transmissible. Regardless of the course of the disease, atopic dermatitis can severely impair the quality of life of those affected. Even mild eczema can severely restrict sufferers and put them under psychological strain.

Causes

The causes of the disease are not known - however, hereditary predispositions as well as environmental substances or psychological stress can favour the development of neurodermatitis. In the case of atopic dermatitis, the body reacts excessively to initially harmless substances such as food, house dust or pollen and produces large quantities of defence substances against these substances, the so-called allergens. As a result, the skin reacts with an inflammatory defence reaction. In addition, the body releases the messenger substance histamine, which promotes inflammation and intensifies the defence reaction, resulting in the itching typical of atopic dermatitis.

Those affected often also have a food allergy that is not causally related to atopic dermatitis. Children with atopic dermatitis are therefore often allergic to milk, eggs, soya, wheat, hazelnuts, peanuts or fish.

Diagnosis

Atopic dermatitis is diagnosed based on the patient's medical history and a thorough examination by a doctor. Depending on the severity or indications of allergies, further allergological investigations may be advisable.

Mild atopic dermatitis can be treated well with telemedicine. Photos of the affected skin areas are provided to help the doctor make a diagnosis. People who have atopic dermatitis often also have other physical characteristics, for example, a double fold under the eye (the so-called Dennie-Morgan fold).

Treatment

Treatment aims to relieve patients of their symptoms as completely as possible. This involves basic therapy and treatment of the acute eczema:

Basic therapy is an important part of the treatment of neurodermatitis. As part of regular care, the skin is moisturised and lubricated. The care is also used in phases without flare-ups and consists of lotions, creams, ointments and oil baths. In general, it is important to avoid aggressive soaps and detergents when caring for the skin, as the skin with atopic dermatitis is more sensitive than healthy skin. Acute eczema should be prevented with good basic therapy.

In most cases, mild to moderate acute eczema can be treated externally. Cortisone preparations or so-called calcineurin inhibitors are used. If those affected are prone to recurring eczema, so-called interval therapy can be used in consultation with the treating specialist. This therapy is intended to prevent eczema from recurring.

Bacterial skin infections, so-called superinfections, are usually treated with antibiotics (tablets or juice).

If external therapy is unsuccessful, atopic dermatitis can also be successfully treated with more modern medications such as biologics in severe cases. Light therapy can also help: Light inhibits the inflammatory cells in the skin.

Prevention

Atopic dermatitis can only be prevented to a limited extent. Doctors recommend exclusively breastfeeding babies up to the age of four months. If breastfeeding is not possible, it is recommended that children who have a first-degree relative with allergic symptoms should only be given hypoallergenic milk. If atopic dermatitis already exists, those affected should avoid so-called trigger factors (factors that trigger the disease) and thus prevent further flare-ups:

• Avoid allergy-triggering substances (e.g. pollen, house dust mites)
• Avoid wearing wool or synthetic fabrics (heat build-up)
• Avoiding certain foods (e.g. nuts, milk, wheat)
• Avoid emotional stress
• Avoid excessive bathing (but: after a bath in chlorinated water, it should be washed off immediately with normal water)