Neurodermatitis

Neurodermatitis (atopic dermatitis, atopic eczema) is based on an inherited predisposition. Neurodermatitis is a chronic inflammatory skin disease which occurs in episodic attacks, mainly in infancy.

 



Adults are almost always episode-free. In 60% of cases the disease starts in the first year of life, while 85% of patients suffer up to the age of five years.

 

Causes and triggers

The causes of neurodermatitis are many and varied. As well as the genetic predisposition, the disease is influenced by a reduction in the skin barrier, altered immune responses and environmental factors.

Deficiency of protein in the skin, which is necessary for its barrier function (such as filaggrin), plays a crucial role in the development of neurodermatitis. These proteins are reduced or not formed at all because of a genetic defect as well as additional immune reactions. As a result, the natural cornification is disrupted and the barrier function of the skin is limited. This means allergens and bacteria are able to penetrate the skin more easily, which can trigger or aggravate inflammatory skin reactions (eczema).

80% of neurodermatitis sufferers have elevated IgE antibodies to environmental allergens in their blood. While allergies to foods predominate in infants, older children, adolescents and adults display allergic reactions to pollen, animals and house dust mites as well as microbial triggers such as bacteria (staphylococci) and yeast fungi living on the skin (Malassezia).
 

Symptoms of neurodermatitis

Neurodermatitis sufferers have dry, sensitive and scaly skin, usually their whole lives. In a neurodermatitis episode, eczematous rashes (eczema) will additionally appear. In babies over about three months, the scalp, cheeks, arms, legs and even the trunk are often affected, but almost never the nappy area. The reddened, scaling, very itchy, weeping and ultimately encrusted areas of skin can “migrate”, i.e. move from one area of the body to another within a week.

The skin changes together with itching are usually found in the knees and elbows in schoolchildren and adults. Face, neck and wrists may also be affected.
 

Diagnosis and differential diagnosis

The diagnosis is mainly made on the basis of the typical symptoms: itching, redness and scaling of the skin as well as weeping areas of skin that later become encrusted. Furthermore, at least one parent often has dry, sensitive skin. The rash responds well to cortisone ointment.

Differential diagnoses: Fish skin disease (ichthyosis – severe thickening of the skin all over the body) and psoriasis.
 

Therapy and treatment

Ointment, ointment and more ointment: this must be applied to the skin regularly. There is no specific neurodermatitis ointment, but there are certainly suitable and unsuitable products. Sufferers often find out for themselves what helps them best. After application, the ointment or cream should be thoroughly rubbed in. Baby massage has proved effective in treating babies: it soothes, removes dry skin scales, promotes blood flow in the skin and supplies fat to the skin.

If a neurodermatitis episode has broken out, topically applied cortisone creams and ointments will be used.

An episode can be triggered by numerous factors. Apart from allergies, stress is a key factor: developmental stress, school or work stress as well as strains and problems in a person’s social surroundings.

People with neurodermatitis suffer from allergies with a higher frequency than the average for the population. If episodes recur time and again or they do not resolve despite treatment, an allergy test should be done. Specialists usually perform tests after the sixth month of life.
 

Tips and tricks

  • Just as the causes of an episode are diverse, so the treatment options are equally varied. It is worth trying out various approaches.
  • Methods from complementary medicine can help to relieve the symptoms of an episode.
  • “Weekend therapy”: prophylactically apply the prescribed cortisone ointment once or twice a week, especially for recurrent eczema on the facial area.
  • As sweating makes the itching worse, it helps not to have too many bed covers on at night and during the day to wear clothing appropriate to the temperature.
     

Facts and figures

Neurodermatitis is not contagious! Major advances have been made in recent years in the differential diagnosis of “eczema”. Therefore it is difficult to judge whether or not the percentage of neurodermatitis cases is on the increase. However, the disease is being diagnosed more frequently than just a few years ago.

15–30% of children and 2–10% of adults are affected by episodes of neurodermatitis. 70% of children with neurodermatitis no longer have any episodes in adolescence.

 

Editors: aha! Swiss Allergy Centre in co-operation with the Scientific Advisory Board.

 

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