Neurodermatitis: A chronic inflammatory skin conditionNeurodermatitis:

Atopic dermatitis is a chronic, inflammatory skin disease that affects 13 percent of children and two to three percent of adults. There is no cure, but there are many treatment options. Neurodermatitis is caused by contact with germs, physical or chemical stimuli, which can lead to inflammation. The disease usually begins in infancy and childhood and progresses in phases. Time often heals, especially with children, and many of those affected are free of symptoms when they start school or puberty.

Causes 

Neurodermatitis is now thought to be caused by a combination of things. Most important are the skin’s broken barrier function and the fact that a person’s immune system tends to overreact to harmless environmental triggers because of their genes.

Along with food allergies, allergic asthma and allergic rhinitis (e.g. hay fever ), neurodermatitis is one of the atopic diseases.

Family history of neurodermatitis

Atopic diseases are associated with a hereditary predisposition, with a 60–70% chance of a child becoming ill if both parents are affected. Many genes have been identified that play a role in the development of neurodermatitis. However, the predisposition alone does not make you ill, but if unfavorable environmental influences and several mechanisms interlock, the disease can break out.

Disease-causing mechanisms

There are many different things that can cause atopic dermatitis, which is a very complicated disease. From what we know now, it starts with a genetic problem with how the skin’s barrier function works. When the skin doesn’t have enough of certain proteins, it doesn’t build up its protective horny layer the right way, so it dries out quickly. All kinds of outside things can affect skin that is so dry.

The skin reacts in a sensitive way by getting red and itchy easily. The inflammatory response is made worse by scratching. The immune system is also getting more and more exposed to things like pollen, animal hair, and dust mite feces, which are called antigens.

 There can be a process called “sensitization,” in which certain immune system cells are set up to fight these antigens and antibodies (immunoglobulins) are made. The disease is now at a point where allergic reactions to things that are usually safe are important.

The exaggerated hygiene behavior of the last decades is partly responsible for this dysfunction of the immune system. According to the so-called “hygiene hypothesis”, the immune system in the germ-poor environment of western households suffers from a lack of employment and seeks other goals.

Triggers and influencing factors

The list of factors that can cause a neurodermatitis flare-up is long. Among the most important

• Factors that dry out the skin (e.g. frequent washing)
• Allergens that get on the skin, are inhaled (e.g. house dust mite faeces, pollen, animal dander) or eaten (food mediator genes such as cow’s milk, hen’s egg, wheat or soy)
• irritating substances on the skin, for example woolen clothing or contact with cleaning agents, fragrances or preservatives in cosmetics …
• Excessive colonization of the skin with bacteria, viruses or fungi (microbial antigens) in the presence of neurodermatitis
• Climatic factors such as extreme cold, dryness or humidity
• Environmental toxins such as ozone, diesel exhaust or tobacco smoke
• Mental stress, stress

Is neurodermatitis psychological?

Psychological factors were once thought to be the main cause of neurodermatitis, but it is now considered outdated to blame a disturbed parent-child relationship or a certain neurodermatitis personality for the disease.

Symptoms: what does atopic eczema look like?

Neurodermatitis can appear in many different ways. Typical signs are:

• generally dry skin, with reddened inflamed areas (eczema), which are usually very itchy
• Areal thickening and coarsening of the skin (lichenification)
• nodules and pustules

In infancy, there are more flat itchy reddenings of the skin, possibly with crust formation. The head (“cradle cap”) and the face as well as the extensor sides of the limbs (e.g. the outside of the arm) and flexor creases, are particularly affected.

The most important details are that in small children and adolescents, the symptoms appear in the bends of the joints, neck, wrists and hands, and the skin becomes thicker and coarser. Adults also experience the same infestation pattern, with itchy nodules and severe itching that can last throughout the day and worsen in the evening and at night.

Complications

Eczema is an ideal gateway for germs, leading to infections with bacteria (e.g. staphylococci) or viruses (e.g. herpes). Fungal infections are also possible, with signs such as pustules, heavy weeping, yellowish crust deposits, fever and swelling of the lymph nodes. In rare cases, a life-threatening course can occur due to these complications. In the case of fungal infections, yeast fungi (Pityrosporum ovale) can trigger eczema, especially in the head and shoulder area.

diagnosis

Various skin diseases can cause symptoms similar to neurodermatitis and yet have completely different causes. The distinction can therefore only be made by a doctor. Speak for atopic eczema:

• Age-appropriate expression and distribution of skin symptoms with itching
• beginning at an early age
• intermittent course
• other atopic diseases in the patient himself or in close relatives

atopy sign

Atopy signs are a set of traits that are common in people with atopic diseases. Which includes:

• dry skin
• reinforced line drawing on the palms of the hands
• a double crease below the eyes (“Dennie Morgan crease”)
• white dermographism (firm stroking of the skin with a wooden spatula produces a white line in atopic patients, while it is reddened in non-atopic patients)
• dark skin around the eyes
• Thinning of the lateral eyebrows (Hertoghe’s sign)
• Tendency to tear ears and corners of the mouth