Neurodermatitis

Neurodermatitis (or atopic dermatitis, or diffuse neurodermatitis) is a chronic inflammatory disease — allergic dermatitis that affects the skin of people with a predisposition in the genome, as well as a disorder of the immune status, nervous and endocrine systems, and the functionality of other organs. The presence of congenital heart abnormalities, clubfoot, hernias, cataracts, etc. in patients also indicates a hereditary factor of atopic dermatosis. Neurodermatitis has a persistent chronic, often recurrent character, differing in form depending on age, causes, symptoms, as well as the season of the year.

The content of the article:
Causes of neurodermatitis
Classification of neurodermatitis
Symptoms of neurodermatitis
Diagnosis of neurodermatitis
Treatment of neurodermatitis
Prognosis and prevention of neurodermatitis
Neurodermatitis
Neurodermatitis has a persistent neurogenic etiology and pathogenesis, it affects more than 20% of the population of developed countries. Over the past decades, the disease has expanded the geography of the lesion and the number of cases, acquiring more complex forms of the course, burdening the outcome of the disease. Neurodermatitis most often affects infants of six months of age (70%), a little less often — children who have reached the first year of life, born from parents prone to allergic manifestations, and the percentage of the probability of the disease is higher in babies whose both parents have allergic reactions or diseases. Neurodermatitis in adults occurs in almost 90%! This debilitating disease affects women more often than men, urban residents more often than villagers. Atopic dermatitis can very often be combined with allergic conditions such as:

bronchial asthma;
allergic rhinitis;
hay fever (pollinosis);
bacterial or viral infection (Staphylococcus, Candida fungi);
white dermographism;
herpes and others.
Various forms of neurodermatitis affect people of different ages, up to 30% of them are on outpatient treatment and up to 70% of patients are treated in inpatient conditions. This dermatological disease leads patients to temporary disability, and sometimes to disability.

Causes of neurodermatitis
Neurodermatitis is a multi—causal, multifactorial disease, therefore it is impossible to name clear, unambiguous reasons for all cases of the disease, they can be different for each patient, and their totality is heterogeneous. Traditional medicine considers such causes of neurodermatitis to be important:

genetic conditioning of the propensity to various allergic reactions, which is proved by the high intensity of diseases of close relatives and identical twins;
endogenous factors — the polluted state of the surrounding external (outdoor) and internal (indoor) environment, which can cause hyperreactivity of the skin;
neuropsychiatric health disorders;
profound disorders of the functioning of the immune, central and peripheral nervous systems, vegetative-vascular syndrome;
prolonged psychoemotional, mental and physical overload, depression;
irrational nutrition, general toxic pollution of the body;
gastrointestinal diseases associated with disorders of fermentation processes, endocrine system failures, ENT diseases;
sources of chronic infection, foci of inflammation in the body and bacterial accumulations on the skin;
medicinal preparations;
climatic factors;
work in harmful conditions and other irritating factors.
Exacerbations of neurodermatitis are caused by many foods, animal hair, fur, pollen of flowering plants, bird feather, mold, cosmetic odors, tobacco smoke, household dust, various paints, spices, fish tanks and much more — each patient has his own “kit”.

In 80% of allergy sufferers, the provocateur is household dust, which contains a large amount of excrement of Dermatophagoides pteronyssinus mites, which are significantly less in the bedding of healthy people, which gives the right to include mites in the list of the main causes of neurodermatitis. The recurrence of neurodermatitis occurs not only from the inhalation of these parasites and their particles with excrement, but also by direct skin contact with them.

Classification of neurodermatitis
The systematization of forms of neurodermatitis was carried out based on the location and scale of the spread of the disease:

The diffuse form symmetrically affects the face, neck, arms, elbow and knee joints, sometimes the foci of dermatosis become continuous, taking the feature of repeated erythroderma and accompanied by severe itching. Often, infection of foci leads to the development of lymphadenitis, as well as to the addition of other allergic problems.

A peculiar form of diffuse neurodermatitis often manifests itself in infants 5-6 months in the form of a rash on the face, under the hairs, bending surfaces of the limbs, sometimes in the upper part of the trunk. Such a rash may be present in a child during the entire early age.

The development of diffuse neurodermatitis as a transitional state from infantile eczema (exudative diathesis) in children from 2 to 12 years old is more difficult and prolonged, it focuses fragmentally on the depressions of the elbow and knee joints, on the neck, in the area of the wrists and ankles.

Diffuse neurodermatitis in adolescence and adulthood is usually manifested in 12-20 years. Lesions are usually concentrated on the flexing parts of the arms, legs and hands. The skin of the face becomes covered with a rash, surrounding the eyes and mouth, sometimes leading to the development of juvenile cataracts. The disease risks becoming a protracted, chronic and universal process, but it can subside at the stage of puberty.

Limited neurodermatitis occurs in the form of oval plaques that cover the lateral and posterior surfaces of the neck, occiput, shins, the area of the elbow and popliteal cavities, the area of the anus and genitals, combined with intense itching. The condition of the skin in certain areas of the lesion is characterized by increased dryness and is covered with many glossy papules, flat nodules that rise above the skin in the form of many thickened folds. The further spread of such foci on the skin leads to a common form of neurodermatitis. The final phase of limited neurodermatitis is pigmented and internal infiltration zones.

Linear neurodermatitis is a form in which rashes are common only on the upper and lower extremities in the form of stripes, characterized by high intensity of itching and lichenization of the skin.

The hypertrophic (warty) form of neurodermatitis has similarities with the tumor process affecting mainly the inguinal zone, interstitial folds, representing a giant lichenification of the skin with significant infiltration of lesions. This form of neurodermatitis is relatively rare.

Follicular neurodermatitis affects exclusively the hair areas of the body with a rash in the form of pointed papules.

Psoriasiform neurodermatitis covers the scalp, face and neck from the back side with large compacted flaky red plaques located close to each other.

Depigmented neurodermatitis sometimes accompanies limited neurodermatitis, which is expressed in a decrease in the amount of pigment in the lesions, which creates the appearance of fusion of neurodermatitis with vitiligo. However, the manifestations of vitiligo are secondary here and are not as serious as in true vitiligo, because when the neurodermatitis subsides / cures, pigmentation normalizes.

Symptoms of neurodermatitis
The most characteristic manifestation of any form of neurodermatitis is the high intensity and persistence of itching that occurs due to the relevance of neurotic disorders of various etiologies, namely:

reduced or increased nervousness;
stable insomnia;
asthenic condition;
emotional instability and the like.
In addition, persons with neurodermatitis, the symptoms of which manifest themselves as disorders of the autonomic system, suffer from thermoregulation disorders, manifestations of white demorphism, increased amount of sweat and sebaceous glands of the skin. Sometimes a sick person shows an imbalance in the functionality of the nervous system as a secondary feature that occurred due to the effects of prolonged persistent itching in combination with insomnia.

The lesions of neurodermatitis that have appeared on the skin for a long time do not respond to changes, representing epidermal papules of a color indistinguishable from the skin. Then, in places of localization, the papules unite into a plaque, creating continuous zones of infiltration of papules, where the skin becomes too dry, scaly and can often be covered with cracks. Combs increase redness, against which flat, variegated, inconspicuous nodular rashes appear.

The general clinical picture of the disease is expressed by lesions of the skin areas with rashes with the presence of severe, exhausting itching and neurotic disorders, the phenomenon of “goose bumps” and a decrease in skin pigmentation is also noted.

With a decrease in the work of the patient’s kidneys, which often happens with neurodermatitis, it is noted:

darkening of the skin (hyperpigmentation);
weight loss;
asthenia and fatigue;
drop in blood pressure;
reduction of gastric juice secretion, blood glucose composition, urinary excretion;
increased allergic reviews.
The seasonality of the disease manifests itself in the improvement of the condition of patients in the warm season and exacerbations — in cold periods of the year, as well as with psychoneurotic stresses, the constancy of which (for various reasons) forces the adrenal glands to be in a stressful state, which reduces and even depletes their functions.

In addition, patients with neurodermatitis have hyperthyroidism more often than hypofunction.

The pathogenesis of limited neurodermatitis is characterized by the presence of chronic auto-intoxication in patients, which is caused by chronic diseases of the gastrointestinal tract, leading to constipation, and constipation, as is known, leads to the absorption of toxins from the intestine.

Diagnosis of neurodermatitis
Diagnosing neurodermatitis is usually not so difficult, the collected complete history of the patient will help in this, and you also need to:

to study the main causes of the disease, its pathogenesis and individual characteristics of the patient’s body;
to assess the nature of rashes, distinguishing them from similar skin diseases;
to determine in the general blood test an increase in the number of eosinophils and lymphocytes, as well as a decrease in ESR;
to conduct an immunogram, where an increase in the number of class E antibodies should be indicated;
examine skin samples and identify positive reactions to allergens;
determine the presence of streptococci, staphylococci and Candida fungi by crops taken from the affected skin;
appoint consultations of narrow specialists if necessary.
Treatment of neurodermatitis
So, the diagnosis of “neurodermatitis” has been made: the symptoms and their treatment should be carried out comprehensively exclusively by a dermatologist or an infectious disease specialist, self-treatment can end very badly. For such a disease as neurodermatitis, treatment usually begins with the removal of painful symptoms with the use of external, restorative and narrowly targeted drugs to eliminate concomitant health problems plus the following measures:

neutral antipruritic creams and ointments for exfoliation and resorption of skin lesions;
drug therapy aimed at reducing aggravating factors;
termination of contact with identified allergens;
drawing up an individual daily routine, including a full night’s sleep, an individually selected diet, physical activity, sun and air baths, wearing clothes made of natural fabrics;
special exercises to raise the tone and reserve forces of the body in the fight against the disease;
the purpose of vitamin and mineral complexes;
inpatient treatment (if necessary);
the appointment of hormonal drugs in the severe course of the disease;
physiotherapy procedures;
the confrontation of depression by raising a positive attitude and thinking;
antibacterial agents with the addition of secondary infection;
spa treatment on the seashore, water procedures with thermal waters and mud treatment during periods of remission.
During the course of treatment, it is necessary to abandon emotional stress loads, all types of overwork, and patience and perseverance are needed to obtain positive results of complex therapy.

Prognosis and prevention of neurodermatitis
Since neurodermatitis is not threatened by dangerous complications, then the prognosis is the most favorable for life, although full recovery does not occur in all cases. When the cause of neurodermatitis lies in deep allergo-genetic structures, it is impossible to exclude relapses, because therapeutic measures may not cover all manifestations of the disease. Diffuse neurodermatitis with severe exacerbations can lead to long-term loss of performance. Limited neurodermatitis does not tend to turn into diffuse, therefore its prognosis is much more favorable.

Preventing neurodermatitis is not very easy. Prevention of the development of complex forms of neurodermatitis is possible if children’s exudative diathesis (eczema) is cured in time, and also immediately consult a dermatologist when the first symptoms of the disease appear in adolescents, men and women. The following actions should be necessary precautions:

protect the sick person from stress, strong emotions, anxiety and depression;
temporarily change the usual climatic and environmental conditions to places where there is a sea or mountains, with a dry hot climate;
to address existing health problems;
to debug the correct alternation of employment and rest, normal sleep and hygiene.
Traditional medicine methods using herbal decoctions and ointments can be successfully used in the treatment of neurodermatitis.

With proper treatment and compliance with all the rules, neurodermatitis passes very soon, leaving no noticeable traces on the skin.

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