A 45-year-old patient was diagnosed with “neurodermatitis” two years ago. During the two years, he sought medical help from various doctors, who prescribed him various medications, including “amoxicillin, fishoil, Xithromax, dexamethasone, vitamins, transfer factor capsules, levocetirizine hydrochloride capsules, epinephrine hydrochloride tablets, and so on. Finally, considering that symptomatic treatment was not working, he changed to infusion, including ceftriaxone sodium and ribavirin, etc. The treatment was not effective and caused great trouble to his daily life. So what kind of disease is neurodermatitis? The following we do a detailed introduction to this disease.
The cause of this disease is unknown and is related to psychiatric factors and has little to do with allergies. Patients are more likely to be female than male, more common in Asians and Native Americans, and often develop between the ages of 20 and 50. Possible causative factors are.
1, mental factors: currently considered the main trigger for the occurrence of the disease, mood swings, excessive mental stress, anxiety, sudden changes in living environment, etc. can aggravate and recur.
2, gastrointestinal tract dysfunction, endocrine system function abnormalities, chronic lesion infection in the body, etc..
3, local stimulation: local friction, chemical substance stimulation, insect bites, sunlight exposure, scratching, etc., can induce the occurrence of the disease.
Clinical manifestations.
Initially, there is only pruritus without primary lesions. Due to scratching and friction, flat papules of corn to mung bean size, round or polygonal, hard and shiny, light red or normal skin color, scattered distribution gradually appear on the skin. Due to paroxysmal itching, the patient often scratches, the papules gradually increase, and over time, they fuse into patches, hypertrophy, moss-like changes, manifested by deepening skin lines, elevated skin crest, lesions become dark brown, dry, fine flaking. Patchy lesions have clear borders and may be bordered by small flat papules, which are scattered and isolated. The number of lesion patches is variable and can be single or generalized around the body, varying in size and shape. The lesions are usually found on both sides of the neck, collar, elbow fossa, N fossa, sacrococcygeal region, wrist, ankle, but also on the lower back, eyelids, extremities and vulva. Self-perceived symptoms are paroxysmal severe itching, especially at night, which affects sleep. After scratching, there may be blood marks and scabs, and in severe cases, folliculitis and lymphadenitis may develop. According to the distribution of lesions can be divided into.
1, limited neurodermatitis: more than 90% preferably in the neck, followed by the elbow, sacrum, eyelids, N fossa, etc., first feel local itching, then appear clusters of corn to rice grain large normal skin color or light brown, light red polygonal flat papules, slightly glossy, covered with a small amount of chaffy scales, and then the papules fused into a patch, itching often scratching to stimulate the skin gradually thickened, the formation of moss-like changes, the boundary is clear. Scratch marks are common around the affected lesions, with blood crust formation.
2. Disseminated neurodermatitis: the lesions are similar to those of limited neurodermatitis, but they are widely distributed, involving the head, limbs and trunk, with paroxysmal itching, especially at night, affecting sleep.
The diagnosis of this disease is not difficult, but needs to be differentiated from the following diseases.
1, chronic eczema: most of the transformation from acute eczema, in the course of the disease there is a tendency to exudate, the rash manifested as infiltrative hypertrophic rash, plaques, mossiness is not obvious, with severe itching.
2, flat moss: the same as neurodermatitis for round or polygonal flat papules, conscious itching. The difference is that the former flat papules are larger than the latter, purplish-red, with wax-like luster, and Wicknam’s lines are visible. Isomorphic reactions occur on the forearm, the extensor side of the calf, the trunk, etc. In addition, mucosal damage (such as damage to the buccal mucosa and the glans), with specific histopathology.
3, psoriasis: chronic restrictive hypertrophic psoriasis occurring on the extensor side of the calf and scalp, with a pale red or dark red infiltrate at the base of the lesion, covered with a silvery scaly layer, with film phenomenon and punctate hemorrhage visible after peeling, with psoriasis damage commonly seen in other parts of the body, with the patient not feeling itchy or slightly itchy, with diagnostic value in histopathology.
4, primary skin amyloidosis: the lesions are sorghum to mung bean large brown hard papules, sometimes the rashes are arranged in a rosary pattern along the skin lines, histopathologically amyloid deposits have characteristic changes.
The most important thing in the treatment of neurodermatitis is to break the vicious cycle of itching-scratching and to avoid patients scratching due to itching, which further aggravates the condition.
A variety of treatments are usually required to achieve effective results.
1. Topical treatment
The first need to control the symptoms of the disease, can use anti-itch drugs and moisturizers to quickly relieve itching or itching associated with dryness, but also the use of glucocorticoid ointment, cream or solution for external use, thick lesions can be sealed package treatment, which can control the itching, but also to prevent the affected areas from further scratching stimulation. Refractory lesions can be treated with glucocorticoid injections within the local lesions to reduce the extent of the lesions.
2.Systematic treatment
Antihistamines and calcium can be used to stop the itching, supplemented by vitamin B taken internally; for severe itching, sedatives such as doxepin can be used, which is both an anti-anxiety and antidepressant, and an anti-itch and antihistamine drug, with obvious therapeutic effects; procaine can be given intravenously to close the rash if it is widespread.
Prevention of disease recurrence is also important and requires attention to the following points.
1, relax tension: patients should remain optimistic, prevent emotional overstimulation, especially pay attention to avoid emotional tension, anxiety, excitement, and strive to have a regular life, pay attention to the combination of work and rest.
2, reduce the stimulation: neurodermatitis repeatedly delayed, the most important reason for the local thickening and roughness of the skin is the itch induced scratching, so patients should build up the confidence that the disease can be cured, avoid scratching, friction and hot water scalding methods to stop the itch. This is an important link to cut off the vicious circle mentioned above.
3, regulate the diet: limit alcohol, spicy diet, keep the bowels open, and actively treat gastrointestinal lesions.
To sum up, the poor treatment effect of this reader is related to the following aspects.
1, no topical medication, topical antipruritic drugs and glucocorticoids are important to interrupt the vicious cycle of itching-scratching, and patients take a variety of oral antihistamine and anti-allergy drugs, which are effective for allergic diseases but not for this disease.
2, the use of a variety of antibiotics, the occurrence of the disease is not related to bacterial infection, antibiotic treatment is ineffective, if it causes drug reactions, but also can aggravate the itching.
3, the lack of relevant scientific knowledge, did not make the corresponding adjustment of living habits for the triggering factors of the disease, resulting in recurrent attacks of the disease.
In conclusion, neurodermatitis is a common and frequent disease in dermatology, patients need to understand the relevant knowledge of the disease, correct the bad habits, to the regular hospital dermatology, most of them can achieve satisfactory results.