Emotional and mental problems are the main triggers of neurodermatitis.
1. What are the triggering factors for neurodermatitis? Are emotional and psychiatric problems the main triggers for the development of neurodermatitis?
Neurodermatitis is not known, but conceptually we can understand that its pathogenesis is mostly thought to be related to neuropsychiatric factors triggered by dysfunctional excitation and inhibition of the cerebral cortex. Patients with neurological dermatitis often experience dizziness, insomnia, irritability, anxiety and other symptoms of neurosis. For example, in some children, neurodermatitis can appear or worsen during the stressful rewriting phase of exams.
In addition to the above emotional and mental problems that can trigger the onset of neurodermatitis, endocrine disorders, gastrointestinal dysfunction, stimulation of infected lesions, overexertion, as well as scratching, sun exposure, alcohol consumption, and mechanical and physical stimulation can trigger or aggravate neurodermatitis. The incidence of neurodermatitis is greatly increased in some perimenopausal menopausal women, also, after giving endocrine conditioning, the neurodermatitis of these patients will improve accordingly.
What is the main danger of neurodermatitis?
The main symptom of neurodermatitis is “itching”. The main feature of this itchy discomfort should be described professionally as “paroxysmal intense itching”, and some patients can even itch to the point of “pain”. The itching is most pronounced at night, so most patients suffer from sleep disruption and even insomnia. This itching causes a decrease in sleep quality, which inevitably affects normal work and study the next day. On a daily basis, patients may also develop neurological weakness such as irritability, anxiety and fatigue, which in turn further aggravate the progress of neurodermatitis. In addition, because of the intense itching, many patients scratching serious, can lead to epidermal peeling, and can even cause skin infection.
3. Can neurodermatitis be contagious?
It is clear that neurodermatitis is not contagious.
The symptoms and diagnosis of neurodermatitis.
1. What is the shape of the papules of neurodermatitis? Is there a papule formation at the beginning of the disease?
Most of the skin is normal at the beginning of the disease, and mechanical stimulation such as scratching or rubbing occurs, and the local skin rapidly develops a deepening skin texture and becomes rough, which is medically known as “mossy skin”. The typical rash appears as a flat papule of normal skin color or light red or dark brown color with a little scaling on top. The papules may join in patches and form coin to palm-sized rashes. Most patients have dry skin, the skin becomes hypertrophic and rough, the upper crestal groove is obvious, the surface can often be seen scratch marks, blood crust and pigmentation.
2.Where does neurodermatitis occur?
Neurodermatitis most often occurs in the neck, lumbosacral region, both elbows and other parts of the body. The back, inner femur, perineum, scrotum and other parts are also common.
3.Why is itchiness more severe at night in neurodermatitis?
All pruritic skin diseases, including neurodermatitis, have more pronounced itching at night. Because most patients are in a busy work and study during the day, the itchy discomfort decomposed, the performance will be mild, but at night, the environment is in a quiet state, attention is relatively focused, itchy discomfort is not in mind to be amplified, so feel more serious itching at night.
4.How to distinguish neurodermatitis from eczema, psoriasis, lichen planus, and skin amyloidosis?
Points of differentiation from the following diseases.
Eczema: Most of them refer to the differentiation of chronic eczema. The disease usually evolves from acute or subacute eczema, without a certain site of predilection, and the course of the disease can show manifestations such as running water and exudation. The key point is that the lesions of eczema are ill-defined, whereas neurodermatitis is a mossy plaque with clear boundaries.
Psoriasis: This is the medical term for psoriasis. Most lesions are more generalized, and in addition to skin damage, other organs are also damaged, such as hair (fascicled hair), nails (thimble-like nails), and tongue (map tongue). Psoriasis lesions have typical features such as flaky or mica-like scales, thin film phenomenon, and punctate bleeding. Some may be combined with joint and other systemic damage. There may be a family history.
Lichen planus: mostly purplish-red, polygonal flat papules. If the refractive Wechsler’s lines are visible after rubbing with paraffin oil, it can be an important diagnostic basis.
Cutaneous amyloidosis: most commonly found on the anterior side of the calf, the rash is characterized by round papules the size of rice grains to mung beans, densely packed in patches, but most do not fuse with each other, and some rashes are arranged in a beaded pattern.
It is worth mentioning that the above diseases are sometimes difficult to distinguish from neurodermatitis, and the ultimate golden indicator for identification is a skin pathology biopsy.
Do I need laboratory tests to confirm the diagnosis of neurodermatitis?
It is not difficult to diagnose neurodermatitis based on the typical mossy skin lesions, together with the location of the lesions and the paroxysmal giant itch. Most laboratory tests are not required. However, if it is suspected but the clinical symptoms are not typical, a dermatopathological biopsy can be performed to clarify.
The cause of neurodermatitis is removed and treated symptomatically.
1. Can neurodermatitis be cured?
The actual fact is that you can’t get rid of it.
2.What are the treatments for itching?
The fundamental purpose of neurodermatitis treatment is to stop itching. It is important to avoid scratching, only then can you break the vicious cycle of “itch – scratch – more itch – more scratch”. There are many ways to stop itching, and they can be chosen according to the condition and the size of the lesions involved.
(1) Topical treatment.
The preferred glucocorticoid ointment, cream or solution for topical application: such as the usual Eloson, Pirenzone, Halometasone, etc.; if necessary, the effect will be better if the treatment is sealed with cling film for about 2 hours after the topical medication; if the lesions are severely hypertrophic, glucocorticoid treatment can be locally injected, such as Tretinoin Acetate Injection, Depo-Provera Injection, etc. Most of them are repeated once in 3-4 weeks.
(2) Systemic treatment.
The first choice is antihistamines: that is, we often mention anti-allergic drugs, such as loratadine (keratan), cetirizine (centrum), imipramine (Petronectin), etc.; for patients with neurasthenia and insomnia, you can choose sedative antihistamines, such as chlorpheniramine maleate (paracetamol), ketotifen, doxepin, etc.; for patients with pancytopenia with severe pruritus, you can try procaine intravenous closure For patients with pancytopenia with severe itching, procaine intravenous closure can be tried.
(3) Physical therapy.
Some patients with generalized, more resistant to local medication can be tried. Such as black light therapy, narrow-wave UVB, etc.
(4) Traditional Chinese medicine treatment.
Most need to dialectic: early erythema, papules mainly, itching bouts, belong to the evidence of wind-heat interruption, should clear heat to dispel wind; after the skin loss of nourishment, the lesions are mossy patches, the surface is dry and flaky, belong to blood deficiency wind dry, treatment to nourish blood to dispel wind; if necessary, acupuncture treatment can be performed to relieve the condition.
3.Is it possible to stop the medication if it doesn’t itch anymore?
Considering the long-term side effects, in principle, glucocorticoid ointment can be discontinued when the itching is relieved, but eventually some moisturizers such as 10% urea ointment, petroleum jelly ointment, 10% cod liver oil ointment, VE cream, etc. need to be used topically to reduce the recurrence rate.
4.How to remove the pigmentation caused by papules?
Including neurodermatitis, all inflammatory skin diseases inevitably have two types of endings after treatment improvement, one is post-inflammatory pigmentation (i.e. the above-mentioned hyperpigmentation), and one is hypopigmentation. When such conditions occur, most do not require medication and generally recover in 3-6 months. If necessary, you can try to use some topical antioxidant moisturizers, such as VE cream, etc.
5.Can topical creams containing hormones be used for a long time?
Most hormonal topical preparations are safe for short-term use. Domestic information with evidence-based medical evidence mentions that children can use them for 6 weeks continuously and 20 weeks intermittently, and the chance of acute side effects is very small. However, glucocorticosteroids may lead to adverse reactions such as non-healing skin wounds, acne, folliculitis, skin thinning, and capillary dilation if used topically for an ultra-long period of time.
6.When do I need physical and radiation therapy?
Commonly used physical and radiotherapy treatments include: nuclear 32P, 90Sr dressing, He-Ne laser irradiation, magnetic therapy, wax therapy, photochemotherapy (PUVA), narrow-wave ultraviolet (N-UVB) and other treatments. Such treatment is limited to patients with generalized and hypertrophic lesions, or itching that seriously affects the quality of life.
7. Is medication required for emotional and mental control?
Patients with significant emotional and psychiatric associations can be treated systemically with additional oral medications. In mild cases, antihistamines with sedative and antipruritic effects, such as ketotifen, paracetamol, doxepin, etc. can be added; in severe cases, sedatives can be added, and even hibernation therapy and procaine intravenous closure therapy can be given.
Daily care and prevention of neurodermatitis.
1. Why is neurodermatitis prone to recurrence? What are the contraindications in daily living habits?
The essence of neurodermatitis is related to the patient’s constitution, as long as the above-mentioned causes exist, it is possible to relapse or aggravate. The actual fact is that you should pay attention to the improvement of your lifestyle habits, such as ensuring sufficient sleep, avoiding stimulating diet and alcohol, avoiding scratching and friction stimulation, etc. Removing the above triggers can greatly reduce the recurrence rate.
2, wash and skin care products should be how to choose?
Skin cleaning care, proper bathing, weak acidic skin cleanser can be used, avoid strong alkaline skin cleanser, time should not be too long, water temperature 36-38 ℃, timely use of moisturizer after the bath. The principle of choosing moisturizers is the simpler the better, such as VE cream, Vaseline ointment, etc. If the conditions allow it, then choose the drug class moisturizer, such as Avène triple cream, Stave moisturizer, etc.
3.What should I pay attention to in the choice of clothing?
Clothes should be slightly thin, cotton, loose and soft; after wearing clothes should be kept cool, ventilated and clean.
4.What do you recommend in terms of diet? What foods are contraindicated and what foods are beneficial?
In principle, there is no excessive contraindication, but if oral certain foods skin lesions aggravated, such as seafood, beef and mutton, spicy stimulants, or try to avoid eating. Patients with neurodermatitis are advised to eat a balanced diet of vegetables and fruits to supplement vitamins that are beneficial to the recovery of the lesions.
The following are the guidelines for consultation.
1. Should I go to neurology or dermatology for neurodermatitis?
Dermatology is recommended, but if there are obvious clinical manifestations of neurological or psychiatric disorders, consultation with the relevant department is recommended.
2. Can the diagnosis be confirmed at the first consultation? What preparations do I need to make before the consultation?
No special preparation is needed before the consultation. Most patients can be diagnosed based on their medical history and skin lesion performance. For a few patients with high suspicion, a skin biopsy is necessary to clarify.