I. What is neurodermatitis
Neurodermatitis is a chronic pruritic skin disease of unknown origin, which is called chronic simple moss in modern medicine. In Chinese medicine, it is called “dermatophytosis” because it is stubborn and difficult to cure. Dry, flaky skin is called “dry ringworm”, and the skin of the lesion is like the skin of a cow collar, also known as “psoriasis”, these are all neurodermatitis. The cause of neurodermatitis is not very clear, but a lot of clinical practice has observed that the onset of the disease is related to neurological and mental factors, probably due to the dysfunction of excitation and inhibition of the cerebral cortex. The common triggers are excessive fatigue, nervousness, impatience, insomnia, indigestion, constipation, internal infection foci autointoxication, endocrine disorders during menopause. Local stimulation by rough woolen fabrics, thick and hard collars and chemical substances cause itching of the skin, the patient scratches the skin repeatedly, and then due to the self-protective nature of the human body, the skin thickens and the typical characteristics of the disease – mossy, epidermal peeling phenomenon. The scratching and frictional irritation is an important factor in the occurrence and development of the aggravation of the disease.
The clinical manifestations of neurodermatitis
1. Preferred site
The common site of neurodermatitis is at the back of the neck and both sides of the neck, but also on the extremities of the limbs, especially the elbows and knees, waist, coccyx, femur, vulva, anal circumference, eyelids and other places.
2.Typing
According to the distribution of lesions, it can be divided into two types.
(1) Limited neurodermatitis (chronic lichen simplex)
The itchy skin at the beginning is insidious, and after scratching, patches of mossy flat polygonal papules appear, and the papules cluster into patches, with deepening skin lines and elevated mounds, which become typical mossy lesions and are an important basis for the diagnosis of neurodermatitis. The skin surface can be covered with a small amount of scales, scabs, or scratch marks of different degrees. As a result of long-term scratching, the skin becomes increasingly hypertrophic, and the thicker it becomes, the more itchy it becomes. In severe cases, the skin may look like leather, and damage on the scalp may form multiple pruritic papules or nodules, and scratch marks and crusts may also be seen, even secondary infections. Pruritus is the main conscious symptom, mostly paroxysmal, and it is often aggravated in the afternoon and evening or during leisure time, affecting work, sleep and life.
(2) Pancystic neurodermatitis or disseminated neurodermatitis
The skin damage is the same as limited neurodermatitis, but the lesion area is more widely distributed multiple skin damage. In addition to the sites of limited neurodermatitis, the scalp, eyelids, extremities, and trunk are often involved. The rash starts on the neck and spreads upward to the eyelids and head, and downward to the back of the chest, waist and extremities. This type of itching is paroxysmal and is more severe than limited neurodermatitis.
Neurodermatitis has a chronic course, sometimes good, sometimes bad, repeatedly and for a long time, and is often aggravated by internal and external stimuli. The intense itching can affect sleep, causing mental irritability, emotional instability, depression, affecting work and life, and even the thought of light life.
The differential diagnosis of neurodermatitis
1, must be distinguished from several diseases
(1) Adult atopic dermatitis
In infants, there is eczema and atopic body. In adults, the rash mainly occurs in the anterior, lateral and four bends of the neck – N fossa and elbow fossa. Serum IgE and eosinophils are elevated.
(2) Chronic eczema
Mostly transformed by improper management of acute or subacute eczema. Skin lesions are predominantly infiltrative hypertrophy and hyperpigmentation, with a tendency to exude, and lesions without typical mossy changes.
(3) Flat moss
It is a polygonal or round purplish-red flat papule or macule with waxy shine on the surface, which is the characteristic manifestation. Histopathology has diagnostic value.
(4) Primary cutaneous amyloidosis
The lesions are usually found on the extensor side of the extremities and are brown or brown hard papules, hemispherical or irregular in shape, fused into flakes or arranged in a rosary pattern, forming a characteristic pattern. Histopathology has diagnostic significance.
(5) Differentiation from other diseases such as pruritus and psoriasis.
2.Diagnostic points
The diagnosis of neurodermatitis can be confirmed based on the typical skin lichenoid changes, intense itching, and the characteristics of the predilection site and the chronic, recurrent course of the disease, except for the above-mentioned diseases.
The prevention and treatment of neurodermatitis
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1, the treatment of the cause
The actual fact is that you can find a lot of people who are not able to get a good deal on a lot of things.
2.Avoid all bad stimulation to the skin
The most important thing is to scratch, not to scratch to avoid the occurrence of dermatitis or even make the dermatitis untreated. For those with neurological symptoms and severe itching, sedatives such as Valium, Eszopiclone, Zolpidem Tartrate, Doxepin, Midazolam Maleate, etc., and antihistamines such as Paracetamol, Loratadine, Cetirizine Hydrochloride, Petrone, Antares, Segundine, etc. can be given.
3.Topical treatment is the most common treatment method
(1)Topical drug application
At present, the most used is corticosteroid ointment, cream, hard cream, dimethyl sulfoxide and nitrogen ketone preparation or coating agent for external use, with anti-itch, anti-inflammatory effect, mostly for limited small area, can be applied for a short period of time. Black bean distillate, bran distillate and coal tar ointment on neurodermatitis can eliminate infiltration, remove hypertrophy, anti-keratinization and antipruritic effect, also has good efficacy. Note that you should not stop the medication too early in the treatment process, but wait until the skin texture is completely restored to normal before stopping it to avoid relapse. The key to relapse prevention is to stop the medication when the skin is completely normal, and topical medication will improve the efficacy if you add the sealing package. How to seal the package please my article: “Application of skin sealing package therapy”.
(2) Local closure therapy
It is to inject drugs into the superficial layer of the dermis at the site of lesions to stop local itching and anti-inflammation.
Commonly used drugs are: corticosteroids (dexamethasone, prednisolone, Depo-Provera), benadryl, benzyl alcohol, vitamin B12, vitamin B1, ethanol procaine solution, etc.
(3) Local physical therapy
The skin lesions can be treated locally with isotope 32 phosphorus or 90 strontium dressing, or laser irradiation, liquid nitrogen freezing, etc.
(4) Intravenous closure therapy
Applicable to generalized neurodermatitis, drug with procaine hydrochloride solution (skin allergy test should be done before use). Once a day, 12 times as a course of treatment. For severe cases can be combined with sleep therapy, can receive very good results.
(5) Traditional Chinese medicine treatment
(1) Chinese medicine identification: according to the skin witness, erythema, papules, paroxysmal itching, is wind-heat type, should be clearing heat to dispel wind; for long time treatment, skin loss of nourishment, mossy skin patches, dry surface peeling, scratches crust, is blood deficiency wind dry type, treatment to nourish blood to dispel wind.
The use of acupuncture, moxibustion, smoke therapy, Chinese medicine point injection, etc. also received some effect.
Although neurodermatitis is difficult to treat, it is still curable and requires patients to have confidence and adhere to the correct treatment method. In my 50 years of clinical work, I have cured a large number of patients, that is, the doctor needs to have patience, the patient has confidence, the doctor and patient cooperation, will be able to overcome neurodermatitis this stubborn disease.