Neurodermatitis (Atopic Eczema)

Brief overview

  • What is neurodermatitis? Chronic or chronic-recurring inflammatory skin disease that occurs in episodes. It almost always occurs in early childhood.
  • Symptoms: excruciating itching, dry skin, in acute episodes also weeping eczema.
  • Cause: The exact cause is unknown. Several factors seem to play a role in the development of the disease, including a disturbed skin barrier. In addition, the tendency to neurodermatitis is hereditary.
  • Triggers: Textiles (such as wool), infections (such as severe colds, flu), certain foods, muggy temperatures or cold, psychological factors (such as stress), etc.
  • Treatment: avoid triggers, careful skin care, proper skin cleansing, medications (such as cortisone), light therapy, etc.

Neurodermatitis: Symptoms

Typical neurodermatitis symptoms are inflammatory skin changes (eczema) with excruciating itching. They occur in phases: Periods without symptoms are followed by phases with sometimes extreme symptoms. The episodes are usually triggered by certain factors, such as certain foods or weather conditions.

Neurodermatitis symptoms in children

As a rule, neurodermatitis in babies begins on the face and on the hairy scalp. Cradle cap forms there: yellowish-white scaly crusts on reddened skin. Their appearance is reminiscent of burnt milk, hence the name “cradle cap”.

Cradle cap alone without further symptoms is not a sign of neurodermatitis!

In addition to the head, neurodermatitis in infants usually also affects the extensor sides of the arms and legs. Blurred, reddened, itchy and weeping skin changes form here. They can also appear on the rest of the body – only in the diaper area, i.e. on the genitals and buttocks, and on the upper third of the legs do infants generally remain symptom-free.

As children get older, the atopic dermatitis symptoms typically change and shift: At this age, the eczema, which now tends to be dry, develops preferentially in the crooks of the elbows, wrists, and backs of the knees (flexural eczema). Often the thighs (backside) and the buttocks, the neck, the face and the eyelids are also affected by the skin changes.

Neurodermatitis symptoms in adults

During puberty, atopic dermatitis often resolves completely. However, in some sufferers it persists beyond this time.

In general, adolescents and young adults show the reddened, scaly and itchy skin changes of atopic dermatitis mainly in the following areas: the eye and forehead area as well as the region around the mouth, the neck (nape), the upper chest area, the crook of the elbow, the back of the knee, the groin and the back of the hand. The scalp is often affected as well. Hair may even fall out in the red, scaly, inflamed areas.

In older adults, atopic dermatitis sometimes occurs in the prurigo form – that is, with small, intensely itchy skin nodules or skin knots on a wide variety of body parts. Usually, however, adult atopic dermatitis manifests with the following symptoms:

  • eczema on hands and feet
  • itchy crusts on the hairy scalp
  • red, itchy and cracked earlobes (at the edges)
  • inflamed, itchy lips
  • burning and/or discomfort in the mucous membranes of the mouth and throat
  • digestive problems (abdominal pain, diarrhea, flatulence)

Sometimes neurodermatitis appears only in a minimal variant, for example as inflammation of the lips (cheilitis), nipple eczema, in the form of tears (rhagades) on the earlobes or scaly redness and tears on the tips of the fingers and/or toes.

The symptoms of atopic dermatitis in adults usually develop as a function of occupational activity. For example, hand eczema is particularly common in patients whose occupations involve frequent contact with irritating substances (e.g., hairdressers, painters) or frequent hand washing (e.g., nurses).

Atopic stigmas

Neurodermatitis – like hay fever and allergic asthma – belongs to the so-called atopic group of forms. These are diseases in which the immune system reacts hypersensitively to contact with allergens or other irritants.

People with such atopic diseases often exhibit so-called atopic stigmata. These include:

  • dry, itchy skin, dry scalp
  • Paleness in the mid-face area (centrofacial), i.e. around the nose and between nose and upper lip
  • double lower eyelid crease (Dennie Morgan crease)
  • dark skin around the eyes (haloing)
  • light skin markings after mechanical irritation, for example by scratching (white dermographism)
  • increased lines in the groin skin, especially on the palms of the hands
  • torn corners of the mouth (perlèche)

Such features may accompany the specific symptoms of an atopic disease (such as neurodermatitis).

Neurodermatitis: Causes and Triggers

The exact cause of atopic dermatitis has not yet been conclusively determined. Experts suspect that several factors are involved in the development of atopic dermatitis.

For example, the skin barrier is disturbed in atopic dermatitis patients: The outermost layer of the epidermis (on the very outside) is the horny layer. It protects the body from pathogens. In neurodermatitis, however, the horny layer cannot properly fulfill its protective function.

The fact that the genetic makeup plays a role in neurodermatitis is also shown by the fact that the predisposition to neurodermatitis is hereditary. Scientists assume that changes (mutations) in various genes on several chromosomes are responsible for this predisposition. And parents can pass these mutations on to their children: If one parent is a neurodermatitis sufferer, the children are 20 to 40 percent likely to develop atopic dermatitis as well. If both mother and father have atopic dermatitis, the risk of their children developing the disease is even between 60 and 80 percent.

Not everyone with a predisposition to atopic dermatitis actually develops it.

If someone has the genetic predisposition to atopic dermatitis, various triggers can lead to a neurodermatitis flare-up. Excessive hygiene could also play a role in the onset of the disease.

Too much hygiene?

In recent decades, the number of atopic dermatitis cases (and allergic diseases in general) has increased sharply in the Western world. Some researchers suspect that a change in lifestyle is (partly) responsible for this:

In addition, washing habits have changed over the past decades: We clean our skin more frequently and more thoroughly than our ancestors. It is possible that this has a negative impact on the skin barrier. This could make the skin more sensitive in general.

Atopic dermatitis: triggers

The most common triggers (trigger factors) in atopic dermatitis include:

  • Textiles (such as wool)
  • @ Sweating
  • unfavorable climatic conditions such as dry air (also due to heating), cold air, sultriness, overall strong temperature fluctuations
  • incorrect cleaning of the skin (use of skin-irritating cleaning agents, etc.), cosmetics (such as skin-irritating fragrances or preservatives)
  • certain activities/occupations such as damp work, highly polluting work or activities where rubber or vinyl gloves have to be worn for a long time (hand eczema!)
  • tobacco smoke
  • Allergy triggers such as dust mites, molds, animal dander, pollen, certain foods and additives (cow’s milk, chicken egg white, nuts, wheat, soy, fish, seafood, etc.)
  • Infections (such as severe cold, tonsillitis, etc.)
  • hormonal factors (pregnancy, menstruation)

Neurodermatitis patients react individually differently to such triggers. For example, stress at work may trigger an attack in one patient but not in another.

Neurodermatitis forms

Very many atopic dermatitis patients have the extrinsic form of the disease: Their immune system reacts sensitively to allergy-causing substances (allergens) such as pollen or certain foods. Thus, an increased amount of antibodies of the type immunoglobulin E (IgE) can be detected in the blood of those affected. IgE stimulate other immune cells (mast cells) to release pro-inflammatory substances. These cause the eczema on the skin of neurodermatitis patients.

Some of those affected also show the typical symptoms of an allergy (e.g. hay fever, allergic asthma, food allergy).

People with the intrinsic form of atopic dermatitis have normal IgE blood levels. This means that allergic reactions do not play a role here as a trigger of neurodermatitis. Those affected also show no increased susceptibility to allergies such as hay fever or a food allergy.

Neurodermatitis: Treatment

In neurodermatitis therapy, experts generally recommend a treatment plan in four stages. This involves different treatment measures depending on the current skin condition:

Therapy measures

Stage 1: Dry skin

To prevent relapses, careful daily skin care (basic care) is necessary. In addition, the patient should avoid individual triggers as far as possible or at least reduce them (stress, wool clothing, dry air, etc.).

Stage 2: Mild eczema

In addition to the measures of stage 1, external treatment with weakly acting glucocorticoids (“cortisone”) and/or calcineurin inhibitors is recommended.

If needed, the patient is also given antipruritic medications and germicidal (antiseptic) agents.

Stage 3: Moderately severe eczema

In addition to necessary measures of the previous stages, external treatment with more potent cortisone preparations and/or calcineurin inhibitors is recommended here.

Stage 4: Severe, persistent eczema or eczema for which external treatment is not sufficient.

The graduated scheme of neurodermatitis treatment is only a guideline. The treating physician can adapt it to individual factors. When planning the therapy, he can take into account the patient’s age, the overall course of the neurodermatitis disease, where on the body the symptoms occur and how much the patient suffers from them.

The individual therapy measures are described in more detail below.

Neurodermatitis children (and their parents) can participate in a special neurodermatitis training course. Doctors, psychologists and nutritionists give tips there on how to deal with the disease properly.

More detailed information on these training courses is available in Germany, for example, from the Neurodermatitis Training Working Group (www.neurodermitisschulung.de), in Austria from the Pediatric Dermatology Working Group of the Austrian Society for Dermatology and Venereology (www.agpd.at and www.neurodermitis-schulung.at), and in Switzerland from the Allergy Center Switzerland (www.aha.ch).

Neurodermatitis therapy: skin care

  • For very dry skin, a skin care product with a high fat content, i.e. a water-in-oil emulsion (e.g. moisturizing ointment) is advisable. This is also a very good way to care for dry skin in winter.
  • For less dry skin, on the other hand, a moisturizing (hydrating) oil-in-water emulsion should be used, i.e. a water-based skin care product that contains less fat and more water (e.g. a cream or lotion).

In addition to the water-in-oil composition, the other ingredients of skin care products should also be considered. For example, a product with urea or glycerin can be useful. Both additives keep the skin moist. In the case of infants (children aged 2 and 3) and inflamed skin, however, such products should first be tested for tolerance on a small area of skin. For infants (children in the 1st year of life), products with urea are generally not recommended.

Skin care products for neurodermatitis patients should also not contain any common triggers of contact allergies. These include fragrances and preservatives, for example.

Apply cream to the skin at neurodermatitis at least twice a day!

In addition to regular application of cream, basic skin care also includes gentle and gentle skin cleansing. Here are the most important tips:

  • Showering is generally better for neurodermatitis patients than bathing (shorter water contact!). In both cases, however, the following applies: not too long and not too hot.
  • Do not use conventional soap for skin cleansing (too high pH value!), but rather a pH-neutral skin cleansing agent (Syndet), which was specially developed for dry and neurodermatitis skin. Leave it on for only a short time and then rinse thoroughly.
  • Do not use a washcloth or sponge for washing, so as not to further irritate your skin by rubbing it.
  • For the same reason, do not rub yourself dry with a towel after washing, but pat yourself dry.
  • After each skin cleansing (e.g. face or hand washing, showering, bathing), the atopic dermatitis skin must be completely creamed with a suitable skin care product. If the skin is still somewhat moist, the skin care product can penetrate the skin particularly well.

Neurodermatitis therapy: Avoid triggers

Such trigger factors can be, for example, acute infections such as severe colds and flu. If such contagious infections “get around”, neurodermatitis sufferers should pay particular attention to hygiene (hand washing, etc.). In addition, it is then advisable to avoid crowds of people and to keep as far away as possible from people with the disease.

Stress also often triggers a neurodermatitis flare-up. Those affected should therefore consider suitable counter-strategies. At work, for example, it can help to delegate some tasks to others. Regular targeted relaxation is also highly recommended, for example with the help of yoga, autogenic training or meditation.

Neurodermatitis patients who are allergic to pollen, animal hair, certain foods, fragrances in cosmetics or other irritants should avoid them as far as possible. If someone has an allergy to dust mites, a special cover for the mattress (encasing) can also be useful.

Travel to areas with extreme climatic conditions (such as extreme cold or damp heat) is also unfavorable for atopic dermatitis.

Neurodermatitis therapy: cortisone

Cortisone is a naturally occurring hormone in the body (here called “cortisol”) that can also be administered as a medication: Neurodermatitis treatment with cortisone preparations effectively relieves inflammation and itching.

External (topical) application of cortisone:

In most cases of atopic dermatitis, it is sufficient to apply cortisone externally as a cream/ointment in a thin layer on the eczema. This is generally done once a day – for as long as recommended by the doctor.

In doing so, the doctor will prescribe a preparation with a suitable cortisone concentration for each patient. This is because thin, sensitive areas of the house (such as facial skin and scratched skin) absorb more cortisone than more robust areas. They are therefore treated with weaker doses of cortisone ointments than, for example, eczema on the arms or soles of the feet.

internal (systemic) use of cortisone:

In severe cases of neurodermatitis, it may be necessary to take cortisone in tablet form. This type of drug application is also called systemic therapy, because the active ingredient can take effect throughout the body here. This internal cortisone therapy is primarily considered for adults with severe neurodermatitis; in children and adolescents it is only used in exceptional cases.

In any case, the attending physician must carefully monitor the neurodermatitis treatment with cortisone tablets. Because of the possible side effects, the tablets should only be taken for a short time (a few weeks).

At the end, patients should “taper” the cortisone therapy according to the doctor’s instructions, i.e., not stop taking the tablets abruptly, but gradually reduce their dose.

Neurodermatitis therapy: Calcineurin inhibitors

They are more suitable than cortisone for treating eczema on sensitive skin areas, such as the face and genital area. This is because some side effects that can be caused by cortisone ointments do not occur with the two calcineurin inhibitors. Tacrolimus and Pimecrolimus, for example, do not cause the skin to thin, even after prolonged use. In addition, they do not cause inflammation around the mouth in the face (perioral dermatitis).

In less sensitive skin areas, however, eczema is preferably treated with cortisone ointments. Calcineurin inhibitors are usually only used here if a cortisone ointment cannot be used or could lead to local, irreversible side effects.

In principle, Tacrolimus (0.03 %) and Pimecrolimus are prescribed for local neurodermatitis treatment only from the age of 3, higher-dose Tacrolimus preparations (0.1 %) even only from the age of 17. In individual cases, however, the drugs can also be used in infants and young children, especially in severe, chronic facial/cheek eczema.

During treatment with calcineurin inhibitors, the skin should be adequately protected from sunlight. In addition, experts advise against phototherapy (see below) during use.

Neurodermatitis therapy: Ciclosporin A

Ciclosporin A is a potent immunosuppressant. It can be used internally (systemically) to treat chronic, severe atopic dermatitis in adults. Eventually, ciclosporin A may also be given to children and adolescents if they have severe atopic dermatitis that cannot be treated with other therapies (in patients younger than 16 years of age, the use of ciclosporin A is off-label).

In most cases, patients take ciclosporin A twice daily. Induction therapy is recommended: A higher initial dose is started and maintained until symptoms largely improve. Subsequently, the dose is gradually reduced to an individually suitable maintenance dose.

Experts advise against performing phototherapy (see below) during the use of ciclosporin A. This is because the combination of the two therapies increases the risk of skin cancer. While taking ciclosporin A, patients should also protect their skin well from UV light (sun, solarium).

If ciclosporin is not tolerated or does not work sufficiently, the doctor may prescribe tablets with another immunosuppressant, for example azathioprine or methotrexate. However, these agents are not approved for the treatment of atopic dermatitis. They are therefore only used in selected individual cases (“off-label-use”).

Neurodermatitis therapy: Biologics

Biologics are drugs produced biotechnologically (i.e. with the help of living cells or organisms). Two biologics are currently approved for the treatment of moderate to severe atopic dermatitis: Dupilumab and Tralokinumab. They block inflammatory messengers, which can alleviate inflammation and soothe atopic dermatitis skin.

The use of these biologics in atopic dermatitis is considered when external (topical) therapy – for example with cortisone ointments – is not sufficient or not possible and therefore internal (systemic) therapy becomes necessary. Dupilumab is approved for patients over the age of six, whereas tralokinumab is only approved for patients over the age of 18 (i.e. adults).

The more frequent side effects of the two biologics include, for example, local reactions at the injection site (such as redness, swelling) and conjunctivitis, as well as – in the case of tralokinumab – upper respiratory tract infections.

Neurodermatitis therapy: JAK inhibitors

In addition to biologics, Janus kinase (JAK) inhibitors are among the newer treatment options for moderate to severe atopic dermatitis when external therapy does not help sufficiently or is not possible.

JAK inhibitors have a targeted immunosuppressive effect: they inhibit the so-called Janus kinases within cells. These are enzymes that are involved in the transmission of inflammatory signals. JAK inhibitors thus exert an anti-inflammatory and antipruritic effect.

All three approved JAK inhibitors are taken as tablets. However, research is already being conducted into further JAK inhibitors that can be applied externally as a cream.

Possible side effects of internal neurodermatitis treatment with JAK inhibitors include inflammation of the upper respiratory tract and headaches.

Neurodermatitis treatment: Supportive measures

Neurodermatitis treatment can be supported with additional measures if necessary:

H1 antihistamines

H1 antihistamines inhibit the effect of the tissue hormone histamine in the body. In allergy sufferers, this hormone is responsible for allergic reactions such as itching. So far, however, studies have not been able to scientifically prove that H1 antihistamines also help against itching in neurodermatitis. Nevertheless, their use is often useful:

For one thing, some H1 antihistamines trigger fatigue as a side effect. This benefits patients who cannot sleep because of their neurodermatitis (itching). On the other hand, some neurodermatitis patients also suffer from an allergic disease such as hay fever. H1 antihistamines are often used successfully against such an allergy.

There are also H2 antihistamines. They also inhibit the histamine effect, albeit in a different way than their “H1 relatives”. However, H2 antihistamines are not recommended for the treatment of neurodermatitis.

Polidocanol, zinc, tannins & co.

Skin care products containing the active ingredient polidocanol or tanning agents are sometimes recommended to combat itching in atopic dermatitis. Experiences of patients as well as some studies show that these preparations can actually help. However, neither polidocanol nor tanning agents are suitable as a substitute for anti-inflammatory therapy (such as cortisone).

Among other things, zinc ointments and creams have an anti-inflammatory and cooling effect. However, their efficacy in atopic dermatitis has not been proven. Nevertheless, many patients have had positive experiences with skin care products containing zinc. Such preparations can therefore be used in basic skin care for atopic dermatitis.

Medication against skin infections

Severe itching tempts many neurodermatitis patients to scratch themselves open. Pathogens can easily penetrate the open skin areas and trigger an infection. If the pathogens are bacteria or fungi, the doctor prescribes targeted active substances to combat them:

Antibiotics help with bacterial skin infections, and antifungals with fungal infections. Patients can apply the active ingredients externally (for example, as an ointment) or internally (for example, in tablet form).

Antimicrobial laundry

For some years now, special underwear has been available that consists of textiles with an antimicrobial (antiseptic) effect. These include, for example, garments coated with silver nitrate. They can somewhat alleviate eczema in atopic dermatitis. However, such antimicrobial underwear is quite expensive. However, those who suffer from chronic atopic dermatitis may consider purchasing them.

Light therapy (phototherapy)

Special variants of light therapy are also suitable for the treatment of neurodermatitis:

In so-called PUVA, the patient is first treated with the active ingredient psoralen. This makes the skin more sensitive to the subsequent irradiation with UV-A light. Psoralen can be applied in different ways. Many neurodermatitis patients bathe in a psoralen solution (Balneo-PUVA) before irradiation. The active ingredient is also available in tablet form (systemic PUVA). However, the risk of side effects is then higher than with Balneo-PUVA.

Light therapy (without psoralen) can also be combined with bath therapy (balneo-phototherapy): While the patient bathes in salty water, his skin is irradiated with UV light. Due to the large amount of salt in the water, the anti-inflammatory rays can penetrate deeper layers of the skin more easily.

Light therapy is mainly used for adult patients. It may also be possible for underage atopic dermatitis patients over the age of 12.

Stays at the sea and in the mountains (climatic therapy).

Moreover, at the sea as well as in the mountains, the climatic conditions are very skin-friendly. They can significantly improve the skin condition of neurodermatitis patients. The high UV radiation (anti-inflammatory) in these regions contributes to this. In higher mountainous areas, the air is also low in allergy-causing substances (allergens) such as pollen. In addition, it can never get humid in regions above 1,200 meters above sea level. Neurodermatitis patients benefit from all this.

Specific immunotherapy (hyposensitization)

Neurodermatitis patients who also suffer from hay fever, allergic asthma or an insect venom allergy can undergo a so-called subcutaneous specific immunotherapy (classic form of hyposensitization). The doctor repeatedly injects a small dose of the allergy trigger (allergen such as pollen or insect venom) under the skin. He increases the dose from time to time. In this way, the immune system is supposed to slowly lose its hypersensitivity to the allergy trigger. This can also alleviate atopic eczema if it is shown to be aggravated by the allergen.

Relaxation techniques

Cotton gloves

When itching is severe, many patients scratch themselves in their sleep – sometimes so much that the skin bleeds. To prevent this, neurodermatitis patients (small and large) can wear cotton gloves at night. To prevent them from getting lost during sleep, they can be fixed to the wrists with a sticking plaster.

Psychological treatment

The soul can suffer greatly from neurodermatitis: the skin disease is not contagious. Nevertheless, healthy people sometimes shy away from contact with those affected, which can hurt them very much. In addition, some patients are ashamed of their appearance, especially if the neurodermatitis affects the face, scalp and hands.

If neurodermatitis patients have serious psychological or emotional problems due to their disease, psychological treatment may be useful. Behavioral therapy has proven particularly effective.

Neurodermatitis & Nutrition

There is no special “neurodermatitis diet” that can be recommended across the board to all sufferers. Some neurodermatitis sufferers can eat and drink anything they feel like – without any noticeable effects on their symptoms.

Neurodermatitis plus food allergy

Especially infants and toddlers with neurodermatitis are often sensitive to one or more foods such as cow’s milk, chicken egg white or wheat. Their consumption can obviously trigger or aggravate an acute disease flare-up in the little ones.

However, only a small proportion of those affected can be shown to have a “real” food allergy (provocation test). If this is the case with your child, you should remove the food in question from his or her diet. It is best to do this in consultation with the attending physician or a nutritionist. The latter will help to plan a targeted “omission diet” (elimination diet). This ensures that the child’s diet provides sufficient nutrients, vitamins and minerals despite the fact that certain foods are not eaten. This is very important for the development of the little one.

If adolescents or adults with atopic dermatitis suspect that they have poor tolerance to certain foods, they should also be tested for a corresponding allergy.

No omission diet for prevention!

Some parents do not give their neurodermatitis children any potentially allergy-causing foods such as dairy products, eggs or wheat flour products “on the off chance” – without a corresponding allergy having been determined in the little ones beforehand. These parents nevertheless hope that the neurodermatitis of their offspring will improve with the “preventive” omission diet. Experts advise against it however!

On the one hand, parents who reduce their child’s diet on their own risk serious deficiency symptoms in their offspring.

On the other hand, dietary restrictions can be very stressful, especially for children: If, for example, other children eat ice cream or cookies together and the neurodermatitis child has to do without, this is not easy. Even worse, if the renunciation would not be medically necessary!

Neurodermatitis treatment: Alternative medicine

  • Plant oils such as argan oil are considered helpful: neurodermatitis patients are said to benefit from the healing-promoting effect of the oil – as are people with psoriasis, for example. The ingredients of argan oil include linoleic acid. This omega-6 fatty acid is an important component of the skin.
  • Other plant oils include evening primrose oil, black cumin oil and borage seed oil. They provide a lot of gamma-linolenic acid. This omega-6 fatty acid can have an anti-inflammatory effect in atopic eczema. Patients can take the oils in capsule form or apply them externally as ointment or cream.
  • Some patients support neurodermatitis treatment with aloe vera. Extracts of the cactus-like plant are said to have various healing effects. Aloe vera is said to moisturize the skin and promote its regeneration. It is also said to have anti-germ (antimicrobial) and anti-inflammatory properties.
  • Depending on the symptoms, homeopaths recommend graphites, Arnica montana or Arsenicum album for atopic dermatitis, for example.

The concept of homeopathy as well as that of Schüssler salts and their specific effectiveness are controversial in science and not clearly proven by studies.

Home remedies against neurodermatitis

Home remedies against neurodermatitis are, for example, cool, moist compresses (with water) against the itching. You can also first apply a suitable care product to your skin and then apply the compress.

Studies have also shown that the effect of a cortisone ointment can be increased with the help of a moist compress. However, it has not yet been tested whether this combination can have long-term side effects.

Some patients rely on compresses with chamomile flowers. The medicinal plant has an anti-inflammatory effect. Pour a cup of boiling water over one tablespoon of chamomile flowers. Let it steep, covered, for five to ten minutes before straining the plant parts. Once the tea has cooled, soak a linen cloth in it. Then place it on the affected skin and tie a dry cloth around it. Leave the poultice to act for 20 minutes.

A help for neurodermatitis can also be full baths with an extract of oat straw: The silicic acid in the straw promotes wound healing. The flavonoids it contains increase blood circulation. This can strengthen the local immune defenses.

For the bath additive, add 100 grams of oat straw to two liters of cold water. Heat the mixture and boil it for 15 minutes. Then strain the straw and pour the extract into the lukewarm bath water. Lie down in the tub for 10 to 15 minutes. After that, you should pat the skin dry and apply a suitable cream/ointment.

Patients often learn many other tips for neurodermatitis treatment in self-help groups.

Home remedies have their limits. If the symptoms persist over a longer period of time, do not improve or even get worse, you should always consult a doctor.

Neurodermatitis: Baby

Neurodermatitis is often particularly hard on babies and small children. The little ones do not yet understand why their skin is inflamed in places and itches so badly. They feel uncomfortable, are often restless and have trouble sleeping.

For more tips and info on atopic eczema in the youngest patients, read the article Neurodermatitis – Baby.

Neurodermatitis: examinations and diagnosis

Neurodermatitis often appears in infancy or toddlerhood. If your child scratches frequently, you notice inexplicable reddening of the skin and these symptoms persist, talk to the pediatrician about it! He or she will first talk to you and take a medical history of your child. Possible questions the doctor may ask include:

  • When did the rash first appear?
  • Where on the body are the skin lesions?
  • How long has your child been scratching and how often?
  • Have you noticed dry skin in your child before?
  • Are there factors that aggravate the symptoms, for example, cold, certain clothing, stress, or some foods?
  • Do you yourself or other family members suffer from atopic dermatitis?
  • Are allergies (such as hay fever) or asthma known in your child or in your family?

Physical examination

After the interview, the doctor will physically examine the patient. In doing so, he will take a close look at the skin all over the body. A clear indication of neurodermatitis are itchy, inflammatory skin changes which, depending on age, occur preferentially in certain areas. For example, in infants the face and the extensor sides of the arms and legs are particularly affected, and in older children often the backs of the knees, crooks of the elbows and wrists.

If these skin inflammations are chronic or recurrent, this is also a strong indication of neurodermatitis. This is even more true if hay fever, food allergies, allergic asthma or other allergies are also known in the patient’s family (or in the patient himself).

In addition, there are other criteria that can indicate neurodermatitis. If, for example, the skin is mechanically irritated (e.g. by scratching with a fingernail or spatula), this often leaves whitish marks on the skin in the case of neurodermatitis (white dermographism).

Further examinations

If the doctor suspects that the neurodermatitis is associated with an allergy, he can arrange for appropriate allergy tests:

In addition, the doctor can have the patient’s blood tested in the laboratory for specific antibodies against certain allergy triggers.

In unclear cases of neurodermatitis, it may occasionally be necessary to take a small skin sample, which is then examined more closely in the laboratory (skin biopsy).

Exclusion of other diseases

In his examinations, the doctor must rule out other diseases that can trigger symptoms similar to those of neurodermatitis. These so-called differential diagnoses include, for example:

  • other eczema, for example allergic contact dermatitis, irritant-toxic contact dermatitis, microbial eczema, seborrheic eczema (especially in infants) and – in adults – the eczema stage of cutaneous T-cell lymphoma (a form of non-Hodgkin’s lymphoma)
  • psoriasis, including the psoriasis palmoplantaris form (psoriasis of the palms and soles)
  • Fungal infection of hands and feet (tinea manuum et pedum)
  • scabies (scabies)

Neurodermatitis: course and prognosis

Neurodermatitis almost always breaks out in early childhood: in about half of all cases already in the first six months of life, in 60 percent of the cases in the first year of life and in more than 70 to 85 percent of the cases before the age of five.

As the child grows up, the eczema and itching usually disappear again: about 60 percent of all children with neurodermatitis no longer show any symptoms by early adulthood at the latest.

At least three out of ten children with atopic dermatitis also suffer from eczema at least occasionally as adults.

The risk of neurodermatitis continuing into adulthood is particularly high if the atopic eczema occurred in very early childhood and has taken a severe course. If a child also suffers from other allergic (atopic) diseases such as hay fever or allergic asthma, the risk is increased that he or she will still suffer from the skin disease as an adult. The same applies if close family members have an atopic disease.

At any time, atopic dermatitis can also heal spontaneously.

Neurodermatitis complications

Complications can occur in the course of atopic dermatitis. Skin infections develop most frequently, for example because scratching the itchy skin provides pathogens with an easy entry point:

  • bacterial infections: Additional bacterial skin infections in atopic dermatitis are usually the result of so-called staphylococci. However, in most neurodermatitis patients the skin is colonized with the representative Staphylococcus aureus without showing the typical symptoms of a bacterial skin infection. At the same time, such symptoms are much more frequently visible in children than in adults.
  • Viral infections: As a result, dell warts or pronounced “normal” warts may develop, for example. Some patients develop a so-called eczema herpeticatum: triggered by herpes viruses, numerous small skin blisters form, usually accompanied by high fever and swollen lymph nodes. In severe cases, there is a danger to life, especially for children and people with weak immune systems!

Rare complications of atopic dermatitis include eye diseases (such as glaucoma, retinal detachment, blindness), circular hair loss (alopecia areata) and growth retardation / short stature.

Some neurodermatitis patients also develop ichthyosis vulgaris. This is a genetically caused cornification disorder of the skin.

Neurodermatitis: Prevention

On the subject of prevention, neurodermatitis is divided into two variants:

  • If neurodermatitis already exists, suitable measures can prevent acute attacks of the disease. This is called secondary prevention.
  • Primary prevention is about preventing a neurodermatitis disease from the outset.

Preventing atopic dermatitis flare-ups

In most atopic dermatitis patients, the flare-ups occur primarily in the fall and winter. In spring and summer, however, the skin often improves. It is not possible to predict how severe the individual attacks are, how long they last and how often they occur.

However, there is much that can be done to prevent a neurodermatitis flare-up. This includes, above all, avoiding or at least reducing the individual triggers. Here are some tips:

  • Neurodermatitis patients with other allergies (such as to pollen, dust mites, animal hair, etc.) should also avoid the allergen as far as possible.
  • People with neurodermatitis should wear clothing that is soft and kind to the skin (for example, made of cotton, linen or silk). Wool clothing, on the other hand, is often difficult for them to tolerate on the skin. New clothing should always be washed and rinsed thoroughly before being worn for the first time.
  • Cigarette smoke intensifies the symptoms of neurodermatitis. A household in which a person with neurodermatitis lives should definitely be smoke-free.
  • Many cleaning, care and cosmetic products contain substances that further irritate the sensitive atopic dermatitis skin. The doctor or pharmacist can recommend products that are also suitable for atopic dermatitis.
  • Neurodermatitis patients should also avoid unfavorable climatic conditions (travel to hot countries, dry air due to air conditioning, etc.).
  • Very advisable for neurodermatitis are cures of several weeks in a so-called stimulating climate (North Sea, high mountains, etc.). It promotes the healing of eczema and can prevent new attacks.
  • The regular exchange with other neurodermatitis patients in a self-help group can help those affected to cope better with their disease. This increases mental well-being and can thus prevent new relapses. Self-help groups are particularly useful for children and adolescents: Many are ashamed of their bad skin or are teased about it.

For adolescents and adults with atopic dermatitis, the right choice of occupation is also crucial: occupations in which the skin comes into contact with water, cleaning agents and disinfectants or chemical products are unsuitable for atopic dermatitis patients. The same applies to heavily soiling activities such as demolition work. Frequent contact with animals or flour can also irritate sensitive skin. Unsuitable occupations for atopic dermatitis are therefore, for example, hairdresser, baker, confectioner, cook, gardener, florist, construction worker, metal worker, electrical engineer, nurse and other medical occupations as well as room attendant.

Reduce the risk of neurodermatitis

Important tips for neurodermatitis prevention are:

  • Women should not smoke during pregnancy. Even after birth, children should grow up in a smoke-free household. This reduces their risk of neurodermatitis and other atopic diseases.
  • Women during pregnancy and breastfeeding should make sure they eat a balanced, varied diet that meets their body’s (and, during pregnancy, their child’s) nutritional needs. This includes vegetables, milk and dairy products, fruit, nuts, eggs and fish.
  • Babies should be fully breastfed for the first four to six months, if possible. This prevents the development of neurodermatitis, hay fever & Co.
  • For babies who are not (fully) breastfed, a hypoallergenic (HA) infant formula is said to be useful if atopic diseases (such as neurodermatitis) occur in their family (at-risk children). However, national and international experts disagree on how effectively such infant formula can actually prevent allergic diseases. You can read more about this topic in the article Allergy prevention.
  • By the way, avoiding common food allergens (such as cow’s milk, strawberries) in the first year of life in order to reduce the child’s allergy risk does not work! On the contrary: protection against hay fever & Co. offers rather a varied diet for infants (also with fish, chicken egg and a limited amount of milk / natural yogurt). You can read more about this here.
  • In households with risk children, one should not acquire a new cat. An existing cat, on the other hand, does not need to be eliminated – there is no evidence that it would affect the child’s allergy risk.

There is evidence that a so-called Mediterranean diet (lots of plant foods, lots of fish, little meat, olive oil, etc.) can also protect against atopic diseases. The same goes for consuming vegetables, fruits, omega-3 fatty acids and dairy fat. However, this needs to be researched further before precise dietary recommendations can be made for the prevention of atopic dermatitis and other atopic diseases.