Neurodermatitis is a group of rashes that all have chronic non healing lesions. The initial cause of the lesion is generally very difficult to pinpoint. Some begin as small acne bumps, others as areas of dry or irritated skin. Some even begin in areas of cuts or scratches. By the time the patient is seen there are no remaining primary lesions, just scratched, raw or scabbed areas. In some patients the skin seems to simply become irritated very easily. In most cases there is no apparent cause for the initial bump or irritated area. Some are itchy while others are simply irritating or even sore. Some physicians believe the root of the problem is hyperactive nerve endings and a strong urge to scratch, pick, squeeze, scrub or clean sore areas which keeps them from healing. This also is fueled tremendously by stress. Of course, the condition itself creates stress promoting a vicious cycle. If patients pick or scratches aggressively the areas become open raw erosions. If they scratch less aggressively, but over a long time, the skin thickens into a calloused-like area. Of course, the more the area is picked the sorer, itchier or thicker and more irritating it becomes again adding to the vicious cycle. Lesions occur predominantly on the tops of the arms and legs, back of the neck and face, but can occur anywhere. Scarring often results.
Most patients are consumed with finding the cause of their problem. Most have seen a number of physicians. Many fear or are convinced that they have some horrible exotic infection, infestation, systemic toxin or defect in their immunity or ability to heal. None of the above are true, and the condition is not rare in dermatology. These beliefs fuel the anxiety and behavior and worsen the condition.
1. Accept the diagnosis and explanation. It is a very common problem and does not mean you are crazy or have any psychiatric disturbance. If you do not accept and understand the problem treatment will fail. If you can, or are at least willing to try, proceed with the following.
2. Stop picking/scratching. This is much more difficult than it sounds. Some patients pick subconsciously, some even at night. Anytime the skin is raw or bleeding you have just picked. If you are having particular difficulty with an area keep it covered with a bandage. If you have an urge to pick or scratch try to squeeze another object while you count to 10. This sometimes confuses the nerve endings and lessens the itchiness.
3. Keep lesions covered with antibiotic ointment changed once a day. This keeps the wound moist allowing it to heal faster than if it dries and scabs. It is also helps prevent infection thus allowing you to rest assured that infection is not part of the problem.
4. Avoid soap, cleaners, alcohol, bleach, scrubbing, et cetera. These are all harsh irritants for open sores, and will prevent the lesions from healing. Clean gently with plain water once daily.
5. Try to reduce your stress level. Remember stress fuels the vicious cycle. Incorporating healthy diet and exercise habits will help. If you feel that you have a serious problem with depression or anxiety please let me know, so that I may refer you for appropriate care.
6. If areas are itchy antihistamine pills can be used.
7. Topical corticosteroid creams can also combat itching and thickening.
8. For thickened areas, freezing and cortisone shots into the lesions can sometimes be very helpful.
9. Some people with this condition have a true obsessive compulsive tendency. In these instances medications called serotonin reuptake inhibitors may be helpful. While these are often used as antidepressants they also have a substantial affect in helping to decrease the urge to pick or scratch the skin.
This is a difficult problem, so do you best to follow all of these steps carefully and faithfully. Certainly, if things are not going well we should take another look at your condition to see if there are other measures we can add to improve it.