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Treatment of neurodermatitis generally aims to control severe itching, prevent scratching, and address underlying causes

Neurodermatitis or lichen simplex chronicus is a chronic, non-life-threatening skin condition that involves intense itching, typically on 1-2 patches of skin. It is estimated that this skin condition affects approximately 12% of the U.S. population.

The challenge with managing neurodermatitis is breaking the scratch-itch cycle. Treatment of neurodermatitis generally aims to control severe itching, prevent scratching, and address underlying causes.

What are treatment options for neurodermatitis?

Treatment options for neurodermatitis may include:

• Medications
  • Topical corticosteroids
    • Applied topically to the itchy patch.
    • Help reduce redness, swelling, itching, and tenderness and often help soften the thickened area of the skin.
  • Corticosteroid injections
    • May be injected directly into the affected skin to help it heal.
  • Antihistamines or sedatives
    • Antihistamines, such as Benadryl (diphenhydramine) taken before bedtime can reduce itching during sleep and help prevent allergic reactions that would worsen the condition.
    • Prescription antihistamines may cause drowsiness and help alleviate scratching while sleeping.
  • Antibiotics
    • Antibiotics are prescribed if the patchy area is infected.
    • Can be applied to the skin or taken orally in pill form.
  • Antidepressants
    • Recommended if it is believed that anxiety, depression, or stress is causing the itching.
    • Obtained with prescription only.
  • Antianxiety drugs
    • Because anxiety and stress can trigger neurodermatitis, antianxiety drugs may help prevent itchiness.
    • Obtained with prescription only.
  • Medicated patches
    • For stubborn itching, topical 5% lidocaine or 8% capsaicin patches may be recommended.
• Moisturizers
  • Thick moisturizers can reduce dryness and itching when applied to the affected area.
  • May provide a soothing and protective effect on the skin.
• Coal tar preparations
  • Skin cream that contains coal tar or capsaicin causes the skin to shed dead cells and helps slow down the growth of new cells.
  • May relieve both pain and itching.
• Cool compresses
  • Can be placed on the skin for about 5 minutes before applying corticosteroids. 
  • Softens the skin so that the medicine can be absorbed easily and relieves itching.
• Light therapy
  • Exposing the affected skin to particular types of ultraviolet light is sometimes helpful in reducing symptoms
• Psychotherapy or counseling
  • Talking to a counselor may help you understand how emotions and behaviors are related to itching and scratching.
  • Psychotherapy can help you control compulsive scratching.
• Coverings
  • Using bandages, socks, or gloves can prevent night scratching, allowing better sleep.
  • Coverings also help topical medications be better absorbed by the skin.

In some cases, if none of the standard medications work, your doctor may recommend an experimental treatment (nontraditional) that has shown some potential in helping people with severe neurodermatitis. These emerging therapies include

• Treatments used for atopic dermatitis or eczema: Examples include tacrolimus and pimecrolimus
• Botox injection: Can cause flaccid paralysis or muscle weakness that may reduce itching and clear up rough skin patches.
• Oral drugs to ease the compulsion to scratch: N-acetylcysteine has been shown to help some people with neurodermatitis.
• Cryosurgery: Destroys unwanted tissues using intense cold.

Can you prevent neurodermatitis?

Neurodermatitis can be prevented with the following measures:

• Avoid rubbing and scratching as much as possible
• Keep fingernails short and trimmed to minimize damage if you do scratch during sleep
• If itching is irresistible, use gloves and socks as occlusive measures
• Apply cold compresses or OTC anti-itch medications to the itchy area
• Avoid hot water baths
• Add colloidal oatmeal to your bath to relieve itching
• Limit bathing time and frequency
• Use mild soaps without fragrances or irritating chemicals
• After washing, pat skin dry and apply unscented moisturizer
• Wear loose clothing, preferably made of cotton
• Avoid triggers that can irritate the skin or cause an allergic reaction
• Use stress management techniques, such as meditation and yoga

What are symptoms of neurodermatitis?

Symptoms of neurodermatitis may include:

• Intense itching that often increases in stressful situations
• Raw areas of skin due to excessive scratching
• Dryness
• Scaly skin
• Discolored patches
• Lesions that are sharply demarcated and leathery in texture
• Hair loss (if itching and scratching occur on the scalp)
• Open sores that may bleed due to repeated scratching
• Infection (indicated by sores with yellow-colored pus discharge)
• Scarring

What are the complications of neurodermatitis?

Neurodermatitis is a noncontagious, non-life-threatening condition, but the itching can be so intense or recurrent that it disrupts sleep, sexual function, and quality of life:

• Insomnia or disturbed sleep
• Impaired sexual function
• Skin hyperpigmentation or hypopigmentation
• Secondary bacterial infections
• Permanent scarring