Neurodermatitis - skin care and treatment

Contents:
1. What is neurodermatitis?
2. How does neurodermatitis develop and what is it associated with?
3. How can neurodermatitis be treated?

Neurodermatitis, also known as atopic dermatitis, is one of the most common chronic inflammatory skin diseases . It usually occurs in childhood and often improves during puberty. However, adults can also be affected by chronic courses. The disease is associated with other clinical pictures of the so-called atopic group (e.g. asthma, hay fever) and manifests itself with severe itching , which usually occurs on very dry skin .

In Germany, 10-15% of all children are affected by neurodermatitis. This makes it the most common chronic disease in childhood. The first manifestation often occurs between the 3rd and 6th month of life. The first symptom is often the so-called cradle cap . Unlike cradle cap , this is flat, yellowish scales on the face and hairy head, which sometimes become wet, form crusts and are difficult to remove.

In childhood, severe itching occurs in bouts of dry, sometimes scaly eczema, which mainly occurs on the extensor sides of the arms and legs. The so-called lichenification begins, which describes the skin becoming thicker and the skin patches becoming coarser. The corners of the mouth can be dry and cracked. The diaper area is typically not affected. A bacterial superinfection of scratched eczema often complicates the course of the disease.

How can neurodermatitis be treated and why is basic care so important in the treatment of neurodermatitis?

The treatment of neurodermatitis is divided into three main pillars: the avoidance of trigger factors, basic care and topical and systemic therapy with medication.

Classic trigger factors for neurodermatitis are cold, dry air, extreme sweating, showering too often, mechanical irritations (e.g. from irritating clothing) and allergens (e.g. fragrances, dyes) and should be avoided as much as possible.

Basic care plays a major role in the treatment of neurodermatitis, as it is intended to prevent the onset of a worsening or acute flare-up by stabilizing the skin. As described above, dry, itchy skin is the main symptom of neurodermatitis, so a good basic cream must prevent the loss of fluid from the outer layers of skin as much as possible. If the skin barrier is intact, the skin is less susceptible to acute flare-ups. Common active ingredients in basic creams are glycerin, evening primrose oil and urea. However, urea can burn on inflamed skin and should therefore not be used on babies and small children.

Depending on the condition of the skin, the basic care product must be applied daily. Moisturizing compresses can increase the effect. Children should continue to be creamed even when there are no flare-ups in order to prevent acute deterioration as best as possible, as described above. Children with confirmed neurodermatitis should therefore not bathe for too long (approx. 5-10 minutes), add moisturizing bath substances to the water and apply a basic cream immediately after bathing.

In acute attacks, basic care is often no longer sufficient. Glucocorticoids (cortisone) or calcineurin inhibitors (e.g. tacrolimus) are usually used. In recent years, therapy with monoclonal antibodies and Janus kinase inhibitors has been developed to such an extent that they are now approved for initial therapy. Drug therapy follows a step-by-step plan and should be prescribed individually by the treating dermatologist. In each stage, further avoidance of trigger factors and continuation of basic care is recommended.