We developed our med base cream for the basic care of skin prone to neurodermatitis. But before we tell you a lot about our base cream, we would like to give you a brief insight into the disease, its development, possible trigger factors, and other therapy options, so that you know approximately what stage you or your child is currently in.
Neurodermatitis, also known as atopic dermatitis, is one of the most common chronic inflammatory skin diseases. It usually appears in childhood and often improves during puberty. However, adults can also suffer from chronic courses. The disease is associated with other conditions of the so-called atopic spectrum (e.g., asthma, hay fever) and manifests with severe itching, which usually occurs on very dry skin.
In Germany, 10-15% of all children are affected by neurodermatitis, making 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 involves widespread, yellowish scales on the face and scalp that sometimes weep, form crusts, and are difficult to remove.
In childhood, severe itching then occurs in episodes on dry, sometimes flaky eczemas, which preferentially appear on the extensor surfaces of the arms and legs. This begins the so-called lichenification, which describes the skin thickening and the skin texture becoming coarser. The corners of the mouth can be dry and crack. Typically, the diaper area is not affected. It is not uncommon for a bacterial superinfection of a scratched eczema to complicate the course.
How does neurodermatitis develop and what is it associated with?
The exact cause of the disease is not yet fully understood. It is assumed to be a combination of genetic, immunological, and allergological processes. Various trigger factors that disrupt the skin barrier also play a role in the onset of flare-ups.
The disease usually recedes in adulthood; about 60% of affected children are later symptom-free. Of course, adults can also suffer from recurring flare-ups. In late-onset manifestation in adulthood, an isolated hand and foot eczema sometimes appears as the first symptom.
There are so-called atopic stigmata that are associated with the occurrence of atopic diseases. These include the double lower eyelid fold (Dennie-Morgan sign), thinning of the lateral eyebrows (Hertoghe sign), and "chicken skin" on the upper arms and legs (keratosis pilaris). Children with neurodermatitis often develop further atopic diseases, such as bronchial asthma or allergic rhinitis (hay fever), later in life.
How can neurodermatitis be treated and why is basic care so important in its treatment?
The treatment of neurodermatitis is divided into 3 main pillars: avoiding trigger factors, basic care, and topical and systemic therapy with medication.
Classic trigger factors for neurodermatitis include cold, dry air, extreme sweating, too frequent showering, mechanical irritations (e.g., from irritating clothing), and allergens (e.g., fragrances, dyes) and should be avoided as much as possible.
The basic care plays a major role in the treatment of neurodermatitis, as it is intended to prevent the onset of worsening, an acute flare-up, by stabilizing the skin's appearance. The dry, itchy skin, as described above, is the leading symptom of neurodermatitis, which is why a good base cream must prevent fluid loss from the outer skin layers as much as possible. If the skin barrier is intact, the skin is less susceptible to acute flare-ups. Common active ingredients in base creams are glycerin, evening primrose oil, and urea. However, urea can sting on inflamed skin and should therefore preferably not be used on babies and small children.
Depending on the skin condition, basic care must be applied daily. Wet-wrap dressings can enhance the effect. Even during flare-free intervals, children should continue to be moisturized to prevent an acute worsening as best as possible, as described above. Children with diagnosed neurodermatitis should therefore not bathe for too long (approx. 5-10 minutes), add moisturizing bath additives to the water, and be moisturized immediately after bathing with a base cream.
In an acute flare-up, basic care is often no longer sufficient. In such cases, the use of glucocorticoids (cortisone) or calcineurin inhibitors (e.g., tacrolimus) is usually required. In recent years, therapy with monoclonal antibodies and Janus kinase inhibitors has also been developed to the extent that they are now approved for initial therapy. Drug therapy follows a stepped approach and should be individually prescribed by the treating dermatologist. In every step, continued avoidance of trigger factors and continuation of basic care are recommended.
In summary, the following can be noted:
- the most common chronic disease in childhood
- Leading symptom: itching on mostly very dry skin
- affected children are often symptom-free as young adults
- Origin not yet fully understood
- Basic care is recommended at all stages of therapy to stabilize the skin and prevent further moisture loss
- Even during flare-free intervals, moisturizing should continue and trigger factors should be avoided as much as possible
O U R E X P E R T
Dr. med Michaela Hagemann I boep founder, doctor & 3-time mom
