Neurodermatitis: An Overview

Medically Reviewed by Stephanie S. Gardner, MD on June 02, 2024
Written by Hallie Levine
7 min read

Neurodermatitis, also called lichen simplex chronicus, is a common type of eczema, a group of skin conditions that make skin itchy and inflamed. About 1 in 8 people have neurodermatitis.

Neurodermatitis tends to appear as just one or two patches on the body. That’s different from other types of eczema that can show up in multiple areas at once. These patches can form anywhere. The most common spots are the feet, ankles, hands, wrists, elbows, shoulders, neck, and scalp.

 

No one knows exactly what triggers neurodermatitis. Some experts think it’s caused by nerves in your skin overreacting. There are a few reasons why that could happen:

  • Skin allergies
  • A bug bite
  • Very dry skin
  • Skin conditions such as eczema or psoriasis
  • Poor blood flow
  • Tight or irritating clothing
  • Sweat
  • Stress
  • Anxiety or depression

Once you have neurodermatitis, it can get worse fast. The more it itches, the more you scratch, and the more your skin gets irritated and inflamed.

Neurodermatitis risk factors

Anyone can get neurodermatitis, but some people are more prone to it than others, including:

  • Women ages 30 to 50
  • People who have other skin conditions, such as contact dermatitis, atopic dermatitis (allergic skin conditions), and psoriasis (an autoimmune disease)
  • People who have anxiety disorders or obsessive compulsive disorder (OCD). Some personality types are also more likely to get neurodermatitis, such as people who have a strong desire to conform and please others.
  • African American or Asian people
  • People with a history of hay fever and/or asthma

Some of the most common signs of neurodermatitis are:

Intense itch. This usually begins on a small patch of your skin. The most common spot is your neck, but it can also show up on your arms, eyelids, scalp, butt, and private parts. As you scratch it, it becomes even itchier, which causes you to rub it and irritate it even more. This is known as the itch-scratch-itch cycle. You may notice it more when you relax or try to sleep, and it may worsen when you’re stressed.

Pain. While the patch itself doesn’t hurt, you may scratch it so much you feel pain.

Open sores and bleeding. You may scratch the spot so much that you even get a skin infection.

What does it look like?

Neurodermatitis patches tend to vary between 3 by 6 centimeters (about the size of a matchbook) to 6 by 10 centimeters (roughly the size of a deck of playing cards). You may also see:

  • A raised, rough patch. It will look red on light skin and violet on dark skin.
  • Thick, leathery skin
  • Scales 
  • Round, scaly patches on your scalp. The flakes may look like dandruff. 

If you have symptoms of neurodermatitis, you should see a dermatologist. To diagnose it, they’ll:

  • Do a physical exam to look for itchy patches of skin.
  • Look over your medical history.
  • Ask when the patches first began, if they itch all the time, and what makes them better or worse.

Neurodermatitis tests

There’s no specific test to diagnose neurodermatitis. But your doctor may order the following tests to rule out other conditions:

  • Patch testing to check for contact dermatitis, or a rash caused by allergens
  • Fungal culture to look for yeast
  • Skin biopsy to rule out skin diseases like psoriasis
  • Blood tests to help find out if you have environmental allergies

Don’t worry about spreading neurodermatitis. It isn’t contagious. It’s usually not a very serious condition, either. That said, torn and irritated skin can make you more likely to get infections. And the itchiness can be very uncomfortable. Some people say it’s so bad that they can’t sleep at night. So you’ll want to treat these issues.

The main focus of neurodermatitis treatment is to stop the itch. Your doctor may recommend:

Corticosteroids. These decrease inflammation in your skin to help relieve itching. You can start with an over-the-counter cream and apply it to your itchy patches. If that doesn’t help, your doctor can prescribe something stronger. Or they can inject medication into your skin directly.

Calcineurin inhibitors. These are topical prescription medication creams such as tacrolimus (Protopic ointment) or pimecrolimus (Elidel cream) that can also help to prevent itch.

Antihistamines. They can help to relieve itching and make you drowsy at night so that you can sleep.

Antibiotics. Your doctor will prescribe these if any of the itchy patches have become infected.

Coal tar preparations. These cause your skin to shed dead skin that contributes to itching. You can apply them to your skin directly or add them to your bath.

Capsaicin creams. These are sold over the counter and can help to relieve pain and itching.

Cognitive behavior therapy. This is a type of talk therapy that will help you address issues that may worsen your neurodermatitis, like anxiety or depression. Your therapist can also help you figure out ways to break the itch-scratch-itch cycle. 

If you don’t respond to any of the above treatments, here are some others your doctor may recommend:

Transcutaneous electrical nerve stimulation (TENS). This is a small device that sends electrical impulses to your skin to help reduce the itch. One small study found that it helped about 80% of people who didn’t report relief from corticosteroids. 

Light treatments. Your doctor will use a special machine that emits UVA or UVB light to help treat your neurodermatitis. Small studies suggest it can help people who don’t respond to corticosteroids.

Botox. It’s not just for wrinkles. One very small study that looked at three people found that it improved their neurodermitis within a month.

Neurodermatitis doesn’t usually go away on its own. You’ll want to get it treated to prevent the following complications:

Infections. A lot of scratching can move bacteria into any open sores you have and infect them. Signs include honey-colored crusts, fluid leaking from the itchy area, or pus-filled bumps.

Scarring. If your scratching creates a deep enough wound, it can leave permanent scars and changes in skin color. These areas can itch, too. 

Sleep problems. The itch and urge to scratch can keep you up at night.

Sexual issues. If you have neurodermatitis, you may feel less desire to have sex. This might happen because you’re sleep-deprived but also because itchy patches may make you feel self-conscious.

There are some self-care measures you can take to make life with neurodermatitis easier. They include:

Cool compresses. Apply a cool, damp towel to itchy spots for 10 to 15 minutes several times a day. 

Cool colloidal oatmeal baths. Colloidal oatmeal is available over the counter and can help relieve itching.

Fragrance-free moisturizer. Apply this at least once a day, after your bath or shower while your skin is still damp. Continue to do this even after your itchy spots heal to prevent another flare-up.

Cover up. It might be a good idea to cover the patch so you don’t keep scratching it mindlessly. Wrap the area loosely with an elastic bandage or ask your doctor about wearing an Unna sleeve. This is a special cover to protect delicate skin.

Trim your nails. Short nails will cause less damage if you accidentally scratch.

Use relaxation techniques. Yoga teaches you mindfulness, which may help you control the urge to scratch.

Wear the right clothes. Loose-fitting cotton clothes are best. If you have neurodermatitis in your private parts, try using satin underwear. They may be more expensive, but they’re also much less likely to irritate your sensitive skin, compared to polyester or rayon.

Neurodermatitis can be itchy and painful, but it’s not dangerous. But it’s important to see your dermatologist and get treatment. If it’s left alone, neurodermatitis can lead to an infection and cause other complications like sleep disturbances. 

What’s the main cause of neurodermatitis?

Neurodermatitis happens when the nerves in your skin overreact. This can happen because of stress, anxiety, an allergy, or a bug bite. 

How do you get rid of neurodermatitis?

You need to clear up the itching. The best way to do this is through over-the-counter or prescription cortisone creams, cool compresses, antihistamines to help you sleep (and not scratch) at night, and moisturizers.

What’s the difference between dermatitis and neurodermatitis?

Dermatitis is a general term for skin inflammation that usually includes itching and swelling. Neurodermatitis is a form of skin inflammation that begins with a small itchy patch of skin. It’s usually confined to one or two patches of skin, unlike other forms of dermatitis, which can be more widespread.

Is neurodermatitis an autoimmune disease?

Neurodermatitis is considered to be a form of eczema, or atopic dermatitis. Eczema isn’t an autoimmune disease, since your immune system doesn’t attack your own skin.

What foods trigger neurodermatitis?

There aren’t specific food triggers for neurodermatitis. But since people with allergies are more likely to get neurodermatitis, it might be worth discussing with your dermatologist whether it makes sense to have skin patch testing for certain foods. The top food allergens include milk, eggs, peanuts, tree nuts, wheat, soy, fish, shellfish, and sesame.

What’s the best medicine for neurodermatitis?

Your doctor will usually recommend a corticosteroid cream (either an over-the-counter or prescription one) and an antihistamine at nighttime to help you sleep.

What does neurodermatitis look like?

Thick, leathery patches on your feet, ankles, hands, wrists, elbows, shoulders, neck, scalp, eyelids, or private parts. It often looks red on pale skin and purple on dark skin.