Neurodermatitis (atopic dermatitis)

Neurodermatitis is an inflammatory skin disease. The following skin symptoms are typical, but they can each occur to varying degrees:

• very dry, very itchy skin
• Redness
• Blisters or knots
• weeping and crusty skin conditions (frequently caused by scratching)

The progression of neurodermatitis is chronic and recurrent. This means that symptom-free intervals alternate with acute inflammatory boosts.

In addition to the inflammatory symptoms, the skin of neurodermatitis sufferers shows further changes (also in the symptom-free interval):

• less moisture and fat
• reduced production of sebum
• changed emission of sweat
• disrupted skin barrier function
• Oversensitivity towards chemical, physical, or mechanical stimuli
• increased susceptibility to skin infections
• increased reaction to psychological factors (stress)

In an acute bout neurodermatitis shows the typical symptoms of an inflammation:

• Redness
• Swelling
• Formation of blisters
• Weeping and the formation of crusts
• Itching

In chronic progression, the skin changes as follows:

• Redness
• Thickening of the epidermis, the uppermost layer of skin
• Scaly skin
• Coarsened lichenification

Age-dependent change

Neurodermatitis frequently begins in early childhood. With approx. 60%, the disease appears as early as the first year. Depending on the age (infants, children, young people/adults), characteristic changes in the skin can be observed. Overall, the inflammatory form declines with increasing age.
The skin symptoms change over the different life stages.

• In infancy, there are normally highly itchy, crusty changes in the skin on the cheeks and head. So-called cradle cap, a whitish-yellow deposit on the scalp, can also be an indication of neurodermatitis. The itching is excruciating. The children cry a lot because they cannot sleep at night. The skin starts to bleed due to the scratching. This, in turn, can lead to inflammations. Ultimately, the entire part of the head covered by hair as well as the face can be affected; in addition, changes in the skin on the torso and extensor sides of the arms and legs can appear. With approx. 50% of young children, the symptoms clear up by the end of the 2nd year.
• In childhood, neurodermatitis frequently occurs in the form of so-called flexural excema. This affects the major joints (elbows, wrist, backs of the knees). Other skin symptoms can typically appear in children at the back of the neck, on the side of the face, in the eyelid region, on the dorsum of the feet and on the hands. Scaly skin symptoms on the finger tips or toes are also characteristic. A thickening of the skin with the accentuation of the normal lines of the skin (lichenification) also occurs in addition to the inflammatory processes.
• Typical forms of eczema in young people and adults affect the face (forehead, eyelids), throat, particularly the neck, upper chest area and shoulder blade as well as the major joints. Neurodermatitis in young people and adults can last for a long time. The intensity of the inflammation, however, typically declines after the age of 30.

Itching

In addition to very dry skin and repeated bouts of inflammation, excruciating itching is a dominant symptom of neurodermatitis. Itching is usually countered with scratching or rubbing. This damages the skin and complex immunological processes are set in motion. Inflammation messenger substances (such as histamin, or the recently discovered Interleukin 31) are liberated and the existing itching intensified. This results in a vicious circle of itching and scratching. The small injuries to the skin can make infections easier. This considerable itching is often unbearable and causes a high degree of suffering, particularly for children. It is therefore extremely important to interrupt this vicious itch-scratch circle.
The disease demands a lot of sensitivity and understanding from parents; in addition to purely medical applications to reduce the itching, a relaxed, harmonious atmosphere in the family is always beneficial, a problematic one always disadvantageous for the skin.