Disease
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Skin, Hair, Nails

Neurodermatitis: symptoms, treatment, causes

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Medical Editor: Oleg Anisimov, the highest qualification category on dermatology. Zav.kozhno and venereal department GBUZ "Kuznetsk RFI".
September 2019.

Neurodermatitis belongs to the group of skin diseases and is a chronic dermatosis with neyroallergicheskoy nature, which proceeds with frequent exacerbations. The pathology is characterized by intense itching, followed by appearance and fusion lichenoid papules (knots), the advent portions lichenification (skin thickened dramatically with increased skin pattern). In a number of cases involving violations of pigmentation. disease code ICD-10 L20.8.

Atopic dermatitis is not a contagious disease, it is characterized by seasonality, disease exacerbation observed in autumn and winter, summer remission. The disease is endemic in all age groups, the incidence in adults is 0.6 - 1.5%. It is noted that the pathology often affects women and residents of large cities. Among the atopic skin disease occurs in 40% of patients.

In modern clinical dermatology group of diseases which occur with cutaneous allergic symptoms are combined by the term "atopic dermatitis". Under this definition the following nosological entities fall apart neurodermatitis: prurigo or prurigo, atopic eczema, exudative diathesis, skin diathesis, diaper dermatitis and others. Although the generic term, each form is seen by dermatologists, pediatricians and allergists as a distinct disease.

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In the medical literature, the concept of "atopic eczema" and "atopic dermatitis" accepted synonyms and limited neurodermatitis It refers to diseases that are not related to allergic reactions and is known as chronic zoster Vidal or itching lichenoid dermatitis.

Kinds

Several distinct forms of the disease:

Atopic dermatitis.

  • Characterized by the appearance of multiple lesions rash, which are located on the significant cutaneous sites. Lesions are localized in the neck, face, genitals, in mezhyagodichnoy crease in the popliteal hollows, on the bend of the elbow.

Limited neurodermatitis.

  • Designated lesions include minor skin portions, which are often arranged symmetrically (at the elbows, knees or feet).

Follicular neurodermatitis.

  • rash elements in the form of genital papules located on the hairy areas (head).

Dekalviruyuschy neurodermatitis.

  • Lots lesions localized on parts of the body covered with vellus hair, which leads to their gradual loss.

Linear neurodermatitis.

  • Affected areas localized on the extensor surfaces and look like a wart or scaly strip.

Psoriazoformny neurodermatitis.

  • Affected areas are represented by red seals with small silvery-white scales. Favorite localization head and neck.

Hypertrophic neurodermatitis.

  • Synonym neurodermatitis Ehrmann, refers to rare pathologies. Lesions are located in the inguinal and femoral folds and are characterized by severe lichenification and infiltration of the skin, often accompanied by swelling in the inguinal lymph nodes.

Causes

The etiology of the disease is still not completely understood. Scientists distinguish 3 theories of neurodermatitis:

Allergic. Based on hypersensitivity (hypersensitivity manifested by allergic reactions) of an organism to various chemicals, food, medicinal substances. Adherents of this theory believe disease is a consequence of the continuation or exudative dermatitis in children. Neurodermatitis confirmed combination with other allergies (urticaria, allergic conjunctivitis, hay fever).

Hereditary. Based on communication pathologies with a genetic predisposition to atopy. Confirmed by the emergence of neurodermatitis in individuals whose parents suffered from this disease.

Neurogenic. It is based on discoordination nerve processes, and starts the development of pathology. A clear relationship neurodermatitis severity of symptoms and the presence of functional disorders in the functioning of the nervous system. Confirmed the debut of the disease or its aggravation after suffering stress. Also, people with this diagnosis characterized by anxiety, suspiciousness, emotional, hypochondria, tension and tendency to depression.

The disease can debut or worsen after exposure to the following triggers:

  • stressful situations, nervous and mental diseases;
  • medications;
  • climatic factors;
  • harmful working conditions, sleep disorders, the mode of the day and rest;
  • poor nutrition;
  • mental or physical stress;
  • acute infections, exacerbation of chronic diseases;
  • disorders of the nervous system (vegetative-vascular dystonia), weakened immunity;
  • diseases of the digestive tract and respiratory organs (pharyngitis, laryngitis, tonsillitis), which creates conditions for the sensitization of the organism;
  • genetic predisposition to allergic reactions;
  • pollution (destruction of the environment, dust, pet hair at home, etc.).

Clinical manifestations

Symptomatology of the disease is determined by its shape. Limited atopic dermatitis is characterized by long and sluggish flow and the appearance of two - desyatisantimetrovyh lesions with irregular outlines and clear boundaries. Skin lesions consist of three zones:

  • central (inner) - characterized by severe infiltration and lichenification;
  • Medium - isolated formed papules with inflammation, which have a shiny surface;
  • peripheral (marginal) - is represented by enhanced pigmentation of the skin (later on the background of scratching possible formation of secondary leukoderma) and the flesh-colored papules, gradually passes into healthy skin.

Foci limited neurodermatitis located in different parts of the body, is more common lesion of the occipital region, back and sides of the neck surfaces, the elbow, inguinal, femoral folds, perineum, genitals, inner thighs, popliteal fossae and mezhyagodichnoy folds.

The appearance of diffuse neurodermatitis precede the first exudative diathesis in infancy, then atopic eczema in childhood. Rashes arising differ true polymorphism: the formation of plaques of various types (nefollikulyarnye, follicular, lichenoid, pruriginous), occurrence of skin scales and excoriations (traces of skin damage due to scratching), exudation (soak), then forming crusting, portions lichenification, cracking and diskhromnyh foci (color change the skin). Rashes characterized symmetrically arranged and localized on the forehead, cheeks, in the region of the vermilion border, with which develops atopic cheilitis lesions in the elbow and knee creases, on the chest and inner thigh surfaces. The leading sign of the disease acts pronounced itching, which is worse at night. Upon accession pyococcus flora appear pustular skin lesions. Agonizing itching leads to insomnia, irritability and changes in the nature of a neurotic. It is also noted dysfunction of the autonomic nervous system in the form of skin "marbling" dermographism (skin reaction - mechanical irritation of the skin not characterized by the appearance of red and white lines as a result of spasm of the blood vessels), frustrated pilomotornogo reflex ( "gooseflesh"), spasms of smooth musculature.

Chronic course of diffuse neurodermatitis is accompanied by the appearance of typical signs of "atopic" person with severe fatigue, dark circles around the eyes against the pale complexion or slabotsiantoichnogo, its swelling, presence Denier lines - Morgan (pronounced wrinkles on the upper and lower centuries). It is also noted dry skin and hair, their dullness, a symptom of "fur hats" - loss of hair on the back of his head, "polished nails" - the nail plate become shiny, longitudinal striations lose as a result of constant scratching, "winter stop" - leather soles infiltrated, shelled, It cracks.

There are 3 forms of diffuse neurodermatitis:

  • a localized area of ​​lesion is less than 10% of the skin;
  • common - hit 10 - 50% of the skin;
  • diffuse - pathological process covers more than 55% of the skin.

For atopic dermatitis in adults is characterized by three degrees of severity:

  • easy - exacerbations are rare and short, limited and localized lesions, itching, a slight, initial treatment has a good effect;
  • average - worsening up to 3 - 4 times a year longer, the lesions spread, the effect of the therapy is not enough;
  • heavy - frequent, more than 4 times a year exacerbations affected area vast, itching pronounced treatment effect is insufficient.

Typical symptoms of neurodermatitis
Photo: manifestation of neurodermatitisphoto neurodermatitis
Photo: site of the Department of dermatology Tomsk Military Medical Institute

complications

Prolonged treatment glucocorticoid ointments leads to the development of bacterial, viral and fungal infection with the development of pyoderma, thrush, folliculitis, boils, hidradenitis sup-, and lymphadenitis lymphangitis. Joining viral infection provokes molluscum contagiosum, common and plantar warts and severe complications - eczema herpetiformis sarcoma.

Diagnostics

Differential diagnosis of the disease is carried out with the following pathologies:

Chronic eczema.

  • Neurodermatitis unlike eczema not accompanied by the formation of vesicles (bubbles with the liquid), and weeping and papules. Dermographism red eczema, itching appears after the formation of vesicles and opening and neurodermatitis first appears itching, then skin lichenification.

Psoriasis.

  • For pathologies characterized by the appearance of plaques, covered with scales, with clear boundaries on the extensor surfaces of the extremities. Often in disease develop arthritis. For psoriasis itching is not typical.

Lichen planus.

  • It is accompanied by a characteristic rash papular: papules have an indentation in the center, glitter and colored in purple. Arranged elements absently rash. Lichenification absent, often affects the mucous membranes, which is not observed with neurodermatitis. Itching in lichen planus expressed moderately.

Scrapie.

  • With this nosologies rashes appear with different elements: the nodules, vesicles, excoriations, ridges, which are located on the chest, the abdomen, the extensor surfaces.

Amyloid lichen.

  • Very similar to neurodermatitis, but nodular rash often localized to the lower leg skin. Nodules are not pointed and flat or semispherical shape, the touch denser than neurodermatitis.

Neurodermatitis suspect physician can then anamnesis (propensity to allergic reactions, allergic presence disease, atopic dermatitis in the family, the relationship between the occurrence of complaints and prolonged exposure to allergens), complaints and general inspection. On the disease indicates the presence of the following features: in the characteristic symptoms of dermatitis skin areas, intense itch with scratching traces, exacerbation replaced by remissions.

Additional examination includes:

  • the study of the digestive tract (feces on eggs of worms, coprogram, analysis on a dysbacteriosis, ultrasound of the abdomen);
  • consultation of the endocrinologist (with the exception of endocrine pathology);
  • complete blood count (eosinophilia - a sign of allergies);
  • blood immunoglobulins (increased IgE);
  • blood for antibodies to the following infection (toxoplasmosis, ascariasis, giardiasis and others);
  • perform skin allergoproby (identifying allergen);
  • biopsy of the skin lesion (morphologic picture of neurodermatitis).

Treatment

Neurodermatitis therapy dermatologist involved with the allergist. If necessary, connect other specialists (gastroenterologist, endocrinologist).

General recommendations in the presence of the disease include:

Clothing.

  • Preference should be given clothes made of natural fabrics (cotton, linen). Wool and synthetics should be excluded (increases irritation, itching).

Linens.

  • It allowed only cotton or linen. Change of linen weekly (more often if necessary). Pillows, blankets and other accessories should not contain feather, feathers, wool, only synthetic filler.

Cleaning of premises.

  • The wet cleaning is carried out on the most possible (daily). Renounce the use of carpets, heavy drapes, stuffed animals, like the dust storage.

Insolation.

  • Patients with neurodermatitis advised not to stay in the open sun.

Hygiene products.

  • Instead of the usual soap / shampoo is recommended to use special cleaning agents with a therapeutic effect. After showering, apply moisturizing creams / lotions. Avoid the use of alcohol-containing means.

Smoking.

  • Patients and their immediate surroundings must be to stop smoking.

Correction of chronic diseases reception sedatives, vitamins and sosudoukreplyayuschee means.

Avoid strenuous exercise (increases perspiration) and stressful situations. Daily water treatments (warm shower).

Diet neurodermatitis

Patients with the disease should follow the nutritional therapy, which increased in the period of exacerbation. It is necessary to eliminate the consumption of the following products: mayonnaise, tomatoes, nuts, chocolate, mustard, citrus, eggplant, mushrooms, honey, products with preservatives and food additives, alcohol, seafood, strawberries, strawberries raspberries. Permission is granted to use boiled beef and potatoes, cereals and vegetable soups, cereals (buckwheat, rice, oatmeal), milk products, cucumbers, herbs, tea, sugar, vegetable oils.

drug therapy

Drug Treatment involves the use of topically (dermal treatment of affected sites) and inwardly. For local therapy applied ointment with corticosteroids, tar, naftalan and medical cosmetics with moisturizing effect. Also effective cryomassage, physiotherapy (phonophoresis with glucocorticoids, magnetic inductothermy) and reflexology. Systemic treatment includes antihistamines, sedatives, immunomodulating agents, corticosteroids, vitamins inside. In severe disease possible appointment of immunosuppressive agents, ultraviolet irradiation of blood, hyperbaric oxygenation, plasmapheresis.

Prediction and prevention

The prognosis for a limited neurodermatitis more favorable, as the milder the diffuse form of the disease. Atopic dermatitis occurs with constant itching that along with cosmetic defects of the skin leads to the patients obsession with their condition, causing the development of neuroses, depression, worsening the performance and quality of life. However, the majority of patients to 25 - 30 years there is a regression of the disease to focal manifestations, and in some cases, spontaneous self-healing.

Preventive measures include breastfeeding, hardening, timely treatment of atopic dermatitis and eczema, the observance of a balanced diet, eliminate stress, moderate physical load. Individuals prone to occurrence of allergic reactions is recommended to adhere a hypoallergenic diet restriction of carbohydrates and sodium chloride. It is also necessary to avoid overcooling and overheating, contact with potential allergens.

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