Neurodermatitis (atopic eczema, atopic dermatitis)

Neurodermatitis (also known as endogenous eczema or atopic dermatitis) is a skin disease that often causes recurrent skin inflammation and itching. Symptom-free periods alternate with mild to severe phases of the disease. People who suffer from atopic dermatitis have a higher risk of developing other atopic diseases such as allergies or asthma.

The psychological consequences of suffering from neurodermatitis also play a major role. Although atopic dermatitis is not a contagious disease, there are people who avoid contact with those affected. Shame about the skin disease can lower the self-esteem of those affected and thus reduce their quality of life.

In many cases, neurodermatitis first becomes noticeable in infancy or toddlerhood. However, it is also possible to develop the disease for the first time at an older age. Some people suffer from neurodermatitis for the rest of their lives, while for others the skin disease eventually heals completely. According to estimates, between 3 and 5 million people in Germany suffer from neurodermatitis.

The exact cause of neurodermatitis is not yet known. However, it is certain that genetic factors play a major role in the development of the disease. If both parents suffer from an atopic disease such as neurodermatitis or asthma, there is a greatly increased risk that their children will also develop the disease.

However, atopic dermatitis does not necessarily break out in people who have a genetic predisposition to developing the disease. Only through the influence of psychological factors and environmental influences does the disease actually break out in people who have a predisposition.

The following substances or factors can trigger neurodermatitis:

• animal hair
• Certain foods
• Flower pollen
• wool
• house dust
• stress
• Grief

People who suffer from neurodermatitis often have an allergy to at least one of these substances - on contact, the skin reacts by forming eczema. In addition, psychological stress, such as stress at work or grief, can also trigger an acute flare-up of the disease.

The symptoms of atopic dermatitis vary throughout life:

• Babyhood: During this time, atopic dermatitis manifests as cradle cap scabs on the scalp. Later, it often manifests itself as red, itchy eczema (rash) on the face. The rash then spreads to the neck and even to the pelvic region. The back of the arms and legs can also be affected. If bacteria manage to penetrate the inflamed areas of skin, this can lead to infection. This results in the secretion of fluid in the area of the eczema.
• Children from the first to second year of life: During this time, the appearance of neurodermatitis changes. The rash occurs preferentially on the neck, wrists, ankles, elbows and knees. The eczema can cause very intense itching. The constant scratching causes the skin to thicken in the affected areas.
• Older children and adults: Now all parts of the body can be affected by neurodermatitis. Often the rash occurs on the face, arm and knee bends, neck and upper body. Due to the inflammation, the skin is dry, red, blotchy and thickened. Bacteria that naturally occur on the skin easily cause the eczema to become infected.

In many cases, people with atopic disease develop what are called atopic stigmata. These are, for example, dark circles under the eyes, furrows in the area under the eyes, tears in the earlobe or when itching is triggered by skin contact with wool or when sweating.

The diagnosis of atopic dermatitis is made by a doctor during an examination of the skin. The characteristic symptoms and the clinical appearance are decisive.

Allergy tests can be used to identify allergies that may cause atopic dermatitis. These can be allergies to certain foods, dust mites or pollen from grasses and trees.

During the symptom-free periods of a neurodermatitis disease, daily skin care is of particular importance. The use of moisturising creams, lotions and oil baths can treat the dry skin and prevent new episodes of the disease.

Various active substances are available for the treatment of atopic dermatitis with medication:

• Cortisone: Creams containing cortisone can be used in the acute phase of the disease and effectively suppress the excessive reaction of the immune system. This reduces the inflammatory process.
• Tacrolimus / Pimecrolimus: Ointments with the active ingredients Pimecrolimus and Tacrolimus are applied directly to the affected skin areas. Pimecrolimus is the less effective agent - it is therefore used for mild to moderate types of atopic dermatitis. If treatment with pimecrolimus is started immediately after the first onset of symptoms, acute eczema flare-ups can be prevented. The active ingredient tacrolimus is used for moderate to severe forms of atopic dermatitis and is only recommended for people after the age of 17. Pimecrolimus and tacrolimus must not be used to treat children before the age of three.
• Ciclosporin: This agent is only used for severe, chronic forms of atopic dermatitis. The dosage is individually adjusted to the body weight and the previous treatment success. In most cases, ciclosporin is used in a short-term interval therapy, whereby the dose is gradually reduced. If the skin condition deteriorates again, ciclosporin can be administered again.

Furthermore, the following measures or therapies can be used as part of a neurodermatitis treatment:

• Antibiotic therapy: if a bacterial infection of the eczema is present.
• Light therapy: for example with UV-A or UV-B light
• Specific immunotherapy / hyposensitisation
• Administration of antihistamines
• Use of skin-friendly clothing: no use of woolen or synthetic textiles
• Learning certain relaxation techniques
• Psychotherapy

The prognosis of atopic dermatitis is difficult, as there are large differences in the frequency, duration and severity of atopic eczema flare-ups between individuals. In many cases, the eczema attacks become milder over time.

A spontaneous healing of neurodermatitis is possible at any age. In many people who suffer from atopic dermatitis in childhood, the disease no longer occurs in adulthood. However, the tendency to very sensitive skin often remains throughout life.

If both parents have a tendency to neurodermatitis or allergies, it is advisable to have a consultation with an allergist (specialist in allergies) with the child while it is still a baby.

According to the latest findings, the risk and severity of atopic diseases such as neurodermatitis or asthma can very probably be reduced by consistent breastfeeding during the first six months of life and by avoiding foreign proteins (e.g. cow's milk). In addition, the breastfeeding mother should ensure that her diet is low in allergens. In particular, foods such as milk, dairy products, nuts, chicken eggs, fish and soya can cause allergies. If breastfeeding the child is not possible, hypoallergenic infant formula can also be used.

By observing the following points, people who suffer from neurodermatitis can specifically protect themselves against new attacks of the disease (secondary prophylaxis):

• The most important measure is to avoid contact with known allergens - if food allergies are known, these foods should be avoided.
• If an allergy to house dust mites is present, the use of special allergy-sensitive bedding can reduce allergen exposure during sleep.
• Since wool can lead to hypersensitivity reactions of the skin, wool textiles should be avoided or at least not worn directly on the skin. Textiles made of cotton and silk are well tolerated.
• Since cigarette smoke can aggravate neurodermatitis, the household of a person affected should in any case be smoke-free.