Symptoms

Signs and symptoms of neurodermatitis include:

• Itchy skin in a single, limited area
• Leathery or scaly texture to the skin
• Raised, rough patch that is red or darker than the rest of your skin

The primary symptom of neurodermatitis is itchy skin — often a single patch on the neck, wrist, forearm, thigh or ankle. Sometimes neurodermatitis affects genital areas, such as the vulva or scrotum.

The itchiness, which can be very intense, tends to come and go. Eventually you may scratch simply out of habit.

When to see a doctor 
See your doctor if:

• You catch yourself repeatedly scratching the same patch of skin.
• You're so uncomfortable that you're losing sleep or are distracted from your daily routines.
• Your skin becomes painful.
• You suspect your skin is infected. Signs of infection include pain or a yellowish, thick fluid draining from the scratched areas.

Causes

The exact cause of neurodermatitis isn't known. Sometimes neurodermatitis begins with something that simply rubs or irritates the skin, such as tight clothing or a bug bite. As you rub or scratch the area, it gets itchier. The more you scratch, the more it itches.

In some cases, neurodermatitis is associated with other skin conditions — such as dry skin, eczema or psoriasis. Stress and anxiety can trigger itching, too.

Risk factors

Certain factors may increase your risk of neurodermatitis, including:

• Being middle-aged. The condition is most common between ages 30 and 50.
• Being a woman. Women are affected more often than are men.
• Having a history of skin conditions. People with a personal or family history of eczema, psoriasis or similar skin conditions are more likely to develop neurodermatitis.

Complications

Persistent scratching can lead to a bacterial skin infection and permanent scars or changes in skin color. Scratching may also disrupt your sleep.

Preparing for your appointment

You may start by seeing your primary care physician. However, you may then be referred to a doctor who specializes in skin disorders (dermatologist).

Because appointments can be brief, and there's often a lot of ground to cover, it's a good idea to arrive well prepared. Here's some information to help you get ready for your appointment, and what to expect from your doctor.

What you can do

• Write down any symptoms you're experiencing, including any that may seem unrelated to the reason for which you scheduled the appointment.
• Write down key personal information, including any major stresses or recent life changes.
• Make a list of all medications, as well as any vitamins or supplements, that you're taking.
• Write down questions to ask your doctor.

Your time with your doctor is limited, so preparing a list of questions can help you make the most of your time together. For neurodermatitis, some basic questions to ask your doctor include:

• What's the most likely cause of my itching?
• Are there other possible causes?
• Do I need any tests?
• Will the itching ever stop?
• What treatments are available, and which do you recommend?
• What side effects can I expect from treatment?
• Are there any alternatives to the primary approach that you're suggesting?
• How long will it take for my skin to return to normal?
• I have other health conditions. How can I best manage these conditions together?
• Is there a generic alternative to the medicine you're prescribing me?
• Are there any brochures or other printed material that I can take home with me? What Web sites do you recommend visiting?

In addition to the questions that you've prepared to ask your doctor, don't hesitate to ask questions during your appointment at any time that you don't understand something.

What to expect from your doctor 
Your doctor is likely to ask you a number of questions. Being ready to answer them may reserve time to go over any points you want to spend more time on. Your doctor may ask:

• When did your symptoms start?
• Have your symptoms been continuous, or do they come and go?
• What steps have you taken on your own to manage the itchiness?
• Have any of these measures helped?

What you can do in the meantime 
While you're waiting to see your doctor:

• Avoid scratching as much as possible.
• Keep your nails short so that if you do scratch, you'll lessen the risk of damaging your skin or creating an infection.
• Try an over-the-counter anti-itch cream or an oral antihistamine containing diphenhydramine (Benadryl, others) or chlorpheniramine (Chlor-Trimeton, others) to ease the itchy feeling.

Tests and diagnosis

Diagnosis is typically based on your skin's appearance and a history of itching and scratching. Your doctor may recommend one of the following tests to rule out other causes or to confirm the diagnosis.

• Patch testing. A patch test (contact delayed hypersensitivity allergy test) can rule out other causes of itchy skin, such as allergic contact dermatitis. During a patch test, small quantities of potential allergens are applied to small patches, which are then placed on your skin. The patches remain on your skin for two days, and then your doctor checks for a reaction. If you're allergic to a particular substance being tested, you develop a raised bump or a reaction limited to the skin just beneath the patch.
• Punch biopsy. During a punch biopsy test, the doctor uses a circular tool to remove a small section of your skin's deeper layers. You may receive stitches to close the wound. A biopsy can rule out other conditions, such as lichen planus, that may mimic neurodermatitis.

Treatment and drugs

To stop the stubborn itch-scratch cycle, you must stop scratching the affected area. It's bound to be tough, but you can do it. And your doctor can help.

Your doctor may recommend one or more of the following treatments:

• Prescription medication. Oral or topical corticosteroids and oral antihistamines may be necessary to reduce the inflammation and relieve the intense itching. Antidepressants or anti-anxiety medications may be helpful for some people. If you develop a bacterial infection in the rash, your doctor may prescribe an antibiotic lotion or oral antibiotics.
• Wet dressings. This involves applying medicated cream to affected areas and then covering these areas with damp cotton material that has been soaked in water or other solutions. The moisture in the wet dressings helps the skin absorb the medicated cream. Covering the area with a plastic tape containing medication in the adhesive, or a tape applied over skin treated with a corticosteroid cream or ointment can also be helpful. Change the tape every 24 hours, or at whatever interval your doctor recommends.
• Counseling. A counselor can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.

Even after successful treatment, mild scarring or changes in skin color could remain.

Lifestyle and home remedies

The following are ways you can lessen the itch and irritation caused by neurodermatitis.

• Try over-the-counter (nonprescription) creams or medications.Apply an anti-itch cream or lotion to the affected area. A nonprescription hydrocortisone cream can temporarily relieve the itch. A nonprescription oral antihistamine, such as diphenhydramine (Benadryl, others), may be helpful if itching is severe.
• Cover the affected area. Bandages or dressings can help protect the skin and prevent scratching. This may be especially important if you scratch during your sleep.
• Keep your nails trimmed. Short nails may do less damage to the skin, especially if you tend to scratch while you're asleep.
• Take cool baths. Sprinkle the bath water with baking soda, uncooked oatmeal or colloidal oatmeal — a finely ground oatmeal that is made for the bathtub (Aveeno, others).
• Wear smooth-textured cotton clothing. This will help you avoid irritation.
• Choose mild soaps without dyes or perfumes. Be sure to rinse the soap completely off your body. And after washing, apply an unscented moisturizer to protect your skin.
• Keep stress under control. Stress and anxiety can trigger itching.

Alternative medicine

Several alternative therapies may help lessen the symptoms of neurodermatitis, including:

• Witch hazel. Applying a witch hazel dampened compress to the affected area may ease the itch.
• Camphor. An ointment containing between 3 and 11 percent camphor can safely be applied three to four times daily to help reduce itching.
• Hypnosis. In this relaxed, trance-like state, you may be more open to suggestions of behavioral changes, such as stopping scratching.