Eczema

and Martina Feichter, medical editor and biologist and Carola Felchner, science journalist

Mareike Müller is a freelance writer in the medical department and assistant doctor for neurosurgery in Düsseldorf. She studied human medicine in Magdeburg and gained a lot of practical medical experience during her stays abroad on four different continents.

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Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

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Carola Felchner is a freelance writer in the medical department and a certified training and nutrition advisor. She worked for various specialist magazines and online portals before becoming a freelance journalist in 2015. Before starting her internship, she studied translation and interpreting in Kempten and Munich.

More about the experts All content is checked by medical journalists.

Neurodermatitis (atopic eczema, atopic dermatitis) is a chronic inflammatory skin disease that occurs in bouts. It often affects the scalp, face and hands and is associated with excruciating itching. In Germany around 13 percent of children and two to three percent of adults have neurodermatitis. Read more about symptoms, causes and triggers, treatment and prognosis of atopic dermatitis!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. L28L20

Neurodermatitis: Brief overview

What is eczema? Chronic or chronically recurring inflammatory skin disease that goes on in flares. It almost always occurs in early childhood.
Symptoms: excruciating itching, dry skin, in acute episodes also weeping eczema
Cause: The exact cause is unknown. Several factors seem to play a role in the development of the disease, including a disrupted skin barrier. In addition, the tendency to neurodermatitis is inheritable.
Trigger: Textiles (such as wool), infections (such as severe colds, flu), certain foods, humid temperatures or cold, psychological factors (such as stress), etc.
Treatment: Avoid triggers, careful skin care, medication (such as cortisone), light therapy, climatic therapy, etc.

Neurodermatitis: symptoms

Typical symptoms of neurodermatitis are inflammatory skin changes (eczema) with excruciating itching. They appear in bursts: Symptoms-free periods are followed by phases with sometimes extreme symptoms. The attacks are usually triggered by certain factors (triggers) such as certain foods or weather conditions.

In individual cases, the symptoms of neurodermatitis can vary greatly: In some patients, the disease is quite mild. Others suffer from severe ailments. Age also plays a role: It not only influences the type of symptoms, but also where they tend to occur on the body.

"The itching is aggravated by heat"

Three questions for

Dr. med. Hans-Ulrich Voigt,
Specialist in dermatology, phlebology, allergology
1
Why does the skin itch more at night?

Dr. med. Hans-Ulrich Voigt
To do this, you have to understand how the itching occurs. Namely through irritation of the nerve endings in the skin by inflammatory messenger substances that accumulate in the skin. This process is intensified by warmth - including in a cozy, warm bed. On the other hand, the cold slows it down, for example when taking a cold shower.
2
Does showering harm with neurodermatitis?

Dr. med. Hans-Ulrich Voigt
No, if it is done correctly: That means taking a short, lukewarm shower. It is best to only shower with water. If you want a shower gel, use a mild, moisturizing shower gel. Or better, a shower cream. Do not rub the towel afterwards, but gently pat dry. Then cream yourself with a rich body milk.
3
How can I soothe the skin in the long term?

Dr. med. Hans-Ulrich Voigt
Work out a long-term program with your dermatologist to build up a stable skin barrier (optimized skin care) and a sensible long-term anti-inflammatory program away from repeated acute therapy. Ensure a balanced, fulfilling and stress-free life with good interpersonal relationships. This also calms the skin immensely.
Dr. med. Hans-Ulrich Voigt,
Specialist in dermatology, phlebology, allergology
Founder and owner of the Skin and Laser Center Dermatology am Dom in Munich, one of the first laser therapists in Munich.

Atopic dermatitis symptoms in children

As a rule, atopic dermatitis begins in babies on the face and hairy scalp. There, cradle cap forms: yellowish-white scale crusts on reddened skin. Their appearance is reminiscent of burnt milk, hence the name "cradle cap".

Cradle cap alone without any further symptoms is not a sign of neurodermatitis!

The skin changes can also ooze. In addition, at this age, atopic dermatitis usually shows up on the outside of the arms and legs. In some cases, weeping eczema also forms in the mouth area.

Small atopic dermatitis patients develop flexor eczema as early as the first year of life. These are reddened, scaly patches of skin covered with crusts in the folds, for example of the hollows of the knees, elbows and wrists. The skin gets wet, but at the same time it is dry and can hardly store moisture. Itching occurs. If the little patients scratch themselves, the open areas of skin can become infected - with bacteria (such as staphylococci), viruses (such as herpes) or fungi (skin fungi such as tinea).

With age, the skin thickens in the affected areas. Doctors call this process "lichen formation" or "lichenification". The complexion becomes coarser.

In addition, the skin color can change: Some areas of the skin are more heavily pigmented and appear darker (hyperpigmentation). Others are noticeably pale (hypopigmentation).

Atopic dermatitis symptoms in adults

In many cases, neurodermatitis regresses completely during puberty. For some of those affected, however, it persists beyond that.

Atopic dermatitis is often more severe in adults than in children. Adult patients usually develop their symptoms depending on their professional activity. For example, hand eczema occurs particularly in patients who often come into contact with irritating substances at work (e.g. hairdressers, painters) or who often have to wash their hands (e.g. nurses).

In general, certain areas of the skin are primarily affected by neurodermatitis in adolescents and young adults: the eyes and forehead area as well as the region around the mouth, the neck, the upper chest area and shoulder girdle, elbows, hollows of the knees, wrists and backs of the hands. Itchy eczema also sometimes forms on the palms of the hands and soles of the feet.

In these areas the skin is dry, reddened and very easily irritated. In addition, excruciating itching occurs. It troubles some patients especially at night. As with children, vigorous scratching promotes skin infections. In addition, the excessive scratching can wear off and polish the fingernails over time ("shiny nails").

A leather-like thickening of the skin (lichenification) is very pronounced in some neurodermatitis patients. Even the skin of the face can thicken like leather. The medical term for this is "Facies leonina" (lion face).

Some patients show only a minimal form of neurodermatitis: It is characterized by lip inflammation (cheilitis), small cracks in the skin (rhagades) in the corners of the mouth, in the area of the ears or on the tips of the fingers and / or toes (pulpitis sicca) and nipple eczema.

A rare variant of neurodermatitis in adults is the so-called prurigo form: those affected suffer from small, extremely itchy skin nodules (prurigo nodules). These can form on very different parts of the body.

Older adults who have new atopic dermatitis often get eczema on their hands and feet. Itchy crusts form on the scalp under the hair. The edges of the earlobes are often cracked, red, and inflamed. Inflamed, itchy lips are also a common symptom of eczema in older adults. In addition, many sufferers report a burning sensation and / or abnormal sensations in the area of the oral and pharyngeal mucosa. Indigestion with flatulence, diarrhea and abdominal pain are also possible symptoms of neurodermatitis in this age group.

Neurodermatitis - typical skin regions

Atopic dermatitis is most common on parts of the body with very thin skin such as the elbows, hollows of the knees and wrists.

Atopic stigmata

Neurodermatitis, like hay fever and allergic asthma, is one of the so-called atopic types. This is understood to be diseases in which the immune system is overly sensitive to contact with allergenic substances (allergens) or other irritants.

People with such atopic diseases often have so-called atopic stigmata. These include:

Paleness around the mouth (perioral paleness)
Thinning of the side eyebrows (Hertoghe sign)
double lower crease (Dennie Morgan fold)
Light skin markings after mechanical irritation, e.g. from scratching (white dermographism)
Eye disorders: repeated conjunctivitis (conjunctivitis), conical deformation of the cornea (keratoconus), cataract (cataracts)

These features accompany the specific symptoms of an atopic disease (such as neurodermatitis).

Atopic dermatitis: causes and triggers

The exact cause of atopic dermatitis has not yet been conclusively clarified. Experts suggest that several factors play a role in the development of atopic dermatitis.

For example, the skin barrier is disturbed in neurodermatitis patients: The outermost layer of the epidermis (the very outside) is the horny layer. It protects the body from pathogens. In atopic dermatitis, however, the horny layer cannot properly fulfill its protective function.

One possible reason for this is that the body is producing too little of the filaggrin protein due to a genetic change. This is important for the formation of the epidermis. Due to the lack of filaggrin, the composition of the skin lipids is changed in neurodermatitis patients. The result is that the skin loses a lot of moisture and dries out easily. The damaged skin reacts quickly to irritants, allergy triggers and germs with inflammation and itching

The fact that genes play a role in neurodermatitis is also shown by the fact that the predisposition to neurodermatitis is hereditary. We now know of various genetic changes (mutations) that make people more susceptible to atopic eczema. Parents can pass these mutations on to their children: If one of the parents is atopic dermatitis, there is a 40 percent chance that the children will also develop atopic dermatitis. If both mother and father have neurodermatitis, the risk of their children getting sick is between 60 and 80 percent.

Too Much Hygiene?

In the last few decades the number of atopic dermatitis cases (and allergic diseases in general) in the western world has risen sharply. Some researchers suspect that a change in lifestyle is (partly) responsible for this: Today, hygiene is much more important than it used to be. As a result, we come into contact with potentially disease-causing and allergenic substances from the environment much less often. As a result, the immune system is in a sense "underemployed". That could be the reason why more and more people react excessively to actually harmless stimuli.

In addition, washing habits have changed over the last few decades: We clean our skin more frequently and more thoroughly than our ancestors. This may have negative effects on the skin barrier. That could make the skin more sensitive in general.

Neurodermatitis forms

The vast majority of neurodermatitis patients show the extrinsic form of the disease: their immune system reacts sensitively to substances that trigger allergies (allergens) such as pollen or certain foods. An increased amount of antibodies of the immunoglobulin E (IgE) type can be detected in the blood of those affected. IgE stimulate other immune cells (mast cells) to release inflammatory substances. These cause the eczema on the skin of atopic dermatitis patients. Some of those affected also show the typical symptoms of an allergy: In childhood this is usually a food allergy, in adulthood it is mainly hay fever or a house dust mite allergy (house dust allergy).

The intrinsic form of neurodermatitis is less common. It occurs in about a fifth (20 percent) of all patients. Those affected have normal IgE blood values. This means that allergic reactions do not play a role here as a trigger for neurodermatitis. People with this form of the disease also do not show an increased susceptibility to allergies such as hay fever or a food allergy.

Researchers now assume that there are other forms of neurodermatitis in addition to the extrinsic and intrinsic forms.

Neurodermatitis: Trigger

If someone has a genetic predisposition to atopic dermatitis, various triggers can lead to an atopic dermatitis flare-up. But that doesn't have to happen: Not everyone with a predisposition to neurodermatitis also gets it.

The most common triggers (trigger factors) in atopic dermatitis include:

Textiles (such as wool)
sweat
unfavorable climatic conditions such as dry air (also due to heating), cold air, humidity, overall strong temperature fluctuations
Incorrect cleaning of the skin (use of skin-irritating cleaning agents, etc.), cosmetics (e.g. skin-irritating fragrances or preservatives)
certain activities / professions such as wet work, heavily soiling work or activities in which rubber or vinyl gloves have to be worn for a long time (hand eczema!)
Tobacco smoke
Allergy triggers such as dust mites, mold, animal hair, pollen, certain foods and additives (cow's milk, egg white, nuts, wheat, soy, fish, seafood, etc.)
Infections (such as severe colds, tonsillitis, etc.)
psychological stress (stress, grief, exciting events such as school enrollment, but also boredom, etc.)
hormonal factors (pregnancy, menstruation)

Atopic dermatitis patients react differently to such triggers. For example, stress at work can trigger a flare-up in one patient but not in another.

Neurodermatitis: treatment

For neurodermatitis therapy, experts generally recommend a therapy plan in four stages. Different treatment measures are provided depending on the current skin condition:

	Therapy measures
Level 1: dry skin	Careful daily skin care (basic care) is necessary to prevent relapses. In addition, the patient should avoid individual triggers as much as possible (stress, woolen clothing, dry air, etc.).
Stage 2: mild eczema	In addition to the measures of level 1, low-impact glucocorticoids ("cortisone") and / or calcineurin inhibitors are applied externally. If necessary, the patient is also given antipruritic medication and anti-germ (antiseptic) agents.
Stage 3: Moderately severe eczema	In addition to the necessary measures of the previous stages, the patient receives more effective cortisone preparations and / or calcineurin inhibitors (both for external use).
Level 4: Severe, persistent eczema	In addition to the measures required in the previous stages, the doctor prescribes tablets that inhibit the immune system (immunosuppressants) such as ciclosporin A. Another therapeutic option is the biological drug dupilumab (a biotechnologically produced protein).

The step-by-step scheme of atopic dermatitis treatment is only a guide. The attending physician can adapt it to individual factors. When planning therapy, he can take into account how old the patient is, how his neurodermatitis disease progresses overall, where on the body the symptoms occur and how much the patient suffers from them.

The individual therapeutic measures are described in more detail below.

Atopic dermatitis children (and their parents) can take part in special atopic dermatitis training courses. Doctors, psychologists and nutritionists give tips on how to deal with the disease correctly. More information is available from the Neurodermitis Training Association (www.neurodermitisschulung.de).

Neurodermatitis Therapy: Skin Care

The most important measure of any neurodermatitis treatment is daily skin care. Which product is suitable in each individual case depends on the condition of the skin.

For example, those who suffer from dry skin should use a moisturizing or moisture-binding ointment. It is best to apply it directly after showering or bathing without drying the skin first. So the water stays in the damp skin. There are special ointments with a very high fat content for cracked areas of skin. They are usually applied overnight.

Pure petroleum jelly and milking fat are not suitable for eczema skin. It is also unfavorable to rub the skin regularly with oils. These dry out the skin over time.

A cream is more useful for less dry or weeping areas of skin: it contains less fat and more water (oil-in-water emulsion). There is even less fat in lotions. They are also suitable for weeping eczema.

Creams with urea as an additive keep the moisture in the skin, make it smoother and soothe itching. However, they can cause a temporary stinging sensation, especially in children under the age of five. Therefore, you should first test how well they tolerate the cream on a small area of skin. For infants (= children in the first two years of life) creams containing urea are generally not suitable.

A urine cream can cause a burning sensation on inflamed skin at any age. A preliminary test on a small area of skin is therefore also useful here.

In addition to urea, other additives in creams and ointments can also do good for the atopic dermatitis skin. These include, for example, glycerine, ceramides, phosphatidylcholine and D-panthenol.

On the other hand, people with neurodermatitis should not use cosmetic products with preservatives, fragrances, dyes, emulsifiers, paraffin oil or petroleum jelly.

Treat neurodermatitis with ointment

Anyone who suffers from dry skin should apply a greasy ointment to themselves.

Skin cleansing

In the case of neurodermatitis, normal soaps and shower gels should not be used. They also dry out the skin. PH-neutral or slightly acidic medicinal soaps (syndets) are more suitable.

Many dermatologists recommend lipid-replenishing medicinal oil baths for cleaning neurodermatitis skin. These are often also suitable for showering.

It is important that atopic dermatitis patients do not bathe or shower too hot - this can irritate the skin and dry it out further. In addition, you shouldn't rub too hard afterwards when drying the skin.

Neurodermatitis therapy: avoid triggers

Atopic dermatitis patients should, if possible, avoid all triggers that experience has shown can trigger an acute episode of the disease.

Such trigger factors can be, for example, acute infections such as severe colds and flu. If such contagious infections "deal with", neurodermatitis sufferers should pay particular attention to hygiene (hand washing etc.). In addition, it is then advisable to avoid crowds and to stay away from sick people as much as possible.

Stress also often triggers an atopic dermatitis flare-up. Therefore, those affected should consider suitable counter-strategies. On the job, for example, it can help to delegate some tasks to others. Regular targeted relaxation, for example with the help of yoga, autogenic training or meditation, is also highly recommended.

Atopic dermatitis patients who are allergic to pollen, animal hair, certain foods, fragrances in cosmetics or other irritants should avoid them as much as possible. If someone has an allergy to house dust mites, a special cover for the mattress (encasing) can also be useful.

Travel to areas with extreme climatic conditions (such as extreme cold or damp heat) is also unfavorable for atopic dermatitis.

Neurodermatitis therapy: immunosuppressants

In the acute episode, neurodermatitis is treated with drugs that reduce the activity of the immune system. These immunosuppressants include cortisone, the so-called calcineurin inhibitors (tacrolimus, pimecrolimus) and ciclosporin A.

cortisone

Cortisone is a naturally occurring hormone in the body (called "cortisol" here) that can also be administered as a drug: Neurodermatitis treatment with cortisone preparations effectively relieves inflammation and itching.

In the case of neurodermatitis, it is usually sufficient to apply a thin layer of cortisone to the eczema as a cream / ointment. This generally happens once a day. The doctor will prescribe a preparation with an appropriate concentration of cortisone for each patient. Because thin, sensitive areas of the house (such as facial skin and scratched skin) absorb more cortisone than more robust areas. They are therefore treated with less dosed cortisone ointments than, for example, eczema on the arms or soles of the feet.

In any case, it is important that those affected use cortisone creams exactly as recommended by the doctor. Above all, using it for too long without interruption should be avoided, otherwise side effects often occur. For example, the skin can become very thin and / or white spots on the treated areas. Sometimes small, enlarged, visible skin veins (telangiectasias) form. In addition, the cortisone treatment promotes skin infections. When used on the face, the skin around the mouth can become inflamed (perioral dermatitis).

In severe cases of neurodermatitis in adults, it may be necessary to take cortisone as a tablet. This type of active ingredient application is also known as systemic therapy because the active ingredient can be effective here throughout the body. The Arut has to monitor the neurodermatitis treatment with corticosteroid tablets. In addition, those affected may only take the tablets for a short time, otherwise the risk of side effects increases. In the end, you should "taper off" the cortisone therapy according to the doctor's instructions, that is, do not stop taking the tablets abruptly, but gradually reduce the dose.

Calcineurin inhibitors: pimecrolimus and tacrolimus

The calcineurin inhibitors tacrolimus and pimecrolimus can also be used as a cream / ointment for local neurodermatitis treatment. Like cortisone, they have anti-inflammatory effects.

They are more suitable than cortisone for treating eczema on sensitive skin areas, such as on the face and genital area. Because some side effects that cortisone ointments can cause do not occur with the two calcineurin inhibitors. Tacrolimus and pimecrolimus do not cause the skin to become thinner, even with prolonged use. In addition, they do not cause inflammation around the mouth on the face (perioral dermatitis).

On the other hand, eczema on less sensitive skin areas is preferably treated with cortisone ointments. The calcineurin inhibitors are usually only used here if the patient cannot tolerate cortisone ointments or if these cannot relieve the symptoms sufficiently.

Tacrolimus (0.03%) and pimecrolimus are only approved from two years of age. Higher dosed tacrolimus preparations (0.1%) are only allowed for local neurodermatitis treatment from the age of 17.

Skin irritations (burning, reddening, itching) can occur as side effects of the treatment, especially in the first few days.

Experts also advise against using phototherapy (see below) while using calcineurin inhibitors.

Ciclosporin A

Ciclosporin A is approved for the treatment of severe cases of neurodermatitis in adults. It strongly suppresses the immune system and so can relieve severe, persistent eczema.

Most patients take the active ingredient twice a day. If necessary, it can be taken over a longer period of time. provided the patient tolerates the drug well. Even then, treatment with cyclosporine A should be interrupted after four to six months in order to prevent possible long-term side effects (such as high blood pressure or kidney damage). If the atopic dermatitis symptoms worsen again significantly, patients can take ciclosporin A again if necessary.

Experts advise against treating severe neurodermatitis with ciclosporin A and phototherapy (see below) at the same time. The combination of the two therapies increases the risk of skin cancer. While taking ciclosporin A, patients should also protect their skin well from UV light (sun, solarium).

If cyclosporine is not tolerated or does not work well, the doctor may prescribe tablets with another immunosuppressant, for example azathioprine or methotrexate. However, these active ingredients are not approved for the treatment of neurodermatitis. They are therefore only used in selected individual cases ("off-label use").

Neurodermatitis therapy: dupilumab

Dupilumab is one of the so-called biologics. These are drugs produced biotechnologically (i.e. with the help of living cells or organisms) that, among other things, target inflammatory messengers. For example, dupilumab can block the effect of two inflammatory messenger substances that play an important role in neurodermatitis. This can relieve the skin inflammation and itching.

Dupilumab is the first biologic to be approved for the treatment of moderate to severe atopic dermatitis - in adults since 2017, and in adolescents from the age of twelve since 2019. The active ingredient can be prescribed when topical medications (such as cortisone ointments) are insufficient to treat and systemic therapy (i.e., injections or tablets) is an option.

In 2020, the German Dermatological Society (DDG) included dupilumab in the neurodermatitis guideline and the staged therapy plan as "an effective treatment that, in contrast to previous systemic therapy options, is also suitable for long-term use".

Neurodermatitis Treatment: Supportive Measures

The neurodermatitis treatment can be supported with further measures if necessary:

H1 antihistamines

H1 antihistamines inhibit the effects of the tissue hormone histamine in the body. In allergy sufferers, this hormone is responsible for allergic reactions such as itching. So far, however, studies have not been able to scientifically prove that H1 antihistamines also help against itching in atopic dermatitis. Nevertheless, it is often useful to use them:

On the one hand, some H1 antihistamines trigger fatigue as a side effect. This benefits patients who cannot sleep because of their neurodermatitis (itching). On the other hand, some neurodermatitis patients also suffer from an allergic disease such as hay fever. H1 antihistamines are often used for such allergies - even if there is no neurodermatitis at the same time.

The active ingredients are used internally (in tablet form). External use in atopic dermatitis is not recommended.

There are also H2 antihistamines available. They also inhibit the action of histamine, albeit in a different way than their "H1 relatives". However, H2 antihistamines are not recommended for the treatment of neurodermatitis.

Polidocanol, zinc, tannins & Co.

Skin care products that contain the active ingredient polidocanol or tannins are sometimes recommended against the itching of neurodermatitis. Experience from patients and some studies show that these preparations can actually help. Neither polidocanol nor tannin preparations are suitable as a substitute for anti-inflammatory therapy (e.g. with cortisone).

Zinc ointments and creams have anti-inflammatory and cooling effects, among other things. However, their effectiveness in atopic dermatitis has not been proven. Nevertheless, many patients have had positive experiences with skin care products containing zinc. Such preparations can therefore be used in basic skin care for neurodermatitis.

Shale oil (bituminosulphate) can be helpful in the form of bath additives or as an ointment in general for superficial, inflammatory skin diseases. Its anti-inflammatory effect could be demonstrated in the test tube ("in vitro" studies). Many patients also report positive effects. Therefore, the use of shale oil for neurodermatitis can be considered.

Medicines for skin infections

Severe itching causes many atopic dermatitis patients to scratch themselves. Pathogens can easily penetrate the open skin areas and cause an infection. If the pathogens are bacteria or fungi, the doctor will prescribe specific active ingredients against it:

Antibiotics help with bacterial skin infections, and so-called antimycotics with fungal infections. Patients can use the active ingredients externally (e.g. as an ointment) or internally (e.g. in tablet form).

Antimicrobial laundry

For a number of years there has been special underwear made of antimicrobial (antiseptic) textiles. These include, for example, items of clothing that are coated with silver nitrate. You can alleviate some eczema in atopic dermatitis. However, such antimicrobial laundry is quite expensive. However, anyone who suffers from chronic neurodermatitis can consider purchasing it.

Light therapy (phototherapy)

Sometimes light therapy can relieve flare-ups. The dermatologist irradiates the affected areas of the skin with ultraviolet light (UV-A and / or UV-B light). This inhibits various inflammatory cells in the skin that are responsible for the acute symptoms of neurodermatitis.

Special variants of light therapy are also suitable for neurodermatitis treatment:

In the so-called PUVA, the patient is first treated with the active ingredient psoralen. This makes the skin more sensitive to the subsequent exposure to UV-A light. Psoralen can be used in different ways. Many neurodermatitis patients bathe in a psoralen solution (Balneo-PUVA) before irradiation. The active ingredient is also available in tablet form (systemic PUVA). The risk of side effects is then higher than with the balneo PUVA.

Light therapy (without psoralen) can also be combined with bath therapy (balneo-phototherapy): While the patient is bathing in salty water, his skin is irradiated with UV light. Due to the high amount of salt in the water, the anti-inflammatory rays can more easily penetrate into the deeper layers of the skin.

Light therapy is mainly used in adult patients. It may also be possible for underage atopic dermatitis patients over 12 years of age.

Stays by the sea and in the mountains (climatic therapy)

Some atopic dermatitis patients take a cure at the Dead Sea. As with combined photo and bath therapy (balneo-phototherapy), those affected bathe in salt water (Dead Sea) and are exposed to UV rays (sun) at the same time. This can relieve the symptoms of atopic eczema.

In addition, the climatic conditions at the sea and in the mountains are very skin-friendly. You can significantly improve the skin condition of atopic dermatitis patients. The high UV radiation (anti-inflammatory) in these regions contributes to this. In higher mountain areas, the air is also poor in allergenic substances (allergens) such as pollen. In addition, it can never get humid in regions from 1,200 meters above sea level. Atopic dermatitis patients benefit from all of this.

Specific immunotherapy (desensitization)

Neurodermatitis patients who also suffer from hay fever, allergic asthma or an insect venom allergy can undergo so-called subcutaneous specific immunotherapy (classic form of desensitization). The doctor repeatedly injects a small dose of the allergy trigger (allergen such as pollen or insecticide) under the patient's skin. He increases the dose from time to time. In this way, the immune system should slowly lose its hypersensitivity to the allergy trigger. This can also alleviate atopic dermatitis eczema if it has been proven that the allergen makes it worse.

Relaxation techniques

Many atopic dermatitis patients have had good experiences with relaxation techniques. Methods such as autogenic training, progressive muscle relaxation, yoga or meditation can help against stress - a common trigger of acute illness flare-ups. In addition, targeted and conscious relaxation can distract from annoying itching and the urge to scratch.

Cotton gloves

If the itching is severe, many patients scratch themselves during sleep - sometimes so badly that the skin bleeds. To prevent this, neurodermatitis sufferers (small and large) can wear cotton gloves at night. To prevent them from getting lost during sleep, they can be fixed to the wrists with an adhesive plaster.

Psychological treatment

The soul can suffer very badly from neurodermatitis: the skin disease is not contagious. Nevertheless, healthy people sometimes shy away from contact with those affected, which can be very hurtful. In addition, some patients feel ashamed of their appearance, especially when the eczema affects the face, scalp and hands.

If atopic dermatitis patients have serious psychological or emotional problems as a result of their illness, psychological treatment can be useful. Above all, behavior therapy has proven itself.

Neurodermatitis & Nutrition

There is no special "neurodermatitis diet" that can be recommended to all those affected. Some atopic dermatitis sufferers can eat and drink anything they want - without any noticeable impact on their symptoms.

Others can get itchy and complexion worse when they consume coffee, alcohol, or spicy foods. Then it is advisable to avoid it if possible.

Atopic dermatitis plus food allergy

Infants and toddlers with neurodermatitis in particular often react sensitively to one or more foods such as cow's milk, egg white or wheat. Consuming them can obviously trigger or worsen an acute flare-up of illness in the little ones.

However, a "correct" food allergy can only be demonstrated in a small proportion of those affected (provocation test). If this is the case with your child, you should remove the relevant food from their menu. It is best to do this in consultation with the attending physician or a nutritionist. This helps to plan a specific "elimination diet" (elimination diet). This ensures that the child's menu provides sufficient nutrients, vitamins and minerals despite the fact that they do not eat certain foods. This is very important for the development of the little one.

The targeted elimination diet is usually not necessary on a permanent basis. Over time, many atopic dermatitis children become more tolerant of the foods to which they initially reacted over-sensitive. Therefore, allergy testing should be carried out again after one to two years. When the food allergy is no longer detectable, the little ones can eat normally again.

If adolescents or adults with neurodermatitis suspect that they tolerate certain foods poorly, they should also be tested for an allergy.

No elimination diet for prevention!

Some parents do not give their atopic dermatitis children any potentially allergenic foods such as dairy products, eggs or wheat flour products "on the go" - without a corresponding allergy having been determined in the little ones beforehand. These parents still hope that the neurodermatitis of their offspring will improve with the "preventive" elimination diet. But experts advise against it! Parents who reduce their child's menu on their own run the risk of serious deficiency symptoms in their offspring.

In addition, dietary restrictions can be very stressful, especially for children: For example, if other children eat ice cream or cookies together and the atopic dermatitis child has to do without them, it is not easy. All the worse if it were not medically necessary to do without it!

Neurodermatitis Treatment: Alternative Medicine

There are different healing methods of alternative or complementary medicine. Even if their effectiveness has in part not been scientifically proven, they are still used in atopic dermatitis.

Homeopathy is one of these healing methods: Depending on the symptoms, homeopaths recommend for atopic dermatitis, for example Graphites, Arnica montana or Arsenicum album.

Vegetable oils such as argan oil are also helpful: Atopic dermatitis patients should benefit from the healing properties of the oil - as well as people with psoriasis, for example. The ingredients of argan oil include linoleic acid. This omega-6 fatty acid is an important part of the skin.

Other valuable vegetable oils include evening primrose oil, black cumin oil and borage seed oil. They are high in gamma linolenic acid. This omega-6 fatty acid can have anti-inflammatory effects in atopic eczema. Patients can take the oils in capsule form or apply them externally as an ointment or cream.

Some patients support neurodermatitis treatment with aloe vera. Extracts of the cactus-like plant are said to have various healing effects. Aloe vera is said to provide the skin with moisture and promote its regeneration. In addition, it should have anti-germ (antimicrobial) and anti-inflammatory properties.

Some patients also use Schüssler salts. Neurodermatitis symptoms such as dry skin or inflammatory skin changes should be able to be successfully alleviated.

Home remedies for eczema

Home remedies for atopic dermatitis are, for example, cool, moist compresses (with water) against the itching. You can also first apply a suitable care product to your skin and then apply the envelope.

Some patients prefer envelopes with chamomile flowers. The medicinal plant has an anti-inflammatory effect. Pour a tablespoon of chamomile flowers over a cup of boiling water. Cover and let stand for five to ten minutes before straining the plant parts. Once the tea has cooled, dip a linen cloth into it. You then place this on the diseased skin areas and tie a dry cloth around it. Leave the poultice on for 20 minutes.

Anyone who is allergic to chamomile should not use the plant - neither externally nor internally.

Full baths with an extract from oat straw can also help with neurodermatitis: the silica in the straw promotes wound healing. The contained flavonoids increase blood circulation. This can strengthen the local immune system.

For the bath additive, add 100 grams of oat straw to two liters of cold water. Heat the mixture and let it cook for 15 minutes. Then strain off the straw and pour the extract into the lukewarm bath water. Lie in the tub for 10 to 15 minutes. Then you should pat the skin dry and apply a suitable cream / ointment.

Patients often learn many more tips for treating neurodermatitis in self-help groups.

Neurodermatitis: baby

Atopic dermatitis is often particularly difficult for babies and toddlers. The little ones do not yet understand why their skin is inflamed in places and itches so badly. They feel unwell, are often restless and have trouble sleeping.

However, there are various measures that can be taken to alleviate the symptoms of young atopic dermatitis patients. The attending physician will suggest appropriate medication and other therapeutic measures for each child. Parents themselves can do a lot to help their child, too. For example, you should rub it gently on a daily basis. In addition, they should regularly cut their little fingernails short and put cotton gloves on the child at night. Then the little ones don't scratch themselves in their sleep.

You can read more tips and information on atopic eczema in the youngest patients in the article Atopic dermatitis - Baby.

Neurodermatitis: examinations and diagnosis

Atopic dermatitis often occurs as early as infancy or toddlerhood. If your child scratches himself frequently, you notice unexplained reddening of the skin and these symptoms persist, speak to the pediatrician about it! He or she will first collect the little one's medical history (anamnesis) in a conversation with you. Possible questions from the doctor include, for example:

When did the rash first appear?
Where are the skin changes on the body?
Since when and how often does your child scratch?
Have you noticed dry skin on your child in the past?
Are there factors that make the symptoms worse, for example cold, certain clothes, stress or certain foods?
Have you or other family members suffered or suffer from neurodermatitis?
Are there any known allergies (such as hay fever) or asthma in your child or in your family?
Are there any other illnesses or health problems known to the patient, for example ichthyosis vulgaris (genetically caused cornification disorder of the skin), sleep disorders, mental disorders, ADHD?

Physical examination

After the interview, the doctor will physically examine the patient. He takes a close look at the skin all over his body. A clear indication of neurodermatitis are itchy, inflammatory skin changes, which, depending on age, tend to occur in certain areas. In children, these are mainly the face and the extensor sides of the arms and legs. In adults, the insides of the arms and / or legs are often affected.

If these skin inflammations are chronic or keep recurring, this is also strongly indicative of neurodermatitis. This is all the more true if the patient's family (or himself) is also aware of hay fever, food allergies, allergic asthma or other skin or respiratory allergies.

There are also other criteria that can indicate neurodermatitis. If, for example, the skin is mechanically irritated (e.g. by scratching with a fingernail or a spatula), this often leaves whitish marks on the skin in neurodermatitis (white dermographism).

Further investigations

If the doctor suspects that the neurodermatitis is connected to an allergy, he can arrange for appropriate allergy tests:

For example, the prick test (patch test) is suitable. The doctor scratches small amounts of common allergy triggers (pollen, animal hair, house dust mites, food, etc.) into the skin, usually on the forearm. If redness and / or wheals have formed in one or more places after 15 to 20 minutes, there is an allergy to the allergen or allergens in question.

The doctor can also have the patient's blood tested for specific antibodies against certain allergy triggers in the laboratory.

In unclear cases of neurodermatitis, it may occasionally be necessary to take a small skin sample and examine it more closely in the laboratory (skin biopsy).

Exclusion of other diseases

During his examinations, the doctor must rule out other diseases that can trigger symptoms similar to neurodermatitis. These so-called differential diagnoses include, for example:

other eczema, for example general contact eczema, irritant-toxic contact eczema, microbial eczema or - especially in infants - seborrheic eczema
Psoriasis of the palms and soles of the feet (psoriasis palmoplantaris)
Fungal infection of the hands and feet (tinea manuum et pedum)
Scabies
in adults: eczema stage of cutaneous T-cell lymphoma (a type of cancer of the lymphatic system)

Mixed pictures of the different types of eczema often occur. It is therefore important to have an experienced doctor and to describe the clinical picture to him in detail. Sometimes it makes sense to consult a dermatologist in addition to the pediatrician and, if necessary, a specialist in allergies (allergist).

Neurodermatitis: course and prognosis

In up to 85 percent of all cases of neurodermatitis, the disease breaks out before the age of five. As they grow up, the eczema and itching usually disappear again: Around 60 percent of all children with neurodermatitis no longer show any symptoms at the latest in early adulthood.

The remaining 40 percent still suffer from neurodermatitis as adults. This can be observed particularly in patients in whom atopic eczema appeared in very early childhood and has taken a severe course. Even if a child also suffers from other allergic (atopic) diseases such as hay fever or allergic asthma, the risk that their neurodermatitis will continue into adulthood is increased. The same applies if close family members have an atopic disease.

In any case, early, consistent treatment is very important for neurodermatitis. The disease cannot be cured with regular skin care, medication, etc. However, a therapy that is optimally adapted to the individual patient can alleviate the symptoms of neurodermatitis in the acute episode. There is also a lot that can be done to prevent new flare-ups (see below).

Eczema complications

Complications can arise in the course of atopic dermatitis. Skin infections develop most frequently, for example because the scratching of the itchy skin gives pathogens an easy entry point:

The germ usually causes additional bacterial infections in atopic dermatitis Staphylococcus aureus. It is often found on the skin, in the nose and throat, even in healthy people.
As a result of virus infections, for example, dellar warts or pronounced "normal" warts can develop. Some patients get what is known as eczema herpeticatum: triggered by herpes viruses, numerous small skin vesicles form, usually accompanied by a high fever and swollen lymph nodes. In severe cases, there is a mortal danger, especially for children!
Fungal infections (mycoses) in neurodermatitis are mainly caused by dermatophytes or Malassezia fungi.

The rare complications of neurodermatitis include eye diseases (such as glaucoma, retinal detachment, blindness), circular hair loss (alopecia areata) and growth retardation / short stature.

Some neurodermatitis patients also develop ichthyosis vulgaris. This is a genetic disorder of keratinization of the skin.

A spontaneous healing of neurodermatitis is possible at any time, usually during puberty. About 30 percent of adults who had previously suffered from neurodermatitis still show eczema at times or have very sensitive skin. If atopic dermatitis still exists in adulthood, the relapses are usually milder than in childhood.

Neurodermatitis: prevention

When it comes to prevention, a distinction is made between two variants in atopic dermatitis:

If you already have neurodermatitis, suitable measures can prevent acute flare-ups. This is called secondary prevention.
Primary prevention is about preventing neurodermatitis from the outset.

Prevent eczema flare-ups

Most atopic dermatitis patients have relapses in autumn and winter. In spring and summer, on the other hand, the complexion often improves. How strong the individual attacks are, how long they last and how often they occur cannot be predicted.

But there is a lot that can be done to prevent an atopic dermatitis attack. Above all, this includes avoiding or at least reducing the individual triggers. Here are some tips on how to do this:

Atopic dermatitis patients with a food allergy should avoid the food in question.
In the case of other allergies (e.g. to pollen, house dust mites, animal hair, etc.), atopic dermatitis patients should avoid the allergy trigger as much as possible.
People with neurodermatitis should wear clothing that is soft and skin-friendly (for example made of cotton, linen or silk). On the other hand, they often don't wear woolen clothing well on their skin. New clothes should always be washed and rinsed thoroughly before wearing them for the first time.
Cigarette smoke increases the symptoms of atopic dermatitis. A household in which a person with atopic dermatitis lives should definitely be smoke-free.
Many cleaning, care and cosmetic products contain substances that additionally irritate the sensitive neurodermatitis skin. The doctor or pharmacist can recommend products that are also suitable for atopic dermatitis.
Unfavorable climatic conditions (travel to hot countries, dry air due to air conditioning, etc.) should also be avoided by neurodermatitis patients.
Cures lasting several weeks in a so-called stimulating climate (North Sea, high mountains, etc.) are very advisable for neurodermatitis. It promotes the healing of eczema and can prevent new flare-ups.
Relaxation techniques such as autogenic training, progressive muscle relaxation, yoga or meditation help against the trigger factors stress and tension.
Regular exchange with other atopic dermatitis patients in a self-help group can help those affected to cope better with their disease. This increases the mental well-being and can thus prevent new attacks. Self-help groups are particularly useful for children and adolescents: Many are ashamed of their bad skin or are teased about it.

For adolescents and adults with neurodermatitis, choosing the right profession is also crucial: Professions in which the skin comes into contact with water, cleaning agents, disinfectants or chemical products are unsuitable for neurodermatitis patients. The same applies to very dirty activities such as demolition work. Frequent contact with animals or flour can also irritate sensitive skin. Unsuitable professions for atopic dermatitis are therefore, for example, hairdressers, bakers, pastry chefs, cooks, gardeners, florists, construction workers, metal workers, electrical engineers, nurses and other medical professions as well as cleaners.

Lower the risk of atopic dermatitis

Some measures can reduce the risk of neurodermatitis and other atopic diseases (hay fever, allergic asthma, etc.). This is particularly important for children at risk. These are children whose families (parents, siblings, etc.) have atopic diseases.

Important tips for atopic dermatitis prevention are:

Women should not smoke during pregnancy. Even after birth, children should grow up in a smoke-free household. This lowers your risk of neurodermatitis and other atopic diseases.
Babies should be fully breastfed for at least four months. This prevents the development of neurodermatitis, hay fever and the like.
Breastfeeding mothers should eat a balanced diet. Fish is also recommended: If women eat fish during pregnancy and breastfeeding, the risk of neurodermatitis and other atopic diseases in the child appears to be reduced.
Babies who are not (fully) breastfed should receive hypoallergenic (HA) infant formula if their family has atopic diseases (such as neurodermatitis) (children at risk).
From the 4th month of life, complementary foods can be fed. Fish also makes sense here: according to evidence, eating fish in the first year of life protects against atopic diseases such as neurodermatitis.
Children at risk should not grow up with cats. Dogs, on the other hand, are not a problem - they do not increase the risk of allergies.

There is evidence that a so-called Mediterranean diet (lots of plant-based foods, a lot of fish, little meat, olive oil, etc.) can also protect against atopic diseases. The same goes for the consumption of vegetables, fruits, omega-3 fatty acids and milk fat. But this still needs to be researched before we can give precise nutritional recommendations for the prevention of neurodermatitis and other atopic diseases.

Additional information

Book recommendations:

Diet and Atopic Dermatitis: A Practical Guide (Carmen Majovski, 2005, Eppe)
Neurodermatitis, what do I cook for my child? An everyday guide for parents (Gerhild Mann, Janna Flach and Karin Bauer, 2005, pala verlag gmbh)
Neurodermatitis: Advice for patients and relatives (Isabel Fell, Thomas Müller, Imke Reese and Esther von Stebut, 2014, akademos Wissenschaftsverlag)