Your doctor may diagnose neurodermatitis by examining the affected skin and determining whether you've been itching and scratching. To rule out other causes, he or she may take a small sample of the affected skin (skin biopsy) for testing.
Treatment is aimed at controlling the itching, preventing scratching and addressing underlying causes.
- Anti-itch medicated creams. If over-the-counter corticosteroid cream isn't helping, your doctor may prescribe a stronger corticosteroid or a nonsteroidal anti-itch product. A calcineurin inhibitor (tacrolimus) ointment may help if the vulva is involved.
- Corticosteroid injections. Your doctor may inject corticosteroids directly into the affected skin to help it heal.
- Medicine to ease itching. Prescription antihistamines help relieve itching in many people with neurodermatitis. Some of these drugs may cause drowsiness and help with alleviating scratching while you sleep.
- Anti-anxiety drugs. Because anxiety and stress can trigger neurodermatitis, anti-anxiety drugs may help prevent the itchiness.
- Medicated patches. For stubborn itching, your doctor may suggest topical lidocaine 5 percent or capsaicin 8 percent patches.
- Light therapy. Exposing the affected skin to particular types of light is sometimes helpful.
- Psychotherapy. Talking with a counselor can help you learn how your emotions and behaviors can fuel — or prevent — itching and scratching.
If your itching persists despite treatment, your doctor may suggest a nontraditional approach. For example, in small studies some people whose symptoms didn't improve with corticosteroid use did report success with the following treatments.
- OnabotulinumtoxinA (Botox) injection. This technique may reduce itching and clear up rough skin patches.
- An oral drug to ease the compulsion to pick and scratch. An oral drug called N-acetylcysteine has been shown in a small study to help some people with picking and scratching disorders and may be of help to people with neurodermatitis.
Lifestyle and home remedies
These self-care measures can help you manage neurodermatitis:
- Stop rubbing and scratching. The itching may be intense, but avoiding rubbing and scratching is key to controlling your condition and preventing a recurrence.
- Apply cool, wet compresses. These may soothe the skin and relieve the itch. Putting a cool, wet compress on the affected skin for a few minutes before you apply a medicated cream helps the cream soak into the skin.
- Try over-the-counter medications. Apply an anti-itch cream or lotion to the affected area. A hydrocortisone cream can temporarily relieve the itch. An oral antihistamine, such as diphenhydramine can relieve severe itching and help you sleep. Some people have success with capsaicin (kap-SAY-ih-sin) cream, but it may sting at first.
- Cover the affected area. Bandages or dressings can help protect the skin and prevent scratching. These may be especially useful 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 short, warm baths and moisturize your skin. Prepare your bath with warm — not hot — water. Sprinkle in colloidal oatmeal. Use mild soaps without dyes or perfumes. Limit bathing time and frequency.
After washing, pat your skin dry and apply unscented moisturizer.
- Avoid triggers. Notice what seems to bring on a recurrence and avoid it. For example, use stress management techniques and avoid clothing that irritates your skin.
Preparing for your appointment
You may start by seeing your primary care physician. He or she may refer you to a doctor who specializes in skin conditions (dermatologist).
Here's some information to help you get ready for your appointment.
What you can do
Before your appointment, make a list of:
- Symptoms you've been having and for how long
- Key personal information, including any major stresses or recent life changes
- All medications, vitamins and supplements you take, including the doses
- Questions to ask your doctor
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?
- What are alternatives to the primary approach 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 them together?
What to expect from your doctor
Your doctor is likely to ask you a number of questions, such as:
- Do your symptoms come and go, or are they fairly constant?
- What products do you use on your skin, including soaps, lotions and cosmetics?
- What steps have you taken to manage the itchiness?
- Have any of these measures helped?
- Have you been stressed or anxious lately?
- How much do your symptoms affect your quality of life, including your ability to sleep?