Baby mit Neurodermitis im Gesicht


Itching, all the time

Last updated on April 25, 2024 First published on April 24, 2024

Inflammatory skin diseases are very common. Neurodermatitis is particularly common and at the same time particularly unpleasant. Much is still unclear about this complex disease.

The reddened areas on the elbows and backs of the knees reappear, especially in dry air. And this despite the fact that Angela is very conscientious when it comes to her personal hygiene. Applying lotion after her daily shower is part of her routine. She can keep her dermatitis under control to a certain extent, but when the air is very dry she still suffers new flare-ups. “Unfortunately, this is a very typical case,” says Claudia Lang. The dermato-allergist specializes in neurodermatitis or atopic dermatitis and researches the disease.

“This is often frustrating for patients. We can now provide much better help, but the disease is still not curable today.”

Genetic predisposition

Neurodermatitis is widespread among children and adolescents worldwide, affecting almost one in five children. It often develops into adulthood. However, around five percent of all adults in Switzerland continue to suffer from this inflammatory skin disease. The diagnosis is made on the basis of the clinical picture: Does the localization of the affected areas match? Does the disease progress in phases? Is it chronic? Does is itch? The exact cause is still not fully understood. Not least because various factors often come together. However, there is a genetic predisposition to the development of atopic dermatitis. “We now know that in many of these patients, a protein that should ensure the cohesion of the skin cells is altered,” explains Claudia Lang. “You can imagine it like a wall: The bricks are the skin cells, the mortar between them is strengthened by the protein. If this protein is defective, the entire wall begins to crumble and becomes permeable.”

Impaired protective function

The specialist uses this image to try to explain to affected people what is happening to their skin. The consequences are serious: the skin becomes dry and brittle. On the one hand, this leads to itching. Because the cement or mortar between the skin cells is missing, the skin also loses its protective function and pathogens or allergens can penetrate much more easily. They trigger local inflammation, which further intensifies the itching. And depending on the pathogen, inflammatory neurodermatitis can quickly turn into infected atopic dermatitis, for example due to a herpes infection. “This makes consistent skin care all the more important,” emphasizes Karin Grando, specialist care expert in dermatology. She explains the prescriptions to the patients in detail and how they should use which products. “Applying moisturizing products several times a day is the be-all and end-all.”

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Not a typical allergy

Very often these patients also suffer from hay fever, asthma or food allergies. Together with neurodermatitis, these diseases are classified as atopic diseases. Atopy means reacting to environmental influences with the formation of IgE antibodies. Atopic dermatitis is not an IgE-mediated reaction, meaning that the skin immediately deteriorates when hazelnuts are consumed, for example. Nevertheless, some patients report a worsening of the skin condition in connection with certain foods or during the hay fever season. It is an inflammatory reaction in the skin that is influenced by various factors and leads to an excessive reaction of the immune system.

Therapy over several stages

Cortisone is often used locally during an acute flare-up. The immune response and thus the violent inflammatory reaction are thus inhibited locally. The side effects for the body are minimal, as local cortisone hardly enters the bloodstream. If neurodermatitis occurs over a large area, medication is also used for a short time to dampen the immune system as a whole. For the dermatologist, however, this is not a sustainable option. “As soon as you stop taking these medications, a new flare-up can occur. The medication is often not tolerated as well.” New medications are intended to provide relief by specifically targeting the relevant messenger substances. They are therefore intended to intercept the message that an ignition needs to be fought so that the “fire department” does not even have to go out.

Effective, simple and without side effects

The second therapy of choice after anti-inflammatory ointments such as cortisone is light therapy. It acts directly on the skin, is practically free of side effects and is therefore also suitable for pregnant women. Thanks to filtering to a specific wavelength in the UVB spectrum, it also does not increase the risk of skin cancer. Above all, however, it can have a long-term, positive effect. In addition, the actual therapy is extremely short: a session lasts only a few minutes. The only disadvantage is the sometimes considerable organizational effort required for two to three sessions a week for three to four months. Integrating treatment into your commute: The USZ’s offer at the Circle at Zurich Airport may make this easier for some.

Learning to live with the disease

For Karin Grando, the most important thing is that the people affected learn to deal with the disease and the constant itching. And not to give up. These are simple tips that she can pass on to patients. “If there is enough time. First and foremost, we explain the prescribed therapy and how to use, apply or take the medication after the doctor’s consultation.” What other tips would she give? “Avoid anything that puts additional stress on the skin. So don’t take a hot shower with a soft jet of water, dab yourself dry and never rub. Or even wear your underwear with the seams facing outwards.”

Claudia Lang, Dr. med.

Attending Physician, Department of Dermatology

Tel. +41 44 255 11 11
Specialties: Atopic dermatitis/neurodermatitis, Mastocytosis, Contact allergies

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