Neurodermatitis – An itchy affair

The skin is dry, red and itchy. Sometimes the symptoms are stronger, sometimes they are weaker. – Neurodermatitis, also known as atopic dermatitis, occurs in episodes and is the most common chronic inflammatory skin disease. The number of people affected has doubled or tripled in industrialized countries over the last few decades. Although the disease cannot yet be cured, it can be easily treated, explains the dermatologist Paul Sator from the Hietzing Clinic in an interview with the “Wiener Zeitung”. He also dispels myths that continue to unsettle those affected and delay effective treatment.

Causes for the occurrence of atopic dermatitis are above all an excessive reaction of the immune system, a disturbed protective function of the skin, a disturbed bacterial flora and a genetic disposition. In the immune system of healthy people there is a balance between the two subgroups 1 and 2 of the T helper cells. TH-2 cells predominate in neurodermatitis patients. They produce inflammatory messengers that stimulate the release of antibodies and histamine, which in turn causes allergic reactions. TH-1 cells, on the other hand, are more likely to produce messenger substances that keep allergic reactions in check.

cause in the genes

Excessive cleanliness, hygiene and cleanliness are conducive to the development of the disease, explains the doctor. “If you grow up sterile as a child and have fewer infections as a result, then the number of TH-1 cells is very low and they can’t control TH-2.” If there is still a genetic readiness, neurodermatitis can appear.

The extent to which the corona pandemic with all its protective measures will ultimately affect the number of sick people cannot yet be foreseen. Yes, “Covid-19 will certainly encourage that,” emphasizes Sator.

The term neurodermatitis came about because it was previously assumed that it was solely based on inflammation of the nerves – neuron for nerve, derma for skin and -itis for inflammation. However, this assumption is outdated. In the medical field, one therefore speaks of atopic dermatitis today. The actual causes have not yet been fully clarified, but they seem to have their origin primarily in the genes. Certain trigger factors such as environmental influences can then lead to an outbreak. Outgrowth of the disease is most likely to occur in infants or young children. The well-known cradle cap, a form of neurodermatitis that develops on the scalp of newborns, usually disappears over time. But the inclination remains, explains Sator. If you become ill later in life, the risk of lifelong problems is much higher.

systemic disease

Basically, atopic dermatitis is a systemic disease. That is, it affects the entire human organ system and, although the symptoms are primarily seen on the skin, is not limited to it. Comorbidities are also common. Around 43 percent of adult patients with a severe form suffer from neurological diseases, anxiety or depression. In addition, allergies are also associated with neurodermatitis.

However, allergies do not cause the disease, but vice versa, emphasizes the expert. Sick people have an increased risk of allergies. Because neurodermatitis can not only express itself through the skin, but also through the respiratory tract – for example through hay fever or asthma.

The disease is not curable to this day, but there are various treatment options depending on the severity. In order to optimize the disturbed skin barrier and the skin’s microbiome, moisturizing and moisturizing skin creams are used. In mild cases, local therapies such as cortisone or immunomodulating creams are also used. UV light also has a positive effect, which is why the symptoms often alleviate in summer.

New therapy methods

In severe cases, the specialist uses individual immunosuppressive drugs. With modern therapy options, immune-modulating messenger substances are applied to the skin. These come in the form of interleukin blockers, so-called biologics, injected or as Janus kinase inhibitors in tablet form. The substances are anti-inflammatory and immunomodulating, among other things. The new treatment methods are definitely a ray of hope, emphasizes Paul Sator.

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