bubble_chart Overview

Neurodermatitis is a localized skin disease caused by neural dysfunction, also known as lichen simplex chronicus. In Chinese medicine, it is referred to as "psoriasis" or "cervical neurodermatitis," named for its frequent occurrence on the neck, where the skin becomes thick and tough, resembling the hide of an ox. As Waike Zhengzong states: "Psoriasis resembles the hide of an ox, stubborn and hard, and when scratched, it feels like rotten wood." The clinical characteristics include lichenification of the skin, thickening and roughness, intense cutaneous pruritus, a slow and protracted course, frequent recurrences, often persisting for years without cure, and a tendency to relapse even after healing.

bubble_chart Etiology

This disease is caused by injury from the seven emotions, mostly due to internal generation of heart fire, spleen channel dampness-heat, and lung channel wind-toxins lodging in the striae and interstice of the skin, external contraction of wind-dampness pathogenic heat, leading to obstruction of the skin, blood deficiency generating dryness, and cervical malignancy with cachexia of the skin. Summarizing its disease cause, it can generally be divided into the following three types.

(1) Neuropsychological factors: Due to emotional fluctuations, excessive mental excitement, depression, tension, anxiety, fear, or neurasthenia, the regulatory function of the cerebral cortex becomes disordered, causing dysfunction of the nerves around the anus. When stimulated, the skin is prone to react, presenting lichenoid changes.

(2) Irritating factors: Such as excessive consumption of alcohol, coffee beans, and other pungent-heat stimulants, or the use of certain drugs that act on the nervous system, as well as local irritations like underwear friction and scratching, all serve as predisposing factors.

(3) Disease cause factors: Digestive system diseases, endocrine disorders, etc., are also significant predisposing factors.

bubble_chart Clinical Manifestations

In the initial stage [first stage], the affected area only experiences intermittent cutaneous pruritus, especially at night, often leading to insomnia. Scratching causes the appearance of light brown circular or polygonal papules, with a smooth surface or covered with sugar-like scales, densely clustered. As the condition progresses, the papules gradually merge into patches, forming a pronounced lichenification. This seasonal disease causes the skin to become dry, thickened, with deepened skin lines that intersect, raised skin ridges, presenting a water caltrop base peel or polygonal shape with clear boundaries. This condition is commonly seen in young and middle-aged males.

bubble_chart Treatment Measures

(1) Internal Treatment:

1. Chinese Medicine Treatment:

(1) Wind-Dampness Heat Type: The skin lesions appear as patches, light brown in color, rough and thickened, with paroxysmal intense itching, especially at night; thin white or white greasy tongue coating, soggy and slow pulse. Treatment should focus on clearing heat and dispelling dampness, dispersing wind to relieve itching. Commonly used prescriptions include Wind-Dispersing Powder or Wind-Dispersing and Heat-Clearing Decoction with modifications.

(2) Blood Deficiency Wind-Dryness Type: The skin lesions are pale or grayish-white, thickened and rough, often accompanied by palpitations, severe palpitations, shortness of breath, lack of strength, excessive menstrual bleeding in women, pale tongue texture, and deep-thin pulse. Treatment should focus on nourishing blood to moisten dryness, dispelling wind to stop itching. Commonly used prescriptions include Four-Ingredient Wind-Dispersing Decoction or Itch-Relieving Mixture with modifications.

(3) Spleen Deficiency with Excessive Dampness Type: The skin lesions are dark gray, thickened and smooth, accompanied by abdominal distension and fullness, poor appetite, loose stools, swollen tongue with tooth marks, white thick coating, and soggy-slow pulse. Treatment should focus on strengthening the spleen and eliminating dampness. Commonly used prescriptions include Dampness-Expelling Stomach Poria Decoction with modifications.

(4) Liver Depression Transforming into Fire Type: The rashes are red, accompanied by irritability, susceptibility to anger, or mental depression, insomnia with excessive dreaming, dizziness, palpitations, bitter taste in the mouth, red tongue edges and tip, thin white coating, and wiry-slippery pulse. Treatment should focus on soothing the liver and relieving depression, clearing heat and nourishing blood. Prescriptions include Liver-Draining and Spirit-Calming Pill or Peony and Gardenia Peripatetic Powder with modifications, or Itch-Cutting Decoction, decocted in water for oral administration.

2. Western Medicine Treatment:

(1) Antihistamines and Sedatives: Chlorpheniramine, Buclizine, Diphenhydramine, Promethazine, Diazepam, etc., may be selected as appropriate to calm and relieve itching.

(2) Intravenous Medication: 0.25% Procaine Injection 10–20ml with Vitamin C 500mg for intravenous injection; or Procaine 4–6mg/kg body weight, diluted with normal saline to 0.1% solution, combined with Vitamin C 500–1000mg for intravenous drip. Alternatively, 10% Calcium Gluconate 10ml may be administered intravenously.

(2) External Treatment:

1. Apply Realgar Powder topically.

2. Apply Neurodermatitis Lotion to the affected area.

3. Apply Jin Yu Ointment externally.

4. Plum-Blossom Needle Local Tapping: Once daily, 10 sessions as one course.

5. The following topical medications may also be selected as appropriate: Fluocinonide Ointment, Compound Dexamethasone Acetate Solution, Fu Ji Ning, 105 Black Soybean Tar Ointment, Itch-Relieving Alcohol, etc.

6. Local Block: Compound Quinine Injection 2ml plus 1% Procaine 4–6ml for subcutaneous injection (avoid superficial injection to prevent skin necrosis), once weekly, 10 sessions as one course. Alternatively, 0.1% Methylene Blue 2ml plus 2% Procaine 5–10ml may be injected subcutaneously at the affected site, once weekly.

7. Radioisotope Therapy: ³²Phosphorus or ³⁰Strontium may be used for topical application.

8. Superficial X-ray Radiation Therapy: 29–43KV, 60–100R per session, once weekly, 3–4 sessions as one course, with no more than two courses per year.

bubble_chart Differentiation

The diagnosis can generally be made based on clinical favorable sites, typical lichenoid lesions, absence of blisters, paroxysmal intense itching, and a chronic course. However, it should be differentiated from the following diseases:

(1) Chronic eczema: For details, refer to the section on anal eczema.

(2) Cutaneous pruritus disease: More common in the elderly, often seasonal, with secondary skin lesions.

(3) Lichen planus: Commonly occurs on the flexor surfaces of the wrists, extensor surfaces of the forearms and lower legs, and the trunk. The lesions are larger, round or polygonal, flat papules with a slightly rounded center, dark red, pale purple, or normal skin color, and a waxy sheen on the surface. There are specific histopathological changes.

(4) Psoriasis: The lesions have a light red or dark red infiltrated base, covered with silvery-white scales. After removing the scales, there is a thin membrane phenomenon and punctate bleeding. Psoriatic lesions are often found in other parts of the body.

(5) Primary cutaneous amyloidosis: Commonly occurs on the extensor surfaces of the lower legs. The lesions are round or semicircular brown papules, ranging from sorghum to mung bean size, densely clustered into patches without fusion, with a waxy sheen, rough surface, and uneven texture. The Congo red intradermal test is positive.