neurodermatitis

Neurodermatitis is a form of eczema (atopic dermatitis). The condition starts with an itchy patch, usually on the ankle or wrist - within easy reach of a scratching hand. Perhaps the type of sock aggravates the itching (e.g., wool). In any case, the act of scratching traumatizes the skin enough to produce - you guessed it - more itching (technical term, pruritis). Which results in more scratching, and so forth (called the "itch-scratch cycle" in dermatologic circles). Unattended, this progresses to produce thickened skin and chronic irritation. Often these patients have had the area for several years by the time they seek medical attention.

The treatment is topical steroids; I often use an occlusive dressing (steroid cream covered overnight by a wrap) to speed healing. These sores are always infected to some degree, so an antibiotic makes sense as well.

Once cured, these patches can reappear if the patient is not careful to avoid scratching, but instead start applying medication when the itching starts.

Severe neurodermatitis of the ankle, of several years duration.

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