neurodermatitis
Introduction
Introduction to neurodermatitis Neurodermatitis, also known as chronic simple moss (lichensimplexchronicus), is a localized skin dysfunction dermatosis, also known as chronic simple moss. And the so-called psoriasis of Chinese medicine, similar to the sore. It is a chronic skin inflammation characterized by paroxysmal itching and skin lichen. The cause is not clear. It is generally thought to be related to long-term scratching, friction and neuropsychiatric factors and some external stimuli. basic knowledge Sickness ratio: 0.01%-0.02% Susceptible people: no special people Mode of infection: non-infectious Complications: folliculitis lymphitis
Cause
Cause of neurodermatitis
Neuropsychiatric factors (35%):
Due to emotional fluctuations, excessive mental excitement, depression, nervousness, anxiety, horror or neurasthenia, the cerebral cortex regulates dysfunction, causing peripheral nerve dysfunction. When stimulated, the skin is prone to reaction and has a lichen-like change.
Stimulus factor (25%):
Such as drinking alcohol, coffee and other hot stimulants, or taking some drugs acting on the nervous system and underwear friction, friction is the most important factor in the incidence of the disease, scratching and other local stimuli are all incentives. Physical stimuli often contribute to the disease.
Disease factors (20%):
Digestive diseases, endocrine disorders, etc., are also important incentives.
The disease is injured by the seven emotions, mostly due to the endogenous heart, the spleen through the damp heat, the lungs through the wind poisoning between the skin care, exogenous rheumatic fever, resulting in block the skin, blood deficiency and dryness, skin glory To.
It is not clear, it is generally considered to be related to nervous system dysfunction, cerebral cortex excitability and imbalance of the process of inhibition, because patients are often accompanied by neurasthenia, insomnia and menopausal syndrome, each time due to mood swings, excessive mental stress and aggravation or recurrence, This disease is similar to the "psoriasis" recorded in the medical literature of the motherland, and the "surgical sore" is similar. For example, "Surgical Authentic" is described in the stubbornness: "Psoriasis is like the skin of a cow, stubborn and firm, and it is like a deadwood." "The Sources of Diseases" took the sore note: "The sore of the neck... It was born on the neck, itching, the collar is screaming, its the cloud, its made by the collar, so its called the sore."
Pathogenesis
The pathogenesis is still not clear, but long-term scratching, friction is the most important factor in the pathogenesis of the disease, other such as sun exposure, sweating and other mechanical, in addition, may be related to gastrointestinal dysfunction, endocrine disorders or in vivo infections .
Prevention
Neurodermatitis prevention
First, avoiding scratching and scratching can make the skin continue to suffer from mechanical stimulation and thicken, and even cause infection. Scratching also strengthens the effect, the patient becomes more and more itchy, the more itching and the more it catches, forming a vicious circle, and the course of the disease is prolonged.
Second, avoid hot water to wash dermatitis, eczema in the acute phase, due to intradermal capillary expansion, there will be varying degrees of skin redness, papules, blisters. Wash or soak with hot water, increase the redness and swelling, increase the permeate, and aggravate the condition. Therefore, patients with dermatitis and eczema should use warm water to shower, avoid immersing in hot water and rubbing hard.
Third, avoid soap washing, especially alkaline soap, which is a chemical irritant to the skin, which can make dermatitis and eczema worse. If you need to use soap to decontaminate, it is best to choose a small irritating boric acid soap.
Fourth, avoid irritating foods such as pepper, wine, tea, coffee and other stimulating foods, can make itching more likely to make eczema worse or relapse, should be contraindicated.
Fifth, avoid blind use of dermatitis, eczema, a longer course, easy to repeat, patients should be patiently treated with the doctor. Some people treat eagerly, and do not apply a high concentration of antipruritic drugs to the skin lesions without medical treatment; instead, they aggravate the condition. Therefore, avoid using drugs without authorization.
Complication
Neurodermatitis complication Complications folliculitis lymphitis
The disease is chronic, the symptoms are light and heavy, and it is easy to relapse after curing. In severe cases, folliculitis and lymphitis may be secondary, and persistent rubbing of the crotch or upper back may cause starchy substances to deposit in the dermis, and then develop into Plaque and mossy amyloidosis.
Symptom
Neurodermatitis symptoms Common symptoms Skin pruritus depends on papules Itchy navel itch skin dry scaly insomnia back acne
In the early stage of the disease, only the intermittent itching of the affected part, especially at night, often cause insomnia, the skin appears light brown round or polygonal papules, the surface is smooth or covered with sugar-like scales, densely integrated, with the development of the disease, The papules gradually merge into pieces, forming a moss-like change of Yingwu. At this time, the lesions are dry and thick, the skin lines are deepened, and they are interlaced. The skin tendons are rhomboid or polygonal, and the boundary is clear.
1. More common in young and middle-aged, old people, children are rare.
2. Chronic menstruation, light and heavy, generally increased in summer, winter alleviation, all diseases can be divided into three phases:
(1) During the quiescent period, the surface inflammation is mild or absent, the lesion is limited, and the boundary is clear.
(2) During the onset period, the inflammation is clear, the infiltration is obvious, the lesions are enlarged, and the edges are blurred.
(3) During the retreat period, the infiltration is slight, the skin lesions become thinner, and the tendency to heal.
3. From the perspective of distribution, the disease can be divided into two categories, limited and generalized. The most common sites are the cervical side, the head, the forehead, followed by the appendix, the elbow fossa, the armpit, and visible. The back, the two hips, the vulva, the anus, the groin, the eyelids, the scalp, the limbs, etc., are often symmetrically distributed, and may be arranged in a line along the folds of the skin or the distribution of the cutaneous nerves.
4. At first, it feels local itching first. Because the skin is quickly mossy, the typical damage is the size of most rice grains to high glutinous rice, light red to yellowish brown or round or polygonal hard and shiny flat papules consistent with skin color. Closely integrated with a small amount of scales on the surface, accompanied by scratches, blood stasis, skin lesions are most prominent in the center, the closer the edge is, the more the edge is unclear, the time is unclear, and the sulcus is obvious because of the irritating skin. For the calf, for a long time, the surface can be tumor-like, persistent scratching rubbing the ankle or upper back can cause starchy substances to deposit in the dermis, and then develop into plaque and bryophyte-like diseases, respectively. Such as folliculitis, bloated and so on.
5. The patient is conscious of paroxysmal itching, especially at night, which can affect sleep, work and life.
Examine
Examination of neurodermatitis
Histopathology : dense positive keratinization, occasional parakeratosis, acanthosis hypertrophy, epidermal protrusion evenly prolonged, intraepithelial cells and intercellular edema, basal pigment particles increased, collagen fibers in the dermal papilla thickened, vertical Arrangement, lymphocytes scattered around the superficial blood vessels, hyperkeratosis of the epidermis, hypertrophy of the acanthosis, prolongation of the epidermis, may be accompanied by mild sponge formation, capillary hyperplasia of the dermis, lymphocytic infiltration around the blood vessels, or visible dermal fibers The mother cells proliferate and are fibrotic.
Diagnosis
Diagnosis and differentiation of neurodermatitis
diagnosis
According to paroxysmal itching, skin lichenification and the predilection of this disease can be diagnosed.
TCM pathogenesis and syndrome differentiation: Chinese medicine believes that this disease is mostly due to emotional discomfort, depressed and uncomfortable, and the heart is on fire, resulting in dysfunctional blood flow, stagnation in the skin, blood loss and yin, blood deficiency and dryness, or Due to the dampness of the spleen, the complex sense of wind and evil, hinders the skin and the disease.
TCM syndrome differentiation:
1. Rheumatoid type
The main card: more common in patients with limited, skin lesions into a piece, was light brown, rough and fat, paroxysmal itching, especially at night, thin white or white greasy tongue, pulse slow.
Dialectical: rheumatism, skin dystrophy.
2. Liver stagnation
Main card: more common in generalized patients, rash red, Zheng Jian upset irritability or depression, insomnia and more dreams, dizziness, palpitations, mouth bitter throat, red tongue, thin white tongue, slippery pulse.
Dialectical: It belongs to the liver and depression, and it is a long time.
3. Blood deficiency and dryness
Main card: more common in the elderly and physically weak patients, skin color or gray, thick and rough, often accompanied by palpitations, shortness of breath, excessive menstrual flow, etc., pale tongue, fine pulse.
Dialectical: blood deficiency and dryness, skin dying.
Differential diagnosis
1. Chronic eczema can cause lichenification, skin infiltration and hypertrophy and itching need to be distinguished from neurodermatitis. The difference is that chronic eczema is mostly caused by acute eczema, and there is a tendency to exude in the process.
2. Lichen planus and neurodermatitis are similar to round or polygonal flat papules, consciously itching, the difference is that the former flat papules are larger than the latter, purple-red, waxy luster, visible wicknam pattern, homomorphic response In the forearm, calf extension, torso, etc., in addition to mucosal damage (such as damage to the buccal mucosa and glans), histopathology is specific.
3. Skin amyloidosis occurs in the calf neurodermatitis, which can be tumor-like, so the need for the two, the skin amyloidosis of the skin lesions sorghum to mung bean large brown brown hard pimples, sometimes rash along the skin lines The beaded arrangement has a characteristic change in histopathological amyloid deposition.
4. Psoriasis occurs in the calf extension and scalp chronic limited hypertrophic psoriasis, similar to neurodermatitis, but the base of psoriatic lesions is reddish or dark red infiltrated, with silvery white scales, stripped After the film phenomenon and punctiform hemorrhage, psoriasis damage is common in other parts of the body. The patient does not itch or mild itching, and histopathology has diagnostic value.
5 scrapie: more common in the elderly, often associated with the season, skin lesions are secondary.
6 primary skin amyloidosis: occurs in the calf stretch side, the skin lesions are high-grade to green beans large round or semi-circular brown pimples, densely integrated with plaques without fusion, waxy luster, rough surface, Inconsistent, the Congo red skin test was positive.
