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Ultrasonic scanning of the digestion organs, carried out in 35 patients with eczema and 20 ones with diffuse neurodermatitis have revealed abnormalities of the liver echostructure in 60% of patients with eczema and in 50% of neurodermatitis patients; abnormal gallbladder echostructure in 65.7% of eczema patients and in 25% of neurodermatitis patients; disturbed echostructure of the pancreas in 34.3% of eczema patients and in 5% of neurodermatitis patients. These abnormalities have not been associated with clinical shifts as a rule. Liver dysfunction and leukocytosis in the B bile have been detectable only in the patients with abnormal echostructure of the organs; these shifts showed a tendency to normalization over the course of treatment irrespective of the skin status. During rehabilitation after discharge from hospital such patients should be kept on diets and administered drug therapy, aimed at the prevention of the digestive organs diseases.
Fifty patients of neurodermatitis attending the dermatology clinic of a general hospital were screened for psychiatric morbidity. Fifty patients suffering from tinea from the same clinic were taken as a control group (age, sex and socio-economic class matched). A majority of neurodermatitis patients were between 21-30 years of age-group (52%), males (84%), married (90%), literate up to primary (42%) and belonged to socio-economic class V (44%). The common sites of neurodermatitis were legs (28%), arms (16%), scrotum (12%) or multiple sites (36%). The duration of symptoms ranged from 1 month to 2 years (average duration was 6 months). The study group also showed significantly higher occupational and psychosexual problems (p < 0.001). The neurodermatitis patients scored significantly higher on N-2 scale and Hamilton rating scale for depression.
Stress medicine has shown that emotional disharmony can be a substantial factor for skin diseases. The harmonisation of the emotional status and a corresponding reduction of stress hormones by the Medical Resonance Therapy Music (MRT-Music) as shown in other studies (1,2,3,4) inspired us to investigate its benefits for patients with psoriasis vulgaris and neurodermatitis (neurodermatitis constitutionalis atopica). Over a period of 14 days we measured the parameters of blood pressure, heart rate, stimulus to scratch and the degree of sickness in two, respectively four groups of 68 patients in total: two experimental groups (psoriasis/neurodermatitis) and two control groups. All patients received the normal treatment of our hospital, the experimental groups were additionally treated with 3 x 30 minutes of MRT-Music per day, while the controls were asked to somehow relax during this time. In the experimental groups the measurements showed a reduction of blood pressure and heart rate and revealed an enhanced reduction of the stimulus to scratch and an enhanced reduction in the degree of sickness. Interestingly the effects of MRT-Music were stronger with the psoriasis patients than with the neurodermatitis patients. The results of this pilot study convinced us to offer the treatment with the Medical Resonance Therapy Music to all our patients.
Neurodermatitis is a multiphasic disease, yet despite intensive research, its etiopathogenesis still remains unclear. A large number of immunological and nonimmunological dysfunctions as well as their diverse interplay lead to very different types of manifestation. Consequently, treatment must also be varied and is mainly determined by the clinical picture. External therapy without glucocorticoids is no longer conceivable in acute and subacute dermatological conditions, although attenuated glucocorticoids which have the least amount of side effects should always be used. Improvement in the therapeutic efficacy of hydrocortisone can be achieved by combining it with urea which, depending on the vehicle used, represents one of the most effective penetration promoters for this glucocorticoid. Fighting the symptoms of dry skin and itching are of central importance in the follow-up treatment and prophylaxis of neurodermatitis. Here, urea preparations have been applied with great success. Urea's efficacy in the skin is largely based on its ability to elevate the water-binding capacity of the corneal layer, on its keratoplastic properties, its antipruriginous effect and its proliferation-suppressant action. However, the intensity and the duration of this therapeutic efficacy are dependent on several factors which must be taken into consideration in the galenics of urea preparations. As a whole, there is a multitude of possibilities for the use of urea in the therapy, follow-up and prophylaxis of neurodermatitis which we have only just begun to exploit in full.
The authors assess the clinical efficacy of sibicort, and ointment manufactured by Orion, Finland, used in therapy of patients suffering from neurodermatitis, eczema, and allergic dermatitis. Pathogenetic treatment combined with sibicort has been administered to 64 patients with disseminated true eczema, 115 ones with diffuse neurodermatitis, and 20 ones with allergic dermatitis. The ointment has been applied to and a little bit rubbed in the foci of lesions twice a day. Sibicort has proved to be a highly effective external drug for the treatment of allergic itching dermatoses. Both immediate and late results have been the best in neurodermatitis patients. No side effects or complications associated with this ointment application have been observed; the drug has been well tolerated.
The authors consider it desirable that the following forms of this condition be singled out as a nosologic entity: (1) atopic neurodermatitis, a hereditary disease with characteristic immunologic shifts; (2) chronic diffuse neurodermatitis of adults, a disease developed by subjects without atopic anamnesis, characterized by a torpid course; remissions and exacerbations are not season-associated; (3) chronic local neurodermatitis, a disease with a typical morphology in foci of involvement, with prolonged remissions following intensive local therapy.
The results of examination of 213 children with neurodermatitis and psoriasis (157 and 56 patients respectively) have led the authors to conclude that borderline psychopathologic symptomatology in patients with neurodermatitis shows greater polymorphism as compared to psoriasis patients. The form, severity and time-course of borderline psychic disorders were presented by asthenic obsessive phobic, subdepressive and hysterical symptomatology and the syndrome of malbehaviour in the neurodermatitis patients and astheno-subdepressive symptomatology in those with psoriasis.
Epidermal nicotinamide adenine dinucleotides were measured in subcorneal and basal epidermal layers in patients with psoriasis and neurodermatitis and in healthy controls. Lowry's microtechniques utilizing enzymatic cycling were used. The total NAD content in these groups was except for the involved psoriatic skin about 1.1 mmoles/kg dry weight. Between 40 and 50% of this content consisted of the reduced form. In the involved psoriatic skin the total NAD content was increased to 1.5 mmoles/kg, this increase being mainly due to a rise in NAD+. There was no difference in NAD content between epidermal layers in the various groups studied. The total NADP content was near 0.15 mmoles/kg in healthy controls and in patients with neurodermatitis. The subcorneal layers contained 10% more of the dinucleotide than the basal layers, but in the two layers the reduced form amounted to about 80% of the total. In both non-involved and involved skin of the psoriatic patients the total NADP content was significantly increased above the control level, by up to 20% in the former and up to 65% in the latter. In the two layers studied the NADP+ content was increased by about 75% in both non-involved and involved areas. In contrast, the NADPH content rose only in the basal layers of the lesion, by 55%. The increased levels of NADP+ and NADPH found in psoriasis might suggest an accelerated or differently conducted NADPH dependent biosynthesis in this disease.
Two patients experienced multiple affective episodes that were consistently preceded by migraine headaches and neurodermatitis. Evidence is reviewed that suggests a possible role for abnormalities of serotonin metabolism for the reported association of affective disorder, migraine, and neurodermatitis.
Eight patients with intensely pruritic lesions of chronic idiopathic prurigo nodularis and three patients with neurodermatitis circumscripta were investigated using the indirect immunofluorescence method. Results showed similarities in epidermal hyperplasia but not in nerve proliferation and neuropeptide immunoreactivity. Increased numbers of calcitonin gene-related peptide (CGRP) and substance P immunoreactive nerve fibre bundles were detected in specimens taken from prurigo nodularis lesions, but no increased immunoreactivity could be seen in specimens taken from patients having neurodermatitis circumscripta compared to normal skin. The neuropeptides, CGRP and substance P, may be responsible for the intense itching of prurigo nodularis lesions.
Correlations between clinical variants of neurodermatitis course and patients' lymphocyte sensitivity to histamine are analyzed. The atopic form is associated with high lymphocyte sensitivity to histamine. Administration of H-1 antihistaminic agents to these patients is not always justified. Antihistaminic drugs should be prescribed to neurodermatitis patients with due consideration for the individual sensitivity of patient's lymphocytes to histamine.
Basing on the findings of fiber gastroscopy, used in examinations of 262 patients with neurodermatitis, the authors describe the so-called "minor endoscopic signs", i.e. enhanced gastric peristalsis, pyloric spasm, hypersecretion, duodenogastric reflux. These signs are diagnostically and prognostically significant for the treatment and rehabilitation of neurodermatitis patients.
Thirty-two female patients suffering from neurodermatitis were examined. Increased hydrocortisone level and reduced estrogen concentration in the blood serum were observed during exacerbation of the condition. During remission these parameters normalized. Exacerbations were associated with marked dyslipidemia at the expense of elevated concentrations of triglycerides, free cholesterol, low-density lipoproteins in the blood serum; these parameters also showed a tendency to normalization during remission. A correlation could be traced between hormonal imbalance and disturbances of lipid metabolism regulated by these hormones. The authors emphasize the necessity of correcting dyslipidemia during exacerbation of diffuse neurodermatitis.
Clinical, psychological, and electroencephalographic examinations of 267 children suffering from neurodermatitis, psoriasis, and total alopecia have revealed neural and mental disorders in 73.78% of patients, these disorders being the most grave and polymorphic in neurodermatitis.
Clinical and electroencephalographic examinations of 182 children with neurodermatitis have revealed paroxysmal neuropsychic disturbances, differing from the psychopathologic disorders, in 16. These disturbances, that may be described as the night fears syndrome, may be cured by long treatment including anticonvulsive therapy. This permits a conclusion that neurodermatitis in children is associated with deep organic involvement of the brain.
Analysis of 66 cases with neurodermatitis has made it possible to distinguish five conditions: atopic dermatitis, diffuse, disseminated, or local neurodermatitis, prurigo. Each of these nosologic entities in characterized by a specific course. The authors consider that the term 'atopic dermatitis' is inadequate and should be changed.