The term neurodermatitis dates back to the 19th century and means inflammation of the nerve skin. At the time, it was assumed that an inflammation of the nerves was responsible for the skin changes. This view has long since been refuted, but the term has remained common. In the meantime, the theses that a disturbed parent-child relationship or even a certain neurodermatitis personality is the cause are outdated. To date, however, the exact causes of atopic eczema have not been fully clarified . Defects in the epidermal barrier function, immune regulation and innate immune defense play a decisive role. The course of the disease is complex and very individual.
The influencing factor of heredity
Atopic eczema arises on the basis of a genetic diagnosis of atopy. This has been clarified. Atopy is a tendency to hypersensitivity reactions , i.e. immediate allergic reactions (type I allergy), which react to contact with substances from the environment that are otherwise actually harmless. Accordingly, atopy describes the physical readiness for an increased pathological formation of immunoglobulin E antibodies, also called IgE. Atopic diseases also include allergic rhinoconjunctivitis, hay fever and bronchial asthma. To date, the exact causes of atopic eczema have not been fully clarified . Defects in the epidermal barrier function, immune regulation and innate immune defense play a decisive role. The course of the disease is complex and very individual.
The influencing factor of heredity
Atopic eczema develops on the basis of a genetic disposition to atopy. This has been clarified. Atopy is a tendency to hypersensitivity reactions, i.e. immediate allergic reactions (type I allergy), which react to contact with substances from the environment that are otherwise actually harmless. Accordingly, atopy describes the physical readiness for an increased pathological formation of immunoglobulin E antibodies, also called IgE. Atopic diseases also include allergic rhinoconjunctivitis, hay fever and bronchial asthma. Familial accumulation is obvious in neurodermatitis. About two-thirds of those affected have an atopic family history. If both parents are affected, the child has a 75 percent risk of also developing atopic dermatitis. If only one parent is ill, the probability for the child is 35 percent. If there is no family history, it is about 15 percent. There are numerous genes which can predispose to atopic diseases and which, for example, trigger an altered immune response or disrupt the skin's barrier function. The type and extent of the mutations in the structural protein filaggrin have an influence on the degree of severity of neurodermatitis. These also have an influence on the likelihood of suffering from allergic rhinitis (hay fever or allergic asthma. Furthermore, the mutation of the filaggrin gene is responsible for a higher allergen permeability and a higher water loss of the skin. Therefore, the skin is very dry. Reinforced this dryness is caused by reduced synthesis of the barrier lipids of the epidermis.It is also known that 40 to 50 percent of atopic dermatitis is associated with ichthyosis vulgaris.ICHTHYOS vulgaris is a keratinization disorder of the skin caused by a genetic defect such as filaggrin -Gen. In addition, there are disease-specific infections of an unspecific immune defence. Skin infections, which are triggered by bacteria such as Staphylococcus aureus, Pityrosporum or Streptococcus pyogens as well as viruses or fungi, especially herpes simplex. These are unfortunately a typical complication of atopic eczema because the interaction of different immune cells is no longer in balance. In turn, defects in immune regulation lead to allergic diseases being advanced.
The connection between skin health and the psyche
The mediators such as leukotrienes, histamine and others that are released by the degranulation of mast cells are responsible for the extreme itching in neurodermatitis. However, a predisposition to neurodermatitis alone does not make you ill, but only more susceptible. Only as soon as unfavorable environmental influences occur and several mechanisms combine can it be possible for the disease to break out. Neurodermatitis is based on a genetic predisposition to atopy. The skin-lipid barrier is disturbed in neurodermatitis. In addition, there are defects in the innate immune system and defects in the innate immune response. The skin is more susceptible to the penetration of allergens and infections, as it cannot perform its protective function to the extent that healthy people can.
The consequence of it
The immune system reacts much more strongly to environmental stimuli. Hardly any other skin disease is so susceptible to internal and external disturbances. Contact with chemical, physical or microbial stimuli can lead to inflammation and an immune reaction, which then start the disease flare. This makes it easier for allergens to enter the body. Frequently observed causes that manage to trigger an eczema flare-up are, for example, sweating, which was triggered by stress. There are also garments made of pure synthetics or wool. Also contact with dust, soaps, extensive or hot washing or bathing and scrubbing. Furthermore, the intake of foods or substances that promote mediator release. Not to forget the allergens that are inhaled or get on the skin, such as pollen, animal hair, etc. Climatic factors such as severe dryness or muggy weather and extreme cold also have an influence. Environmental toxins such as diesel exhaust, tobacco smoke or ozone can trigger an allergy, as can colonization of the skin with fungi, viruses or bacteria in the case of neurodermatitis. These belong to the provocation or trigger factors and thus also stimuli that can cause an eczema flare-up without a cause for the disease being apparent. Therefore, great hopes and expectations of healing are placed in both identification and elimination.
The psyche
It also has an influence on neurodermatitis. Atopic dermatitis is one of the multifactorial dermatoses. With these, the psychological aspects play an immense role in the development and processing. Sensitive people in particular often suffer from flare-ups that trigger psychologically. Not every neurodermatitis is psychologically conditioned. The result of the study is: One third of neurodermatitis sufferers can be influenced by psychological factors. At nine percent, it is also interesting to see that stress shows an improvement in the condition. This group is called resting neurodermatitis sufferers. A higher tendency to allergies in neurodermatitis is often found in the area of food. The most common reason food flares are triggered is an actual food allergy. This is a problem especially in childhood and in infancy. A third of children with neurodermatitis have additional allergies to one or two foods. These are mostly basic foods: such as cow's milk, wheat or chicken protein. With the guidance of a doctor, it should be found out whether allergies are present and if so, which ones. Skin tests such as the skin prick test, food diaries and elimination diets with a subsequent provocation are used for this. If the allergy has been confirmed, the food in question must be consistently avoided. In children, these allergies often disappear by the time they reach school age, which is why a new test is carried out every two years after the diagnosis has been made. Sensitization to fish, hazelnuts or peanuts can last longer. Just like real allergies, pseudoallergies in neurodermatitis sufferers can worsen the eczema symptoms. In the case of pseudoallergies, the body reacts to flavorings and additives or biogenic amines. Also common on tomatoes or acidic foods.
