Neurodermatitis – medically known as atopic dermatitis – is a chronic inflammatory skin disease that affects millions of people. But what is really behind this condition? Why does neurodermatitis suddenly appear in some people, while others remain symptom-free their entire lives? The causes are complex and extend far beyond mere skin irritation. In this article, we take an in-depth look at the causes of the disease, its triggers, and modern approaches to relief – well-founded, understandable, and holistic.
What is atopic dermatitis?
Atopic dermatitis is one of the most common skin diseases worldwide. It is characterized by dry, scaly, and intensely itchy skin patches that occur in phases and are often associated with allergic conditions such as asthma or hay fever. It is a so-called atopic disease , which means it is associated with an overreaction of the immune system.
According to the Robert Koch Institute, approximately 10–15% of all children and up to 5% of adults in Germany are affected. The disease is particularly common in infants and toddlers.
The complex causes of atopic dermatitis
1. Genetic predisposition
One of the most important risk factors is genetic inheritance . Studies show that if one parent is affected, the probability that the child will also develop atopic dermatitis is around 40%. If both parents are affected, the risk increases to over 70%.
This is due, among other things, to changes in the filaggrin gene . Filaggrin is a protein essential for a healthy skin barrier. If it is missing or defective, the skin loses moisture more quickly and becomes more permeable to allergens, germs, and irritants.
2. Immunological dysregulation
In atopic dermatitis, the immune system reacts hypersensitively – especially to otherwise harmless stimuli such as house dust mites, pollen, or certain foods. This is caused by a malfunction of T helper cells, particularly Th2 cells, which release inflammatory messengers such as histamine, interleukin-4, or interleukin-13.
The result: inflammation, redness, and excruciating itching. This immune reaction is chronic, meaning it can remain active even without an external trigger.
3. Disorders of the skin barrier
The skin of people with atopic dermatitis is often dry and sensitive because it produces fewer lipids and loses moisture more quickly. This weakens the skin's natural protective function. Germs like Staphylococcus aureus can more easily colonize and trigger additional inflammation.
A vicious circle develops: the more irritated the skin, the more itches – and the more you scratch, the more your skin suffers.
4. Environmental influences and lifestyle
Even if genetic predisposition forms a basis, external factors often determine whether and when the disease breaks out:
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Climatic conditions : Cold, dry air in winter or overheated rooms often worsen the symptoms.
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Allergens : House dust mites, pet hair, mold spores or pollen can trigger attacks.
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Diet : Certain foods such as milk, eggs, nuts or wheat are suspected of intensifying reactions.
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Psychological stress : Studies show a clear connection between stress levels and neurodermatitis attacks.
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Hygiene hypothesis : Children who grow up in very germ-free environments are more likely to develop atopic diseases – presumably because their immune systems are not sufficiently “trained”.
Atopic dermatitis in children and adults: differences
While in children the face, scalp and extensor surfaces of the arms and legs are primarily affected, in adulthood the symptoms often shift to the hands, neck, eyelids or the crooks of the elbows and backs of the knees.
In addition, the disease often occurs in more severe forms in adults, accompanied by severe skin thickening (lichenification), chronic itching and frequent bacterial colonization.
The influence of the psyche: How stress and emotions affect the skin
Atopic dermatitis is not only a skin condition, but also a psychosomatic one. The constant itching leads to sleep deprivation, exhaustion, and often social withdrawal. Conversely , psychological stress such as anxiety, depression, or work-related stress can also exacerbate the condition.
The so-called " skin-brain model " describes this interaction impressively: The skin and the central nervous system originate embryologically from the same germ layer. It's no wonder, then, that emotions literally get under the skin.
Modern diagnosis and individual therapy approaches
Diagnosis is usually made clinically, based on typical skin changes and a detailed medical history. Allergy tests or blood tests for IgE levels may be helpful.
What helps against neurodermatitis?
There is no cure-all, but treatment options are varied and should be tailored to the individual :
Basic care
Daily, consistent skin care forms the basis of every therapy:
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Moisturizing creams and ointments
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Care products without fragrances or preservatives
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Regular oil or salt bath therapies
Acute therapy
In case of severe attacks, short-term anti-inflammatory drugs are used:
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Corticosteroids (cortisone creams) – effective, but only recommended to a limited extent
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Calcineurin inhibitors such as tacrolimus – especially for sensitive skin areas
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Antihistamines to relieve itching
Systemic therapies
In severe cases, systemic treatment may be necessary:
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Biologics such as dupilumab specifically intervene in the immune response
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Phototherapy with UVB light can also help
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Immunomodulators such as ciclosporin or methotrexate in severe cases
Holistic approaches: More than just creams
More and more people are turning to holistic methods to better manage their atopic dermatitis. And rightly so – because treating symptoms alone often falls short.
Nutrition and intestinal health
Many sufferers report improvements through an anti-inflammatory diet , such as the clean eating principle or the so-called low-histamine diet . Gut health also plays an important role, as around 70% of immune cells are located in the gut.
Probiotics and a diet rich in fiber can be helpful here.
Relaxation techniques
Techniques such as progressive muscle relaxation , mindfulness training or yoga help to reduce stress and soothe the skin through neuroimmunological processes.
Naturopathy and complementary medicine
Herbal preparations , such as evening primrose oil, aloe vera, or chamomile, are also used as supportive treatments. Homeopathy and acupuncture have also shown positive effects in individual cases, but are scientifically controversial.
The right way to handle it in everyday life
Living with atopic dermatitis can be challenging—but it's possible to live well with the condition. Small changes in your daily routine can make a big difference:
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Lukewarm showers instead of hot water
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Cotton clothing instead of wool or synthetics
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Gently dry rubbing instead of scrubbing
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Short fingernails to avoid skin injuries
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Itching diary to better identify triggers
Conclusion: Understanding is the first step towards improvement
Atopic dermatitis is more than a superficial skin problem—it's a complex, chronic inflammatory disease with physical, immunological, and psychological aspects. Understanding the causes allows for more targeted countermeasures and long-term minimization of flare-ups. A combination of medical therapy, personalized care, stress reduction, and a conscious lifestyle offers the best chance for noticeable improvement.
Even though atopic dermatitis cannot currently be cured, it can be treated – and in many cases very successfully.
