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Harvard Medical School
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General Medical Questions
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Question : I have been suffering from a skin rash for about 10 years. A large patch of my skin constantly itches, and the skin is thick and feels like leather. I have gone through almost every ointment on the market, and none works.
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The Trusted Source
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Rebecca Campen, M.D., J.D., is an assistant professor of dermatology at Harvard Medical School. She divides her time between clinical practice of dermatology at the Massachusetts General Hospital and private practice in Savannah, Ga.

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January 30, 2012
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A:

Yes, antidepressants can help neurodermatitis.

Neurodermatitis, or lichen simplex chronicus, is a chronic skin condition characterized by intense itching. When you scratching the itch, it irritates nerve endings in the skin. This just causes more itching and scratching. An “itch-scratch-itch cycle” sets in, and it is tough to break.

Anything that causes itching can start this cycle — an insect bite, an itchy scar, or a reaction to a skin product. Stress or habit can also start the cycle. For instance, you can unconsciously scratch your leg while studying, scratch your arm when you’re nervous, or scratch as a chronic habit. But whatever the original cause, continued scratching results in itchy, thickened, discolored skin.

Neurodermatitis is often seen on the arms or legs. But it can happen on any area that can be reached. Once the skin gets irritated and thickened, itching is intense. Scratching feels good and is hard to resist. This is especially true at bedtime, when you have fewer distractions. Persistent itching can result in anxiety. And scratching can lead to skin break down and infection.

To treat neurodermatitis, you need to break the itch-scratch-itch cycle. Here are some tips:

  • Use a mild, unscented soap for bathing
  • Avoid any perfumed products
  • Try soothing lotions and ice packs to relieve itching

If the itching keeps up, your doctor may want to evaluate you for underlying factors or conditions that may be contributing to the itching. He or she may recommend a skin biopsy and/or allergy testing.

Your doctor may prescribe Steroid creams and ointments to help with itching and redness. But these alone will not be enough if the scratching continues. These oral medicines can help:

  • Antihistamines
  • Certain low-dose antidepressant drugs, such as doxepin
  • A sedative to help with sleeping
  • A mild tranquilizer to ease the anxiety you feel from itching

Constant scratching lets bacteria or other germs to get into the skin, causing a skin infection. If this happens, your doctor will prescribe a topical or oral antibiotic.

Neurodermatitis is not a simple skin condition. It may have started with an itch. But scratching becomes a necessity, and causes stress and anxiety. That’s why anti-anxiety, anti-depressant, and mood-altering drugs may be very helpful in breaking the itch-scratch-itch cycle.

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