Background: Neurocutaneous interactions play a crucial role in the pathogenesis and clinical manifestations of various skin disorders. Understanding the anatomical and functional relationship between the nervous system and skin can provide insights into disease mechanisms and management. Objective: To evaluate the anatomical and clinical involvement of the nervous system in common dermatological conditions. Methods: A prospective observational study was conducted on 110 patients with neurocutaneous disorders at the Dermatology Department, Narayan Medical College and Hospital, Sasaram, Bihar, from February 2024 to January 2025. Clinical examinations, neurological assessments, skin biopsies, and autonomic function tests were performed. Results: Pruritus (68%) and burning (42%), neurological complaints, were common. Patients had 35% sensory impairment and 28% autonomic dysfunction. 40% of persistent pruritus and atopic dermatitis patients had reduced intraepidermal nerve fibre density. A significant link (p<0.05) was identified between neural involvement and illness aggravation. Conclusion: The nervous system significantly contributes to the pathogenesis of dermatological disorders. Integrating neurological evaluation in dermatological care may improve disease management.