Integrative View of Atopic Dermatitis – Part II

With regard to Traditional Chinese Medicine (TCM), there are many possible TCM patterns that correspond to the Western diagnosis of atopic dermatitis (eczema).

In chronic cases, a rather complex overlapping of multiple syndromes can be present. Practitioners should differentiate based on the presentation of lesions and patient history, and not just adhere to the list of TCM patterns I cover here.

Treatment should definitely include internal herbal medicine as atopic eczema definitely has underlying imbalances that cannot be effectively treated just using topical substances; though topical herbs can be quite helpful to ease symptoms such as itching, oozing, flaking and redness. Diet improvements must also be considered for each patient.

In both infants and children, the most common TCM pattern for AD/eczema is Damp Heat. For internal herbal treatment, it is important to determine which pathogenic factor is more predominant: Damp or Heat. More exudate or weepy/oozing lesions indicate more Damp. When Heat predominates, there may be more redness, but there will also be more itching and dryness. Chubbier babies who tend to sweat more tend to be more prone to a Damp condition. Their eczema will likely have more exudate and lesions will form yellow crusts when they dry. Thinner or weaker babies have a tendency to develop the drier type of eczema where Heat is more predominant (some sources differentiate this from Damp Heat and call it Fetal Heat). In this type, the lesions will not be very weepy and there will be more dry, flaky crusts that look like white or gray "bran-like" scales on top of the lesions. There might be cracking (fissuring) of the skin or even bloody scabs if scratching is intense. In infants who are dependent on formula or in children who have a poor diet (lots of sugary foods, milk and dairy products, fatty or greasy foods), there will also be underlying deficiency of Spleen and Stomach. The TCM pattern of Damp Heat accounts for most cases of acute eczema regardless of the age of the patient. Both Damp Heat and Deficiency of Spleen and Stomach are a possibility in subacute stages of eczema.

The TCM pattern of Heat in the Blood is also a possibility during the childhood phase of AD/eczema as well as the adolescent/adult phase. Though some Damp Heat may also be present, this pattern presents as the drier type of eczema, with more redness and more intense itching than when there is only Damp Heat. Heart Heat is typically the underlying source of the Heat in the Blood. Heat in the Blood pattern can occur in the acute or subacute stages of eczema.

Most chronic stages of AD/eczema are seen in the adolescent/adult phase. The skin may exhibit lichenification: it is thicker, drier, rougher, and may have scaling. Itching can be intense, especially at night which can lead to insomnia. These cases are most often (but not always) diagnosed in TCM as Blood Dryness Due to Damaged Yin with Accumulation of Dampness. This develops over a long period of time from Damp Heat. The Heat damages Yin. When the Damp accumulates in the skin and oozes out, this exudation also damages Yin. This all eventually leads to dryness. At first, the patient's tongue may be puffy and moist with scalloped sides (signs of Dampness), but the moisture will decrease over time, cracks may form in the center and a red tip or sides may begin to develop (signs of dryness and Yin deficiency). There may also be Blood Stasis, which is indicated if the lesions remain hyperpigmented after healing. This condition can be quite complicated to diagnose and to treat. We must first eliminate Dampness, but caution must be used so as not to exacerbate the Blood Dryness and the developing Yin Deficiency. Next treat the source of the Dampness (usually Spleen qi Deficiency) and then also Nourish & Move Blood and Nourish Yin. It is sometimes necessary to both Eliminate Dampness and Nourish Blood and Yin at the same time.

In addition to addressing the patterns described above, most eczema presentations are also accompanied by Fire Toxins and Wind. Herbal formulas for AD/eczema should also include herbs to resolve toxins (to treat the over-proliferation of staph bacteria that so often is present in the lesions) and to Dispel Wind (to address the itching). While many cases of AD/eczema can benefit from herbal treatment combined with acupuncture, in cases with lesions over most of the body or cases with significant erythema (redness and inflammation), it sometimes may be best to avoid acupuncture since placement of the needles can sometimes aggravate symptoms locally, especially on the delicate skin of the face.

Tips to Improve AD/Eczema:

FOR KIDS, TEENS and ADULTS:

• Steer clear of common food allergens (a frequent trigger for atopic eczema): eggs, milk, peanuts, soybeans (including tofu), fish (esp. shellfish and shrimp), and wheat (or other gluten-containing foods like oats, barley and rye). You may want to research food allergies to get more information or seek the help of a health care practitioner to help you determine which foods you may be allergic to.
• Avoid foods that are fatty, spicy or fried. Don't overindulge in sweets. Don't eat too much fish or seafood, esp. shrimp. Don't consume too much dairy either (including milk, cheese, yogurt). From the TCM perspective, excess consumption of any or all of these foods weaken the energy of the Spleen and encourage the development of energetic Dampness and Damp-Heat, a common underlying cause of eczema.
• Although eating too much fish seems to worsen eczema, increasing intake of fish oil (for the essential fatty acids) seems to help. Try cod liver oil 3-4 grams daily for one month then cut back to 1 to 2 grams daily. Flax seed oil is also an option: 1 tsp, 3 times per day (great as salad dressing if you dislike to swallow it alone).
• Take good quality probiotics (healthy bacteria for your gut) between meals. They are a very important factor in keeping the immune system healthy. Available at health food stores, usually kept refrigerated.
• If you also have airborne/respiratory allergies (dust mites, mold, seasonal pollens, animal dander, etc.) avoid those allergens as best you can. Also stay away from people with colds/flu. If you have any type of immune response it can trigger a flare-up of your eczema.
• Fluctuations in hormones can trigger eczema, so if you have irregular periods or thyroid issues, keep them well managed.
• Avoid over-washing your hands or over-bathing. Keeping your skin clean is important, but over-cleansing can strip your skin of moisture and actually make your eczema worse.
• While eating oats may trigger eczema if you are allergic to gluten, bathing with oats can really reduce itching. Try adding 2 cups of rolled oats (oatmeal) to your bath. Soaps and lotions containing oats are good, too.
• Avoid glycerin soaps or lotions high in glycerin if you live in a really dry climate. Glycerin is a humectant and is said to attract moisture to the skin. This is great if the climate you are in is humid but if the air is drier than your skin, a humectant will leach water from your skin into the air. Not helpful if you want to keep your skin from drying out.
• Apply moisturizer immediately after bathing.
• Avoid contact with wool: clothing, coats, socks, blankets, upholstery.
• Avoid extreme temperatures for air as well as water that contacts your skin. Wash with lukewarm water, avoid really hot and humid climates, stay covered-up in very cold, windy or dry conditions.
• Stay happy! Emotional stress and upset can exacerbate your skin problems, especially eczema. Deal with your stress in healthier ways than stuffing emotions or letting minor annoyances stress you out. Try acupuncture, yoga or other form of regular exercise. Walking each day will help more than you may think.
• If you have herpes simplex infection, get it under control.
• Apply only high quality skin care products to your face and body. Cheap cosmetics and lotions often contain harsh or even dangerous ingredients. Products with high alcohol content will also irritate skin.
• Ointments and lotions formulated specifically for skin with eczema can be helpful to reduce itching and soothe skin.

FOR BABIES:

• Keep their nails trimmed short (to break the cycle of itch-scratch-secondary infection of lesions).
• Keep the skin creases and folds of chubby flesh clean (legs, buttocks, groin, arms, armpits, neck).
• Avoid contact with wool blankets/clothing.
• If mom is breast feeding, mom should avoid foods that are fatty, overly sweet, spicy or fried. Don't overindulge in fish or seafood, esp. shrimp. Don't consume too much dairy either (including milk, cheese, yogurt).
• Don't feed your infant/toddler the above foods. Also avoid common allergens: eggs, milk, peanuts, soybeans, wheat and fish (already mentioned above).
• Keep baby clean, but don't over-bathe them as too much washing can cause dehydration of skin and worsen the condition.
• Ointments and lotions formulated specifically for skin with eczema can be helpful to reduce itching and soothe skin.
• Mittens (or socks) on their hands at night can reduce scratching in their sleep.