Your Eczema and You: Yes, Your Skin Can Be Clear Again!
Today, we’re continuing in our series on Chinese medicine and skin disease. First we covered the basics (review the August online issue if you missed it), and then in September’s issue we took a closer look at acne. Today we’re going to take a tour through you and your eczema.
What is eczema?
First off, when we say “eczema,” what do we mean? “Eczema” is synonymous with “dermatitis,” and there are many types: atopic, pompholyx, nummular, and stasis, just to name a few. Pompholyx, dyshidrotic, or vesicular eczema is notable for just that: the vesicles or small blisters that are the hallmark of this condition. Very itchy vesicles form on the sides of the fingers and palms of the hands (occasionally the feet or toes). The itchy active phase lasts 1-2 weeks before resolving into a dry, scaling phase. Often, just as things appear to be healing, an active phase begins again and the whole itchy, frustrating cycle continues.
Nummular or discoid eczema is named for its shape—disc or coin—and indeed this type of eczema is diagnosed almost entirely on appearance. We see very clearly demarcated patches of affected skin, generally presenting symmetrically on the dorsum (backs) of the hands, arms, legs, or torso. This eczema is also often very itchy; just a little patch can be surprisingly irritating.
Stasis eczema is also known as varicose eczema, gravitational eczema, or hypostatic eczema. What does that mean? It means this type of eczema is a common disorder of the lower limbs that arises as a consequence of venous tension. Valves in the veins are compromised, the veins aren’t able to hold blood properly (working, as they do, against gravity), and blood seeps out into the surrounding tissue. Interestingly, this type of eczema is particularly prone to what’s called autosensitization, or to spreading to other parts of the body for no good reason—parts without the same compromised venous system as the lower leg.
And there are others: seborrheaic dermatitis, contact dermatitis, and lichen simplex, to name a few more, as well as atopic eczema, which is probably the “eczema” you think of when you hear the word. This is the eczema we see more often in babies and children (though it affects adults, too), the eczema that tends to run in families along with asthma, food allergies, and other allergic diseases.
As was the case for acne, Chinese medicine has for centuries identified each of these types of eczema as distinct disease processes and treated them accordingly. For example, traditional names for atopic eczema include Wind of the Four Crooks (Si Wan Feng—so-called for the tendency of atopic lesions to show up in the flexures or “crooks” of the elbows and knees).
Eczema and Western medicine
From here on out, we’ll focus on atopic eczema, but keep in mind that Chinese medicine has much to offer in the treatment of all the varieties of eczema listed above. So, what’s the cause? From a Western biomedical perspective there’s no single, definitive cause, but there are many theories regarding the underlying mechanisms. The conflagration of symptoms begins when the immune system over-reacts to an irritant, allergen, or offending substance. This reaction, for some reason, turns on the skin. That’s what we know, for sure.
Eczema and Chinese medicine
Similarly, Chinese medicine doesn’t delineate one, singular, definitive cause for eczema. Illness—dermatological or otherwise—always arises as a result of some kind of imbalance in the body, an imbalance caused by the impact of the environment, stress, improper diet, toxin buildup, and other lifestyle and emotional factors as they intermingle with your unique, individual constitution. As we mentioned in the treatment of acne, practitioners of Chinese medicine have the benefit of an altogether different approach to human physiology that allows us to look at disease processes from a perspective unavailable to a Western physician. The benefit of that different perspective is that it gives us different treatment options. Where Western medicine has failed you, Chinese medicine may well have the answer.
As was the case with acne, you’ll again hear us talking about your skin condition in seemingly “unscientific” ways. We use terms like “damp heat,” “Blood heat with wind,” or “fire toxin” when we’re differentiating your particular version of atopic eczema. Again, what’s useful for us as clinicians is that these seemingly “unscientific” terms are actually very scientific! They’re part of a larger, complex, time-tested, and elegant system of understanding the inner-workings of the human body. These terms, based on your individual symptoms and presentation, then match up your personal eczema with an individualized treatment plan. You take your personal medicine, and your eczema symptoms improve. Hoorah! Notably, quite a few other symptoms are likely to improve, as well.
As is the case for all skin diseases, your lesions tell us a lot. Where are they located? Are they in the crooks of your knees and elbows (the flexures) or in an opposite presentation (i.e. actually on your elbows and knees)? What color are they? Are your lesions more flat (macular) or are they raised as plaques? Do you have bumps (papules), tiny blisters (vesicles), or pustules? Does anything ooze? If it does, what color is it and where on your body is the oozing located? Are there scales? Do you sweat? Is your skin thickened? How itchy are you? Is the itch worse at night? Do you wake up scratching? Are the affected areas swollen? How clearly demarcated are the edges of the lesions—are the borders clear or kinda murky? We’ll also want to know the details of your sleep, your digestion, your mood, your temperature, your bowel habits, your urination, and your menstrual cycle. We’re not treating your skin; we’re treating a person who has skin. All of you matters.
How about a few examples? We’ll start with an infant, a male, 8 months old. He developed eczema at 3 months, confined to his head and face. The lesions are clearly itchy and somewhat swollen. He’s prone to get very hot, especially in the evening and at night, but he doesn’t sweat much. His sleep is restless with frequent waking and crying, and the eczema is much more active each time he cuts a tooth. Otherwise, his general health is very good.
Or how about the case of a 17-year-old male. His eczema began at around the age of the previous patient—9 months old. It was mild at first, but by 2 years old had spread to involve most of his body and face. He used the typical steroids and topical medicines prescribed by his dermatologist, and by age 6 the eczema had settled down (this is not uncommon; 50% of children grow out of it). At age 12, however, his skin deteriorated again so that he had to use a very potent steroid regularly to keep his skin in check.
Over the past 6 months, in an attempt to improve his health, he’s avoided the use of steroids and has changed his diet significantly—no dairy, wheat, refined carbohydrates or sugars. A valiant effort but one that unfortunately has produced limited benefit. (Diet can certainly make a big difference in eczematous conditions, but in most cases diet alone is not enough.) His itching is severe, especially in the evenings and at night. His sleep is always disturbed and he wakes feeling exhausted. He’s prone to feel very hot all day and night, but rarely sweats.
Or this last one, a female, age 41. She’s had atopic eczema since childhood, and also suffers with asthma and allergic rhinitis. Her skin has been very active for the past 2.5 years, following a period of much stress and frustration in her life. It’s erupted more fully around her underarms and genitals, and the eczema of the genitals is prone to weep. Her sleep is very disturbed by the itching. Her appetite is poor, and she suffers with much bloating that starts with any food intake and persists all day long. She tends to be constipated with incomplete evacuation of her bowels only every 3-4 days. Her mood is a combination of worried, anxious, frustrated, and irritable, with a tendency toward depression. She’s exhausted and has no stamina.
All of these cases are atopic eczema cases. They have some symptoms in common, but they each have their own individual particularities, and this is where Chinese medicine truly thrives: in recognizing the individual presentation of any particular disease or complaint, and treating accordingly.
As I mentioned at the close of my last article, skin disease is notoriously difficult to treat—this is true in Western as well as Chinese medicine, and eczema is no exception. Changes don’t happen overnight. That said, most patients see improvement where before they’d found none, and many patients see very significant improvement or complete resolution of their skin problems. For those of you suffering from lesions on the most public part of your body—your skin—please consider Chinese medicine. It may offer you some hope where other methods have failed.
Alexa Gilmore is a board-certified acupuncturist and Chinese herbalist practicing Chinese Medicine at ATX Acupuncture in Portland, Maine. She takes a no-nonsense approach to the healing arts and expects positive outcomes. In addition to providing high quality treatments, she works in partnership with her patients, empowering them to make lasting changes in their health profile by implementing simple, effective principles of Chinese Medicine into their daily lives. Learn more about Alexa and ATX Acupuncture at www.atxacu.com