Eczema

Symptoms and Causes

Eczema develops because of an interaction between the person and the environment: someone has a genetic propensity for dry skin and an inflammatory response.  When this person has contact with a chemical, bacterial, or environmental irritant, it will trigger the development of eczema (1).

Eczema skin is dry, itchy and flaky. Scratching will intensify the redness, itchiness, and swelling, and may cause the skin to become oozy or weepy. Babies and young children are most likely to be affected by the skin on their cheeks, wrists and inner elbows. While the skin of the neck and inner elbows as well as the backside and knees is more common in older children and adults. Eczema is more common in childhood, but it often improves in adulthood and adolescence. In some cases, eczema may persist into adulthood.

There are many different types of eczema. Atoptic dermatitis is the most common type, characterized by dry itchy skin and may also be associated with allergies and asthma. 

The number of people with eczema is rising rapidly throughout the recent decades. No one knows the exact cause of the increase in eczema, but factors include irritants, harsh soaps, over-bathing, allergies, environmental pollutants, and diet.

While the exact cause is unknown, eczema skin has distinct characteristics: dry skin, increased IgE production, a tendency for the overgrowth of staphylococcus aureus, higher skin pH, and a deficiency in gamma-linolenic acid (GLA) (2). Correcting these imbalances can help improve the condition.

Eczema in Chinese Medicine

Traditional Chinese Medicine refers to eczema as the “wind of four crooks” referring to the eczema rashes on the inside of the elbows and knees which are the common locations of the condition (3)

Chinese medicine terms for eczema include Shi Zhen (damp eruption), wind-damp sore, as well as Jin Yin Chuang (wet spreading sore). Chinese medicine categorizes eczema based on the site of the lesions and the phase of eruption.

 An evaluation of the whole person is required to determine the underlying imbalance. This includes skin symptoms and appearance as well as digestion and sleeping patterns. For example, eczema with dry, cracked and reddened skin shows that heat and wind are likely dominant. Eczema with blistering, crusting, and weeping is often caused by damp heat. Poor appetite and pale skin are indicators of Qi deficiency.

Different imbalances will respond to different herbal formulations and acupuncture points. If the eczema is caused by damp heat, herbs which are bitter and cold that drain heat and dryness are used.  But if the eczema is caused by wind, dryness, and heat, herbs that clear heat and moisten the skin will be used. If the wrong herbs are used they will not work, and at times can make the condition worse. 

Treatment

We will use many therapies to address the underlying imbalances.  By removing the imbalances, the body can work to heal itself. Chinese medicine therapies will reduce inflammation and infection, as well as help stop itching to help you feel better.

Chinese medicine therapies can be used alongside Western medicine in order to reduce the use of medications or help come off of your medications.  They can also be used to reduce medication side effects.

This article is for educational purposes only and does not serve as medical advice. Please consult a Chinese Medicine Practitioner before taking Chinese herbal medicine.

Chinese medicine can bring about profound and lasting results.  This is thought to be due to the immuno-regulatory effect of Chinese herbs, acupuncture, and topical herbal medicines.  Rather than suppressing the immune function acupuncture and Chinese herbs help to bring it back into a healthy state. I like to say this is like hitting the reset switch on the body.

Chinese Herbal Medicine:

Chinese herbs are prescribed in a combination of 8-12 herbs called a formula. Each type of eczema requires the use of different herbs in order to address the root cause. For example, eczema from dry-heat requires herbs that are cold but not drying. If damp heat is present herbs that are cold and drying are effective.

Some herbs we may use include Ku shen which is well-known for its ability to reduce inflammation, itching, and the growth of Staphylococcus. It has also been shown to regulate the inflammatory process, making it less likely your immune system will react to an allergen.

Jing Jie and fang Feng (ledebouriella roots) are classic combinations to reduce itching caused by wind and heat. Another classic combination is honeysuckle ( jin yin hua) and forsynthia fruit (lian qiao). These herbs are well know for the anti-inflammatory, antibacterial, and anti-allergic properties.

When the eczema is of a damp heat nature, bitter cold herbs are used.  Huangqin (skullcap roots), huanglian (coptis Rhizome), and huangbai (phellodenron-bark) are known as the three yellows. These herbs make up the formula huanglian jie de tang (coptis formulation to reduce toxic effects), which has been shown to have anti-inflammatory and antibiotic effects. This formula is very bitter, and is used when the damp heat or toxicity is very strong.

Topical Herbal Medicine:

Topical herbal medicine is important to reduce inflammation, reduce itch, and moisten the skin. Herbs come as topical creams, oils, and balms. We will different creams based upon the qualities of your eczema and also the location. Balms and oils are used for the body and face. While herbal soaks can be effective if the eczema is on your hands or feet.

For infants and young children, herbal baths are the first-line treatment and often the only therapy that is needed. For this, the powdered herbs are dissolved in 5-6 cups of water and the child bathes in the herbs. This is followed by the use of an herbal or general moisturizer.

Acupuncture:

Acupuncture works to relieve itch and reduce the itchiness, redness, and swelling of eczema. It can also boost immunity, improve sleep, and reduce stress. Acupuncture can also be helpful in reducing the frequency and severity of flare-ups.

Research has shown that acupuncture decreases itching by altering the brain’s itch response. Acupuncture might also help reduce itching by decreasing the activation of basophils (a white blood cell that is involved in the inflammatory response in eczema).

Acupressure is the application of pressure and massage at acupuncture points. For children and infants, acupressure is a great option for helping to reduce itch and make the child more comfortable, because it can be done at home. A small study found that self-administration of acupressure at Qu Che (LI11) decreased itching. Massaging this point with oil after a bath as part of the daily routine helps to calm the individual and create a greater sense of peace.

To find the acupressure point, hold the arm slightly bent with the palm facing the body.  Qu Che (Large Intestine 11 or LI 11) is located on the top or thumb side of the elbow, right in the center.

Eczema can disrupt sleep. The great thing about acupuncture, regardless of the reason for the visit, is that it can help patients feel more relaxed and well-being. Acupuncture is also known to lower anxiety, improve sleep quality, and provide more energy.

The Skin Barrier

The skin barrier is a crucial part of your overall health. The skin barrier plays an important role in protecting the body from allergens, chemical injuries, and microbial pathogens.

The skin barrier is a complex network of proteins, lipids, and cells. It is made up of ceramides, cholesterols, and fatty acids. These ingredients help to bind your skin cells together. Atopic dermatitis is characterized by decreased levels of certain lipids that are essential for the formation of the functional skin barrier.  This lipid loss leads to increased skin permeability and may induce the release of proinflammatory cytokines. 

Atopic dermatitis causes a breakdown of the epidermal barrier, leading to increased permeability of the skin. It also allows increased penetration of allergens. 

Chinese medicine uses topical herbal oils, ointments, and baths to reduce inflammation and help restore the skin barrier.

Types of eczema

There are many types of eczema which we often treat with acupuncture and Chinese medicine. Below I have described many of the subcategories of eczema in terms of TCM. 

Atopic Eczema

Atopic eczema is a very common condition affecting up to 20% of people in developed nations. Unfortunately, atopic eczema numbers are on the rise. Atopic skin is also be sensitive to infection, stress, changes in the weather, particular foods, or irritant substances which may cause a flare in the condition (5). Atopic eczema is treated most often with topical steroids that suppress the inflammatory response. Unfortunately, steroids also have many side effects. Studies have shown that Chinese herbal medicine can reduce corticosteroid usage in children. (4)

Chinese medicine treats atopic eczema not by suppressing the immune response, but rather correcting the imbalances that are causing the eczema. By correcting these imbalances your body is able to heal on its own. Heat and dampness are the most common causes of eczema.

Pompholyx Eczema

Pompholyx eczema is a type of eczema of the hands and feet that causes vesicle eruptions, itching, and fissures which can be quite painful. Sometimes called dyshidrosis eczema because it is thought to be caused by sweating on the palms and feet. Pompholyx eczema generally cycles in periods of flare ups with vesicles and resolves with the formation of scales. Pompholyx eczema can be a very difficult condition because it affects your ability with common daily functioning.

The most common imbalances which cause pompholyx eczema are damp heat and toxins. The skin will reflect characteristics that provide information as to the nature of the imbalance. For example, redness in the skin and yellow crusting are signs of heat toxicity. While vesicles and swelling are a reflection of damp heat. The level of itching shows how intense the signs of dampness are.

Chinese medicine treatment for pompolyx eczema is very effective. It will consist of herbal teas, creams, and herbal soaks for the hands.

Stasis Eczema

Stasis Eczema occurs on the lower legs in some patients with poor circulation and swelling of the legs. After a number of attacks of inflammation the condition may become chronic and recurrent. In Chinese medicine, this is most often related to a lack of circulation of blood, called blood stagnation, and damp heat.

Nummular Eczema

Nummular eczema is a common type of eczema that affects primarily middle aged and elderly persons. It’s characterized by a coin shaped red and itchy eczematous lesion which often occur on the arms and legs. Small blisters called vesicles are common and it is easy to become infected. In Chinese medicine, Nummular eczema is most often related to damp heat and heat toxins.

Fingertip Eczema

Fingertip eczema may begin as an allergic reaction or it may develops from unknown causes. If often becomes chronic and very irritating as it impedes on daily activities. The skin of the fingertips can become very dry, cracked and scaly. Fingertip eczema can be treated with Chinese herbal balms, oils, and soaks are very successfully helping to avoid and reduce the use of topical steroids.

Lichen Simplex

Lichen simplex is a chronic eczematous like reaction caused by scratching. This can often be brought upon by a stressful situation in one’s life. Long term scratching of an area leads to thickening of the skin. The Chinese medicine treatment aims and reducing itch and calming the mind through acupuncture and herbs.

Clinical Research

A number of studies have shown that a Chinese herbal formula is effective in treating eczema. One double blind randomized crossover study treated 40 adults with chronic eczema with an herbal formula (in later studies, this formula is entitled Zemaphyte). This study concluded that the herbal formula was effective for reducing skin lesions, redness, itching, and helped the patients sleep better. This same formula later showed to have immune system regulatory effects.

1. Cork MJ, Danby SG, Vasilopoulos Y, et.al. Epidermal Barrier Dysfunction in Atopic Dermatitis Journal of Investigative Dermatology. (2009) 129, 1892–1908. Published online 4 June 2009.
2. Ruzicka T. Atopic eczema between rationality and irrationality. Arch Dermatol. 1998 Nov;134(11):1462-9.
3. Mazin Al-Khafaji. Atopic Eczema “Wind of the four crooks.” Journal of Chinese Medicine. Number 77: p5-8. February 2005.
4. Chen HY, Lin YH, Wu JC, et. al. Use of Traditional Chinese medicine reduces exposure to corticosteroid among atopic dermatitis children: a 1-year follow-up cohort study. J Ethnopharmacol. 2015 Jan 15;159:189-96.
5. PubMed Health. Atopic Eczema. Accessed 1/5/2015.