Atopic eczema can be both an acute or chronic relapsing inflammatory skin disorder that can severely affect the patient's quality of life. Most often this condition begins during infancy, however adult onset atopic eczema has become more common over the past 40 years. Currently 15% of children and 3% of adults are affected by this condition, and these growing numbers seem to be associated with the continued industrialization of our planet. The reactive immune response of those with atopic eczema leaves them predisposed to other allergic disorders such as asthma and/or rhinitis. Although environmental toxicity and allergens play a role in atopic eczema, there is also a strong genetic predisposition to developing this condition. Statistics show that approximately 60% of adults with atopic eczema have children with atopic eczema. This number increases to 80% when both parents suffer from atopic eczema. In the past 40 years there has been a steady rise in atopic eczema and also a significant increase in adult onset atopic eczema. This continual growth is making this disorder much more common, and unfortunately many people are unaware of treatment options outside of the standard steroid therapies.
ATOPIC ECZEMA AT DIFFERENT STAGES OF LIFE
Atopic eczema is a complex condition that can take on a wide array of presentations during different stages of the disease. During infancy, a child who is prone to atopic eczema will typically begin to manifest symptoms between 2-6 months of age. By 2 months of age babies have usually developed an itch reflex in which they are able to scratch at their own skin. The more an individual itches the skin, the more the condition becomes exacerbated. In fact, atopic eczema is often referred to as “the itch that rashes” due to the fact that this condition often begins with itching, before there is any visible rash on the skin. As the individual itches, the skin becomes more inflamed, and this leads to visible lesions and an aggravation of symptoms. In infants, the condition most often starts on the face and scalp before spreading to the extensor surfaces. Very often we see lesions that are swollen, red and weeping, which in Chinese medicine we attribute to the presence of damp heat and fire toxin.
During childhood the lesions tend to move to the four flexures of the elbow creases and back of the knees, wrists, ankles, neck and sometimes the eyelids. If the condition persists into adulthood, the face becomes affected more often and the areas of the four flexures become lichenified (thickened), which further compounds the itching problem. These are what many people think of as the more typical locations of atopic eczema. It is this classic distribution on the four flexures of the elbows and knees that gives rise to the Chinese name 'Wind of the Four Crooks' (sì wān fēng 四灣風).
DIFFERENT PRESENTATIONS REQUIRES DIFFERENT TREATMENT
Because there are so many different ways in which atopic eczema can present, a clinician must carefully examine the skin in order to determine what is causing the inflammation for each individual patient. From this information we are able to formulate a treatment that is unique and appropriate for each patient. You may ask yourself, what could be so unique about my skin lesions that distinguishes it from another person's eczema? For example, some lesions can be very wet and crusted in nature and may be prone to infections, while others can be very dry and fissured covering large areas of the body. In some cases the lesions are macular (flat) and red, whereas others may be raised papules or some combination of the two. The macular lesions can also be well defined along the circumference of the erythema (redness) where there is a clear border between the red skin and normal skin tone. In other cases, this border is not distinct and has a diffuse presentation where the erythema blends into the normal skin tone leaving no distinct border. Lesions with a distinct yellow crusting or sheen are often indicative of the presence of Staphylococcus aureus colonizing the skin at an aberrant level. This is very typical of atopic sufferers due to the dysbiosis on their skin that leaves their skin less apt to fight off infections on the skin surface. The toxins produced by the Staphylococcus aureus bacteria can trigger a strong immune response leading to rapid progression of the condition. This is often the cause of very sudden and dramatic worsening of the eczema.
As you can see, there are many different ways in which atopic eczema can appear on different individuals. Beyond the initial appearance of the lesions, the activity level of lesions is also an element that must be considered in Chinese medicine. When assessing activity level we are looking to see if the skin lesions are staying mostly the same over time, or if they are rapidly changing. In Chinese medicine, when we see new lesions that are rapidly evolving and have pronounced localized erythema (redness) then the presence of fire toxin is evident and must be addressed as well. In other instances the lesions may have been long standing and static with very little erythema but mostly presenting with dryness. In these cases, a very different treatment approach must be applied which includes gently nourishing yin and blood. This later form of eczema is much less common but is something that is sometimes encountered. As you can see from the brief descriptions given here, there is a lot of variation in the way in which atopic eczema can present on the skin. Chinese medicine uses this information to classify the pathology that is occurring in each unique case of atopic eczema so that an appropriate and individualized treatment can be utilized.
When we talk about an individualized treatment approach in Chinese medicine, we are referring to the unique way in which each patient's presenting signs and symptoms are accounted for in the treatment. For example, when we see atopic eczema that is swollen, red and weeping we will apply a treatment that will in essence dry this damp presentation and remove the presenting heat. There are always going to be varying degrees of dampness and heat in any particular case and so close attention to detail in assessing the patient is necessary to achieve optimal results. In some cases, there will be dry, red, papular and macular (flat) lesions on the skin that are intensely itchy. These cases may not require a treatment that addresses the damp component, but solely one that addresses what is referred to as Blood Heat with wind. Then there are cases that have a mixture of both of the aforementioned presentations. In these cases, striking a balance between the damp and dry aspects of the condition is the key to success. When dealing with these cases, there can sometimes be a slight aggravation that occurs on the skin while implementing a treatment approach that addresses one aspect of the condition more strongly than the other. For example, while addressing the damp and heat aspect of the skin, an aggravation on areas of the body that may be presenting with a blood heat pattern may occur. However, once the damp and heat affected areas begin to recede, a shift in the treatment approach is warranted to begin clearing the blood heat presenting areas so that the condition can be put into remission. It is these gradual shifts in the herbal formula as the presenting condition changes and improves that allow us to achieve optimal results and a stabilization of the condition.
CHINESE MEDICINE’S LONG-TERM APPROACH TO SKIN CARE
In addition to treating the atopic eczema during the time that it is flared up (the acute phase), Chinese medicine is also used once the lesions have resolved in order to help the patient maintain long-term resolution of their condition. We call this phase of the treatment the consolidation phase. Often times the herbs utilized to achieve this stabilization are not used during the acute inflammatory stage due to the fact that they can aggravate the inflammation at these stages. However, once out of this inflammatory state, a positive therapeutic effect can be achieved from their use. So the proper use of different herbs at the appropriate time during treatment is necessary for the success of the treatment both in the short term and over time. The stabilization process that occurs through the Chinese herbal treatment is something that I observe over and over in practice. For all my patients this is a big relief as most have been struggling to control their skin for years with topical steroids, which when removed only triggered a rebound flare of their eczema. For them to find this natural solution to their chronic condition brings back a sense of control into their lives.
With the continued industrialization of our society and the rising environmental irritants that come with it, we will only continue to see an increase in atopic eczema and other atopic disorders. It is imperative that there be a safe and effective therapy that can be provided to these individuals that doesn't come with the deleterious side effects of steroid therapies, which only temporary provide symptomatic relief. Chinese medicine is able to provide this safe and effective alternative to steroid therapies that is unfortunately the first line of treatment for most people. Over the years there has been more interest surrounding the therapies employed in Chinese medicine treatments of atopic eczema. The results speak for themselves and this is catching wind. Medical journals have published numerous clinical studies that illustrate the efficacy of Chinese medicine in the treatment of this condition. With this increase in exposure comes an increase in awareness by the public regarding alternative treatment approaches that are available to them. It is only a matter of time before this treatment approach becomes a mainstream method of addressing atopic eczema. For other dermatology related articles, please visit my blog.