Modern Medicine | Traditional Chinese Medicine <Explanation of Eczema>

Modern Medicine

Traditional Chinese Medicine

Eczema is a general term for various types of dermatitis, including atopic dermatitis, contact dermatitis, dyshidrotic eczema, and seborrheic dermatitis.

Disease Names 

In Traditional Chinese Medicine (TCM), eczema is classified under conditions such as "spreading sore" or "damp sore."

It may also be named according to the affected body part, for example:

• Sore behind the ears

• Sore on the lower legs

• Sore in the elbow or knee creases

• Sore in the scrotum

These localized names help TCM practitioners identify the disharmony pattern and tailor treatment accordingly.

Modern medicine attributes the causes of eczema to allergic predispositions, external physical or chemical irritants, and psychological factors.

Intrinsic causes: These are often related to an individual's constitution, including genetic factors. For instance, children whose parents have a history of eczema are more likely to develop the condition.

Extrinsic causes: These include exposure to allergens such as dust, wool, pollen, pet dander, and certain food proteins like eggs, seafood, dairy products, beef, and peanuts. Seasonal and weather-related factors such as excessive sweating in summer or dry skin in winter can also trigger eczema.

Causes

TCM views eczema as a condition triggered by both internal imbalances and external pathogenic invasions.

The internal factors may include:

Innate deficiency: A constitutionally weak body surface that is more vulnerable to attacks by wind, dampness, or heat pathogens.

Improper diet: Poor eating habits can impair spleen and stomach function, leading to internal damp-heat accumulation.

Secondary pathogenic conditions: These include dampness predominance, blood heat, blood stasis, wind pathogens, and spleen deficiency, all of which can contribute to the development or worsening of eczema.

However, disease staging of eczema is more important consideration for clinical diagnosis and treatment in TCM:

Early stage: At this stage, pathogenic factors such as wind, dampness, and heat accumulate in the skin. If not treated properly, these superficial pathogens may transform into internal damp-heat, intensifying skin irritation. Over time, this can evolve into toxic heat that affects the blood.

Middle Stage: Persistent skin irritation during this stage is often caused by turbid dampness, damp obstruction, or heat in the blood. These conditions may lead to blood stasis. A combination of wind, dampness, heat, and stasis can worsen the rash and make it more difficult to treat.

Late Stage: When eczema becomes chronic or recurs frequently, it is usually associated with internal deficiencies. These may include insufficient blood to nourish the skin, qi and yin deficiency, or blood deficiency accompanied by wind-dryness. These imbalances result in dry, itchy, thickened, and hardened skin lesions.

The types of Eczema include: 

Atopic Dermatitis

The most common type of eczema, often associated with an allergic predisposition and considered hereditary. Symptoms include itching, redness, cracked skin, and sometimes oozing of clear fluid. It typically begins in childhood, with severity varying by age.

Contact Dermatitis 

It is divided into two types: irritant contact dermatitis caused by exposure to irritative substances; allergic contact dermatitis triggered by allergens.

Dyshidrotic Eczema

The exact cause is unknown, but stress is a known contributing factor. It presents small, raised, grain-like blisters on the fingers, palms, toes, or soles. These blisters appear without inflammation and dry out into flaky skin.

Seborrheic Dermatitis

Caused by the overgrowth of the yeast Malassezia furfur, leading to rapid shedding of skin cells and inflammation. It is characterized by greasy, yellowish scales. In infants, it may cover the entire scalp and is commonly known as "cradle cap."

Pregnancy-Related Eczema

Hormonal changes during pregnancy can disrupt the immune system, leading to eczema. Physical stretching of the skin, especially on the abdomen, can further aggravate symptoms.

Types

In Traditional Chinese Medicine, the diagnosis of different types of dermatitis involves identifying underlying disharmony patterns, which are determined by the characteristics of the skin lesions and the patient's overall condition.

Damp-Heat Soaking Pattern

Severe itching with noticeable skin discharges, there are also red patches, a burning sensation, and densely clustered papules and vesicles.

Damp-Heat Damaging Yin Pattern

Intense itching with skin oozing and purulent scabs, accompanied by red papules. The condition tends to be persistent and difficult to heal.

Damp-Heat Obstruction Pattern

Thickened skin with darker lesion areas, presenting a lichenified appearance. The condition is chronic and resistant to treatment.

Spleen Deficiency with Excess Dampness Pattern

Itching sensation with skin erosion and exudation. Lesions appear as pale red patches with scabs, scales, papules, or vesicles.

Blood Deficiency with Wind-Dryness Pattern

Itching occurs intermittently and worsens at night. Skin lesions are dry, rough, thickened, and lichenified with dark red coloration and pigmentation.

Liver and Kidney Deficiency Pattern

Frequent episodes of skin itching aggravated at night. There are also pale red rashes, dry skin, scaling, and thickened (lichenification) in the affected areas.

Modern Medical Treatments for Eczema include:

Topical Corticosteroids

These are effective for reducing inflammation and itching in mild to moderate eczema. However, long-term use may lead to skin thinning. As an alternative, topical calcineurin inhibitors such as tacrolimus and pimecrolimus are often used, especially on sensitive areas like the face or skin folds, as they do not cause skin atrophy.

Antibiotics and Antifungals

These are prescribed when eczema is complicated by bacterial or fungal infections. It is essential to complete the full course of treatment to prevent recurrence or worsening of the condition.

Antihistamines

Commonly used to control itching in atopic dermatitis. Sedating antihistamines (e.g., diphenhydramine, hydroxyzine, cyproheptadine) are often more effective than non-sedating ones. Some patients may require long-term use, with gradual tapering as symptoms stabilize.

Topical Immunomodulators

A newer class of non-steroidal treatments for atopic dermatitis, including calcineurin inhibitors. These medications work gradually, typically showing improvement within two weeks. Initial side effects may include a mild burning or itching sensation, which usually subsides with continued use.

Oral Vitamin A (Retinoids)

Used for severe cases of contact dermatitis. Treatment usually lasts 3–4 months. Patients must avoid pregnancy during treatment and undergo regular monitoring of liver function and lipid levels due to potential side effects.

Treatment

Oral Herbal Treatment for Eczema

The herbal remedies are prescribed based on the specific disharmony patterns identified in each patient. To address both the root cause and the symptoms of eczema, the main therapeutic principles will aim at clearing heat, dispelling wind, and eliminating dampness; there may also be complemented by strengthening the spleen and harmonizing the stomach; activating blood circulation and resolving stasis; nourishing the blood and moisturizing the skin. This holistic approach aims to restore internal balance while relieving external symptoms.

Commonly used herbal formulas include:

• Cooling Blood and Dispelling Stasis Decoction (liang xue san yu tang)

• Eliminating Dampness and Harmonizing the Stomach Decoction (chu shi wei ling tang)

• Nourishing Yin and Eliminating Dampness Decoction (zi yin chu shi tang)

• Dispersing Wind Powder (xiao feng san)

• Three Marvels Powder (san miao san)

• Dioscorea Decoction to Separate the Clear (bi xie fen qing yin)

• Strengthening the Spleen, Eliminating Dampness, and Relieving Itching Decoction (jian pi chu shi zhi yang tang)

External Herbal Treatments

Herbal powder application: Herbs like natural indigo, golden thread rhizome, talc, and liquorice root are ground into powder and applied to affected areas.

Herbal decoction compress: Decoctions made from dictamnus root bark, sopora root, amur corktree bark, and belvedere fruit are used for wet compresses.

Herbal steaming & wash: Using herbal steam devices and selected herbs such as honeysuckle, belvedere fruit, sopora root, schizonepeta herb, amur corktree bark, and atractylodes rhizome to treat affected areas.

Herbal ointments: Well-known ointments such as Purple Cloud Ointment, Indigo Ointment, and golden thread rhizome Ointment) can be applied to control eczema and relieve itching.

Acupoint Therapies & Others: Methods like acupuncture, moxibustion, cupping, massage, catgut embedding, and auricular therapy can be flexibly applied for acute, subacute, or chronic eczema.