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Acupuncture Today
November, 2003, Vol. 04, Issue 11
 
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Eczema - The Seven Year Itch?

By Mary Elizabeth Wakefield, LAc, Dipl. Ac., MS, MM

In our last column, we explored a unique synergy of Oriental medicine and feng shui, expressed in a system of facial feng shui called Bagua Beauty. This innovative modality combines sound - specifically, tuning forks - placed on acupuncture points, plus the vibrational energy of gem stones and essential oil blends to address signs and symptoms of imbalance determined in a process of facial "mapping" using the bagua.

This month, as we begin our annual migration from the warmth and moisture of summer to the dryness of autumn and eventually to the coolness of winter, it seems appropriate to examine herbal medicines, particularly as they are applied to a chronic skin ailment experienced by all age groups.

Eczema (Atopic Dermatitis)

Childhood Eczema

This condition tends to be hereditary, and can be seen in families with a history of hay fever, asthma and allergies. It manifests as a localized, raised, itching rash with swelling, which later develops blisters that can ooze and crust. It usually begins on the face, elbows and knees, then spreads.

Characteristics:

  • It is a chronic, fluctuating disease that usually manifests before age 1.
  • Itching is the primary symptom.
  • Three percent to five percent of infants suffer from eczema. It is more commonly found in males.
  • In babies, it tends to manifest initially on the face and the scalp, before spreading out to other parts of the body in symmetrical lesions.
  • These lesions "weep" easily and itch intensely, with secondary symptoms of skin crusting and erosion.
  • Babies with eczema usually have inherited the "atopic triad": hay fever, asthma and allergies.
  • Factors such as teething; bacterial infections; emotional stress; exogenous pathogens; diet; and recent immunizations affect the severity of the outbreaks.

Adult Eczema

  • Adult eczema is similar to that manifested in childhood, but with an increase of lichenification (thickening and hardening of the skin from continual irritation).
  • The skin areas that are particularly impacted include the knuckles; the dorsum of the hands; elbows; knees; ankles; wrists; neck; and chest. The face can also be involved. · More diffuse erythema and scaling of the skin can be seen.

Other Disorders Associated with Eczema

  • asthma/allergic rhinitis;
  • anaphylactic reactions;
  • food allergies and intolerances;
  • urticaria - allergic reactions;
  • bacterial and viral infections;
  • alopecia areata;
  • retarded growth (long-term steroid therapy);
  • issues involving the eyes (cataracts, photophobia, conjunctivitis);
  • low anterior hairline;
  • absence of the lateral aspect of the eyebrows;
  • Dennie's line: an accentuated line below the margin of the lower eyelid; and
  • periobital darkening.

History

  • Seventy-five percent of cases occur prior to 6 months of age.
  • Fifty percent grow out of it after the completion of puberty.
  • There can be a spontaneous improvement during childhood; at the same time, sudden relapses may occur with the onset of puberty (perhaps due to the increase in hormonal activity).

More Chronic Cases

  • These tend to occur with late onset of the condition (usually after 1 year of age).
  • There is usually a genetic history present in both sides of the family.
  • Customarily, the patient has asthma or allergic rhinitis.
  • Periorbital darkening and Dennie's line are common symptoms.
  • More chronic instances tend to be associated with severe eczema during infancy and childhood.
  • The onset of puberty does not diminish symptoms; rather, it continues during adolescence.

According to the National Eczema Association, people with eczema can suffer from:

  • dry, easily irritated skin;
  • hand dermatitis (occupationally);
  • skin infection (staphylococcus and herpes);
  • eye problems (cataracts and eyelid dermatitis); and
  • family and relationship-associated psychological disruptions.

Triggers of Eczema

  • cold weather;
  • dry winter house heat;
  • intense heat;
  • raw winter weather;
  • emotional and psychological stress;
  • wool clothing;
  • detergents, perfumes or dyes;
  • perspiration;
  • pollen;
  • irritants, such as food additives;
  • dry skin; and
  • food allergies: sweets, alcohol, corn, chocolate, tomatoes and other nightshades, beans, dairy, wheat (gluten products) shellfish and soybeans.

Dietary and Supplemental Suggestions

  • Use stress reduction techniques.
  • Avoid triggers of eczema by identifying food sensitivities and allergies.
  • Clear the digestive system. Consume foods rich in essential fatty acids such as wild salmon, mackerel, anchovies and herring. Fish oil supplements have anti-inflammatory properties.

Supplements: essential fatty acids (omega 3 and 6); vitamins E and A (to moisturize the skin); vitamin B and quercetin (a flavonoid which prevents skin rashes); zinc; black currant oil; cod liver oil; bioflavonoids.

According to Eric Lewis in Essential Fatty Acids, people with eczema have an essential fatty acid deficiency. Use evening primrose oil (500 mg per day) and omega 3 and 6 fatty acids (3 to 4 grams per day) to plump up cellular membranes, repair old cells and construct new cells. (EFAs also help with psoriasis, dandruff, hair loss and dry nails.)

Western Treatments

  • corticosteroid creams, which do help itching, but have long-term side effects;
  • oral antihistamines;
  • ultraviolet light or sunlamps; and
  • immune modulators (now being studied).

TCM Treatments

In general, the following herbs can be used not only internally, but also as topical poultices:

  • Bai zhu (rhizoma atractylodis), white atractylodes: tonifies qi and dries dampness
  • Huang bai (cortex phellodendri), cork tree bark: eliminates heat and dampness, and sedates fire, good for sores and damp lesions of the skin. Both bai zhu and huang bai work together by clearing heat externally; the excess is released from the skin
  • Ku shen (radix saphorae flavescentis), saphora root: helps stop chronic itching, clears heat and damp toxic skin lesions
  • Long dan cao (radix gentianae longdancao), gentian root: also drains damp heat

Note: Do not confuse thin and itchy skin (often called "parchment skin") in elderly patients with atopic dermatitis or eczema. It is usually due to blood deficiency with wind, Kidney (jing) deficiency and calcium loss, which affects the bones.

When treating elderly patients, it is recommended that you tonify the Kidney and use a combination of dang gui (radix angelicae sinensis) and gui zhi (ramulus cinnamomi cassiae) to warm and facilitate blood flow to the skin. This herbal duo opens the luo vessels, distributes the blood, stops itching, and can be used both internally and externally. Ensure that the poultice is not too hot, or you run the risk of possibly burning the skin. Elderly patients suffer from a loss of the skin's fatty layer and may also be desensitized to temperature due to stroke, etc.

Sample Case: Heat in the Blood with Wind

Signs and symptoms: extreme thirst; restlessness, especially agitated at night, with an absence of sweat; severe itching, particularly at night.

  • dry red macular and papular lesions with bloody scabs
  • scaly scalp and skin with silvery sheen
  • little or no exudation

Tongue: red, dry body, with possible red dots on the tip and the sides

Pulse: rapid and wiry

Etiology: heat and dampness in the Liver. This chronic presentation of damp, heat and wind generates dryness and deficiency of blood and yin.

Herbal Recommendations

The following standard blood cooling herbs are recommended:

  • Sheng di huang (radix rehmanniae glutinosae), Chinese foxglove root: nourishes the yin, calms irritability and addresses insomnia and upward blazing of Heart fire
  • Chi shao (radix paeoniae rubrae), red peony root: clears heat at the blood level, helps skin blotches due to Liver fire
  • Mu dan pi (cortex mouton radicis), cortex of the peony tree root: clears blood heat, drains pus and reduces swelling. Use this herb both internally and externally for firm, non-draining sores, and for stagnant heat in the face. This herb has a wonderful relationship to the skin and the complexion.

Three herbs particularly effective in scattering wind are:

  • Fang feng (radix ledebouriella divaricata), ledebourilla root: this herb not only expels wind damp, but has analgesic and antimicrobial properties
  • Chan tui (periostracum cicadae), cicada moulting: clears heat and wind, vents rashes, also has antihistamine properties; additionally prevents itching
  • Jing jie (herba seu flos schizonepetae), schizonepetae stem or bud: vents rashes and alleviates itching (add at the end)

Other recommended herbs include:

  • Shi gao (gypsum), which also clears heat and drains fire, and is especially effective for eczema and ulcerated sores. It can be applied topically in powdered form after being calcined and mixed with other herbs. It also may be taken internally.
  • Ze xie (rhizoma alismatis orientalis), alisma: drains damp, clears heat, and supports Kidney yin.

You can also add:

  • Bai xian pi (cortex dictamni dasycarpi radicis), dictamnus root bark: expels wind, dries damp and clears heat; has a particularly strong effect on yellow rashes with pus
  • Gan cao (radix glycyrrhizae uralensis), licorice root: can be used raw for sores caused by fire toxins. May also be used either topically or internally.

Please bear in mind that these herbal suggestions are offered as just that - suggestions; the specific combinations of herbs and dosages depend on your patients' individual presentations and are mediated by your professional judgment.

Herbal Recipes for the Treatment of Eczema

Ocean Potion: for weeping and crusting sores caused by eczema, insect bites, poison ivy or any kind of dryness

Ingredients: 1 cup sea salt; 5 drops carrot seed essential oil; 5 drops calendula essential oil; 5 drops lavender oil; and almond oil to cover mixture. Add salt to wide-mouthed jar; add essential oils and almond oil to cover. Store by your bathtub and use a scoop when bathing. Do not bathe more than 20 minutes, so as not to dehydrate. Moisturize and relax.

Eczema Moisturizer: You must keep moisture in! Use vegetable shortening or non-petroleum jelly with: 2 drops lavender essential oil; 2 drops calendula essential oil; and 2 drops German chamomile or carrot seed essential oil. You can massage the entire body or use as a spot treatment.

Another Moisturizer for All Types of Irritated Skin

Add 1 cup finely ground oatmeal to tepid bath
2 cups licorice tea (relieves itching)

Prevention for Eczema

Moisturize with infused calendula oil ("eczema eater"); good for eczema, psoriasis and rashes. Use as massage and bath oil.

Ingredients: 2 cups dried calendula flowers; 1 quart extra virgin olive oil; 1 tablespoon vitamin E oil. Slow cook olive oil (on very low heat). Add flowers, stir and leave 12-14 hours over very low heat. Stir, if you can, every two hours. Pour through a strainer lined with panty hose; add vitamin E oil and store in refrigerator for six months.

"No More Itch" Eczema Oil

Ingredients: 10 drops German chamomile; 10 drops yarrow; 5 drops tagetes. Dilute in 2 tablespoons almond oil (or other cold-pressed vegetable oil). Add 30 drops jojoba oil and 10 drops evening primrose oil.

This is a fantastic recipe that can be applied to the patient's face with a Q-tip while you a giving a facial acupuncture treatment. Often the eczema will fade by the end of the session! Note: please test the patient for sensitivity to essential oils prior to any application.

Conclusion

It is important to educate your patients about self-management and assist them in the identification of their specific triggers, whether they be food sensitivities, allergens or situations involving high levels of stress. Institute a process of digestive cleansing, and recommend a diet high in essential fatty acids.

Bear in mind that eczema is a chronic condition, with cycles of ebb and flow, and is most likely rooted in the individual's genetic heritage. Prevention and lifestyle changes are paramount. Taking all of these factors into consideration, the good news is that a successful outcome can be achieved with appropriate treatment, provided the patient is willing to make a complete commitment to the process.

References

  1. Bensky D, Gamble A. Materia Medica. Eastland Press, Inc., 1993.
  2. al-Khafaki M (co-author). A Manual of Acupuncture. Eastland Press, Inc., 1998.
  3. Wakefield ME. Skynergy: Recipes from Chinese, Western and Folk Medicine. Chiakra Press, 2003.

Click here for previous articles by Mary Elizabeth Wakefield, LAc, Dipl. Ac., MS, MM.

 

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