Eczema
Definition
Western
Eczema, or dermatitis [1], is a type of skin inflammations causing itchiness, redness, swelling and blisters. Itch is an integral part of eczema and occurs throughout every stage of the disease [1-5]. The most common form of eczema, called atopic dermatitis, can be seen amongst adults [1-5], and even infants. Any part of the body can be affected but common areas are in front of the elbows and ankles, behind the knees and around the neck [1]. Eczema is usually recurrent, and long term inflammations may lead to scabbing, scaling and skin discoloration. Uncontrollable scratching can trigger an itch-scratch cycle that worsens the condition [2, 5]. Scratching the affected areas can break the skin which may lead to bacterial infections [1-2].
Traditional Chinese Medicine (TCM)
Known as Shī Chuāng (湿疮) in traditional Chinese medicine, eczema is recorded in ancient texts for more than 2000 years ago [17]. It was clearly characterised by lesions, itchiness, oozing, with high recurrence rate and had the tendency to become chronic [17-18]. In TCM, an inherent factor that causes diseases is the body’s inability to withstand both external and internal pathogens [16]. One of internal pathogenic factors of eczema is the overconsumption of certain spices and seafood [15, 17-18]. Such foods are known to affect the body’s defences and trigger onsets of eczema. Classification of eczema is based on the duration of each onset, the appearance of the lesions and the location of affected areas [17-18].
Classifications & Symptoms Displayed in TCM Context
Acute Eczema
Initial symptoms is characterised by redness of the skin, blisters or bumps, moist lesions and intense itch that may last throughout the night [1, 15, 17-18]. The onset is usually sudden, and may be very severe such that large areas of the body are affected. Other symptoms include frustration, body feels warm from within, hard stools or constipation and dark pigmentation of the urine. Acute eczema, if not well controlled, may progress to subacute, or even chronic eczema [17-18].
Subacute Eczema
Usually progressed from acute eczema [1, 15, 17-18]. The affected area is slightly red and itchy. Instead of blisters or moist lesions, the affected areas are also dry, flaky or crusted. Oozing of the lesions may still occur when scratched. Such patients may be accompanied by poor appetite, diarrhoea, fatigue and may feel bloated easily [17-18].
Chronic Eczema
May last for a few months to even decades. It either progresses from acute and subacute eczema, or as a result of recurrent onsets of eczema [1, 15, 17-18]. Symptoms are characterised by thickening of the skin, rough and hardened skin surface [1, 15, 17-18]. The skin tone of affected areas is usually darker than the normal skin. Patients may also suffer from loss of appetite, dryness in the mouth, and feeling bloated [17-18].
Causes
Genetic Factors
Research has found that atopic eczema might be a genetically complex, familial disease with a strong maternal influence [1].
External Factors
Can be triggered or aggravated by irritants and allergens from the environment including pollen, house dust-mites, detergents, clothing, or even cosmetics and perfumes. Changes in temperature and humidity have also been found to cause outbreaks in some people [1-5].
Internal Factors
Psychological stress is another factor found to make eczema worse. Consumption of foods such as seafood or certain spices may also worsen the condition [1-5, 17-19].
Risk Factors
Family History
Those with family history of eczema or other allergic conditions such as asthma often develop this condition at least once in their lifetime [1-5].
Lifestyle
Unbalanced diets, irregular mealtimes, unhygienic environment, subtle changes in humidity or temperature, and stress can increase eczema outbreaks significantly [1-5, 17-19] in some individuals.
Treatments
Herbs commonly used in prescriptions:
1. Fáng Fēng – 防风
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English/ Common name
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Divaricate Saposhnikovia Root
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Latin species
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Saposhnikovia divaricata
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Park of plant used
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Roots
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Action/s
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Helps to relief itchiness [6, 20]. It also has anti-allergic and anti-inflammatory properties [7].
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Precaution/s
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This herb has warm properties and should be used with caution [20].
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2. Kŭ Shēn – 苦参
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English/ Common name
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Light Yellow Sophora Root
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Latin species
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Sophora flavescens
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Park of plant used
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Roots
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Action/s
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Effective in relieving and preventing itchiness [8, 20]. It is also found to inhibit allergic reactions [9].
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Precaution/s
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Not to be used with Black False Hellebore (Veratrum nigrum L.) 藜芦[20].
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3. Bái Xiān Pí – 白鲜皮
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English/ Common name
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Densefruit Pittany Root-bark
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Latin species
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Dictamnus dasycarpus
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Park of plant used
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Roots
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Action/s
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Found to have broad anti-microbial and anti-fungal activities [10]. Widely applied for various skin diseases [20]. Also found to contain anti-mutagenic properties [11].
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Precaution/s
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People with poor digestion are advised to use with caution [20].
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4. Bàn Biān Lián – 半边莲
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English/ Common name
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Chinese Lobelia
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Latin species
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Lobelia chinensis
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Park of plant used
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Dried grass
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Action/s
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Found to have anti-inflammatory, anti-viral and diuretic properties [12, 20].
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Precaution/s
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Those with poor body constitution should use with caution [20].
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5. Lóng Dán Căo – 龙胆草
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English/ Common name
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Japanese Gentiana
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Latin species
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Gentiana manshurica, G. scabra, G. triflora, G. rigescens
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Park of plant used
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Dried grass and rhizomes
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Action/s
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Found to have anti-fungal activities [13], and is well known for its mild properties in protecting the functions of the liver [14].
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Precaution/s
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People with weak digestive system are advised to use with caution [20].
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Home Remedies
Green Bean + Barley
a) Put all ingredients in a cooking pot and pour enough water to fill half the pot.
b) Bring to boil for 10 minutes.
c) Simmer for a further 30 minutes.
d) Add sugar or honey to taste.
e) Remove from heat. Serve warm.
References
1. P Kumar, M Clark. Kumar & Clark Clinical Medicine. 2007. pp1326-1331.
2. Dermatitis. The Merck Manuals: Home Edition. http://www.merck.com/mmhe/sec18/ch203/ch203c.html. Accessed August 28, 2010.
3. Atopic Dermatitis (Eczema). Mayo Clinic. http://www.mayoclinic.com/health/eczema/DS00986. Accessed August 28, 2010.
4. Eczema (Dermatitis). MedicineNet. http://www.medicinenet.com/eczema/article.htm. Accessed August 28, 2010.
5. Eczema (Atopic). NHS Choices. http://www.nhs.uk/Conditions/Eczema-(atopic)/Pages/Introduction.aspx. Accessed August 28, 2010.
6. K. Baba, Y. Tabata, M. Kozawa, Y. Kimura and S. Arichi. Studies on Chinese traditional medicine Fang-Feng (1). Structures and physiological activities of polyacetylene compounds from Saposhnikoviae Radix. Shoyakugaku Zasshi. 1987. 41. pp 189-194.
7. JH Wang. Pharmacognostical Studies of Chinese Drug Fang Feng. Ph D Thesis, Beijing Medical University, China. 1986
8. Yamaguchi-Miyamoto, T Kawasuji, Y Kuraishi and H Suzuki. Antipruritic effects of Sophora flavescens on acute and chronic itch-related responses in mice. Biological and Pharmaceutical Bulletin. 2003. 26. pp. 722-4.
9. MH Hong, JY Lee, H Jung, DH Jin, HY Go, JH Kim, BH Jang, YC Shin and SG Ko. Sophora flavescens Aiton inhibits the production of pro-inflammatory cytokines through inhibition of the NF-κB/I-κB signal pathway in human mast cell line (HMC-1). Toxicology In Vitro. 2009. 23. pp251–8.
10. JC Lei, JQ Yu, HD Yu, ZX Liao. Composition, cytotoxicity and antimicrobial activity of essential oil from Dictamnus dasycarpus. Food Chemistry. 2008. 107(3). pp1205-9.
11. F Uenobe, S Nakamura, M Miyazawa. Antimutagenic effect of resveratrol against Trp-P-1. Mutation Research/Fundamental and Molecular Mechanisms of Mutagenesis. 1997. 373(2). pp197-200.
12. YC Kuo, YC Lee, YL Leu, WJ Tsai, SC Chang. Efficacy of orally administered Lobeliachinensis extracts on herpes simplex virus type 1 infection in BALB/c mice. Antiviral Research. 2008. 80(2). pp206-212.
13. M Xu, CR Yang, YJ Zhang. Minor antifungal aromatic glycosides from the roots of Gentiana rigescens (Gentianaceae). Chinese Chemical Letters. 2009. 20(10). pp1215-7.
14. LH Lian, YL Wu, Y Wan, X Li, WX Xie, JX Nan. Anti-apoptotic activity of gentiopicroside in d-galactosamine/lipopolysaccharide-induced murine fulminant hepatic failure. Chemico-Biological Interactions. In Press, Corrected Proof. Available online 15 June 2010.
15. 张学军. 皮肤性病学. 人民卫生出版社. 2009. pp106-8.
16. 孙广仁. 中医基础理论.中国中医药出版社. 2002. pp246-250.
17. 李曰庆. 中医外科学. 中国中医药出版社. 2002. pp166-9.
18. 李元文, 张丰川. 皮肤性病手册. 人民卫生出版社. 2004. pp185-193.
19. 孙乾. 皮肤病的常识. 华视出版社. 1987. pp20-2.
20. 高学敏. 中药学. 中国中医药出版社. 2002. pp60-1, pp112-5, pp156-7.