TCM for Childhood EczemaAdina Stanescu, R.TCMP February 1, 2006
Good Results with Dietary Adjustments and Customized Formulas of Chinese Herbs
Atopic Dermatitis (AD) is the most common form of childhood eczema, and is on the increase everywhere in the industrialized world. It manifests with red, itchy, flaky or weepy skin, and possible secondary infection. While it is not life threatening, it can profoundly affect well being and quality of life and persist for years to a lifetime. Atopic broadly means allergic, and AD sufferers may also be affected by an allergic “package” of hay fever, asthma or anaphylactic nut reactions.
According to current estimates, between 15-20% of infants will develop this condition, most between two and six months of age. This represents a five fold increase over the last 30 years.
There are many known triggers of AD. Allergies to pets, moulds, dust, wool, cosmetic chemicals and food dyes are common. Vaccinations are a known trigger in many cases, while interestingly, studies have found a protective effect from measles and other childhood infections which appear to train and regulate the immune system.
Food allergies are very strongly implicated, with 1/3 to 1/2 of babies affected. The most common food allergens are milk, wheat, soy, peanuts, eggs and shellfish. The proteins in these foods are highly allergenic, especially in the context of a baby’s immature digestive system. Allergy testing has revealed that babies are most susceptible to these foods before age two, and delaying or avoiding exposure to them may go a long way toward preventing or lessening AD, especially in families with a genetic component. Indeed, TCM does not consider a child’s digestive system to fully mature until age five, and advises careful feeding with easily digestible foods until that time, as well as exclusive breast feeding in infancy.
Finally, there is a strong genetic component. A child has a 60% chance of getting AD if one parent has it, and 80% if both do. Environmental factors are strongly suggested by the high incidence in the industrialized world, as well as by the fact that people who move here from less affected countries soon begin to show similar levels of occurrence. It is reasonable to imagine that the plethora of chemicals we are exposed to from conception may eventually make the immune system hyper-reactive.
ECZEMA FROM THE TCM PERSPECTIVE
Traditional Chinese Medicine (TCM) offers the strong likelihood of a cure for this condition. Its effectiveness has in fact been confirmed by two scientific studies published in the prestigious Lancet in 1992, and eMedicine’s AD section states: “Chinese herbal teas have been shown to be efficacious in inducing remission in some children and patients with recalcitrant disease. Because these teas can contain up to 10 different herbs, which have various anti-inflammatory, antihistaminic, or immunosuppressant activities, these effects have not yet been specifically linked to any one ingredient.”The last part of this quotation, from Dr. Caroline Spagnola, explains why, despite promising studies, dermatologists do not actually prescribe Chinese herbs to their patients. Modern medicine continues to insist there must be one “active ingredient” to account for TCM’s effectiveness, and one which might be developed into a drug. However, as this article will illustrate, it is only the combination of herbs and their hundreds of constituents that can do the job.
Let’s put to rest the common misconception that Chinese herbs will not be taken by babies or children because of their foul taste. Nothing could be further from the truth. Our experience at the TCM Skin Clinic has shown that the single biggest factor which determines the child’s compliance and ability to take the medicine is the parents’ intention and determination to administer it. It is remarkable how quickly and decisively children pick up on Mom or Dad’s determination, or conversely, their doubt and defeatism, as the case may be. Some parents have declared loudly in front of their child, “my daughter will never take this stuff!” Indeed.
Babies do not yet have what I call “prejudiced” taste buds and are actually the easiest patient group to treat, both in their taste tolerance to the herbs as well as their responsiveness to treatment. The herbal liquid is given via droppers, baby bottles or syringes without much trouble. Older children can be coaxed, reasoned with, asked to participate in the preparation, or taught about the herbs in order to facilitate their interest and cooperation. I have asked children to help me weigh and package their herbs in clinic, where they invariably become fascinated by the colours and textures of the plants. Afterward I give them a slice of dried licorice root to clinch the deal. In worst case scenarios a favourite activity like TV can be withheld until the medicine is taken.
As always with TCM, treatment is tailored to the specific visual characteristics of each case. Babies tend to have a wetter, crustier eczema which requires herbs that treat Damp Heat, meaning that they dry up the weeping liquid, treat any secondary infection and subdue the inflammation. Any associated symptoms like constipation, poor digestion or a confirmed food allergy trigger are treated concurrently. It is because there are so many elements to address in this condition, that the medicine needs to include several herbs, generally 10 to 15.
Dosages for babies and children are calculated in proportion to their weight. No toxic ingredients are ever used, and side effects are generally limited to a somewhat looser stool.
If the AD is untreated and progresses through childhood, it tends to turn into a drier, thickened presentation that lodges in the flexure creases of the arms, wrists and behind the knees. At this stage, it is a Blood Heat problem, and different herbs are used to cool, moisten and subdue itch. If there is concurrent sweating, irritability or hyperactivity, this is treated as well.
Many children naturally outgrow the eczema by puberty while some continue into adulthood when it is typically much harder to control. Because of this, and because it is impossible to know which children will outgrow it and which will not, it is always a good idea to try to cure it early. Children are generally very responsive to TCM treatment and the chances of success are high.
Steroid creams, and the immune suppressant Protopic and Elidel creams are the mainstay of Western medical treatment. (Unfortunately the last two have now been found to increase the risk of skin cancer and lymphoma and are subject to a Health Canada advisory). While there are no known interactions between Protopic, Elidel, steroid creams and Chinese herbs, the fact is that these suppressive treatments make it very difficult to see the eczema as it really is, and this is vital for composing the herbal formula. Similarily, it is not possible to assess the progress of the herbs and thus know if we are on the right track. However, any decision to discontinue steroids must be made by the parents in consultation with a doctor or dermatologist and the process done gradually, as sudden interruption can cause a severe flare.
THE ANTI-ALLERGY DIET
As mentioned, if there are confirmed food allergies, the diet of the child and nursing mother will need to be modified in order to decrease the burden on the immune system. Even without confirmed allergy, dairy products should not be consumed by those with weepy, Damp eczema as they may aggravate the condition. It is generally a good idea to consult a holistic nutritionist to establish a hypoallergenic diet. All food for the child and mother should be cooked from scratch without additives, food colours and preservatives, and preferably organic. Pregnant women who want to minimize the risk of their baby developing an atopic disease should follow the same protocols. In TCM it is also recommended to avoid too much fruit juice and refrigerated, raw foods as these may cool the digestive fire and predispose to more food reactivity. With atopic dermatitis, Chinese herbal therapy treats to cure, and with most patients this is a realistic aim. It may take several months to accomplish this, but once there, relapse is unlikely and treatment can be discontinued completely.