Traditional Chinese Medicine—Skin Diseases of the HandsAdina Stanescu, R.TCMP May 1, 2013
Are you looking at your hands with disgust
You hate them now and hide them you must
But mama, there’s no shame in hands so worn
Because of all they’ve touched since you were born
(From Our Mama’s Hands by Marcella L. True)
Few things hurt as much as the broken skin of our hands! Second only to the face in their impact on our lives and self-esteem, skin conditions of the hands, with their blisters, fissures, pustules, and sometimes open wounds, can make daily tasks, and touch, a misery. For some, like the Mama in the poem, the skin disease is brought on by housework or other occupational exposure, while for others it seems to come out of the blue, without apparent rhyme or reason. Unfortunately, in all cases it is characterized by a stubborn persistence. Patients gaze on hands they barely recognize, with a certain awe and disbelief, as if to say – what sort of demon is in there, and how do I get it out?
The first step to a successful treatment is hope. Many sufferers have been told that there is no cure for their condition, and they must live with it. In fact, Traditional Chinese Medicine (TCM) would beg to differ. It has vast experience and an excellent track record in treating many skin conditions, and the hands are no exception. As always, we must treat from the inside, in order to correct the inner imbalances that have nurtured the disease. Here are some of the most common hand diseases encountered in my clinic:
This is a localized form of psoriasis, affecting the palms of the hands and sometimes soles of the feet. It is characterized by redness and yellow pustules which turn brown soon after forming. The skin may peel in yellow flakes, and the condition may or may not be itchy. There is a great spectrum of severity to this condition, ranging from mild to disabling. In severe cases, the skin is so red, tight, and brittle that opening the hand properly is nearly impossible.
TCM applies a sophisticated treatment method to this condition, using multi-ingredient herbal formulas that strike in three directions at once: strengthen the body’s qi to help it outwardly expel the toxin with astragalus root, which also has the ability to treat “non-healing sores”; attack the toxin directly with strong cooling herbs such as isatis root; and clear damp heat (inflammation, redness, yellow flaking) with bitter yellow herbs such as scutellaria root and gentiana. In this way, the condition is attacked from all sides while the body’s innate healing response is activated to take over the job. Localized pustular psoriasis of the hands generally responds very well to this approach, and an improvement can usually be seen within a couple of weeks of treatment, although total treatment time falls between four to six months.
Dry Hand Eczema
This eczema causes peeling on the palms and fissuring on the tips of the fingers and thumb. When severe, there can be great swaths of skin lifting off the hands (called exfoliative keratolysis, not a true eczema), and many rough and sandpapery snags on the fingers.
When encountering dryness in any skin disease, TCM asks a most important question: is the dryness due to deficient “dry” blood that cannot nourish the skin, or is it secondary to heat in the blood which scorches the fluids? Each answer will point to a completely different herbal approach: dry blood needs rich blood tonics such as angelica (dang gui), black sesame seeds, flax seeds, and other oily herbs; heat in the blood requires cooling substances such as moutan root, rehmannia, and scrophularia roots.
One way to tell these apart is through the colour of the skin and the colour of the tongue. If both are red, there is likely hot blood. If both are pale or normal, deficient dry blood is primary. In some cases, especially chronic cases that have persisted for years, both factors may appear and must be treated in the correct proportion. This is achieved by some trial and error with the prescriptions at the beginning of treatment. It is indeed fascinating to observe how reliably the skin answers these questions for us, as the wrong approach will quickly cause a worsening of symptoms. This feedback also validates the sophistication of Chinese herbal treatments, as we see unfold before our eyes exactly the effects that the herbs are supposed to have.
Fingertip and hand eczema can be a surprisingly stubborn entity and requires dedicated treatment for up to one year. While improvement can be seen quite quickly, it has a propensity to relapse and so maintaining the momentum of treatment is paramount.
Also known as tinea manuum, this is a fungal infection, the hand version of what we know as athlete’s foot. It is characterized by redness, peeling, dryness, mild itch, and, rarely, blisters. While not nearly as common as the foot presentation, it may well accompany it, or it may masquerade as psoriasis or eczema, with which it is often confused. A skin scraping culture will positively diagnose the presence of fungal organisms. Additionally, visual features will point us to the diagnosis: usually only one hand is affected, whereas psoriasis and eczema are symmetrical. There may be a raised, “leading” border, which represents the advance of the fungal organisms on the hand, and central clearing in the area they’ve left behind.
Conventional anti-fungal creams may well work to clear this up, and if so, then no herbal treatment is needed. Unfortunately, steroid creams are often mistakenly prescribed for fungus, and they will always make it worse, as they suppress the immune response and give the fungus free rein to march on.
If the fungal infection resists treatment with creams or recurs, herbs are a good option. This is a skin condition where topical treatment is essential, as it allows the herbs direct access to the offending invader. Fungal infection is more truly skin deep than eczema and psoriasis. Topical minerals such as alum and sulphur are used in various creams or washes, for their pronounced antifungal effects. If the condition has persisted for a long time, we will also use internal medicine to make the body less damp, and therefore less friendly to fungus and yeast. For this we use herbs such as sophora flavescentis root, poria mushroom, and diascorea hypoglauca.
Fungal infections are much easier to treat than other, more internal conditions and results are reliably obtained in nearly every case.
This infamous condition of the hands presents with a dynamic cycle of fluid-filled blisters alternating with cracks and fissures. It is often a stress eczema, or an adult development of childhood eczema. It may also be triggered by irritants such as excessive handwashing or by allergic contact dermatitis. Once again this eczema illustrates the wisdom of matching treatment to symptoms and causes as closely as possible, so that instead of having an “eczema formula,” we may prescribe a blister formula when there are blisters, and a fissure formula when there are fissures.
Fluid-filled blisters indicate the presence of damp heat in the liver and gall bladder, or, if digestion is poor, in the spleen and intestines. This damp heat stews and stagnates, and generates a secondary fire toxin. All of this must be cleansed out of the body via the urine and bowels, with the aid of bitters such as coptis root, phellodendron, gentian, dandelion leaves, and dictamnus.
On the other hand, when fissures appear, they are treated with the blood cooling herbs that we already met in the dry eczema section: rehmannia, moutan, and the specific fissure herb tribulus. As treatment progresses, the cycle of eruptions becomes slowly more muted – less often and less severe, until finally it disappears altogether.