Chinese Medicine: Treatments for Atopic Dermatitis

Atopic dermatitis, also known as atopic eczema or allergic dermatitis, is one of the most common skin diseases of modern, affluent societies. This eczema is often associated with other allergic conditions such as hay fever, nut and food allergies, and asthma. Severe atopic dermatitis is a stubborn variant which  deviates from the usual presentation and distribution of lesions. It is generally body-wide and aggressive, persists into adulthood, and fills the patient’s life with untold suffering.

East vs. West

Some western patients suffering from severe atopic dermatitis have found by-the-book Traditional Chinese Medicine (TCM) approaches insufficient or even aggravating. That’s because their complicated manifestations of eczema are still fairly rare in China.

I recently spent one month in the dermatology department of a TCM hospital in Guangzhou, a large, polluted, relatively affluent city in southern China. I expected that this modern city would produce the same types of eczema I see here, but this was not the case. I saw hundreds of patients during my stay, but I can count on one hand those whose eczema resembled the Canadian cases I see.

This was a fascinating lesson in the interaction between environment, lifestyle and illness. I believe Guangzhou’s pollution and modern lifestyle changes have not existed long enough to produce the same deep heat and toxins that we have accumulated here. Another plausible explanation is that Chinese patients, including children with skin problems, consult their herbalists right away and receive prompt treatment, so that their eczema does not have a chance to become quite as entrenched, complicated or longstanding.

Whatever the reasons for these differences, it has become clear to me that it’s up to western TCM practitioners to fine-tune treatments that work in our context. I returned home feeling profoundly grateful for the existence of one such fine-tuner: my longtime dermatology teacher, Mazin al Khafaji. Mazin has worked tirelessly for 25 years to formulate effective herbal treatments for all manner of skin diseases. His teachings, along with my own 10 years of experience treating eczema of all types, have provided me with the tools to tackle this difficult problem.

Symptoms

In its milder, textbook form, especially in children, atopic dermatitis tends to lodge in the bends and joints: the wrists, elbows, back of the knees and neck. These areas become diffusely red, dry, itchy and flaky. At this stage, the condition responds well to a straightforward treatment of cooling and wind-scattering herbs.

In severe cases, however, the inflammation proceeds to cover most of the body with mixed lesions: scattered red bumps, weepy crusty lesions, dry red patches, cracks and fissures, hives, bloody scratch marks, and thickened areas of extremely dry skin with deep creases. Whereas the classic form is confined to the inside of joints, the severe form covers the back and front of limbs and trunk, and also affects the face and scalp.

Severe atopic dermatitis presents with a bewildering array of seemingly contradictory symptoms: obvious dryness, manifested by the creases, cracks and toughness of the skin; and dampness, manifested by the tendency of fluid to seep out of the skin and form crusts. The face can look pale and red at the same time. At first glance the complexion is pale, but a closer look reveals a deep, patchy redness underneath. This is the raging heat of inflammation, which obstructs proper blood circulation to the skin, giving it a superficial and deceptive pallor.

Treatment

The TCM treatment of severe atopic dermatitis will take a long time, six to 12 months,  sometimes longer. Persistence and patience are paramount as the herbal treatment gradually unravels the knots of heat, dampness and toxins that have accumulated over decades, guides them out of the body, and then restores proper blood nourishment to the damaged skin.

Herbal formulas are taken internally, in the form of boiled herb teas, and the treatment proceeds in stages, as follows:

a) Clearing Damp-Heat and Deep Toxins – We begin by flushing away the accumulations of deep heat, dampness and toxins. We deploy a variety of strong, often bitter, herbs that reach deeply into the blood, expelling damp toxins through the bowels and urine. Gentian root, scutellaria root, dictamnus bark, gardenia fruit, dandelion and common violet are good choices at this stage. They will help take care of the tendency of the skin to ooze, crust and form secondary bacterial infection.

b) Cooling – When the skin is no longer weepy, bitter herbs are replaced by sweet and cooling medicinals, which help cool and moisten the desiccated blood, and lighter anti-toxin herbs that help “float” the toxins out to the surface. Examples of some good cooling and anti-toxin herbs at this stage are rhemannia root, scrophularia root, lonicera flower, campsis flower and moutan bark.

c) Nourishing – This is a later stage of treatment which employs moistening, nourishing herbs to restore the blood to a rich luxuriance in order to repair the skin. Nourishing herbs must be introduced gradually and cautiously, because they tend to aggravate any residual and deep-lying inflammatory heat, exactly as oil thrown on a fire. Nonetheless, they are essential at the end of treatment in order to consolidate the effect of the first stages and restore resiliency to the long-suffering skin.

d) Supporting digestion – At all stages of treatment, attention is paid to the gastrointestinal function in order to prevent further generation of the dampness and mucus that are often the byproduct of poor digestion. Herbs such as coix seed, atractylodis root, orange peel and poria mushroom play a key role at this stage, protecting the stomach from the prolonged use of cleansing herbs. Dietary recommendations are limited to the avoidance of confirmed food allergens, red wine, spicy food and shellfish.

Outcomes

The patient reliably experiences a decrease in weeping and itching during the first month of treatment. From there, progress is slow and steady, with a gradual reduction in areas of redness and dryness. As the heat is cooled, the skin recovers some of its elasticity and natural moisture. The most tenacious cases are those that present with concurrent weeping and fissuring in equal measure, where the treatment must walk the fine line between these two paradoxical manifestations, as treating one will often aggravate the other. It is in these cases that the patient and TCM practitioner must persevere, as we navigate some turbulent middle stages of treatment. Perseverance does pay off in the end, since most cases of severe atopic dermatitis can be vastly improved, and a great proportion of these completely cured, with careful treatment.

Case Study

The patient was a gentleman in his early 40s with severe dermatitis from neck to toe. No area was spared, and his skin flamed with fire, itching, crusting and bumps. He responded within the first week of treatment with a very slight reduction in weeping and redness, especially on the upper body. The legs continued to rage, foreshadowing what would become our main battlefield.

After many weeks, his upper body was completely clear, but the legs continued to produce isolated patches of redness, itch and occasional weep. His digestive system was beginning to object to the use of so many bitter, cleansing herbs, so the strategy was changed to one of strengthening digestion and only mildly clearing heat. Herbal creams were also used at this stage. Progress was considerably slower at this point, but the patient was uncommonly dedicated. Over what became an eight-to-nine-month course of treatment, he did not miss a single dose of the boiled decoction.

Very slowly, we nudged the remaining 20% of eczema out of his skin, and continued treatment a while longer to consolidate the result. At the end of treatment, the dermatitis had completely cleared except for some residual dryness and brownish marks, which show that inflammation has passed and become inactive. These clear up by themselves in time.