Dermatological Disorder

“Dermatology is a branch of medicine concerned with the diagnosis and treatment of skin disorder.” However, dermatology is not a study of intrinsic disorders of the skin, but must also internal medicine and the many environmental and occupational factors that so frequently causes skin problem. Therefore, due to various of factors should be concerned, in order to deal with dermatological issues of the patients, it is particularly difficult and long fight for both patients and practitioners.

Dermatology in TCM (Traditional Chinese medicine) & Acupuncture

TCM is an alternative method of therapy that can be administered in oral, topical, or injectable forms. It emphasizes the importance of using many herbs that are combined in different formulations for each individual patient. TCM utilizes classical yet unique diagnostic and differentiation method to analyzes patient’s current issues with both internal and external Perspectives
Acupuncture represents one of the most mainstream CAM (Complementary and alternative medicine) treatment modalities. There is evidence for its efficacy in both acute and chronic urticaria, with studies showing a 90% and 30–50% resolution of lesions compared with placebo, respectively. Moreover, recent studies show that acupuncture may help relieve pain associated with herpes zoster and post-herpetic neuralgia.

Most Common dermatological skin conditions in the clinic

Eczema and Atopic Dermatitis (AD)

Eczema is characterized by itchy polymorphc skin lesions of symmetrical distribution, repeated recurrence and the tendency to develop into a chronic condition. Eczema can be localized or can cover the entire body. It occurs regardless of the season of the year or age of the patient; patients congenitally susceptible to allergic reaction are most commonly affected.
Eczema and atopic dermatitis (AD) are recognized as major health problems worldwide. Prevalence estimates are as high as one-third of the population. Especially, Atopic dermatitis is a common condition affecting approximately 17% of the population, with a slight female preponderance (1.3:1 in children) and one of the most common skin disorders in young children, has a prevalence of 10% to 20% in the first decade of life. The incidence has increased twofold to threefold since the 1970s. A recent study found that the prevalence of eczema in adults could be as high as 10.2%, which suggests that most children with eczema/atopic dermatitis continue to be affected even in adulthood. For example in US, 3% of adults have moderate to severe eczema/atopic dermatitis requiring systemic therapy.

In Traditional Chinese Medicine, eczema is known by different names based on the location and particular characteristics of the rash. Eczema appearing over the entire body and characterized by an excessive amount of exudates is known as wet spreading sores (浸淫疮), or as millet sores (素疮). Eczema localized at the back of the knees and insides of the elbows it is known as four bend win (四弯风); localized to the ears is known as ear-circling sores (旋耳疮). Localized in the navel it is known as umbilical sores (脐疮); localized in the scrotum it is known as scrotal wind (阴囊風).

Psoriasis

Psoriasis is a common, chronic, relapsing, immune-mediated, inflammatory disorder with primary involvement of the skin and a strong genetic predisposition. Nearly three percent of the world’s population, men, women, and children, even newborn babies, endure the symptoms of psoriasis. Many tolerate constant pain from cracking and bleeding skin. They bear the humiliation of continually shedding scales that litter their clothes and surroundings. They struggle with the disappointment of treatments and the lack of a cure. Psoriasis is a chronic condition that most often requires lifelong treatment. And because there are so many different medications and treatment options, and no person is alike another, it may take some time before the right treatment or combination of treatments will work for an individual.

In Traditional Chinese Medicine, psoriasis is known as Ox-hide tinea (牛皮癬). It is named because the thick leathery skin of affected areas resembles the skin of an ox’s neck. It frequently manifests over the neck but can also affect the upper eyelids, sacral region, outsides of the arms and legs, perineum or the entire body.
Ox-hide tinea corresponds to neurodermatitis in modern medicine. It generally presents with periodic itching of the affected area during the early stages, later developing clusters of round or polygonal flattened papules that may take on a light brown color.
With continued development, papules spread to form large patches, the skin thickens, dries out and becomes crisscrossed by wrinkles, a condition known as lichenification. With scratching of the local area, there is some peeling of the dried skin with periodic bouts of extreme itching. The itching generally increases in severity with emotional stress. Ox-hide tinea is a very persistent condition and prone to recurrence.

Acne (Acne vulgaris)

Acne is a common pilosebaceous (pertaining to the hair follicles and sebaceous glands) disorder that occurs in about 85% of individuals 12–24 years of age and 15–35% of adults (especially women) in their 30s–40s. It has clinical presentations range from mild comedones to severe, explosive eruptions of suppurative nodules associated with systemic manifestations. Acne May result in scarring and psychosocial repercussions such as anxiety, depression,
and social withdrawal.

Non-inflammatory acne

– Closed comedones (whiteheads) are small (~1 mm), skin-colored papules without an obvious follicular opening
– Open comedones (blackheads) have a dilated follicular opening filled with a keratin plug, which has a black color due to oxidized lipids and melanin.

Inflammatory acne

– Erythematous papules and pustules
– Nodules and cysts filled with pus or serosanguinous fluid; may coalesce and form sinus tracts.
– Acne conglobata (severe nodulocystic acne) is classified in the follicular occlusion tetrad along with dissecting cellulitis of the scalp, hidradenitis suppurativa, and pilonidal cysts; it is also a part of pyogenic arthritis, pyoderma gangrenosum, and acne conglobata (PAPA) and pyoderma gangrenosum, acne, and suppurative hidradenitis (PASH) syndromes.

Pathogenesis of Acne

a. Early comedo
• Hyperkeratosis and corneocyte cohesiveness in the upper sebaceous follicle, which lead to microcomedo formation
• Androgen stimulation of sebum production

 

b. Later comedo
• Accumulation of shed keratin and sebum
• Formation of whorled lamellar concretions
• Comedo may be closed (no obvious follicular opening) or open (dilated follicular opening; keratin plug darkens due to oxidized lipids & melanin)

 

c. Inflammatory papule/pustule
• Propionibacterium acnes proliferation, which upregulates innate immune responses (e.g. via TLRs)
• Mild inflammation (primarily neutrophils), which increases upon rupture of the comedo wall
• Sebaceous lobule regression

 

d. Nodule/cyst
• Marked inflammation (primarily T cells)
• May lead to scarring

Acne patterns in TCM

Lung Meridian Wind Heat Pattern
The face tends to be red with red lesions which feel hot and may be painful and there may be pustules.

 

Intestine & stomach Damp Heat Pattern
Red lesions with nodular papules, especially located on the course of the yang ming, oily skin, strong appetite, easy hungering, bad breath, oral thirst with a desire for chilled drinks, dry, bound stools, short voidings of scanty, dark-colored urine

 

BLOOD STASIS PATTERN
Purple scars, enduring, recalcitrant disease, a dark, purple tongue and/or static spots or macules, possible menstrual irregularities in women, clots in the menstruate

 

HEAT TOXINS PATTERN
Pustules on a erythmatous base, larger, more inflamed, angrier lesions, pussy abscesses, possible pain, lesions also on the chest and upper back

 

SPLEEN VACUITY-PHLEGM DAMPNESS PATTERN
Deep cystic nodules under the skin, oily skin, possible profuse phlegm, possible loose stools

 

YIN VACUITY-FIRE EFFULGENCE PATTERN
Small, light red papules spread diffusely, often primarily over the forehead, a flushed red face, especially in the afternoon and early evening, dry skin, dry lips, a thin body, possible perimenstrual acne in females, a tendency to vexation and agitation, possible late menarche, scanty or delayed menstruation in females