Skin diseases and their treatments

Skin diseases and their treatments

Tissue structure of skinThe skin is considered as the largest organ of human beings, with a total area of about 20 square feet (1.86 m2). It contains two layers, each with its own important parts (Fig.1):

  1. Epidermis, the outermost layer of the skin, provides a waterproof barrier, prevents pathogens, regulates body temperature and creates our skin tone.
  2. Dermis, beneath the epidermis, contains sensory nerve endings, hair follicles, sweat glands, sebaceous glands, apocrine glands, lymphatic vessels and blood vessels. The latter provides nourishment and waste removal from its own cells as well as for the epidermis.

Beneath the dermis lies the hypodermis or subcutaneous tissue. It supports skin with nutrients, attaches skin to the underlying muscle and acts as a cushion for skin [[1],[2],[3]].

Any metabolic problems of above parts may result in a skin disease. The plenty of blood and nerve distribution causes the symptoms of redness, swollen, itching, flaking, etc.

 

AcneAcne (acne vulgaris, common acne) is a disease due to blockages in the follicles and sebaceous glands of skin, sometimes with infections. The excessive formation of keratin (a structural protein of skin) and sebum (skin oil), occurred with increased androgen (a sex hormone), may block the ducts of the follicular glands. If bacteria involve under this condition, it will result in inflammatory lesions (papules, infected pustules, or nodules) in the dermis around the acne. The imbalance of sex hormones during menstrual cycles, puberty and later ages contributes an important role in acne formation [[4]]. Stress and diets also affect the sex hormone, insulin, and lipid metabolisms [[5],[6],[7]], leading to the acne worsening [[8],[9]]. The interesting thing is the teenager of a few primitive isolated tribes living in Neolithic societies have no acne [[10]]. In Traditional Chinese Medicine (TCM) believes that acne was mostly related with heat, dampness, phlegm, blood stasis and imbalance of Chong channel and Ren channel from the perspective of TCM. The accumulation of phlegm and dampness was the major syndrome type [[11]].

RosaceaRosacea is a chronic, inflammatory skin condition that produces small, red, pus-filled bumps or pustules. The exact cause of acne rosacea is unclear, a variety of factors are likely to induce or aggravate the disease, including local vasomotor disorders, hair follicle insects and local recurrent infections, the use of spicy food, alcohol, hot and cold stimulation, mental stress, emotional excitement, endocrine dysfunction. In recent years, Helicobacter pylori infection and immune factors is concerned to the causes of rosacea [[12]]. From the TCM perspective, the blood stasis develops from pre-existing accumulated heat in the lungs and stomach or the disharmony of the Chong & Ren channels. If cold or wind-cold invades the face (from exposure to cold air or cold water), the skin’s exterior defenses become blocked and the cold settles in the skin preventing the ventilation of accumulated heat on the face. This combo causes local stasis of the blood and Qi. The patient’s tongue will be dull red or purple and may even have ecchymosis (dark purple spots) with a sticky yellow coating. The pulse will likely be choppy or wiry [[13]].

 

PsoriasisPsoriasis is a non-contagious, common, chronic and incurable skin disease that occurs when faulty signals in the immune system cause skin cells (keratinocytes) to regenerate too quickly – every three to four days instead of the usual 28-30 day cycle. These extra skin cells build up on the skin’s surface, forming red, flaky, scaly and inflamed lesions that can itch, crack, bleed and be extremely painful. These lesions can be very disfiguring, causes others to stare and discriminate against people with psoriasis. The disease generally affects joints, limbs, genitalia and scalp, but it can appear anywhere and even cover the whole body [[14],[15]]. In TMC, psoriasis is considered by the invasion of pathogenic wind which incubates in the yin and blood, or accumulation and stagnation of qi and blood caused by emotional upset. They were transformed into heat, and wind and heat struggle in the skin. Psoriasis may also be caused by impairment of the Liver and Kidneys, or by disharmony between the Chong and Ren channels, between the yin and the blood or between the yin and yang in the Zangfu [[16]].

 

Acute eczemaEczema (from Greek, meaning “to boil over”; often referred to as atopic dermatitis but the latter has its own defination) is a term for many different types of skin inflammation that is characterized by one or more of these symptoms: redness, skin edema (swelling), itching and dryness, crusting, flaking, blistering, cracking, oozing, or bleeding. The cause of eczema is unknown and may be complicated, involving environmental or genetic factors or their combination (Fig.5, [[17],[18],[19],[20]]).

Causes of eczema:

1. Allergen

2. Mechanical stimulation

3. Chemical stimulation

4. Microorganism infection

5. Skin dryness

6. Functional disorders of skin barrier

7. Immune reactions

8. Neuropsychiatric factors

9. Systemic reaction abnormality

10. Circulation disorders

Pompholyx11. Metabolic and genetic factors

According to Chinese medicine, eczema is caused by improper diet, emotional trauma and external evil invasion [[21]]. Damp and heat appear mostly in acute eczema. Blood deficiency and wind dryness appear mostly in chronic eczema [[22]].

 

Treatments on skin diseases

Due to the complicated pathological mechanisms on above skin diseases, there is no cure for them in Western medicine. Managements of them are usually the treatments available. Corticosteroids, such as triamcinolone (Kenacort),methylprednisolone (Medrol), prednisolone (Prelone) and dexamethasone(Decadron), can effectively reduce inflammation, itching and pain through a wide range of physiological processes, including stress response, immune response, and regulation of inflammation, carbohydrate metabolism, protein catabolism, blood electrolyte levels and behavior [[23],[24]]. However, they are not curative and attempt to increase more adverse effects if with long time oral or injection use, including Cushing’s syndrome, hypertension, osteoporosis, cataract, colitis, ulcer, hypogonadism, hypothyroidism, amenorrhoea, and retinopathy [24], which can mean that the “treatment” could be worse than the “disease” itself.

 

Western medicine sees each organ of the human body independently for their functions, while TCM believes the body as a whole, where each organ is related to each other. For example, lung can disperse and transport the wei-qi (defensive qi) and body fluid to the skin to warm, nourish and moisten the skin so as to maintain the normal functions of the skin [[25]]. In TCM, external pathological factors such as Wind, Dampness, Dryness, or Heat can invade the body and cause skin disorders. Internal imbalances are differentiated into patterns such as Blood Stasis, Disharmony of Liver and Kidney, or Blood Deficiency, and are often reflected on the skin. When skin problems are generated by internal imbalance, in addition to the topical skin care, the individual underlying problems must be addressed, in order to clear up the surface manifestation [[26]]. Therefore, the patients with skin diseases are usually prescribed with conventional formulas, such as Long Dan Xie Gan Tang for eczema, see Table below, with some modifications by syndrome differentiation of traditional Chinese Medicine.

Treatments of skin conditions with Chinese herbal medicines

Table: Chinese herbs on skin diseases

Skin condition Common Clinical patterns Composition
Acne
  • Heat accumulation in stomach and lungs
  • Heat accumulation in stomach
  • Blood-heat
  • Qi & blood stagnation
  • Blood stasis with phlegm
  1. Pi Pa Qing Fei Yin Jia Jian
  2. Tiao Wei Cheng Qi Tang
  3. Tao Hong Si Wu Tang He Liang Xue Wu Hua Tang Jia Jian
  4. Liang Xue Qing Fei Yin Jia Jian
  5. Hai Zao Yu Hu Tang Jia Jian
Eczema
  • Acute eczema
  • Sub acute eczema
  • Chronic eczema
There are many different patterns and manifestations of eczema. It’s important to talk to your practitioner about the history and onset of eczema.
Psoriasis
  • Plaque psoriasis
  • Guttate psoriasis
  • Flexural psoriasis
  • Pustular psoriasis
  • Erythrodermic psoriasis
  • Psoriatic arthritis
There are many different patterns and manifestations of psoriasis. It’s important to talk to your practitioner about the history and onset of psoriasis.
Rosacea
  • Heat accumulation in stomach and lungs
  • Blood-heat stasis
  • Blood stasis
  1. Pi Pa Qing Fei Yi Jia Jian
  2. Liang Xue Qing Fei Yin Jia Jian
  3. Tong Qiao Huo Xue Tang Jia Jian

 

 

References:

[1] Figure of Skin from Wikipedia: http://en.wikipedia.org/wiki/Skin

[2] Structure of skin: http://www.webmd.com/skin-problems-and-treatments/picture-of-the-skin

[3] Structure of skin: http://www.clinimed.co.uk/Wound-Care/Education/Wound-Essentials/Structure-and-Function-of-the-Skin.aspx

[4] Acne from Wikipedia: http://en.wikipedia.org/wiki/Acne_vulgaris

[5] J. P. ter Horst et al: Relevance of Stress and Female Sex Hormones for Emotion and Cognition. Cell Mol Neurobiol. 2012 July; 32(5): 725–735.

[6] María del Mar Romero et al: Effect of Sex and Prior Exposure to a Cafeteria Diet on the Distribution of Sex Hormones between Plasma and Blood Cells. PLoS One. 2012; 7(3): e34381.

[7] Lin Manting et al: The model of rat lipid metabolism disorder induced by chronic stress accompanying high-fat-diet. Lipids Health Dis. 2011; 10: 153.

[8] Noor Hasnani Ismail et al: High glycemic load diet, milk and ice cream consumption are related to acne vulgaris in Malaysian young adults: a case control study. BMC Dermatol. 2012; 12: 13.

[9] Behnaz Behnam et al: Psychological Impairments in the Patients with Acne. Indian J Dermatol. 2013 Jan-Feb; 58(1): 26–29.

[10] Neolithic societies: http://www.medicinenet.com/acne/article.htm

[11] Guo Lian et al: earch Comment on the Treatment of Acne by Traditional Chinese Medicine. rnal of Henan University of Chinese Medicine. http://lib.cqvip.com/qk/97416B/201206/42172821.html

[12] Rosacea from Baidu: http://baike.baidu.com/view/2859369.htm?fromId=64260

[13] Rosacea: http://zizaidermatology.wordpress.com/2011/05/25/rosacea-according-to-chinese-medicine/

[14] Psoriasis: http://www.medicalnewstoday.com/releases/15573.php

[15] Psoriasis from Wikipedia: http://en.wikipedia.org/wiki/Psoriasis

[16] Zhu Zhi Qiang: Psoriasis treatment by traditional chinese medicine. JOURNAL OF CHINESE MEDICINE NUMBER 55 SEPTEMBER 1997. http://www.jcm.co.uk/media/sample_articles/55-10.pdf

[17] Eczema from Wikipedia: http://en.wikipedia.org/wiki/Eczema

[18] Dyshidrotic eczema from Wikipidia: http://en.wikipedia.org/wiki/Dyshidrosis

[19] Ruiyao Yu and Lingzhan Kong: Diagnosis and treatment of dermatitis and eczema. Color atlas. People’s Militery Medical Press, 2006.7. ISBN 7-5091-0328-2

[20] Jingwen Xue, Qian Xue and Pei Xue: Guide to Dermatology Diagnosis and Therapeutics. Tianjin Science & Technology Translation & Publishing Corp. 2005.5, ISBN 7-5433-1868-7

[21] Eczema by TCM: http://www.med66.com/html/2005/1/he112675640171150025928.html

[22] Eczema by TCM from Baidu: http://baike.baidu.com/view/1001.htm

[23] http://www.behcets.com/site/pp.asp?c=bhJIJSOCJrH&b=260550

[24] Corticosteroids from Wikipedia: http://en.wikipedia.org/wiki/Corticosteroid

[25] Skin and lung: http://tcmdiscovery.com/BasicTheoryofTCM/info/20080923_361_2.html

[26] TCM on skin problems: http://www.tcmpage.com/hpdermatosis.html

 

Common childhood conditions part II of II

Common childhood conditions part II of II

In addition to the weakness of child immune defense to the microorganisms during the development, the whole body is facing the challenges in the interactions of material metabolism to the outside world.

 

Allergies

AllergiesThe medical term of allergy is defined as the Type I hypersensitivity disorder of the immune system [[i]]. The rapid inflammatory response of the Type I hypersensitivity involves a type of antibody called Immunoglobulin E (IgE) and certain white blood cells called mast cells and basophils. It can cause many diseases, such as asthma, allergic rhinitis, allergic otitis media, etc. [[ii],[iii]]  The lay term “Allergy” may include any discomfort or illness caused by the reactions of our immune system to foreign materials, which includes other types of hypersensitivity, such as rheumatoid arthritis (Type III), contact dermatitis (Type IV), etc. [[iv]]. The risk factors for allergy are from both sides of host (our body) and environment. Host factors include heredity, gender, race, and age. The environmental factors include microorganisms, environmental pollution and foods [1] (Fig. 1, [[v]]). Allergies in infants and children are common. Food allergies affect about 6% to 8% of children under age 5 [[vi]]. By age 6, 42% children have symptoms of upper respiratory allergies [[vii]]. If both parents have allergies, their (biological) child has a 75% chance of having allergies [[viii]]. The symptoms and signs of allergy include runny nose, nasal stuffiness, sneezing, nose rubbing, sniffling, Itchy, runny eyes, skin rashes, swollen, hives, fever, eczema, asthma, stomach pain, diarrhea, vomiting, headache, etc. [[ix], [x], [xi]]  The treatment of allergy includes finding/avoiding the allergens and releasing the symptoms by medications such as antihistamines, glucocorticoids, and anti-leukotrienes. In addition to avoiding the environmental factors, TCM pays more attention to the adjustment of the host. According to TCM theory, the appearance of an allergic reaction is the sign—the pathological change resulted from  the inside and outside pathogenic factors; while the system disability is the origin—the disorder of the internal environment stability and adaptability [[xii]]. An allergy is associated with the specific physical constitution. There are two allergic constitutions: heat and cold. The heat constitution is prone to an allergic reaction to increased temperature. TCM believes that “Heat can drive wind”. A “wind” is a kind of an allergic reaction, such as itchy skin when in heat. On the contrary, the person with cold constitution is easy to allergic to cold temperature. The outside cold is considered as a “cold evil”. When the cold evil invades the respiratory tract, the body’s Yang will expel the evil out. Sneezing and runny nose are the process of expelling the cold evil out. As long as the chill is out, the allergic reaction will stop [[xiii]]. Therefore, the TCM treatment strategy is scattering wind, clearing heat (for heat constitution) or expelling cold (for cold constitution), and drying wet. Here is an example of a formula for an allergy from the well-known doctor Chen Yu Zhu (祝谌予): Fang Feng (防风)、Chai Hu (柴胡)、Hu Mei (乌梅)、Wu Wei Zi (五味子),for allergy treatment with modifications. For the one with wind cold, add Gui Zhi (桂枝)、Ma Huang (麻黄)、Sheng Ma (升麻) and Jing Jie (荆芥);For the one with wind heat, add Ju Hua (菊花)、Chan Yi (蝉衣)、Yi Hua (银花) and Be He (薄荷);For the one with blood heat, add Dan Pi (丹皮)、Zi Cao (紫草)、Bai Mao Gen (白茅根);For the one with heat evil in the interior, add Lian Qiao (连翘)、Yin Hua (银花)、Gan Cao (甘草)、Pu Gong Ying (蒲公英)、Zi Hua Di Ding (紫花地丁) and Ban Lan Geng (板蓝根) [[xiv]]. In allergy treatment, it’s important to treat the Taiyin (Lung, Spleen) realm as the effective function of these two organs (according to TCM theory), the problem will be  treated at the at the root. This means, that during the active stage of the allergic reaction the formula can focus on the “wind-evil” (the branch) where as during the latent stage, Taiyin should be supported. There are many formuls to consider, some examples are: Yu Ping Feng San (玉屏风散), Gui Zhi Tang (桂枝汤), Li Zhong Wan (理中丸), Si Ni Tang (四逆汤).

 

Eczema in Children

EczemaEczema often refers to as atopic dermatitis. It also refers to as allergic skin disease in lay term. The eczema in Children most commonly presents before the age of 5. About 60% of patients will experience symptoms of atopic dermatitis by age 1 (Fig. 2, [[xv]], and another 30% will experience symptoms by age 5. It is a non-contagious inflammatory skin condition [[xvi]]. The cause of eczema is unknown but is presumed to be a combination of genetic and environmental factors [[xvii]]. Children born into families that have a history of allergic diseases such as asthma or hay fever are at an increased risk for eczema developing [16]. The main environmental factors to cause the eczema in children are the intake foods (especially cow’s milk, egg, wheat, fish, soy and peanuts), inhalation (especially house dust, mite and grass pollen), and direct contact (such as soap, bubble bath, sweat, saliva, clothes, metals and pets). Initially the children suffering from skin redness, rash, then rough skin and scaling.  The child’s skin feels like touching on sandpaper. The hot and wet environments or situations can make the eczema performance significantly [15,[xviii],[xix],[xx]]. The treatment of allergy includes removing the environmental factors, the use of ointments, lotions, steroid creams, oral antihistamines, steroids and antibiotics if involving infections. In TCM, the infant and toddler eczema refers to “milk tinea”. It is caused by endogenous damp toxin, exogenous wind evil and loss of spleen functions. Therefore, the appearance of an eczema often reflects the child’s dyspepsia [[xxi]]. In clinic, the infant and toddler eczema can be divided into two categories: (1) Damp-heat flourishing in the interior: flushing skin, red papules and vesicles, the outflow mucus on the broken blister and scabs after the dryness, red eye, red tongue, a tongue with thin yellow greasy coating, and slippery and rapid pulse. (2) Blood dryness and wind prevailing: dry and rough skin, itching, scratching white dander, dry stool, often accompanied by a thirsty throat, restless sleep, thin coating of tongue with less fluid, and thready and rapid pulse. The treatment for the first situation (damp-heat): clear away heat and promote diuresis, dispel wind and arrest itching by Xiao Feng San (消风散) with modifications. The treatment for the second situation (blood dryness): nourishing blood and Ying, dispelling wind and moistening dryness by Si Wu Tang (四物汤) and San Miao Wan (三妙丸) with modifications [[xxii]]. In addition, it was very effective for the eczema in children to scrub gently the affected area with the water boiling juice from Qing Li Cao (清沥草), 3 times a day for a few days. One of the main topical treatments for an active stage of eczema is Qing Dai Gao (青黛膏), Dian Dao San (颠倒散) or San Huang Xi Ji (三黄洗剂), depending on the exact presentation of the condition.

 

ADHD

ADHDAttention deficit hyperactive disorder, or ADHD, is a mental disorder that has been affecting more and more people throughout the world. It is diagnosed with inattentiveness, hyperactivity, and impulsiveness that go beyond what would be considered for a normal child (Fig. 3, [[xxiii]]). These symptoms must emerge before 12 years of age for a diagnosis to be made. Children diagnosed with ADHD have trouble focusing and sitting still for long periods of time, as well as acting impulsively upon their first thought without thinking things through. This will impact the child’s home, social, and, especially so, school life, as children with ADHD usually do poorly in school. Currently, the causes of ADHD remain an area of controversy – risks factors involve genetics, executive function, environment, diet and social. The pathophysiology of the ADHD brain may or may not be changed. Treatment, which is controversial, involves stimulant (Adderall) and non-stimulant (atomoxetine) medications, as well as psychotherapy ([xxiv], [xxv]). TCM believes that the imbalance of Yin and Yang is one of the basic pathological abnormal consciousness of ADHD. Its specific performance reflects in the disorders of visceral function, involving the four viscera of heart, liver, spleen and kidney. In clinic, ADHD is divided into three types: (1) Kidney-Yin deficiency and liver-Yang hyperactivity: Dysphoria with feverish sensation in the chest, palms and sole, or burning cheeks; less shiny on nails and hair; dry mouth and throat; night sweats; preferring cold diet; red tongue with less or no coating; thready and rapid pulse. (2) Qi deficiency of heart and spleen: Unwholesome complexion, thin body shape; dreaminess, a light sleeper; poor food intake, pale tongue with scalloped edges, thin and white coating; thready and weak pulse. (3) Accumulation of damp-heat inside, phlegm-fire disturbing heart: Restless, chest tightness and epigastric fullness and pain; bitter taste in mouth and anorexia; thirsty and desiring for drinking; abundant phlegm, yellow urine, dry stool; red tongue with yellow greasy coating; slippery and rapid pulse. The treatment strategies are (1) Nourishing the liver and kidney, nourishing Yin and Yang, calming the mind and promoting mentality; (2) nourishing Qi and invigorating the spleen, nourishing the heart and tranquilizing the mind; (3) clearing heat and purging fire, removing dampness and resolving phlegm [[xxvi]]. Some studies showed that the total effective rate on ADHD by TCM treatment reached 86%-94% for children’s IQ tests or academic records, although there is no significant difference between the herbs and western medicine (Ritalin), the TCM group had less side effects than the western medicine group [[xxvii],[xxviii]]. As many factors are to consider for ADHD, it’s vital to see a qualified Chinese medicine practitioner to determine an effective treatment approach for your child.

 

References:


[xxvi] ADHD diagnosis and treatment by TCM: http://baike.baidu.com/view/564071.htm