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An Eczema Case Study: Treating Dermatitis

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Main complaint: A 25 years old male complains of eczema, which comes and goes particularly during stressful periods. The skin itches and patient has experienced eczema for 10 years.

History of present illness: Patient experiences itching in the elbow crease and behind the knees. The eczema is often symmetrical and occurs in both areas during stressful times in his life. They are itchy, without differentiation, the itching seems uncontrolled and can often affects the patient’s sleep, because of this, he feels very tired. He tends to feel hot and is irritable.

The eczema tends not to ooze, have pus or scare after being he scratches. Patient also complains that he gets colds often and has an aversion to the wind. Within the last week, the patient has had very loose and sticky stools that have a very strong odor to them His urine is dark and the flow is not strong.

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The patient has a very poor diet and tends to eat whenever he gets a chance due to his very busy work schedule. He prefers heavy pastas and bread, drinks soda and energy drinks to keep him going throughout the day. He has 4-6 cups of coffee per day and always feels bloated after meals.

Past history: Includes asthma, which started at age 4 and started in the wintertime. He was given an inhalant to help control his bouts of asthma that seemed aggravated by indoor dust and mold. His asthma seemed less severe in the summers and seemed to become much less in severity by the age of 9. He would always tend towards getting severe and frequent colds in the winter by age 10 and his eczema started at the age of 15.

The location of the itching changed from the age of 15 from the elbow crease to the back of knees and seemed to be on the right side of his body. His asthma seemed to stop at the age of 19, but the eczema got worse once he entered college.

Between the ages of 19 -25, the patient used steroid cream which his doctor prescribed which helped the itching but seemed to stop helping him in severe situations when the itching got worse.

Physical examination showed red thick areas with erythema located at the back of knees and elbows.

Tongue: The tongue had a red tip whilst the body was swollen with teeth marks around the edges. The coating was thick yellow and greasy.

Pulse: The pulse was rapid and slippery on both left and right sides.Western Diagnosis: Eczema for 10 years.

Western Perspective

Any skin inflammation may be considered dermatitis. Substances that irritate the skin, allergic reactions to drugs, detergents, and other chemicals are all problems. Dermatitis can affect almost any area of the body. Redness, scaling, and thickening of the skin may occur. Pinpointing the cause of the problem is the first step toward alleviating the symptoms.

Dermatitis is a broad term covering many different disorders that all result in a red, itchy rash. The term eczema is sometimes used for dermatitis. Some types of dermatitis affect only specific parts of the body, whereas others can occur anywhere. Some types of dermatitis have a known cause; others do not. However, dermatitis is always the skin’s way of reacting to severe dryness, scratching, a substance that is causing irritation, or an allergen.

Typically, that substance comes in direct contact with the skin, but sometimes the substance is swallowed. In all cases, continuous scratching and rubbing may eventually lead to thickening and hardening of the skin.Eczema is a type of dermatitis that is allergy related. It appears as dry, cracking, crusting and red patches on the skin. Often there are swelling, weeping blisters.

The skin can become inflamed and itchy. Many factors can contribute to eczema. Stress is a major factor. Exposure to cleaning compounds, perfumes, detergents, household chemicals, soaps, food allergies, as well as, nutrient deficiencies.

Atopic dermatitis is one of the most common skin diseases, affecting 15 million people in the United States. Almost 66% of people with the disorder develop it before age 1, and 90% by age 5. In half of these people, the disorder will be gone by the teenage years; in others, it is lifelong.

Doctors do not know what causes atopic dermatitis, but people with it usually have many allergic disorders, particularly asthma, hay fever, and food allergies. The relationship between the dermatitis and these disorders is not clear; atopic dermatitis is not an allergy to a particular substance. Atopic dermatitis is not contagious.

Many conditions can make atopic dermatitis worse, including emotional stress, changes in temperature or humidity, bacterial skin infections, and contact with irritating clothing.

In some infants, food allergies may provoke atopic dermatitis.

Asthma at an early age is often seen. With the development of eczema and asthma, western medicine sees this as an allergic IgE response. This is a genetically determined disorder that occurs in association with asthma and hay fever. Symptoms usually include erythematous, scaling and lichenified areas, which when active show crusting but no vesicles. If a blood sample is taken, it will most likely show an increase in IgE levels and a high number of eosinophils.

Supplements for Eczema

*A study published in the British Medical Journal Lancet showed a significant improvement in eczema when patients took high doses of Evening Primrose Oil (EPO) in capsule form. There have been some reports that EPO can help in cases of atopic dermatitis. It takes a rather large number of these expensive capsules to produce results and it can take at least six months to see any results.
*Flaxseed oil taken internally or applied externally often eases symptoms of eczema.
*Aloe vera gel and Calendula lotion or cream can sooth irritated skin.
*Take 500 milligrams of Black Currant Oil twice a day. Give children under 12 half that dose. This takes six to eight weeks to produce the desired effect.
*Eat at regular times with relevant portions of food.

Aromatherapy

Aromatherapy can help by easing irritation, inflammation, and dryness. Helpful, are Essential oils such as Chamomile, Geranium, Tea Tree, Lemon, Myrrh and Ylang Ylang. Apply 8-10 drops of one oil or combine two to three oils in a base of 4 ounces of sunflower oil.

Hydrotherapy

The mysterious and amazing healing power of water has been utilized for centuries. Water cleanses, refreshes and restores all life. We are always drawn to water. Hydrotherapy is the use of water in any form, in the treatment of dis-ease. Hydrotherapy was used by the ancient Greek physicians. The use of baths for such purposes as well as for religious purification, personal cleanliness, and private or social relaxation dates from at least the time of ancient Greece.

For dermatitis, take an oatmeal bath.

Oats are warming thermal in nature, sweet and slightly bitter flavor, soothing, restores nervous and reproductive systems, strengthens spleen-pancreas, builds and regulates qi energy, removes cholesterol from the digestive tract and arteries, strengthens cardiac muscles. Can be used in cases of dysentery, diabetes, hepatitis, nervous and sexual debility, indigestion and swelling including abdominal bloating.

One of the richest silicon foods, oats help renew the bones and all connective tissues. oats also contain phosphorus, required for brain and nerve formulation during youth. For an additional soothing treat, add milled oatmeal to the bath, and even using oatmeal as a soap substitute.

For the bath, pour 2 cups of milled oatmeal into a tub of lukewarm water. Milled oatmeal is simply oatmeal that has been ground to fine powder that will remain suspended in water. Bath in the oatmeal for up to 20 minutes.

Homeopathy

This medical system uses infinitesimal doses of natural substances to stimulate a person’s immune system and body’s natural defenses. Homeopathic remedies are named for the plant or animal ingredients they are made from. Homeopathy not only offers relief from temporary disorders but, can provide long term healing of a person due to its individual and “wholistic” approach.

This often leads to a complete recovery from the dis-ease, as well as, providing an improved understanding of the patient’s situation. This type of healing makes it easier and possible to avoid recurrence or relapses in the future and, homeopathy stimulates the body’s natural defense system by reestablishing normal immune system and cell functioning. For dermatitis, consider these remedies:

Rhus Toxicodendron 6c for symptoms of intense itching, pain is worse after scratching, restlessness.

Sulfur 6c if symptoms occur after bathing or exposure to water, burning itch, moist or weepy rash.

Apis Mellifica 30c if symptoms occur due to an allergic reaction to food or chemicals. Red swollen skin that burns, hives.

Nutrition

*Water is essential in any healing process. Distilled water is the best. 6-8 eight ounces glasses per day.
*Food allergies can play a major role in dermatitis during childhood. They are related before age 6. You can manipulate an infant’s diet and do well in helping their skin. Eggs, orange juice, and milk have been implicated as eczema aggravators in children. Parents should consult with their physicians about trying elimination diets. In general, these are foods that should not be eliminated. It is only after testing them out by, by first eliminating them and then re-introducing them back into the diet. Such diets seem to work best in infants less than 2 years old. After age 6, it is believed by experts that food plays a minimal role in most people.
*For adults, diet manipulation should be undergone by each individual. If you think there’s any food you eat that has an adverse effect on your skin, avoid it and see what happens, If your problem clears up, you may have a food allergy.
*Eliminate milk and all milk products from the diet.
*Take 500 milligrams of Black Currant Oil twice a day. Give children under 12 half that dose. This takes six to eight weeks to produce the desired effect.

Traditional Chinese Medicine Perspective (TCM)

This case is a combination of excess and deficiency. The excess is the accumulation of Damp-Heat in the body with an underlying Spleen and Lung Qi deficiency.

Atopic dermatitis is known as Si Wan Feng, which means ‘four bends wind,’ and shows in the skin regions that are commonly affected; the elbows and the knees. The pathological causes include the six external evils. Other patterns include fetal toxins and blood dryness

From a TCM view, atopic eczema and asthma involve the connection between the Lungs and the skin. These two symptoms are very clearly related and often one will appear as the other improves. There is a relationship between the Lungs and skin.

The irritability and anger caused by the itching and lack of sleep leads to stagnation of the Liver Qi as indicated by the poor Blood circulation. This further weakens the Spleen as the stagnated Liver Qi invades the Spleen.

TCM Diagnosis: Damp-Heat obstructing with underlying constitutional Lung Qi deficiency.

Principles of Treatment: Clear heat, drain damp, stop the itching.

Root: Tonify the Lung Qi

Herbal Formula

Chu Shi Wei Ling Tang with Er Miao Tang plus Ku Shen and Bai Xian Pi.Cang Zhu 3g, Hou Po 3g, Chen Pi 3g, Zhu Ling 3g, Ze Xie 3g, Chi Fu Ling 3g, Chao Bai Zhu 3g, Hua Shi 3g, Fang Feng 3g, Zhi Zi 3g, Rou Gui 1g, Gan Cao 1g, Deng Xin Cao 3g, Huang Bai 9g, Ku shen 9g, Bai xian pi 6g

To be decocted and taken once in the morning and once in the evening after meals. This formula is used to clear heat and dry dampness in the lower burner, regulate Qi, and harmonize the middle burner.

This formula is modified to include other herbs to relieve the itching. Cang Zhu dries the dampness in the lower Jiao. Hou Po and Chen Pi both regulate Qi and transform dampness. Zhu Ling and Ze Xie leech out dampness and promote urination. Chi Fu Ling clears damp-heat. Chao Bai Zhu dries dampness. Hua Shi expels dampheat through urination and Fang Feng expels wind-damp. Zhi Zi clears heat, drains damp-heat and eliminates irritability.

Rou Gui leads fire back to the source and encourages the generation of Blood. Gan Cao acts to protect the middle Jiao and harmonize the formula. Deng Xin Cao clears heat from the Heart channel and promotes urination. Huang Bai treats the damp-heat in the lower Jiao, Ku Shen clears heat, dries dampness and relieves itching. Bai Xian Pi also clears heat, eliminates dampness and relieves itching.

External application: Shi Zhen San

Huang Qin 150g, Duan Shi Gao 150g, Han Shui Shi 250g, Wu Bei Zi 125gGrind all the herbs together into a fine powder. Mix with vegetable oil to form a paste, or sprinkle some of the powder directly on the affected area. Apply once or twice daily.

Shi Zhen San is used topically to clear the damp-heat. Huang Qin clears damp-heat, and Duan Shi Gao clears heat. Han Shui Shi drains fire and Wu Bei Zi relieves fire toxicity and absorbs moisture.The root of this disorder is deficient Qi which predisposes the patient to damp-heat. Once the damp-heat has been cleared, Bu Fei Tang be used to tonify the root. Tonifying the Lung Qi, will strengthen the Lung and Wei Qi, which augments the Qi and stabilizes the exterior. Once the Lung Qi is strong and able to nourish the Wei Qi and stop the reoccurring colds, then Spleen should be tonified in order to maintain a constant supply of Qi and Blood for all the organs.

Acupuncture Points

The points used for eczema (atopic dermatitis) include: Du14, LI11, Sp10. St36, Sp6, Ht7, UB17 plus Ht8, Lv5 (for severe itching) and Sp9 (for dampness).

Managing Dermatitis

Dermatitis is aggravated by dehumidified air, especially during winter months when forced-air heat circulates in the home. Forced-air heat is more drying than other types of heat.

Since dry air tends to aggravate the itching of eczema or dermatitis, keeping indoor air moist should be a primary concern of sufferers and their families.

If you can counter dry air with a good humidifier, then forced-air heat is not as much of a problem. Humidifiers are like air conditioners— you really need a big unit to do anything. If you sleep next to it, however, that’s okay. Put it next to your bed.

Phototherapy (exposure to ultraviolet light) often helps adults. This treatment is rarely recommended for children because of its potential long-term side effects, including skin cancer and cataracts.




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