An Eczema Case Study: Treating Dermatitis

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An Eczema Case Study: Treating Dermatitis

 

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. 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 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 125g

Grind 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.

 

 

Andrew Pacholyk, MS, L.Ac

http//www.peacefulmind.com/dermatitis.htm

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