Eczematous and Psoriatic Skin Disorders

Paul L. Reller L.Ac. / Last Updated: August 03, 2017


This article groups eczema and psoriasis together because the patient must understand how to differentiate these disorders, get an accurate diagnosis, understand the similarities and differences in the pathological mechanisms, and proactively take charge of their overall care. These diseases are widely variable and demand a persistent and comprehensive approach. Since there is traditionally limited results with the treatment of eczema and psoriasis, it is essential that the patient persists with the right comprehensive course of therapy. Lack of persistence and avoidance of a comprehensive approach is usually the reason for failure in therapy. Therefore, it is also important to choose the right medical dermatologist and also the right Licensed Acupuncturist and herbalist to guide the choices in therapy and make the most accurate diagnosis. A diagnosis of eczema or psoriasis is not a simple matter, as the terms imply a wide variety of presentations and pathological mechanisms that must be addressed according to the type. The M.D. has one system of diagnostic typing, or differentiation, and the TCM physician has another, although the two systems basically fit over the other, albeit with different terminology. Both systems utilize the same treatment principles in essence, although the TCM physician also treats the individualized underlying causes and contributors to the disease. Since these disorders are complex, this article is complex, but it does stick to the most pertinent information that the patient may need.

Patients diagnosed with eczema and psoriasis must realize that these skin disorders are classifications of skin disorders rather than specific diseases. They are still actually defined more by the array of symptoms than by the array of causes, or disease mechanisms, which remain poorly understood. Both groups of skin disorders are multifactorial, which implies that a multidisciplinary and holistic approach to treatment may be more successful. Complementary and Integrative Medicine offers the patients more and more research based treatments each year, and the Licensed Acupuncturist is able to utilize both thousands of years of clinical empirical evidence and the latest scientific data to increase success in therapy.

Psoriasis may be the best illustration for the need to integrate holistic Complementary Medicine with standard care. Pharmaceutical allopathic approaches dominate standard care in the United States, and these target specific disease mechanisms to reduce symptoms. The very nature of allopathic approach is to create a synthetic therapeutic that targets a specific physiological mechanism. Unfortunately, research now proves to us that psoriasis is an accumulation of pathological mechansims, and that drugs that target one pathway, or mechanism, have limited effect. A variety of T-cell, cytokine, and chemokine immune responses are responsible for the perpetuation of the cellular dysfunctions that create psoriatic skin inflammation and cellular debris (plaque). Each pharmaceutical is expensive and targets just one or two of the immune mediators or cellular hormones that create the complex chronic response at the skin cells, or keratinocytes. Herbal, or botanical, medicine contributes an array of naturally evolved chemicals that may target all of these immune mediators and cellular hormones, as well as their receptors. By combining effective pharmaceuticals with a course of herbal medicine enhanced by acupuncture and nutrient medicine, the patient is able to thoroughly address the immune dysfunctions and have a better outcome. This is not to say that there is a simple herbal approach. No, the patient must choose a knowledgable and experienced Licensed Acupuncturist, and persist with therapy in a very proactive collaboration, for the outcome to be successful. The array of research that is being published in the world shows the patient that Complementary Medicine is being integrated into the standard treatment of psoriasis and eczematous conditions around the world. As usual, the United States is one of the last countries to adopt this approach.

Understanding the pathophysiology of Eczematous and Psoriatic syndromes

The term eczema comes from the Greek ekzema, meaning 'to boil out / eruption', and implies that this is a type of skin disease that originates from an internal disorder manifesting on the skin, which separates it from common allergic skin conditions. Eczema in its most common form is technically called atopic dermatitis, meaning characterized by allergic reactions (atopic), and producing chronic skin inflammation (dermatitis), but other classifications may illustrate other disease mechanisms that the patient should be aware of, such as neurodermatitis (nerve generated symptoms driven by itching), dyshidrotic eczema (cellular dryness causing unhealthy skin), and stasis dermatitis (poor circulation causing symptoms). Seborrheic dermatitis is another type of common eczema of the scalp or trunk, where overactive sebaceous glands that produce oil, mainly to lubricate hair follicles, become dysfunctional. Xerotic eczema, also known as "Winter Itch", is characterized by skin patches that become abnormally dry and easily reacts to dry weather. These types of eczema often overlap and encompass a variety of symptoms, and a wide variety of causes. Most atopic and seborrheic eczema syndromes begin in early infancy, and while most seborrheic eczema clears in a few weeks, atopic eczema usually recurs episodically, expands in complexity, and may continue to recur in adulthood, even after long periods of remission. Although the eczema is triggered by an external allergen, the disease mechanism that perpetuates it is attributed to an internal dysfunction that could involve multiple systems, the immune system, the nervous system, and the hormonal system. Successful treatment protocols should ideally not just address the symptoms, but also examine and improve the function of these physiological systems.

Psoriasis presents symptoms that are similar to eczematous conditions, namely itch, red skin, dry scaly skin, and perhaps periods of puffy swelling and exudate, but the causes of psoriasis are much different than eczema. Psoriatic conditions also have many classifications of type or cause, and like eczematous conditions, are defined as multifactorial, meaning that a variety of factors present both cause and aggravation of the skin condition. These essential facts are very important for the patients to understand if they are to accomplish more than periodic symptoms relief, which is all that modern medicine offers at present. Complementary and Integrative Medicine offers the patient more of a chance to treat a variety of factors and achieve a successful cure, or at least a prolonged remission of symptoms, although this is by no means an easy task in most cases.

Psoriasis is a term applied to autoimmune reaction that is characterized by itch. Psora in Greek means itch. Often, the severe itching actually creates skin lesions that result in patches of chronic psoriatic redness and exudate. Psoriatic conditions, though, can also effect joints and other tissues, and may involve substantial pain in some patients. The autoimmune dysfunction in psoriasis results in cells undergoing apoptosis, or programmed cell death, too fast, causing excess cellular debris that the body is not able to break down and circulate away fast enough. Normal cell lifespan of keratinocytes, or epidermal skin cells, is 28 days, while some cases of psoriasis may present with a keratinocyte cellular lifespan of only 3 days. Of course, psoriasis sufferers understand that this mechanism is worse at times, and at other times the immune system functions normally. The key is to get the immune system to function optimally most of the time.

Since psoriasis is a term for a variety of skin disorders with a common presentation, some types are found to be not linked to an autoimmune mechanism, which makes the modern system of disease classification problematic. The key to treatment in psoriasis is that it must address a variety of mechanisms, decreasing the immune reaction and apoptosis, clearing the tissue of excess debris, and stimulating a healthier immune response. The treatment must follow the individual course and be taken in response to the stage of the disease, as well as address the individual underlying factors of cause, or diverse disease mechanisms. Obviously, the allopathic approach, which tends to create a single one-size-fits-all and consistent type of therapy, does not fulfill the treatment needs. Traditionally, Chinese physicians specialized in TCM have classified these diseases based on the underlying disease presentation, as well as the symptoms, and individualized the treatment to the patient. The patient may choose to utilize an extensive treatment from the TCM physician, or Licensed Acupuncturist, utilizing mainly herbal formulas and topical herbal ointments and emollients, or the patient may instead choose to utilize the skill and knowledge of the TCM physician to address the underlying health only, so that the standard pharmaceutical approaches may be more effective, and periods of remission more likely. Since standard pharmaceuticals in this arena come with a substantial risk of side effects over time, the patient might also want to utilize the TCM physician to address these concerns. In any case, in a patient centered approach, the patient makes these decisions based upon an array of advice from the various treating physicians, and integrates their care.

Both of these classifications of skin disease, eczema and psoriasis, are commonly seen in the population, with increasing incidence, and are both noncontagious. Psoriasis affects a minimum of 4 million persons in the United States, while eczematous conditions have been noted in 37 million. These figures are considered to be underestimated because less than half of the population polled in studies have been clinically diagnosed by a medical doctor, and patients with episodic mild symptoms have tended to ignore the problem. Estimates consider that about 15% of the population has one of these conditions, or has had it in the past. Evidence also suggests that both types of disorder have a genetic predisposition, or an epigenetic pattern, and recent evidence implies that solving your epigenetic problem may result in future generations of your children not acquiring a strong predisoposition to these diseases. No specific genes have been found that are responsible for psoriasis or eczema because a number of genetic and epigenetic responses act in concert to express the disease. Psoriasis presents with only a small percentage of patients with single generation inheritence, but there is evidence that epigenetic traits are passed, often skipping generations. Eczematous conditions show a higher percentage of epigenetic and genetic traits. Recent studies of prevalence in the United States find that today, some areas of the country report incidence of eczema in over 17% of schoolchildren (Journal of the American Academy of Dermatology 2000;43:649-55). This alarming statistic prompts many women with eczema, or a family history of eczema, to seek a more thorough treatment protocol utilizing Complementary and Integrative Medicine. There is a growing public health concern as well that eczematous atopic dermatitis predates the development of allergic rhinitis or asthma in a large percentage of children, and that these diseases are interconnected, even in the adult population. An effort to understand and address the various causes and epigenetic inheritance in the population and successfully decrease infant acquisition of these chronic morbid health conditions is an important subject in public health currently. Although the public has been led to believe that a genetic cause should lead the patient to standard medicine alone, and away from Complementary Medicine, the opposite is true. Evidence of a complex genetic and epigenetic mechanism implies that a holistic approach to health is necessary to correct this complex epigenetic dysfunction.

Understanding the potential causes of psoriasis onset and flare-up

The common causes of psoriasis are still poorly understood, but we do know that increased incidence and risk of occurence are seen with synthetic steroid medication use, other medications, family history, or after incidence of illness, injury, infection, unusual exposure to cold temperature, or periods of high stress, which confirms an epigenetic predisposition that needs a trigger, rather than a set-in-stone genetic inheritance. In fact, simple genetic inheritance has been hard to prove even with the advanced genetic research today. Only 8% of psoriasis patients have a single parent with a history of psoriasis, and even when both parents have psoriasis, the incidence of the children acquiring the trait is less than 40% (genes are made up of two alleles, one of each usually acquired from each parent). Even if you have psoriasis, and both parents have psoriasis, you do not know for sure that you are genetically doomed to suffer from this disease. These findings also imply that increased physiological stress on the immune system, rather than genetic cause, may have created an immune missense that needs to be corrected. Regardless of genetic or epigenetic inheritance, it is well understood that psoriasis patients go through periods of remission, and these periods imply that more is involved in the disease mechanism than genetic expression.

It is well documented that synthetic steroid medication may have set off the disease mechanisms in psoriasis in a sizable percentage of patients. Sudden withdrawal of corticosteroid medicine is also a prevalent trigger for severe flaring of the disease, and the irony is that we still prescribe corticosteroids to treat psoriasis. Concurrent prescription of oral corticosteroids with psoriasis patients is widely considered to imply malpractice, as the incidence of severe and sometimes fatal blistering psoriasis episodes when the synthetic corticosteroid is discontinued is high enough to warrant much concern. Nevertheless, rebound effects with topical corticosteroid ointments and steroid inhalers are considered mild enough to be tolerated, and are not life threatening. It doesn't take a medical genius to understand, though, that this may create a dependancy on the corticosteroid therapy. Since corticosteroids are now prescribed very liberally, despite warnings from health authorities, the increasing incidence of psoriatic conditions may be attributed to the increased prescription of corticosteroids for treatment of allergies, asthma, pain, and other conditions. You may read more about corticosteroids on another article on this website. Other common prescription medications that induce psoriasis and psoriatic flaring include hypertension medications, such as beta-blockers (atenolol), calcium channel blockers, and ACE inhibitors (lisinopril, captopril, Altace), the diabetic medication glyburide (a sulfonylureas), lipid lowering drugs (high cholesterol - statins), interferons, interleukens, lithium, antimalarials, and the antifungal medication terbinafine (Lamisil) (James, Berger et al; Andrews' Diseases of the Skin: Clinical Dermatology. (10th ed.) Saunders).

While many dermatologists still are reluctant to admit that these commonly prescribed medications cause onset of psoriasis or flaring of the disease, the evidence is now indisputable, although the complex mechanisms of cause and effect are still being researched. In 2005, various University medical centers in Israel conducted a thorough review of evidence linking these drugs to onset and flaring of psoriasis, and published the evidence in Acta Derm Venereol 2005; 85:299-303. The medical doctors at two University medical schools, Soroka and Ben-Gurion, one research center, Silaal, and one extensive health services group, Clalit, combined to examine a large amount of data. The doctors stated that: "Despite the potential benefit for primary and secondary prevention of psoriasis, most of the current knowledge on the topic of drug-induced or drug-triggered psoriasis is based on case reports and uncontrolled case series (before this study)." The medical doctors examined the records of hundreds of consecutive cases of patients hospitalized for extensive plaque-type psoriasis vulgaris at more than one hospital to perform the case-crossover study of risk or association with various pharmaceuticals and onset or flaring of serious psoriasis. Both case-control and case-crossover controls were used, and single factors as well as multi-factorial risk was assessed. The findings showed that three types of blood pressure medication, ACE inhibitors, beta-blockers, and calcium-channel blockers, as well as NSAIDS (non-steroidal anti-inflammatories, in particular proprionic acid derivatives, or COX-2 inhibitors), benzodiazepines (anxiety drugs), and antibiotics (penicillins and macrolides), all were statistically associated with risk of onset or flaring of psoriasis. The study data showed contradictory information on calcium-channel blockers, antibiotics, and benzodiazepines, though, and the authors recommended further study. The authors did recommend: "In summary, it has been shown that extensive psoriasis vulgaris may be associated with intake of ACE inhibitors, NSAIDS, and beta-blockers. It is recommended that physicians taking care of patients with extensive psoriasis should consider withdrawal of these drugs." Since the Allhat trial of the NIH, and the National Heart, Lung and Blood Institute, in 2006, stated that their large controlled trial showed that a simple diuretic alone outperformed all other medication protocols and reduced cost to 4 cents per day, many prescribing medical doctors with a patient centered approach are following this recommendation. Anti-inflammatory NSAID use can also be significantly curtailed with the use of Complementary Medicine. Conservative care, meaning care that is without risk of side effect, can resolve many chronic inflammatory conditions, and herbal and nutrient medicine can exert a significant inflammatory modulating effect. If the NSAIDS are taken due to musculoskeletal pain syndromes, soft tissue mobilization, myofascial release, and acupuncture can be combined to resolve these problems, and thus decrease the risk that NSAID use will flare the psoriasis.

As with many chronic conditions, prevention requires better overall general health care, maintaining a healthier immune system, quicker recovery from injury, illness and infection, and stress relief, all of which can be accomplished by utilizing Traditional Chinese Medicine. Treating this psoriatic condition with a holistic regimen that addresses the underlying disease mechanisms as well as symptom control may well reduce the risks of passing this inherited predisposition to future generations. This does require persistence and a pro-active approach from the patient. Because the treatment of psoriasis demands a treatment strategy that varies with the stages of the disease, the patient must actively work with the physician to insure that the correct therapies are taken at the right time.

As always, the first step in achieving a cure in chronic disease that remains difficult to treat is for the patient to gain a better understanding of the mechanisms of the disease. This is essential in a patient centered medical approach that demands a pro-active engagement by the patient in therapy. To increase your chance of successful outcome, key information is presented below, and as always, is followed by some useful information on specific therapeutic products and regimens, and links to outside resources and scientific study.