Eczematous and Psoriatic Skin Disorders

Treatment considerations with Complementary and Integrative Medicine

Treatment of chronic eczema has proven to be very difficult, both with standard medicine and with TCM therapies. A 2009 consensus statement on standard treatment is cited below in additional information, and suggests that there is still little success. A number of novel therapies utilizing herbal chemicals has now been incorporated into many standard clinical practices. Still, these skin disorders remain difficult for the TCM physicican as well to treat successfully with a short course of therapy. Nevertheless, there is much clinical report of success with treatment with TCM, and many cases of childhood eczema have cleared, or gone into long remission with this approach. Identification of the various underlying causes and disease mechanisms, and persistence with a course of therapy that addresses these factors in each individual case, is very important to the treatment outcome.

The treatment in eczematous conditions must not only rely on herbal and nutrient medicine, but must incorporate identification of allergens and antigens specific to the individual, and avoidance of these allergens and antigens whenever possible, until the disease is resolved. Acupuncture and improved diet should also be incorporated to have a better overall effect and address more factors in the disease. If the eczema is stimulated by neurological stress, habitual itching, dry skin, or seborrhea, these aspects must be adequately addressed to achieve success. The modern patient has been indocrinated into a mentality that there should be a single pill that resolves any health problem, and this unrealistic attitude is very problematic in treatment of difficult multifactorial diseases such as eczema. Utilize the health professionals to identify and treat these various aspects of the disease, which often present a difficult puzzle and are not easy to identify, especially as mechanisms such as superantigens may stimulate symptoms even when the allergen or antigen is avoided, and because there may be a combination of these factors that drive the disease in the individual.

Scientific studies have confirmed a number of mechanisms by which herbal chemicals address the underlying pathophysiological mechanisms in chronic eczema. Antiinflammatory, immunomodulating, and itch relieving activities are well documented, and various herbal chemicals have shown efficacy in inhbiting various inflammatory mediators that may drive symptoms in different cases. A formula of herbs provides a variety of these therapeutic chemicals, and improves succcess over single herb use. One reason that there is still little published evidence in the West is that the complexity of the herbal formulas discourages scientific studies. Identification of specific evidence in the studies is thus complicated, and our system is set up to examine specific chemicals in an isolated system, as with pharmaceuticals. Nevertheless, a number of scientific studies demonstrate efficacy in herbal and nutrient therapy, and some of these studies are cited below in additional information. Because of the multifactorial causes and variety of types of eczematous conditions, one herbal formula may work in one case and not in another. This fact also creates conflicting study data, and more specific subsets of eczema patients need to be found when conducting human trials of more complex herbal formulas and nutrient medicine. The ultimate goal in treatment of a difficult disease is not to discover

Herbal and Nutrient chemicals with antieczemic qualities

• Vitamins B12, B6, folic acid, selenium, OptiZinc (zinc methionine): studies have shown a consistent deficiency of glutathione and glutathione peroxidase, as well as selenium in eczema patients, and these supplements may help restore these important antioxidant chemicals. To better understand glutathione metabolism, go to the article on this website entitled glutathione balance and restoration. Milk thistle, European olive leaf, and gotu kola also benefit glutathione metabolism and may aid skin repair.
• Lecithin and Phosphatidylcholine: a number of organizations (National Psoriasis Foundation) and doctors have recommended lecithin for years, often at a high dose of 1000mg, for both eczema and psoriasis. Phosphatidylcholine is the lipid component of lecithin that is now widely used in therapy, and topical lecithin has been purported to provide positive results. The phosphatidylcholine softgels can be cut and the liquid applied to the skin. There is also a cream from the UK called Psoriderm that utilizes lecithin with coal tar to soften and remove scale and slow the growth cycle of the psoriatic cells.
• Vitamin C ascorbic acid: studies have long linked deficiencies of Vitamins C, B1, A, and trace minerals zinc and manganese in the blood of eczema patients. Supplementation with quality products, along with herbal therapy, may produce positive results if these deficiencies are affecting the individual patient. Vitamin C ascorbic acid supplementation can reduce excess copper in circulation, which is associated with decreased immune response and increased sensitivity to infection, particulary yeast and fungal infections. Ascorbic acid is also a key coenzyme in skin maintenance and repair. Scientific studies have also identified excess alcohol consumption as a reducer of zinc and copper in blood serum. Zinc levels are hard to determine with blood tests, since zinc concentrations in the blood are controlled by a binding protein metallothianein. There is also evidence of an inverse relationship between zinc and copper in the body, and copper excess is consistently found in the blood of eczema patients. Zinc insufficiency is also associated with elevated carnosine/histidine ratio, and low levels of leucine, isoleucine, and histidine. Isoleucine and leucine are essential amino acids in tissue repair. Histidine is an amino acid precursore of histamine. When excess histamine is produced, low levels of histidine, due to increased demand, cause excess excretion of zinc, depleting zinc in the blood. Folate deficiency may also cause deficient histidine. We see that not only ascorbic acid could be beneficial to restore zinc/copper balance, but that supplementation with low dosage of OptiZinc (zinc monomethionine), active folic acid (5MTF), and L-Isoleucine with B6 (P5P) may be beneficial.
• Dried barley grass powder: this amazing nutrient contains a variety of antioxidants and other chemicals, including beta carotene and Vitamin A. Most important, is contains a good source of the antioxidant superoxide dismutatse (SOD), which aids in maintaining proper utilization of zinc, copper and manganese. SOD counters the free radical oxidant exesses of superoxides, and also helps to maintain cellular health. You may also be able to purchase a copper/zinc SOD supplement at some health food stores.
• Linoleic (CLA) and gamma-linolenic acid (GLA): these essential fatty acids are key to a health antiinflammatory mechanism, and have been found to be deficient in a majority of patients with chronic atopic eczema. They are found in a variety of healthy oils, spirulina, evening primrose oil, and a number of Chinese herbs, and are now available as supplements. The NHI Medline Plus states that there is reliable evidence that evening primrose oil is effective in the treatment of eczema. Research has found that there may be a reduced conversion of linoleic acid to gamma-linolenic acid (GLA) in atopic eczema, and some studies have shown a benefit for GLA in treatment. Consistently high levels of linoleic acid in circulation and adipose tissues, and consistently low levels of linoleic acid metabolites suggests this defect in atopic eczema patients, and may even be inherited, or an epigenetic effect.
• Curcumin, Guaiacol, and Resorcinol: Curcuma longa, or turmeric, Yu jin and Jiang huang in Chinese herbal medicine, and Curcuma zedoaria, or E zhu, as well as white mulberry, Sang bai pi, Chinese skullcap, Huang qin (Scutellaria baicalensis), sesame oil, and Chinese cinnamon, Gui zhi, all contain these useful chemicals. Curcumin exerts significant antioxidant activity and enhances glutathione peroxidase, as well as inhibition of mast cell derived TNF alpha and interleukin 1, exerting potent antiinflammatory action. Yu jin, Curcuma longa, may contain the highest concentration of curcumin, and is also a stimulant of the blood and nerve circulation, which could significantly aid therapy. Curcuma zedoaria, or E zhu, contains curcumin, curcumenol, and curdione, and exerts a more potent anti-inflammatory effect. Curcumin is now standardized and prepared in patented ways to increase the effective circulating dosage, as there appears to be a natural rate-limiting effect in the human organism, but the combination of curcumin derivatives and other symbiotic chemicals in the plants may provide a broader effect. In scientific studies, curcumin significantly increases glutathione metabolism in the liver, exerts anti-inflammatory effects on leukotrienes, potently inhibits lipooxygenase and cyclooxygenase activity (Jim XL, Zhen QR, Chin Journal of Chin Mat Med, 19, 695, 1994), exerts potent antioxidant activity, inhibits platelet aggregation, and moderates eicosanoid biosynthesis (The Pharmacology of Chinese Herbs, Kee Chuang Huang). All of these effects could significantly aid the protocol in treatment of eczema.
• Tamanu oil, and other oils for the skin: Tamanu, Calophyllum tacamahaca, is a rich oil produced from the nut of the Tamanu tree, which is in the Mangosteen family. The oil has been used for centuries by Pacific islanders and has demonstrated potent skin healing properties in scientific study. A medicinal oil not only helps with skin healing, but provides a barrier against allergens and antigens, and helps prevent drying of the skin. Tamanu oil also has bactericide and fungicide properties, and inhibits lipid peroxidation, exerting significant antioxidant clearing. Health Concerns Tamu Oil contains not only Tamanu oil, but avocado oil, which is rich in essential fatty acids, Vitamin A and D, and other nutrients known to help eczematous conditions.
• Nimbidin: Neem, Azadirachta indica, is a medicinal herb from Pakistan and India that has long been used to treat skin disorders. Clinical studies found that neem oil is more effective than coal tar and cortisone, and has a wide variety of benefits, including stimulation of increased glutathione peroxidase. It is especially effective for seborrheic eczema.
• Nattokinase and Serratiopeptidase: studies have long confirmed increased fibrinogen and clotting factors in eczema patients during the periods of active clinical symptoms. Nattokinase and serratiopeptidase are recently researched enzymes that help to decrease tissue clotting factors and fibrinogen excess. Increased local circulation would result, improving the overall treatment effects. In addition, these two metalloprotease enzymes are found to reduce the ability of superantigen membrane proteins to adhere to host cells. Serratiopeptidase has proven in numerous studies to significantly reduce tissue swelling and improve symptoms in a variety of chronic inflammatory disorders.
• Quercetin and Resveratrol: the antioxidant and antiinflammatory chemical quercetin is a key active ingredient in a number of Chinese herbs, which has led to its recent popularity as a medicine where querecetin is isolated in extraction and delivered at a higher dose, sometimes combined with another potent antioxidant and antiinflammatory found in Chinese herbs, resveratrol. Quercetin and forskolin are chemicals that have been studied as mast cell stabilizers as well. Mast cells are inflammatory mediators that produce the overreaction that drives eczematous inflammatory dysfunction. Forskolin is found in Coleus barbatus, and quercetin is found in Mu dan pi, Huang bai, Curcuma longa, Chi shao, Astragalus (Huang qi), Sang bai pi, Gingko biloba, Yarrow, Neem, Capsaicin, and many of the herbs that are traditionally used in formula to treat eczema. Resveratrol, usually derived from the Chinese herb Polygonum cuspidatum (Hu zhang), but also found in minute amounts in grape skins, was found to not only exert antioxidant effects but also inhibit the formation of new blood vessels (angiogenesis) in diseased tissues, such as psoriasis, cancer, rheumatoid arthritis, and cardiovascular disorders. A standardized high dose quercetin, combined with a high dose of magnesium and citric acid, has been shown to be effective in modulating the histamine metabolism to improve symptom expression as well.
• Hyaluronic acid: if you suffer from a type of eczema called dyshidrotic eczema, or aggravated by dry cells, hyaluronic acid, a bioidentical molecule that hydrates cells, could be very helpful. Topical application of just a few drops will penetrate to dry cells, and one molecule of hyaluronic acid is able to hold 1000 times its weight in water.
• Beta-carotene: this antioxidant is well known to be deficient in most eczema patients, and is especially good for maintenance of the skin and membranes, and protective against allergies and infections. Foor sources include walnuts, carrot juice, spinach, barley, barleygrass, papaya, spirulina, alfalfa sprouts, bok choy, mustard greens, beets, bell peppers, sweet potatoes, and watercress. Herbs such as comfrey, gotu kola, chrysanthemum, wormwood, gouqizi berry, and hibiscus are also good sources.

The most effective herbal treatment strategy involves a customized and changing herbal protocol that first addresses the predominant aspect of the acute and subacute stages of expression, then, after decreasing the severity of the symptoms at the skin, treats the underlying mechanisms that trigger a return or worsening of symptoms. The acute symptoms may have a predominant redness, swelling, dryness, exudate, or scaly lichenification, and the herbal formula and topical herbs should ideally focus on whatever of these predominate each week. A proactive approach by the patient is also very integral to success. Aggravating factors must by diminished, such as habitual itching, use of commercial soaps and beauty products, and exposure to allergens. The patient may want to look at a variety of the possible causative factors, such as medications, stress, emotional stress, food allergies, etc. and work to achieve a more controlled daily environment. The physician may turn to other strategies when the symptoms decrease. The most important mistake commonly seen in therapy for eczematous conditions, is that when the symptoms quiet, the therapy stops. This approach will only insure a return of symptoms. The patient must be persistent in the goal of treating the underlying disease mechanisms and improving immune responses when there is a period of remission. The TCM physician has many choices of herbs and nutrients that can address a wide variety of physiological problems, and acupuncture may have a very synergistic effect to enhance the overally effectiveness of treatment.