Eczema

Definition:
A non-infective skin disease characterized by an inflammatory skin reaction to various internal and external stimuli with such typical manifestations as erythema and vesiculation, which may lead to exudation and crusting. Lesions tend to be circumscribed in the chronic phase with infiltration, lichenification and severe itching, recurrence is frequent.

Aetiology:
External pathogenic factors
1. wind: manifests as multiple lesions and pronounced itching.
2. Dampness: manifests as lingering non-healing lesions mainly located in lower part of body.
3. Heat : manifests as red and swollen skin, possibly leading to infection by toxins
Internal factors:
1. Heart-fire due to emotional disturbances: lesions are red , inflamed and extremely itching.
2. Dampness due to spleen dysfunction: maceration and erosion .
3. Liver-wind
Dietary irregularities:
Over intake of spicy, greasy or rich food can lead to depletion of yin and damp-heat.

Pathogenesis:
Acute phase
In the acute phase, wind, heat and dampness are the main causative factors.
In chronic phase, damp-heat has accumulated internally over a long period. Heat damages yin and blood, lead to dryness, manifesting as gradual lichenification, dry skin, desquamation, or fissuring.

Patterns and Treatments:

1.Wind predominating over dampness( Acute phase )
Main symptoms and signs:
Worse on the upper body, manifesting as red papules and a small number of vesicles, mild exudation, and incessant itching. The tongue body is red with a thin white coating, pulse is wiry and slippery.
Treatment principle
Dispel wind and eliminate dampness
Formula:
Modified Xiaofeng san
Jing jie 6g, kushen 6g, chan tui 6g, zhimu 6g, gancao 6g, fangfeng 10g, dang gui 10g, cangzhu 10g, chao jiu bang zi 10g, sheng di huang 12g, shigao 12g, bai xian pi 12g, tong cao 3g.

2.Heat predominating over dampness ( Acute phase )
Main symptoms and signs:
Characterized by acute onset, inflammation, numerous red 1-2 mm papules and a few vesicles, with a sensation of scorching, heat. Accompanying symptoms and signs include irritability, thirst, itching, short voiding of reddish urine, and constipation. The tongue body is red with a thin yellow coating, pulse is slippery and rapid.
Treatment principle
Clear heat and eliminate dampness
Formula:
Modified Liang xue chu shi tang
Sheng di huang 15g, ren dong teng 15g, bai xian pi 15g, liu yi san 15g, mu dan pi 10g, chi xhao 10g, hai tong pi 10g, di fu zi 10g, xi xian cao 12g, chi xiao dou 12g, lian zi xin 6g.

3.Damp-heat ( Acute Phase )
main symptoms and signs:
acute onset and short duration. Various types of lesion- erythema, papules, vesicles, erosion and exudation – may appear simultaneously or in succession at any body site; borders are indistinct. Accompanying symptoms and signs include severe itching, dry throat with no desire for drinks or irritability with thirst, constipation, and yellow urine. Tongue body is red with a thin yellow coating, slightly greasy at root; the pulse is slippery and rapid, or wiry and slippery.
treatment principle
clear heat and benefit movement of dampness, dissipate wind and alleviate itching.
formula:
modified Long dan xie gan tang
chao longdan cao 6g, huang qin 6g, chai hu 6g, jing jie 6g, chan tui 6g, sheng di huang 15g, ze xie 15g, bai xian pi 15g, che qian zi 10g, jiao zhi zi 10g, chi shao 10g, fang feng 10g.

4. Damp obstruction due to spleen deficiency ( Chronic Phase )
main symptoms and signs:
manifests in lower body with a dull, pale skin and numerous vesicles with exudation on rupture after scratching. Accompanying symptoms and signs include itching, poor appetite, thin and loose stools, and lassitude. The tongue body is pale with a thin white coating; pulse is thread and moderate.
treatment principle
tonify spleen and regulate dampness
formula:
modified Chu shi wei ling tang
cang zhu 10g, chenpi 10g, hou po 10g, chao zhike 10g, sheng di huang 12g, fu ling pi 12g, che qian zi 12g, zhu ling 12g, chi xiao dou 15g, yi yi ren 15g, ze xie 15g, sha ren 8g

5.Dampness predominating over heat ( Chronic Phase )
main symptoms and signs:
the disease is of long duration, with lesions presenting as discrete pale red or dull red macules or papules, with a few vesicles or papulovesicles and occasional exudation of fluid. Scaling and crusting occur as the lesions dry. Accompanying symptoms and signs include intense itching, epigastric discomfort, poor appetite, a sallow facial complexion, loose stools, and scant urine. The tongue body is pale red with a greasy white or greasy yellow coating; the pulse is deep, sorry, wiry, and slippery.
treatment principle
tonify spleen and regulate heat
formula:
modified Jian pi chu shi tang
fuling pi 15g, sheng di huang 15g, baizhu 12g, huang qin 12g, jiao zhi zi 12g, chao zhi ke 12g, bai xian pi 12g, chi xiao dou 30g, yi yi ren 10g, chao mai ya 10g, chao guy a 10g.

6.Blood-dryness due to damage to yin with accumulation of dampness ( Chronic Phase )
main symptoms and signs:
this condition is lingering and recurrent. Lesions are dull red or dirty gray, and the skin is rough, infiltrated or lichenified with scratch marks, crusting or scaling, or small amounts of exudation. Accompanying symptoms and signs include difficulty in falling asleep vecause of the intense itching, mental exhaustion, dry throat, and thirst. The tongue body is dry and red with a thin coating or no coating; the pulse is thread and slippery, or wiry and thready.
treatment principle
enrich yin and nourish blood, eliminate dampness and alleviate itching
formula:
modified Zi yin chu shi tang
shengdi huang 30g, xuan shen 10g, dang gui 10g, dan shen 10g, she chuang zi 10g, fu ling 12g, ze xie 12g, bai xian pi 12g, chao bai bian dou 15g, shan yao 15g, yi yi ren 15g, yi mu cao 9g, xu chang qing 9g.

Acupuncture and other treatment
Damp-heat: zhongji, xuehai, sanyinjiao, ligou and dadun
Damp obstruction: zusanli, sanyinjiao, zhongwan, diji
Blood-dryness: ximen, zusanli, sanyinjiao, dadun
External treatment:
Sanhuang xi ji or qingdai san: for erythema, papules and vesicles with a little exudation
Pu gong ying or ye ju hua: lesions with erosion and large

From:
Xu.Y.(2004).Dermatology in Traditional Chinese Medicine. Donica Publishing