Addressing the Symptoms and Underlying Causes of Contact Dermatitis with Chinese Herbal Medicine and Acupuncture

Contact dermatitis is an acute inflammatory condition of the mucosa or skin caused by contact with certain stimulants or irritant substances. Both sexes and people of all ages can develop this skin condition, although, it tends to occur more frequently in children; women are more prone to this disease than men. One trait of contact dermatitis is that it tends to appear after the sufferer has been exposed to allergenic substances. Certain stimulants or substances that cause contact dermatitis include contact with animals, certain materials used in creating clothing, plants, lacquer, ointment, and medicated plasters. The development of skin lesions depends on the part of the body that came in contact with the irritant and is more often confined to those body parts.

Symptoms of contact dermatitis include tenderness of the lesions, swelling, a burning sensation, and itchiness. In serious cases, systemic involvement can come about. The condition often gets better after a week or two with proper treatment is given and once the irritants are removed. But, once the person has been exposed again to the irritant, the condition may reoccur once more.

Contact dermatitis from the viewpoint of traditional Chinese medicine (TCM) is not considered a disease but a syndrome (a specific set of symptoms). TCM classifies diseases of the skin as some type of surgical trauma as they are depicted in several ancient surgical texts. Since TCM has no general term for contact dermatitis, this condition is called by terms that refer to its cause and symptoms. Some examples of these terms include:

1. Tar Sore – In ancient times, tar was used to waterproof furniture in China
2. Pollen Sore
3. Commode Ringworm – During ancient times, cases of buttock inflammation sometimes occurred when old-style commode seats were lacquered)
4. Plaster Rubella – Caused by Chinese herbal poultices
5. Lacquer Sore

Causes

The spleen and lungs are the primary organs responsible for supporting and promoting the function of the skin and thus have a major role in the development of contact dermatitis. The hair and the skin, from the perspective of TCM, serve as walls that prevent negative exogenous factors from entering the body. Responsible for absorbing nutrients from food and distributing fluids throughout the body, the spleen can contribute to skin swelling and disease when its function is impaired. The lungs regulate the protective qi that enhances the integrity of the hair and skin. So, if a skin condition arises, it is often attributed to a disharmony affecting the lungs. Contact dermatitis, according to TCM, may be the result of both exogenous (originating from outside the body) and endogenous (originating from inside the body).

Exogenous Causes – Infiltration by Environmental Pathogen

In cases where external pathogens have managed to directly enter the body directly, abundant yang energy will arise and accumulate. The flow of qi and blood to the surface of the body is affected and slows down or stagnates. As a result, the function and integrity of the skin is impaired leading to the rise of dermatitis.

Endogenous Causes – Inborn Susceptibility

The constitution of the body influences the occurrence of contact dermatitis. People with an inherited or congenital disorder are highly predisposed to this condition. The tissues and the skin are loosely bonded in cases of congenital deficiency, which results in a weak protective qi making the body susceptible to a raging yang (a flare-up) or to the rise of internal wind fire. Contact with certain substances can trigger the transformation of internal raging yang. These substances can include certain plants, dyes, rubber products, plastic, drugs, and lacquer. The conflict between qi and blood versus the raging yang sets off the dermatitis symptoms.

Symptoms

Swelling, a burning sensation, and itch that comes with rash are the main symptoms of contact dermatitis. In serious cases, the rash may be accompanied with blisters. Commonly though, the rash may develop clusters of raised spots (red papules). Leakage or exudation may occur if the rash is scratched which can also exacerbate the irritation. On very few instances, tenderness and swelling of the perineum, lips, and eyelids can occur.

Overstimulation of body function can also come about from contact dermatitis. TCM practitioners describe this overstimulation as an asthenia syndrome which is caused by a relatively strong body-resistance in battling excessive pathogens. Signs and symptoms wrought by asthenia syndrome include a dark-colored urine, constipation, stomach discomfort, irritability, thirst, and fever. The degree of the symptoms depends on how much the disease has progressed.

Upon examining the patient, a TCM practitioner can classify the symptoms under special syndrome sets called “disharmony patterns.” Certain patterns of disharmony may show up during the different phases of the disease. Contact dermatitis can be classified into the following types:

Dryness and Wind Accumulation Coupled with Blood Deficiency

The lesions on the skin become scaly, dry, and thickened with repeated relapses of the disorder. A thickened leathery appearance may develop on the lesion. The intensity of the irritation can cause scar development in the skin due to too much and/or intense scratching.

Dampness Coupled with Excessive Fire

This type of syndrome is a more severe form of contact dermatitis. The blisters may develop and grow up to the size of an egg-yolk while the red papules become edematous (filled with water). Fluid can easily leak out if the rash is scratched. The lesion can swell and generate a burning sensation and the rash can become very, very itchy. Systemic upset includes poor appetite and dryness of the mouth.

Accumulation of Excessive Yang (fire)

This type of syndrome presents with acute onset. There is accumulated edema as well as a distinct margin in the base of the tissue and the skin will initially have a red rash or appear pink. Later on, the rash produces clusters of raised spots (papules) and a sensation of burning and itchiness then comes along. Related systemic symptoms include constipation, dark urine, irritability, fever, thirst, and a dry mouth.

Treatment for Contact Dermatitis

External Treatment

The identification of the cause followed by its avoidance is the most important aspect in the treatment of contact dermatitis. Important too are the therapeutic modalities to help resolve the skin lesions. Any substance used in the treatment should by simple to apply, non-stimulating, and mild in order to facilitate healing. Listed below are some treatment examples:

For simple rashes

-Indigo powder lotion (sanwang lotion)

For severe erosion and exudation of skin lesions, moist dressings need to be applies immersed with one or more of the decoctions listed below:

-Mulberry leaf (sang yu)
-Dandelion (pu gong ying)
-Pyrrosia leaf (shi wei)
-Emilia sonchi folia (yang di cao)
-Amur cork tree (wang bai)
-Purslane herb (ma chi hsian)
-Green tea (lu cha)

For skin lesions that have scarred and eroded, Indigo emulsion. Black soybean-distillate ointment can be used in instances of skin lichenification, coursing, thickening, or scaling.

Some home-made prescription can also be used to treat the skin lesions. They include:

-Fresh balsam pear
-Fresh ground mung beans
-Amur cork tree (wang bai) and fresh garden burnet root (shang di yu) – they can be used when there is exudation after the lesion has been scratched. Soak or wash the lesions with this decoction
-Alum (ming fan), purslane herb (ma chi hsian), amur cork tree, Baikal skullcap root (wang chin) – use this decoction to soak or wash the lesions if vesicles start to appear on the rash
-Fresh ground purslane herb

Internal Treatment

Holistic therapies such as Traditional Chinese medicine consider skin conditions as caused by underlying problems (internal disharmonies). TCM believes that the imbalance of yin and yang is responsible for the superficial presentations (symptoms) arising in the skin.

Accumulation of Wind and Dryness Combined with Blood Deficiency

Treatment Objectives: to rehydrate the skin, nourish the blood, and dispel wind and excess heat.

Hsiaofeng powder made up of

-Licorice root (gan cao)
-Gypsum (shi gao)
-Great burdock achene (niu bang his)
-Atractylodes root (cang shu)
-Fine-leaf schizonepeta herb (ching chie)
-Common flax ( hu ma)
-Light yellow sophora root (shi mu)
-Cicada slough (chan tui)
-Divaricate saposhnikovia root (fang feng)
-Dried Rehmannia root (sheng di)
-Angelica (dang gui)

Danggui decoction made up of

-Licorice root (gan cao)
-Milk vetch (wang chi)
-White peony root (bai shao)
-Fleece flower root (he shou wu)
-Angelica (dang gui)
-Puncture vine caltrop fruit (bai ji li)
-Divaricate saposhnikovia root (fang feng)
-Fine-leaf schizonepeta herb (jing jie)
-Szechwan lovage root (chuan hsiong)
-Common yam root (sheng di)

Dampness Combined with Excessive Yang (heat)

Treatment Objectives: relieve swelling, eliminate toxins, and dispel dampness and heat

Longdan Hsiegan decoction is made up of:

-Oriental water plantain root (hse hsie)
-Angelica (dang gui)
-Dried Rehmannia root (shang di)
-Plantain seed (che chian hsi)
-Cape jasmine fruit (shi hsi)
-Chinese gentian (long dab cao)
-Baikal skullcap root (wang chin)
-Chinese tororwax root (chai hu)

Accumulation of Abundant Yang (heat)

Treatment Objectives: clear the rash, dispel toxic materials, and eliminate heat

Puji hsiaodu dissolution drink (alleviates rashes of the head and face).

-Root of licorice (gan cao)
-Cimicifuga rhizome (sheng ma)
-Chinese tororwax root (chai hu)
-Dried tangerine peel (chen pi)
-Platycodon root (chie geng)
-Stiff silkworm (jiang can)
-Peppermint (bo he)
-Great burdock achene (niu bang hsi)
-Puff-ball (ma bo)
-Figwort root (yuan shen)
-Golden thread (wang lian)
-Baikal skullcap root (wang chin)
-Large head atractylodes root (lian chiao)
-Isatis root (ban lan gen)

Lianghsie jiedu decoction (resolves rashes on other parts of the body).

-Baikal skullcap root (wang chin)
-Gromwell root (hsi cao)
-Tree peony bark (dan pi)
-Wild chrysanthemum flower (ye ju hau)
-Dandelion (pu gong ying)
-Isatis root (ban lan gen)
-Weeping forsythia capsule (lian chiao)
-Honeysuckle flower (jin yin wa)
-Red peony root (chia hao)
-Dried rehmannia root (shang di)

Acupuncture and Moxibustion

Acupuncture has the ability to treat contact dermatitis since this condition is viewed as an excessive (asthenic) syndrome. Certain acupuncture points are selected to purge or relieve the symptoms of contact dermatitis. These acupoints include the spleen 6 (san yin jiao), bladder 40 (wei shong), stomach 36 (hsu-san-li), pericardium 3 (chu hse), large intestine 4 (he gu), large intestine 11 (chu chi), and lung 5 (chi hse).

Food Treatment
For the relief of the symptoms of contact dermatitis, a congee made of raw Job’s tears (coix) and mung bean can be helpful.

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