Chinese Medicine Differential Diagnosis of Dermatitis and Eczema

This is a page for Chinese medicine professionals who are interested in the traditional disease diagnosis and differentiation of dermatitis and eczema. If you are a patient, and would like to know more about the way I use acupuncture and herbal medicine to treat dermatitis and eczema, please visit the Eczema Page.

Dermatitis, or Eczema, is a relatively superficial condition causing inflammation of the skin. This may appear as redness, crusting, scaling, weeping and/or itching. Dermatitis and eczema are often used inter-changeably.

Acupuncture and Chinese medicine call dermatitis shi zhen, or damp rash, as a category. Each of the sub-types of dermatitis have a unique name a treatment strategy as follows:

  • Contact Dermatitis, or jie chu xing pi yan, is caused by coming in contact with an irritant chemical, pollen, jewelry, cosmetic or other substance which irritates the skin. Contact dermatitis appears in the form of transient wheals, itching and possible vesiculation (appearance of small liquid-filled blisters). It is possible for contact dermatitis to spread to areas neighboring the site of contact with the irritating substance. Symptoms generally resolve when contact with the irritant is discontinued. It is important to take a thorough history when differentiating contact dermatitis from other lesions. A guiding internal herbal formula is Wu Wei Xiao Du Yin and a guiding external herbal wash is San Huang Xi Ji. Acupuncture should be applied to strongly drain heat and reduce toxicity as per the identified pattern.
  • Atopic Dermatitis, or si wan feng, occurs most commonly on the insides of the elbows and the backs of the knees. Its chief characteristics are chronic nature, itching and redness. People with atopic dermatitis commonly have a family history of allergies. Itching is often exacerbated by stress and contact with certain clothing fibers, like wool. Atopic dermatitis may begin in infancy with children showing signs at just a few months of age. The first signs of atopic dermatitis in children often appears on the cheeks and scalp. Differential diagnosis is based on location and duration of symptoms. Changes to the diet along with treatment are key to long-term and permanent remission of symptoms. There are 3 main disease patterns in acupuncture and Chinese herbal medicine: Fetal toxin (more redness with dark urine), Damp-Heat (itching, redness and oozing) and Blood Dryness (less red; oozing or dry, flaky). There are a number of topical herbal washes to relieve symptoms depending on the age of the patient. Acupuncture treatments should clear heat and tonify deficiency as appropriate.
  • Lichen Simplex Chronicus, or niu pi xuan, is a localized type of neuro-dermatitis. The lesions are chronic, superficial and very itchy. Patches of dry skin appear scaly and thickened, and are often hyper-pigmented. Worsening of lichen simplex chronicus is strongly link to mental stress. Women are more often affected than men. Differentiation from psoriasis (heaped-up lesions with silvery scales and Auspitz’s sign) and lichen planus (symmetrical distribution) is imperative. Acupuncture and Chinese medicine patterns for lichen simplex chronicus are Wind-Heat-Damp (dense lesion pattern with papules, either eroded or crusted lesions) and Blood deficiency with Wind-Dryness (very thick, dry lesions and severe itching worse at night). Acupuncture treatments should include Plum Blossom and Surround the Dragon needling and regular needling by pattern.
  • Seborrheic Dermatitis, or mian you feng, is an inflammatory disease of the face and scalp. Symptoms are dry or greasy dandruff. This is also called Cradle Cap in infants, and is often accompanied by red rash on the face and persistent diaper rash. Itching is not very severe. Seborrheic dermatitis is common in people with AIDS and Parkinson’s disease. The two main patterns from a Chinese medicine and acupuncture perspective are Wind-Heat with Blood Dryness and Damp-Heat in the Yangming. Both internal herbal formulas and external herbal washes are helpful. Acupuncture includes points as per the presented pattern.
  • Diaper rash (also known as diaper dermatitis), or yan kao chuang, appears in the diaper areas of babies and young children. Improper washing combined with extended exposure to urine and stool may cause diaper rash. The best treatment for diaper rash is to let the child spend as much time without a diaper as possible. Fresh air and a clean bottom will often resolve lesions on their own. A Chinese folk remedy for diaper rash is to use Millet to make a soup in which the child’s diaper area can be bathed. Topical herbal ointments may also be applied.

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