Eczematous and Psoriatic skin disorders

Paul Reller, L.Ac.

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). Sebborhoeic 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. 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.

Eczema

Eczematous conditions are still defined and diagnosed largely by the symptom presentation. Common diagnostic criteria (Sweet and Sampson) describe the symptom presentation as “an irritating papular eruption, focal or diffuse, which may become exudative, crusted, scaly, or lichenified and which may be expected at some stage to show spongiosis (puffy inflammatory swelling) with superficial vasodilation and lymphocytic infiltration, no matter where on the body it occurs or what may have contributed to its cause.” The Stedman's medical dictionary defines eczema as a “generic term for inflammatory conditions of the skin, particularly with vesiculation in the acute stage, typically erythematous (reddened skin), edematous (swollen), papular (small raised bumps), and crusting; followed often by lichenification (a pattern of flattened papules resembling lichen on a rock), and scaling and occasionally duskiness of the erythema (red skin) and, infrequently, hyperpigmentation (darkened patches of skin); often accompanied by itching and burning; the vesicles form by intraepidermal spongiosis (intercellular edema of the epidermis, or swelling between skin cells).”

Eczema is distinguished from psoriasis largely by symptom presentation alone. The description of psoriatic skin lesions from the same medical dictionary describes them as circumscribed (bounded by a line), discrete and confluent (both separated and grouped), reddish, silvery-scaled, and maculopapular (ranging from flat spots to small bumps). In other words, the eczema and psoriasis may be hard to differentiate, but often, the eczema is diffuse, and often cycles through a more distinct pattern of bumps, redness, and then swelling and crusting. The psoriasis tends to stay the same, and may have a more defined area, although the boundary does not typically show as defined of a line as other chronic skin rashes, such as fungal infections. The typical areas of eczema occur on the forearm, wrists and hands, while the psoriatic lesions typically occur on the elbows, knees, wrists, scalp and trunk. Eczema typically occurs on the flexor areas of joints, while psoriasis typically occurs on the extensor areas, where circulation of cellular debris is decreased. Often, the psoriasis on the limbs is bilateral and symmetrical in presentation, although a significant percentage of cases, especially mild cases, are not. Inverse psoriasis, or psoriatic lesions on the opposite, or flexor, areas, is also not uncommon. It is best to get an accurate diagnosis from a good dermatologist, because the first step in designing a working protocol of treatment is accurate diagnosis. Once again, patients with these disorders should take a proactive approach and integrate their standard medical care with Complementary Medicine.

The most common type of eczema involves atopic dermatitis, or skin inflammation in a patient prone to allergic reactions. This type usually first occurs in early infancy after the second month, and may resolve if the infant's immune responses are developed properly. Sometimes the immune system is not fully developed until the teens, and hormonal changes during puberty can also affect the responses to allergens and antigens. If the immune system develops chronic dysfunction, atopic dermatitis may recur in adulthood when various aggravating factors increase.

Testing for eczematous conditions is problematic. No routine laboratory test is helpful in making the diagnosis of atopic dermatitis. Elevated percentage of eosinophils may be evident during active symptoms, and allergy testing, RAST and skin pricking tests, may be positive in about 80% of patients. RAST is a blood test for allergen-specific IgE antibodies. These tests will be negative with seborrheic eczema. The allergy testing may also reveal many potential allergy reactions that are not specific to the eczema, though. If allergy testing is performed, it is still best for the patient to keep a diary and record the effects of avoidance of allergens, and take a step-by-step approach, first avoiding the most common allergens. Elevated levels of allergen-specific IgE antiodies usually indicates a true allergy, but do not competely confirm that you have an actual physical allergic reaction to that allergen, and levels of allergen-specific IgE do not necessarily predict the potential severity of the allergic reaction, if there is one. As always, a complete array of tests gives valuable information, but all test results need to by analyzed in relation to the individual patient and their symptoms presentation. Identifying potential allergens and allergic immune reaction helps all of the integrated physicians to deliver the best treatment protocol.

Understanding the pathophysiology of eczematous skin conditions

There is evidence that atopic eczema, the most common type, usually emerges for the first time during early infancy, and may or may not persist throughout adulthood, and that a relatively small percentage of cases actually initiate during adulthood. This leads us to investigate what immunologic mechanisms lie at the heart of this disorder, both to improve prevention during early infancy, as well as to direct therapy during adulthood. Atopic is a term that means prone to allergic reaction. Atopic eczema is frequently associated with respiratory allergies, particularly those that stimulate asthmatic reactions. Scientists investigate both the array of immune dysfunctions, including local immune signaling via cytokine release, helper T cells, IgE antibody roles, and the role of unhealthy skin cells, as well as the role of infectious agents and superantigens, when looking for new treatment protocols and better understanding of the confusing pathophysiology of eczema.

Blood tests may reveal a high percentage of IgE, as well as eosinophils, during active symptoms in atopic eczema. Immunoglobuin E (IgE), is a class of immune antibody proteins that are our main defense in the skin, and overexpression is associated with allergic response. Certain IgE antibodies may react or overreact to specific allergens. Eosinophils are white blood cells that control immune response mechanisms to allergens, along with mast cells. Mast cells are the main immune effectors in allergic reaction, producing the histamines, eicosanoids (leukotrienes and prostaglandins), serotonin, cytokines, and heparins that cause redness, swelling and other symptoms, and express a high affinity for IgE. Mast cells are a major effector of allergic symptoms, and are stimulated by high IgE antibody responses. T-cells that are specific to allergens that commonly trigger eczematous symptoms often trigger mast cells, and mast cell activation has been reported to induce T-cell migration to an area, either directly by releasing interleukins and other immune modulators, or indirectly, by inducing genetic expression of adhesion molecules. Increased mast cells also present more allergens and antigens to T-cells. This interdependent relationship between immune mediators implies that a complex approach in treatment is needed to holistically decrease the immune hyperactivity, and herbal medicine provides a variety of chemicals that achieve these various results, whereas allopathic medicines may target only one specific mechanism.

An antigen is defined as any substance, not only infectious agents, but also environmental toxins, drugs, food molecules, and altered membrane molecules, that induce a state of sensitivity and/or immune responsiveness after a latent period of days to weeks, and which reacts with antibody proteins and/or other immune mediators, of a sensitized subject. Superantigens are a class of antigens that cause non-specific T-cell activation, and massive release of immune cytokines. Superantigens are able to activate up to 20% of the body's T-cells, which would explain the link between respiratory and skin allergies, and probably intestinal sensitivity and allergic reaction. Superantigens would disrupt the strength of our adaptive immune system, which is the learned ability to target antigens with a high specificity. Of course, in early infants, this immune system is still undeveloped, and the infant relies on the innate immune system, passed via colustrum in the mother's milk, as well as imprinted upon the genetic code. The decrease in breast feeding in modern times, as well as the incidence of childbearing at a late age, and the rise in the use of artificial fertility methods and incidence of triplets, have all been implicated in the dysfunction of the early infant's immune responses. The rise in C-sections has also been implicated in the increase in eczema and asthma at an early age. For both the child and adult with eczema, immune enhancement, perhaps with bovine colostrum and herbal formulas, would seem appropriate. The reason that so many cases of childhood eczema resolves as the child ages is that the learned, or adaptive, immune response develops, and is able to handle the superantigen mechanism. Periods of increase biological stress may result in a flare-up of eczema in the future, though.

Superantigens thus present the most intriguing factor in scientific understanding of the mechanisms of pathology in eczema, as well as in psoriasis. Superantigens activate a large percentage of T-cells, which secrete large amounts of cytokines. TNF-alpha is one of the most important cytokines in relation to the inflammatory response, and is normally secreted locally in low levels. High TNF-alpha levels systemically could activate unusual responses locally by increasing cytokine responses in local tissues that experience irritation, thus tipping the scales to an adverse immune response. In other words, normally low levels of TNF-alpha would create healthy immune responses in areas of exposure, such as the hands and forearms, but high levels would create an allergic skin reaction, which may set off a cascade of events that perpetuates the eczematous condition. Many superantigens are proteins secreted by the normal bacteria on our skin, Staphylococcus and Streptococcus. Today, we see an unusual amount of Staph and Strep varieties that have evolved resistance to antibiotics because of antibiotic overuse. This evolved resistance often involves the acquiring of the ability to create membrane proteins that thwart antibiotics. It could be that our desire to protect our children by overuse of antibiotics has created abnormal bacteria that produce superantigens which threaten them. Superantigens could also be produced by viruses, and identification of viral superantigens is progressing. Fungal superantigens are also linked to atopic eczema of the seborrheic variety, such as those produced by Malassezia furfur.

Superantigens can be endogenous, or encoded on the genetic or epigenetic code, exogenous, such as described above as proteins on the coating of normal strains of bacteria, and can even be specific to B cell response instead of T cells. Once activated, superantigens can continue to stimulate an allergic or sensitivity response in the abscence of local antigens. The patient with eczema may experience increased symptoms both when exposed to allergens, and when not exposed to allergens. This would explain the persistence of the condition. Since antigens may induce a hyperresoponsive inflammatory response after a latent period of weeks, it is often difficult for the patient to see a clear and immediate connection between the antigen and the eczematous response. We should take superantigens seriously when seeking a cure, and obviously this would require a broader therapeutic treatment protocol, combining correction or enhancement of the immune system as a whole, with treatment of local tissue health and responses. This has always been the protocol espoused in Traditional Chinese Medicine. Unfortunately, this course of therapy requires some persistence, and a varied course of therapy over time. It requires use of both topical herbs, herbs specific to local immune hyperreactivity, and herbs that address improved systemic reaction.

Specific allergies and antigens that drive the eczematous atopic dermatitis

Despite the possibility that superantigens and other physiological mechanisms drive the eczematous expression even in the abscence of exposure to an allergen, the patient should understand the importance of the role of allergens and antigens in eczematous atopic dermatitis and other forms of eczema, and work to solve the puzzle of what factors stimulate the individual case and reduce these allergens and antigens. Two common allergens in atopic dermatitis are dust mites and milk casein.

Dust mites are tiny living creatures that thrive on fresh dust, especially the dust that accumulates from the skin flaking. Dust in the home and office contains skin cells, plant pollens, hair, natural textile fibers, paper fibers, soil minerals, and other nutrients for the dust mites. Depending on the location of the dust, the organic content may vary from 5 to 95%. Scientists estimate that the human skin sheds at a rate of 7 million skin flakes per minute. The peripheral immune responses are at their lowest at night, when our immune system focuses on internal tissues and functions. The most important aspect of decreasing exposure to dust mites is to decrease the accumulation of high organic content dust on the bedding and bed clothing at night. If you just take a few minutes each morning to shake the fresh skin flake and dust out of the bedding and bed clothes, you will do the most to decrease dust mite allergens during the most vulnerable time for your peripheral immune response. Of course, if you also remove dust collecting items from your bedroom and use an air purifier that collects minute pollens and other organic material from the air during the day, especially if you keep a window open, this may also be extremely beneficial. Scientific studies show that of all allergens, dust mites produce the highest percentage of T-cell immune responses specific to an allergen in atopic eczema. The study is cited below in additional information.

Milk caseine is of course avoided by quitting the consumption of milk. As with all potential allergens, one can only try avoiding the allergen and see what happens over time. Keeping a diary of your dietary changes and relationship to eczematous symptoms is very important. The benefits and symptom reduction is often not explicit, and some form of objective analysis is very helpful to judge the effects of allergen avoidance. Other key allergens noted in scientific studies are wheat, soy, eggs, peanuts, soap additives, fragrance chemicals, household chemical cleaners, and others. It may be helpful to avoid metal jewelry at the wrist and fingers, buy natural hypoallergenic cosmetics and soaps, use the best natural skin moisturizing creams, use the most natural household cleaners, switch to natural fragrances and essential oils and avoid common perfumes, and wear soft cotton gloves or isotoner gloves when performing activities that may involve exposure to allergens and antigens, or even at night. If you do wear gloves, make sure that you frequently turn them inside out and skake out the skin flakes and dust, and wash them routinely.

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 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: 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. Phosphatydilcholine is the lipid component of lecithin that is now widely used in therapy, and topical lecithin has been purported to provide positive results. The phosphatydilcholine 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 and gamma-linolenic acid: these essential fatty acids are key to a health antiinflammatory mechanism. They are found in a variety of healthy oils, sprirulina, evening primrose oil, and a number of Chinese herbs. The NHI Medline Plus states that there is reliable evidence that evening primrose oil is effective in the treatment of eczema.
Curcumin, Guaiacol, and Resorcinol: Curcuma longa, or turmeric, Yu jin and Jiang huang in Chinese herbal medicine, 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. In scientific studies, curcumin significantly increases glutathione metabolism in the liver, exerts antiinflammatory 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: this antioxidant and antiinflammatory chemical 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. Quercetin and forskolin are chemicals that have been studies 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, Astagalus, Sang bai pi, Gingko biloba, Yarrow, Neem, Capsaicin, and many of the herbs that are traditionally used in formula to treat eczema.
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.

Psoriasis

Psoriasis is described above in its typical form, but it must be remembered that psoriatic conditions affect the rate of cell turnover and programmed death (apoptosis), and may affect not only the areas of difficult circulation at the skin, such as elbows, knees and scalp, but also areas of difficult circulation with tight joints, creating a recurrent arthritis resembling rheumatoid arthritis in presentation. The presentation on the skin may vary from barely noticeable to severe, with stages representing the body's ability to clear the accumulation of cellular debris. Of course, one helpful habit would be to encourage increased circulatory clearing at the sites of psoriasis with such methods as range of motion, heat, light brushing in the shower, topical herbal lotions and salves, and acupuncture. Patients with more severe psoriatic lesions should be careful to avoid skin irritation, though. Each patient may respond differently to these stimulations, and an individualized program should be devised. This is only one of the various treatment modalities that need to be combined into a complete package of maintenance, symptoms relief, and possibly cure. Acupuncture and herbal medicine may benefit the patient in a number of ways.

One underlying mechanism that we have known about for a long time in psoriasis is the decrease in cyclic guanosine monophosphate, which contributes to the shortened cell life cycle, or transit time. Nitric oxide is a chemical released in the body by the immune cascade to increase circulation and local vasodilation, and plays a big part in the normal cyclic guanosine monophosphate metabolism. Decreased periods of nitric oxide production are associated with a host of health problems, and the amino acid L-Arginine is a necessary precursor molecule in the pathway. Other diseases associated with this deficiency include menstrual migraine headaches and problems with pregnancy and labor, as well as erectile dysfunction. While the psoriasis patient may not experience these disorders, there may be an implied link to neurohormonal health that needs to be addressed in treating the underlying causes. The hypothalamus exerts significant effects on nitric oxide autonomic and neuroendocrine control, and basal cyclic guanosine monophosphate immunoreactivity is highly associated with hypothalamic function, and GABA producing cells in the hypothalamus. For this reason, anxiety, depression, and excitable mood are often seen in the psoriatic patient. This brain center of neuroendocrine regulation, the hypothalamus, could also be associated with the mechanisms of psoriasis. Dysfunction in the diurnal melatonin cycle has long been associated with mid-day hypermelatonemia which may result in hyperproliferation of epidermocytes noted in psoriasis, as well as the acquired photosensitivity seen in a sizable percentage of chronic patients. This is another reason to address underlying neurohormonal imbalances if signs and symptoms point to this dysfunction.

The reason that chronic diseases such as psoriasis still evade treatment success is the complexity of both the disesase mechanisms and the underlying causes. There is no single simple disease mechanism, and there is no simple underlying cause. Allopathic medicine continues to look for the pharmaceutical drug that will address and alter one part of the complex physiological mechanism, rather than look for a way to understand and restore the complex neuroimmunological homeostasis that is necessary to maintain health skin growth. The approach in Complementary and Integrative Medicine is to look for the means to correct the dysfunction holistically, taking a step-by-step approach of systems restoration, as well as achieving symptom relief. The end result of this therapy is not only relief from psoriasis, but improve overall health and function in the body. The approach does take more work. Both the patient and the physician must be attentive to individual diagnostic assessment and be persistent with use of the many aspects of the treatment protocol. Even though there has been limited success in the past with psoriasis, new research is uncovering more tools each day to aid the overall therapeutic protocol, and recent studies (cited below in additional information) point to the effectiveness of specific herbal topical and oral medications for a high percentage of patients.

As stated, the predominant theory of what pathologiocal mechanism is responsible for the shortened cell cycle in psoriasis is the superantigen. The difference between the mechanism in eczematous conditions and psoriatic ones is that the superantigen in psoriasis creates an autoimmune reactivity rather than an allergic one. To explain this more simply, the body is exposed to superantigens which elicit an abnormal activation of the adaptive immune system, with potent systemic activation of a percentage of T cells. This is why immunosuppressant synthetic drugs were created to treat psoriasis, although the T-cell inhibitor drugs were removed from the market in 2009 due to serious immune suppression risks. The current strategies in pharmaceutical medicine continue to address the superantigen response with a class of drugs called biologics, inhibiting specific cytokines. Biologics were developed in part because of the research in herbal medicine and the mechanisms of action. The superantigen mechanisms (more fully explored on another article on this website) are the most promising aspects of the disease pathophysiology to explore for therapeutic protocols to date. The reasons that the systemic superantigen responses target specific areas of the body in psoriasis is also interesting. In areas of the body where the circulation is inhibited, such as the elbows and scalp, the abnormal immune response triggers various mechanisms that result in the immune cascade attacking its own cells mistakenly. In eczema, the abnormal immune responses react to external allergens at the extremities of the limbs in areas of normal to high circulatory flow, the flexor surfaces. In psoriasis, the superantigens activate auto-reactive T cells not involved in the initial bout of the the disease. In other words, superantigens activate selective T cell responses, and in psoriasis, the selective T cell responses are usually autoimmune reactions that are specific to skin cells in areas of the body with pressure impeding circulation. The superantigen theories do not explain all psoriatic disease expressions well, but are the most promising scientific explanations to date.

When a superantigen response perpetuates a systemic T-cell dsyfunction, the bilateral, symmetrical lesion patterns are produced, as is typical in psoriasis vulgaris of the limbs. This systemic T-cell dysfunction also explains the patients with disseminated psoriatic lesions over a large part of the body. The T-cell dysfunction has produced a variety of confusing data studies in medicine, with a number of inflammatory mediators showing some consistency in the reactions, such as the interleukins, IL6, IL12, IL23, which are often overexpressed, while other interleukins appear to be underexpressed. There is even confusing data on the complement of T-cell expression and the direction of these various T-cells by chemokine proteins. Various T-helper cell imbalances have been consistently noted, with the imbalance between Th1 and Th2 well publicized, and now the Th17 overexpression being a focus of study. The various immune complement pathways involved may produce a variety of routes of expression that account for this study data and the variations, as well as the difficulty in physiological explanation.

Since most medical studies in the United States are created in order to promote a pharmaceutical, these studies often do not give the medical doctors the full picture. It is becoming clear, though, both to patients and scientists, that the complement immune system functions via a complex feedback response, often with other chemicals affecting the function as well, such as hormones and neurotransmitters. Restoring homeostasis to this system would be the optimal goal. Concentrating on one inflammatory mediator and its genetic expression is probably always going to have limited success. Research into herbal medicine has shown consistently that herbs that have been used empirically for centuries to treat psoriasis do indeed correct these specific interleukin and T-helper cell imbalances noted in modern research. This new research helps to guide herbal therapy. Such herbal therapy has also opened up a new field in pharmaceuticals called Biologics, where proven herbal chemicals are altered in a patentable way to produce a specific chemical that can be a profitable pharmaceutical product. Some of these Biologics may turn out to be very useful medicinals, but frequently we see that altering the natural herbal chemicals produces some alarming side effects. Fooling with the the products of Mother Nature's evolutionary laboratory, which has had millions of year to conduct experiments, may be more problematic that we would like.

Herbal medicine is the ideal form of chemical medicine to counter the effects of superantigens. Superantigens are ubiquitous in our environment, toxic proteins created by microbes such as bacteria, evolving perhaps with the help of viral DNA. Herbal medicine utilizes chemicals that evolve within the plant organisms to counter the complex effects of superantigens. Plant-based medicines utilize a variety of synergistic chemicals evolved in Nature's laboratory, not just a single chemical created in a modern laboratory. Superantigens also stimulate a wide variety of immune reactions in the body that need to be addressed by a variety of chemicals, not a single chemical. Because of the complexity of disease mechanisms with superantigens, we need to perhaps try a variety of different chemicals within the same class to see what works the best. The professional herbalist has the data avaiable to make use of a wide variety of herbal chemicals and adjust the therapy over time in response to patient response. The proof that specific herbal chemicals target the T-cell cytokines responsible for most psoriatic, as well as eczematous, conditions, is mounting as more money is available for research. Some of this research is presented below in additional information with links to the United States public medical database PubMed.

Treatment considerations for psoriasis in Complementary Medicine

Nutritional Supplements: each patient may try supplements and see if a sufficient course contributes to improvement. Variances in the disease mechanisms, utilization of the nutrient chemicals, and deficiencies of essential nutrients may create differences in the effectiveness.

L-Arginine: an essential amino acid that is found to stimulate increased nitric oxide may exert a positive effect on the deficiency of cyclic guanosine monophosphate long observed in the psoriatic lesions, that leads to shortened cell cycles and increased accumulation of scaly lesions. Vitamin B6, or the active metabolite P5P, is recommended to increase utilization.
Melatonin: a neurohormonal molecule associated with the diurnal cycle and sleep patterns is both found to be deficient at the nocturnal peak in psoriasis patients, and deficiency is associated with deficient cyclic guanosine monophosphate, which is also observed in psoriasis. Studies have also noted that changes in the diurnal dynamics of melatonin levels may account for the mid-day hypermelatoninemia associated with hyperproliferation of epidermocytes in psoriasis. Melatonin circulates in the body, is a useful antioxidant in the skin, protecting against excess UV radiation, and when normal diurnal levels are exceeded in mid-day, it stops the normal proliferation of healthy skin cells. Since the melatonin metabolism is tightly controlled, a variety of herbs and supplements that improve melatonin bioavailability should be utilized. The combination of P5P, melatonin, 5HTP, and St. John's Wort shows much clinical efficacy (Positrol from Vitamin Research).
Vitamins B12, B6, folic acid (the active 5MHTF), selenium, OptiZinc (zinc methionine): studies have shown a consistent deficiency of glutathione and glutathione peroxidase, as well as selenium in psoriasis 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.
Vitamin D3: D3 cholecalciferol is actually not a vitamin, but a prohormone. Studies have shown that supplementation has a beneficial effect in psoriasis, and cholecalciferol as a liquid can be applied topically as well. (Synthetic D3 metabolites, 1,24-dihydrocycholecalciferol and calcitriol (calcipotriol), used as topical ointments, provided even more benefit, but do have possible side effects, including dry skin, itch and peeling, and may worsen the condition, as well as cause calcium metabolic dysfunction in a small subset of patients with chronic use.)
Lecithin: a number of organizations (National Psoriasis Foundation) and doctors have recommended lecithin for years, often at a high dose of 1000mg. Phosphatydilcholine is the lipid component of lecithin that is now widely used in therapy, and topical lecithin has been purported to provide positive results. The phosphatydilcholine 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.
Beta-carotene: carrot juice is one source that has been recommended for years for psoriasis patients. Beta-carotene is a potent antioxidant for the skin, and is easily converted to Vitamin A in the body. Vitamin A deficiency has long been linked to psoriasis, and Vitamin A has long been given as an adjunct therapy. 50,000 to 200,000 IU of Vitamin A are often recommended, but there may be some risks with high dosage long term.

Topical agents: these are very important for many patients for a number of reasons. Creams, oils and ointments may provide essential fatty acids, such as oleic and linoleic acid, moisturize the cells for easier clearing of dry scale, decrease itching and inflammation, etc.

Tamu oil from Health Concerns: Tamanu oil, avocado oil, and peppermint oil are combined to provide essential fatty acids and other chemicals proven to aid in skin healing in psoriasis. Tamanu oil contains calophyllum inophyllum, calophyllic acid, lactone, and has been researched for its skin healing properties since 1918. Initial reactivity may occur, and the patient may try to slowly introduce the oil.
Psoralen extracts from Chinese herbs: Psoralen and ultraviolet light phototherapy (PUVA) has been used successfully for some time, and inhibits the abnormally rapid cell cycle in psoriasis with multiple effects. This therapy can be duplicated by utilizing natural psoralen extract from various Chinese herbs (e.g. Bu gu zhi), topically and orally, and exposing the psoriatic lesions to midday sun for at least 10 minutes, or using a black light. This is much less expensive than PUVA therapy and is free of side effects, although this too may cause some skin irritation and increase the chance of sunburn at first. The therapy should initiate with low dosage and no sun exposure for a few days, and then proceed to increased sun exposure after application. Oral intake of the herb extract is less effective, but free of reaction on the skin. A percentage of chronic psoriasis patients develop sensitivity to sun exposure, and should try very short periods of midday sun exposure, such as 1-3 minutes on the affected skin lesions, at first.
Capsaicin ointment: capsaicin has proven to be effective in a number of clinical trials to date. Capsaicin can stop the production of the inflammatory mediators and slows the life cycle of the skin cells, decreasing the buildup of scale. As with all topicals, some patients may experience initial skin irritation, and the use of the ointment should be introduced slowly, with minimal application at first.
Pregnenelone cream: this basic bioidentical hormone may provide a inflammatory modulator that will help, and the creams have a number of agents that moisturize and nourish the skin effectively, with careful attention to non-allergic ingredients and avoidance of chemical fragrance etc. in most products. The concurrent us of hyaluronic acid to increase cell moisture may also be helpful. If you use HLA, apply this first.
Indigo naturalis ointment: studies in 2007 in China demonstrated that this herbal ointment both modulates the proliferation and differentiation of keratinocytes in the epidermal skin, and inhibits the infiltration of the stimulating T lymphocytes. This is the most widely used and effective ointment in Traditional Chinese Medicine, although the TCM skin specialists will usually combine other herbs as well.
Mahonia aquifolium ointment: a multicenter trial of 443 patients in Germany in 1995 found that 81% of patients had symptoms that improved or disappeared with this treatment over time. Subjective evaluation by the patients showed that 79% felt that the psoriasis had improved or healed completely with continued use of the ointment. After 12 weeks of use, the 30% of patients that had moderate to severe psoriasis had improved enough that at this 3 month term, only 5.6% had moderate to severe symptoms. (Journal of Dermatalogical Treatment (UK) 1995, 6/1 (31-34)

Herbal therapy: a professional herbalist will prescribe formulas of herbs that work synergistically and are tailored to both the individual case and the stage of the psoriatic expression. There are a wide variety of herbs that exert various treatment activities that are proven to aid the overall protocol. Antiinflammatory chemicals and antixodants are common, but antiproliferative chemicals that slow the cell cycle, lipoxygenase inhibitors, and mast cell stabilizing chemicals in herbs have also been studied. The last few years have produced an accelerated understanding of the science of herbal medicine, which like the human physiology, is complicated but workable. Difficult diseases such as psoriasis, which is still poorly understood despite our scientific study, and for which the pharmaceutical industry, with trillions of dollars to invest, has still failed to produce effective chemical medicines, do require a more complicated and persistent course of herbal therapy than we would like. A knowledgable professional herbalist utilizes this new research each year to improve success rates. The list of helpful herbal and nutrient chemicals is large, and there is no single herb or nutrient that will produce a magical cure, but a persistent course of herbs in formula that is chosen from both empirical and historical clinical experience, and from new research, and tailored to the individual and the course of the disease, will produce a successful outcome for most patients. The most assured outcomes come from the individualized formulas of raw herbs decocted by the patient (until professional herbal pharmacies are created in the United States that use machine decoction), which are combined with individually tailored ointments. Treatment courses may produce good results within 3 weeks, or may take a number of months. Successful outcomes usually occur only after the disease mechanisms are alleviated, and so the patient often sees no effect for some time. If the superantigen systemic mechanism is strong, relief of the psoriatic lesions may only occur months after the treatment is started. A comprehensive approach is often needed to address all the disease mechanisms, and the patient should insist on this approach, rather than trying one part of a comprehensive approach at a time. Below are a few examples of antipsoriac chemicals in herbs, based on scientific databases.

Psoralen: psoralen is used now in standard medicine with UV radiation, called PUVA therapy, but the chemical is extracted from the Chinese herbs Bu gu zhi (psoralea coryfolia) and Bei sha shen (glehnia littoralis), and is found in Angelica archangelica, fennel, parsley, coriander, and carrot. The effects of the herbal chemical at the skin require some ultraviolet stimulation of the melanocyte cells to achieve a full effect. Melanin is a class of compounds in our body that is produced by our cells and is well known as the chemical pigment that creates the tan when we sunbathe to protect our skin from harmful radiation. But, like many chemicals in our body, melanin has many uses and physiological activities depending on its interaction with other chemical compounds. Although we still do not know the full physiological cascade of events that makes psoralen plus UV radiation effective in psoriasis, we do see that it works for many patients. Clinically, the high dose psoralen analog and UV radiation used in standard PUVA therapy does produce unwanted effects in some patients that cause a high drop-out rate. Used in a natural form as part of a more complex therapeutic protocol, there is almost no incidence of negative effects. As most psoriasis patients will tell you, periods of time with low stress and much exposure to sunlight usually have a dramatic beneficial effect. Since L-tyrosine, an essential amino acid, is the backbone of melanin, the patient may also try to supplement with this amino acid in case there is a deficiency.
Coumarin: a chemical that is also found with psoralen in Bu gu zhi (psoralea coryfolia), as well as in aloe vera, lavender oil, Qing hao (artemisia annua), Gui zhi (cinnamon), thyme oil, red clover, fennel, and nettle.
Forskolin: found in Coleus barbatus and false Coleus (plectranthus barbatus), this chemical is receiving much recent attention in the scientific community. It is an antihistamine antiinflammatory, and mast-cell stabilizer as well, and a beta-adrenergic receptor blocker, which may explain its overall effect. In studies, it is proven effective in the treatment of psoriasis when combined with beta-adrenerbic blockers. There are other herbs that also have this activity and may pontentiate the effects of coleus. Beta-adrenergic hyporesponsiveness has been noted in a large percentage of psoriasis patients in study.
Fumaric acid: a chemical this is found in Milk thistle, as well as Myrrh, Arnica, California poppy, Schisandra berry, Angelica archangelica, fennel, and Da huang (rhubarb). Fumaric acid is now available in 500mg capsules, and is widely prescribed by skin specialists to treat psoriasis.

Corticosteroid Therapy

Corticosteroid therapy, a treatment to control the inflammatory processes to ease joint pain, decrease asthmatic bronchiole or tracheal swelling, decrease skin inflammation, or to decrease undesirable immune response in various autoimmune disorders, has long been considered an effective but potentially harmful means to decrease symptoms that are threatening to the patient. The high risk of serious side effects and long term damage to the hormonal, or endocrine system, has prompted most authors of medical texts to recommend that other therapies be tried before resorting to this type of therapy. Unfortunately, since the medical field has increasingly moved away from simpler conservative therapies to a greater dependence on new pharmaceutical approaches, and the pharmaceutical industry has not generated effective medications to treat inflammatory disorders, the use of corticosteroids has become routine rather than the treatment of last resort.

The psoriasis patient should be especially aware that flaring of psoriasis frequently occurs with discontinuation of higher dose synthetic corticosteroids. The rare incidence of fatal severe flaring has led many dermatologists to consider the prescription of oral corticosteroids such as prednisone, to psoriasis patients, malpractice, unless the patient is suffering from a threatening acute health problem that demands this corticosteroid treatment. The patient needs to be aware that much care needs to be applied to the gradual withdrawal of the corticosteroid medication, if they are taking it. Low dose corticosteroids, such as topical ointments, creams, lotions, and asthma inhalers, also can present some problems with withdrawal and psoriatic flaring. The reasons for this withdrawal phenomenon include the fact that the synthetic corticosteroids supplant the natural adrenal excretion of corticosteroid, reducing the ability of the body to respond well when the synthetic product is withdrawn. Chronic use of synthetic corticosteroids has also been found to potentially cause adrenal stress syndrome and deficient function. An integrative approach may be helpful as the patient attempts to discontinue use of the corticosteroid, especially as the M.D. may not have the time to monitor this process closely. This may be discussed with the dermatologist and the Licensed Acupuncturist.

The patient should consider and discuss potential side effects with the prescribing doctor when considering this treatment (corticosteroids) and considering possible alternatives that are less potentially harmful. The National Institute of Health (NIH) gives these side effects as common for patients taking higher doses, and potential for all patients: stomach irritation, muscle weakness, increased blood pressure, diabetes, fluid retention and weight gain, easy bruising, delayed wound healing or tissue repair, glaucoma, decreased calcium absorption and osteoporosis, and decrease in the body’s natural production of corticosteroid hormones. In addition corticosteroids, even applied topically, have consistently shown to cause birth defects in laboratory animals. Corticosteroids may also lower your resistance to infections and make infections hard to treat. After prolonged use there is usually a prolonged time of adjustment, lasting up to a year, with side effects of muscle and joint pain, reappearance of disease symptoms, shortness of breath, tiredness or weakness, headaches, nausea, dizziness, fainting, abdominal pain, low fever and loss of appetite.

Since there are a number of corticosteroid hormones produced naturally in the body, the taking of a particular synthetic corticosteroid will inhibit various other natural corticosteroid functions. The body utilizes corticosteroid chemicals to regulate and control many processes in the body. Depending upon the patient’s health history, this effect could be dramatic or go unnoticed. In addition, since the hormonal or endocrine system operates on an elaborate feedback mechanism, and many hormones are converted to other hormones as needed in this system, the other steroid hormones in the body will potentially become deficient over time. This is the reason that diabetes is a common side effect, since the pancreas is an endocrine gland and insulin and glucagons are steroid hormones. In addition, a study at the Dept. of Pharmacy and Therapeutics at the University of Pittsburgh (PMID:16901792), found that: “Hyperglycemia occurs in a majority of hospitalized patients receiving high doses of corticosteroids.” This effect is seen in corticosteroid injections as well as oral dosing.

The most common type of corticosteroid, the asthma inhaler, has acquired a number of warnings from the FDA in recent years. Many of the inhalers now prescribed combine long-acting beta-adrenergic inhibitors with corticosteroids to increase the effectiveness. Inhibiting beta-adrenergic response quiets the bronchial spasms, while direct corticosteroid application inhibits the inflammatory swelling of the bronchioles. Government warnings state that even though these medications may decrease the frequency of asthma episodes, they may make episodes more severe, and in some patients, these severe episodes have ultimately ended with a fatal asthmatic event. Studies have shown that patients have increased the frequency of use of these inhalers, increasing the risk of severe episodes. This points to the fact that for many patients, frequency of asthma attacks have also increased with use. The physiological reason that the asthma has worsened with use is that the body's natural hormone reactions are being inhibited. A new type of asthma medication, Alvesco, was created to help with the problem of adrenal damage from chronic use of asthma corticosteroid albuterol. This new version is designed to inhibit release into full circulation by requiring a metabolic step to activate the corticosteroid. Alvesco was created due to clinical studies showing widespread injury to adrenal health with chronic use of corticosteroids.

The effects of long term use of corticosteroid therapy has been well documented. For example, studies at the Albert Einstein College of Medicine in New York (PMID:1682792) showed that: “Long-term low dose corticosteroid use may reversibly decrease B-cell counts and specific antibody responses.” While this may produce desirable effects with specific symptoms, it may also produce many undesirable effects on the whole immune response in your body, with increased risk of other diseases and infections. The risk of tuberculosis dissemination and fungal overgrowth, such as candidiasis is well documented. The medical faculty of the University Hospital Clinics in Barcelona Spain (PMID:8941496) concluded that: “Osteoporosis is one of the most serious adverse effects experienced by patients receiving long term corticosteroid therapy.” Inflammatory bowel conditions and relative lack of weight bearing exercise may increase the risk of corticosteroid induced osteoporosis, and postmenopausal women are particularly at risk. The most rapid bone loss occurs in the first 12-24 months after starting corticosteroid therapies (PMID:10769436). Steroid use has been found to cause fat cell enlargement resulting in blockage of veinous blood return in bone and leading to bone deterioration and small fractures (Univ. of Washington Radiology, www.rad.washington.edu/maintf/cases/unk54/answers.html). Cataracts are also a frequent side effect. The incidence of cataracts in the normal population is 0-4%, but in chronic users of steroid therapies at moderate dose, 30-40% are found to get cataracts, and over 80% will acquire cataracts at high long-term dosage (National Institute of Neurological Diseases and Blindness, NIH grant, Washington Univ. School of Medicine, St. Louis Mo.)

Does a regimen of calcium supplements with vitamin D prevent this osteoporosis? A large study by the Womens’ Health Initiative in 2005 showed little if any effect from this regimen in prevention of osteoporotic fractures in menopausal women, yet a military study showed that large dosage supplementation decreased incidence of stress fractures in young healthy women undergoing strenuous training. This seems to suggest that utilization of the supplements is the key, with hormone deficient women showing problems in utilizing calcium supplements. This is because calcium is the most regulated nutrient in the body.

Are patients on corticosteroid therapies being monitored for long term side effects? There are few reports of systems of monitoring for side effects after administering these therapies. There are few reports of studies on the follow up of corticosteroid therapies, especially in the United States. In Australia, a study was conducted at the Universtity of Tasmania School of Pharmacy (PMID:10886467) and concluded from a randomized review of 212 patients consecutively admitted to a large hospital and receiving long-term corticosteroid therapies, such as inhalers, oral meds, or injections, that less than 20% of these patient were being tested for bone density decreases and less than half had had blood glucose tests administered in the last year. There is little data to show any follow up in the U.S.

The proof that acupuncture and herbal medicine does have sufficient evidence-based effects to treat chronic inflammatory conditions

A growing body of evidence from scientific study is confirming not only that acupuncture has proven efficacy to treat chronic inflammatory conditions, but how this needle stimulation works. Acupuncture is difficult to assess under the double-blind placebo-controlled conditions used to prove efficacy of corticosteroid pharmaceuticals, yet has been held to this standard. Creating an acupuncture placebo is problematic, and blinding both the administering physician and the patient to this so-called placebo versus real acupuncture has been a challenge. Acupuncture, in effect, has been held to higher standards of proof than any other manual therapy. Despite this, the NIH and WHO have reviewed evidence over decades and long ago declared that acupuncture is a proven evidence-based therapy for many chronic inflammatory conditions. Meta-analysis since then has shown that success in human clinical trials has been demonstrated in the treatment of rheumatoid arthritis, bronchial asthma, pruritic dermatosis, carpal tunnel syndrome, and other inflammatory disorders in humans and animals (SCOGNAMILLO-SZABO, BECHARA, 2001). Specific trials in recent years have confirmed the efficacy of acupuncture treatment on allergic rhinitis, bronchial asthma, eczema, rheumatoid arthritis, and other chronic inflammatory disorders (TOWNSEND et al 1999; TUMACHI 1999, CASIMIRO et al 2002, STERUER-STEYA, RUSSUB, STEURERC, 2002; BIELORY, HEIMALL, 2003, MADSEN et al 2003; MCCARNEY et al 2004). Each year clinical study is advancing and producing greater proof of the efficacy of acupuncture.

How does acupuncture control chronic inflamamtory conditions? Since the inflammatory response involves a complex set of highly orchestrated events in the body, with a cascade of chemical mediators insuring a highly regulated and modulated effect, this is a difficult question to study. The initial response to tissue injury and disease is largely controlled by the hormone cortisol, which is constantly produced mainly by the adrenal glands in a controlled diurnal cycle. Many health problems, especially hormonal imbalances, can adversely affect the diurnal cortisol levels and responses. Corticosteroids are synthetic chemicals that mimic this hormonal inflammatory mediator. There are many other inflammatory mediators in the body besides cortisol. Prostaglandins and interleukins are inflammatory mediators that are inhibited by non-steroidal anti-inflammatories. The problem with these pharmaceutical approaches is that when the whole cascade of inflammatory mediators is not addressed by the therapy, and that severe inflammatory dysregulation can occur, with disastrous results. Since the inflammatory process is a beneficial process in the body, evolved to repair and maintain healthy tissues, inhibition of a part of the process can produce unwanted results. The trials of malpractice and medical injury concerning the anti-inflammatory COX2 inhibitor, Vioxx, revealed that chronic use of this medication resulted in perhaps 50,000 deaths related to inflammatory dysregulation. The promise of acupuncture is that is may stimulate the whole natural cascade of inflammtory mediators in the body, and thus avoid these dangerous and unwanted side effects.

A 2005 study on animals at University Medical Schools and Veterinary Schools in Sao Paulo, Brazil, (Szabo et al, Sao Paulo State University and University of Sao Paulo, Faculty of Medicine, funded by ELISA and FAPESP), investigated the more specific effects of inflammatory modulation with acupuncture. Previous studies had demonstrated that acupuncture significantly suppressed neutrophil migration to the site of induced inflammation in the peritoneal cavity of study animals. Neutrophils are white blood cells that are the main immune reaction to acute infection and inflammation, and the peritoneum is the lining of the abdominal cavity. It was found that this acupuncture effect was not mediated by corticoid adrenal hormones, because a drug that blocked the corticoid receptors, RU-486, did not interfere with the immune response. Three cytokines, or inflammatory mediators, tumor necrosis factor alpha (TNFalpha), interleukin-1 beta (IL-1beta), and interleukin 10, were measured. It was found that acupuncture stimulation from just 3 needles distally placed, significantly inhibited just the interleukin-1beta, an important cytokine that stimulates neutrophil migration in the inflammatory complement system in humans. The researchers found that acupuncture stimulation exerts a modulatory effect on inflammation, and that specific effects are probably also tied to specific acupuncture locations on the body. In this study, the sites were between the eyebrows, at the lumbosacral junction, and near the anus. As with all such studies, the choice of acupuncture points and stimulation was designed for simplicity, and was probably less effective than many clinical acupuncture treatments.

The implications of this study, and numerous other scientific studies of anti-inflammatory, or inflammatory modulation effects of acupuncture, are that acupuncture stimulation is now proven to have an array of effects that modulate chronic and acute inflammatory states, and that these various effects stimulate an improved natural response in the body to inflammation. These studies also imply that various types of point selection and stimulation techniques are proven to have specific effects. In short, the empirical evidence collected over centuries in China concerning the application of acupuncture are proving true, based on modern laboratory measurement and modern scientific method.

Anti-inflammatory effects of Chinese herbs are the subject of numerous well-funded studies and clinical trials in the United States, as well as China, many European countries, Japan, Australia, Brazil, etc. One only needs to go the U.S. Natiional Institutes of Health Pub-Med database to access many of these scientific studies. The important points we see elucidated in herbal studies are that the effects are dose dependant, that the choice and quality of herbs are important, and often that the extraction methods are important to achieve the correct chemicals. The way to insure that these objectives are achieved is by utilizing professional herbalists and their professional products. Most of these highly trained professional herbalists in the United States are Licensed Acupuncturists.

The key point when examining scientific evidence of the anti-inflammatory effects of acupuncture and Chinese herbs is the difference between the use of steroidal and non-steroidal synthetic medicines and the effects of acupuncture and Chinese herbs. The pharmaceutical approaches are specific and allopathic, meaning that the chemicals are designed to alter specific mechanisms in the inflammatory cascade. Acupuncture and Chinese herbs have been shown to have similar effects, but in a modulatory and varied manner, stimulating areas of the complex inflammatory cascade that may not be working efficiently due to some health problems in the body. The chance of side effects with the latter approach are slim, and the possibility of restoring the patient metabolisms are great. The endproduct of therapy should be a healthier immune system with Complementary Medicine, whereas the chronic use of synthetic corticosteroids has been found to have negative effects on the whole system, especially in producing adrenal insufficiency, which would negatively impact the ability to respond to future inflammation and infection. Acupuncture and Chinese herbs may also be varied each patient and treatment, producing individualized effects that the physician can choose in response to a changing condtion of the patient. The last significant advantage of the acupuncture and Chinese herbs is that the treatments can also be expanded to stimulate improved adrenal and immune function, producing future indirect benefits for the patient.

Patient choices in the treatment of inflammatory disease

What are the considerations when discussing this type of therapy and what are the more conservative therapies that you can try? Risk versus benefit and lowering dosage are important considerations that should be included in your discussion. Monitoring for serious harm should be adopted on a schedule. The ultimate decision on whether to take these medications always lies with the patient. Never abruptly stop corticosteroid therapies, because the body needs to respond by starting to increase the natural production of these hormones. Safer conservative therapies can be tried and you can see for yourself whether you are making progress with these therapies. Scientific study has confirmed the efficacy of both herbal medicines and acupuncture in the role of inflammatory regulation and modulation, but the best approach is often to combine a variety of therapies to specifically address both the symptoms and underlying causes of chronic inflammatory and rheumatic conditions. This includes herbal prescription, improved diet and lifestlye, dietary supplements, physiotherapies, and acupuncture. The expertise and ability of the therapist administering these therapies is all important, as well as the attention of scientific study and evidence-based medicine. Herbal therapies, acupuncture, and physiotherapies are complicated subjects and there is much variation in the outcome depending on the skill of the practitioner. The choosing of the Licensed Acupuncturist if often very important, especially in more difficult diseases.

Choice of herbal medicine to treat chronic inflammatory and rheumatic conditions is also important. Many patients are swayed by internet sites that present herbal information and promote products with outlandish claims of benefit. Since the herbal industry is unregulated, commercial products should not be trusted for serious medical problems. Professional herbalists have access to products that are genuine and tested, since professional herbalists are much more demanding and educated in herbal science than the general public. These professional products may cost more than the discount products that are highly advertised, but this quality is essential to the cure. Physiotherapies may be very important in the overall treatment of inflammatory rheumatic conditions, but may be administered by therapists that have received only a few months of training. Hospitals and clinics often choose to hire the less trained physiotherapists for ‘therapeutic massage’. On the other hand, a TCM physician, or Licensed Acupuncturist, may have advanced training in physiotherapies, and be able to apply this training better, due to the years of advanced education in pathophysiology received in the TCM medical school. Physical therapists are well trained but often emphasize only rehabilitative exercise rather than soft tissue therapy and passive manipulation. The TCM physician may or may not have advanced training in physiotherapy, called Tui Na in China, and this too should be a consideration when choosing an acupuncturist. Acupuncture outcome, too, is completely dependant on the skill of the practitioner. While the act of needle insertion is simple, the obtaining of a response is a subtle and complicated process that depends on both the manual skills of the acupuncturist and the attention to the responses of the individual patient to the needle manipulation.

Hopefully, you can arrive at a course of therapy that is both safe and beneficial. You may choose to try safer conservative therapies before resorting to corticosteroids, or you may be on corticosteroids and try to see if you can have success with safer conservative therapies and gradually reduce your use of these potentially harmful corticosteroids. Either way, I hope this handout had helped you to make these important decisions.

One more note: many patients feel that the steroid asthma inhalers and medications must be safe because of the widespread use. Clembuterol, an asthma medication similar to albuterol, is used by professional athletes and bodybuilders to promote muscle growth. This steroid inhaler has the same strong effects that other steroids have.

Information Resources

A 2009 consensus statement on the management of chronic hand eczema with standard medicine, published in the medical journal Clinical Experience in Dermatology, states that current treatment is often inadequate, and is limited to emollients, barriers, soap substitutes, topical steroids and calcineurin inhibitors: http://www.ncbi.nlm.nih.gov/pubmed/19747339
A 2009 study at Yonsei University Department of Dermatology in Korea finds that topical calcineurin inhibitors induce serious negative effects in the skin, exposing the patient to risk of infection and dryness: http://www.ncbi.nlm.nih.gov/pubmed/19703225
Currently, the Allergy Society of South Africa, and other organizations worldwide, reluctantly acknowledge that treatment with Chinese herbs is known to be clinically effective in treating eczema, although very problematic to study due to the complex pharmacology of herbal formulas. The page link acknowledging Chinese herbal medicine has since been taken down, but this page, showing that the medical society acknowleged efficacy of herbal medicine to treat eczema as far back as 1995, is still up: http://www.allergysa.org/C_OL_Alternative.asp
As far back as 1995, scientific research has understood that specific allergens produce altered immune responses that are tied to eczematous atopic dermatitis, yet the identification and avoidance of allergens to resolve eczema is not widely practiced. Here, German researchers show that dust mites and milk casein produced specific T-cell responses that caused eczema symptoms. Mast cells in the skin induce increased migration of T-cells to the area and present the antigen or allergen to the T-cells that are stimulated by specific allergens. http://www.sciencedirect.com/
A 2000 statement by the University of Colorado Health Services Center points to the need for a more complex multidisciplinary and holistic approach to atopic eczema, especially as public health studies showed that eczema, or atopic dermatitis, preceded the onset of allergies and asthma in a high percentage of patients, and seems to be associated with a number of physiological systems in the body: http://www.sciencedirect.com/
A 1993 study found that increased fibrinogen and clotting factors were evident in the blood of eczema patients during times of active symptoms. The enzymes nattokinase and serratiopeptidase, as well as various herbs other nutrient medicines may address this aspect of the disease: http://www.ncbi.nlm.nih.gov/pubmed/8108797
A 2006 study found a consistent deficiency of selenium and an excess of copper in the blood of patients with eczema: http://www3.interscience.wiley.com/journal/119478134/abstract
An overview of nutritional medicine in eczema treatment can be seen at sites such as this: http://findarticles.com/p/articles/mi_m0ISW/is_2003_May/ai_100767893/
A 2008 study found that a Chinese herbal formula with Mu dan pi, Chi shao, Huang bai, Jin yin hua, and Bo he significantly attentuated histamine release and prostaglandin synthesis from mast cells activated by IgE antibodies, explaining the efficacy of the formula in treating eczema http://www.ncbi.nlm.nih.gov/pubmed/18725279?itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_RVDocSum&ordinalpos=2
A 2008 study found that the hypothalamus was integral to the cyclic guanosine monophosphate immunoreactivity in our bodies, which has long been associated with psoriasis and the mechanism of the shortened cell cycle in the skin: http://ajpregu.physiology.org/cgi/content/abstract/295/4/R1341
A 2010 article in Canada describes recent findings by Harvard University researcher Dr. Zinaida Lima that psoriasis is linked to increased risk of micarriage, preeclampsia and ectopic pregnancy, and that many standard drugs used to treat psoriasis carry such risks themselves. The article covers a Canadian doctor who specializes in herbal therapies to treat psoriasis and cites a high percentage of success, as well as an article in the International Journal of Dermatology in 2004 that cites a 75% rate of improvement in symptoms with Chinese herbal therapies: http://www.streetinsider.com
The National Psoriasis Foundation in 2010 confirms that Complementary and Integrative Medicine (acpuncture, herbal medicine etc.) is proven effective and that acceptable scientific studies are now rapidly providing new guidelines for expanded use with standard medicine: http://www.psoriasis.org/netcommunity/sublearn03_comp_approach
A 2008 study of Chinese herbs that treat allergic diseases, performed at Konkuk University School of Medicine in Korea, found numerous herbs that were effective, and one herb, Sophorae Flos (Huai hua mi) that exerted the most significant inhibition of mast cell allergic responses: http://www.ebmonline.org/cgi/content/abstract/233/10/1271
A 2007 study in China found that an ointment with Indigo naturalis, or Qing dai leaves, was effective in controlling and inhibiting psoriasis, both by modulating proliferation and differentiation of keratinocytes in the epidermal skin, and by inhbiting T lymphocyte chemokine attraction to the keratinocytes, which stimulates that abnormal growth cycle: http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowAbstract&ProduktNr=224164&Ausgabe=232802&ArtikelNr=98576
Medscape Today lists the top 10 herbal remedies currently utilized by medical doctors in the United States: http://www.medscape.com/viewarticle/567028_2
The role of melatonin in the pathogenesis of psoriasis has long been noted in modern medicine: http://cat.inist.fr/?aModele=afficheN&cpsidt=18763047
The role of sulfur compounds and the natural cell detoxification of these compounds, such as glutathione and methionine are well documented in the normalization of skin cell disease mechanisms. Therapy may utilize sulfur containing herbs in ointment as well as nutrient medicines to boost glutathione metabolism: http://archderm.highwire.org/cgi/content/summary/34/4/568
The role of superantigens in psoriasis has been the subject of much of the research to find cures in the last decade. This research summary is from Duke University Medical Center, Durham, North Carolina, in 2001: http://ebm.rsmjournals.com/cgi/content/abstract/226/3/164
Herbal research has proven in a double-blind placebo human trial that Mahonia aquifolium produces significant benefit in the treatment of psoriasis with 12 weeks of use. This herb is analogous to the most common herb studied in China, Berberis vulgaris, or ,the active ingredient berberis is found in Coptis chinensis, or Huang lian: http://journals.lww.com/americantherapeutics/pages/articleviewer.aspx?year=2006&issue=03000&article=00007&type=abstract
A 2009 study at Harvard Medical School and Immune Disease Institute found that a chemical derived from the Chinese herb Chang Shan, or Dichroa febrifuga, halofuginone, selectively inhibits a driver of autoimmune T-cell responses, Th-17, by activating a natural chemokine protective response, the amino acid starvation response. This activity would potentially inhibit the root autoimmune response that causes psoriasis. Unfortunately, the synthesized chemical derivative is highly toxic. Once again, use of the traditional Chinese herbs has been proven safe for thousands of years, but attempts to synthetically create chemical derivatives for patented use often proves to be risky: http://www.ncbi.nlm.nih.gov/pubmed/19498172 describes birth defect risks
Bass and Boney Pharmaceuticals website www.rosacea-ltd.com/pregnant-rosaceans.php.3 describes birth defect risks
About.com, accredited by Health on the Net http://ibdcrohns.about.com/cs/prescriptiondrugs/p/medprednisone.htm
British Medical Journal: http://adc.bmj.com/cgi/content/full/90/5/500
Lymphomation.org: www.lymphomation.org/side-effect-prednisone.htm
Respiratory Medicine vol.100, issue 8; 1307017 (Aug 06): www.resmedjournal.com/article/PIISO9546110500510X/abstract

“long-term use of high-dose inhaled corticosteroid therapy has potential to cause systemic side effects – impaired growth in children, decreased bone mineral density, skin thinning and bruising, and cataracts. Hypothalamic-pituitiary-adrenal-axis suppression, measured by serum or urine cortisol decrease correlates with the occurrence of systemic side effects of high-dose inhaled corticosteroids.”

The information on this website is not intended to be used as a specific medical advice or cure. Please consult with the practitioner or an appropriate physician, such as a licensed acupuncturist, naturopath, or medical doctor, to discuss the proper application of the information contained on this website.