Eczema / Atopic Dermatitis

Eczema is a term for a group of skin conditions that are characterized clinically by itching, redness, scaling, clustered papules, and vesicles. Histologically, it is a superficial dermatitis, showing spongiosis in the epidermis and inflammatory cell infiltration around the blood vessels in the dermis.Eczema is commonly used synonymously with dermatitis. However, dermatitis is a broader term referring to any inflammatory skin lesion, while eczema is one type of dermatitis. Eczema can occur on any part of the body. Well-known types include hand eczema, eyelid eczema, external auditory canal eczema, and nipple eczema.Hand eczema accounts for over 80% of occupational dermatitis cases. Occupations exposed to moist environments, such as hairdressers, food service workers, and healthcare professionals, have a higher incidence of hand eczema. Frequent exposure to water during household chores can lead to skin contact with water or detergents, damaging the stratum corneum and compromising the skin’s protective barrier, making eczema more likely. Low humidity is also a risk factor for hand eczema, as it increases the penetration of allergens or irritants, damaging the skin barrier and potentially leading to eczema.In the early stages of eczema, itching is accompanied by blisters and papules, which become red and swollen. Over time, swelling and blistering decrease, but skin folds increase, and the skin thickens. Pigmentation changes and cracking may develop, and severe cases may lead to bleeding. Rarely, scarring can occur.Eczema is generally identified through a visual examination. Diagnosis considers the appearance and distribution of skin lesions, medical history, and environmental factors.To treat eczema effectively, it is essential to avoid environmental triggers. Conventional medical treatment restores the skin to its original state rather than making it more resistant to water or detergents. Therefore, treatment cannot succeed if exposure to water or irritants continues after therapy. Wearing vinyl gloves when handling water can help, but sweat may accumulate under the gloves and irritate the skin. Wearing cotton gloves inside vinyl gloves is beneficial. Moisturizing is crucial in managing dermatitis, so it is recommended to frequently apply creams or ointments to maintain skin hydration.In Traditional Korean Medicine (TKM), eczema is largely considered a major dysfunction of the water metabolism and circulation functions of the body. Because of certain environmental triggers as well as innate constitutional factors, inflammation is believed to paradoxically be accompanied by excessive bodily fluid retention as well as dryness and itching in the affected areas. Treatment aims at restoring the function of the “Triple Burner” organ system, which is believed to be responsible for the normal movement of bodily fluids throughout the body. Treatment Case 1: 10-year-old female childThis patient had a history of asthma and allergic rhinitis since age 1, and suffered from occasional hand and foot eczema. She had a relatively weaker constitution, with a pale tongue, weak pulse, and voice that was difficult to hear. Since about a week ago, she has been suffering from a particularly bad spell of eczema, accompanied by redness, flaking, and severe itching. She was prescribed the ointment Celtect 40mg for 7 days from the family doctor. This helped with the redness and reduced inflammation, but it wasn’t greatly effective at resolving the itching and discomfort. First herbal medicine and acupuncture aimed at reducing the inflamed state of the affected areas was prescribed for a month. This helped reduce the itching feeling, but the patient still complained of flaking and some remaining itching. The treatment plan was changed at this point to nourish the bodily fluids and after another month the patient reported a great reduction in her symptoms.