Eczema (atopic dermatitis) is the most common skin condition among children worldwide. Traditional Chinese medicine (TCM) practitioners have been treating it for thousands of years, and those treatments are just as effective for children today.

Skin conditions are difficult to ignore. Atopic dermatitis is a common, chronic, life-altering disease that affects the skin. Atopic dermatitis is often referred to as "eczema" (and these terms are used interchangeably throughout the article).

Eczema is a general term for several types of inflammation of the skin (of which atopic dermatitis is the most common). The word "dermatitis" means inflammation of the skin and "atopic" refers to a group of diseases where there is a tendency to develop other allergic diseases such as asthma and hay fever. Eczema comes from the Greek word meaning 'weeping skin' and is the most common skin disease in children. In Chinese, the name for eczema is Shi Zhen ('damp sore').

Worldwide eczema affects 12-25% of children. Of these children, 49-75% will develop eczema before they are 6 months old and 80-90% before they are 5 years old. There are three phases of eczema and this article we will discuss the first two – the infantile and childhood phase. The discussion of these two stages will relate to any eczema sufferer whose first onset of eczema was before puberty. About 6 out of 10 children will continue to have eczema after puberty and 10-15% of adults continue to suffer from their childhood eczema. Over 2 million Canadians and 15 million Americans suffer from eczema.

Changes in the reported prevalence of childhood eczema since World War 2 were studied in 3 national cohorts of children born in 1946, 1958, and 1970. The overall rates of this disease rose from 5.1% in children born in 1946, to 7.3% in those born in 1958, to 12.2% in the 1970 cohort.

Since 1970, the prevalence of eczema has nearly tripled. The latest research from England of 14,000 children born in the 90's showed that 1/3 of these children developed this disease by the age of 3 years old. This, coupled with the chronic and recurring nature of the disease, has made it difficult for Western physicians to treat and frustrating for children and their parents. Eczema often starts in babies when food is first introduced or when new foods are introduced. Eczema is most common in children who have family members with asthma, allergies and/or eczema.

According to a recent study, more than 50 per cent of eczema sufferers are not satisfied with their current treatment1. There is no cure for this disease in modern medicine and management of this disease is the only treatment available. Traditionally in modern medicine eczema has been treated or managed with moisturizers to rehydrate the skin, topical corticosteroids for inflammation, oral antihistamines to control the itch, and when there is infection, antibiotics. Topical corticosteroids have been used for 30 years to treat eczema but they are not an ideal treatment because they do not produce a cure and they have side effects. The unpredictable nature of eczema and lack of a good treatment in Western medicine makes it difficult to manage and some people simply give up on searching for an effective treatment. What everyone does not know is that Traditional Chinese Medicine is very effective in the treatment of this disease and can reduce the discomfort and severity of their eczema. TCM offers a long-term solution to this chronic disease and because it treats the root-cause of the disease it can often produce a cure for pediatric eczema.

TCM and Atopic Dermatitis (Eczema)
Chinese medicine has been proven over 2000 years to be effective in treating various diseases including eczema. Many clinical studies have been completed on the effectiveness of various Chinese herbal formulas in the treatment of eczema. Unfortunately, these studies are completed in China and therefore written in the Chinese language making them not accessible to modern medical doctors. [This is why I learned to read Chinese to access this vital information!]. However, because of the remarkable success TCM doctors in England were having in the treatment of stubborn cases of eczema that would not respond to many types of conventional treatment, various skin doctors started to take notice. Doctors have a natural antipathy towards anecdotal evidence and so there seemed little else to do but to set up a proper scientific study in English. Multiple studies were conducted and reported in British medical journals. All studies concluded that Chinese herbal medicine was an effective treatment for atopic dermatitis and there were no side effects to these treatments.

One of these research projects (placebo-controlled double-blind trial) was a one year study2 of 37 children suffering from eczema conducted at The Hospital for Sick Children, London, England. This study revealed that Chinese herbal medicine offered an effective treatment particularly for those children who failed to respond to modern medical treatments. At the end of the study, 18 (49%) had at least a 90% reduction in the severity of their atopic dermatitis after 8 weeks of treatment. Another 5 cases (14%) improved to a lesser degree during the same length of time.

In clinical practice, Chinese medicine is customized to the individual but for the sake of research, in the above study the treatment had to be standardized for each patient. To minimize the error introduced by prescribing identical medicine for all patients, only those cases with a particular type of eczema according to the Chinese pattern discrimination were selected for the clinical trial. Although not ideal from a holistic perspective, all patients received the same herbal prescription. The only allowance made for individuality was in terms of dosage. I believe the results would have been even better if the study allowed the practitioner to further modify the patient's prescription based on their clinical presentation. Also it is important to remember the results obtained were spectacular given the circumstances and considering this study included only very severe cases of eczema.

Symptoms of Atopic Dermatitis (Eczema)
Regardless of how minor or severe a person's eczema is, everyone has the same basic symptoms – dry skin, sore rashes, and terrible itching. The management and prevention of 'flare-ups' can be both frustrating and uncomfortable, especially for a young child. When atopic dermatitis is severe, it can lead to serious health problems and negatively affect their quality of life by interfering with normal, everyday activities.

Symptoms (signs) vary from person to person. Extreme itching (pruritus) is the most important symptom of atopic dermatitis. Scratching and rubbing in response to itching irritates the skin and leads to the other common symptoms of eczema such as redness of the skin, swelling, cracking, "weeping" clear fluid, and finally, dryness (xerosis), crusting and scaling. Itching is a particular problem during sleep when conscious control of scratching is lost.

The appearance of the skin that is affected by atopic dermatitis depends on the amount of scratching and the presence of secondary skin infections. One other type of lesion common in atopic dermatitis is lichenification, which appears when the skin over time becomes thick and leathery due to repeated damage from scratching and rubbing. It is also common for individuals with eczema to have a higher incidence of asthma and hay fever (i.e. allergic rhinitis) with 30% of these patients presenting with these associated diseases.

According to modern medicine the symptoms of atopic dermatitis discussed above are associated with malfunction of the body's immune system and appear when the body reacts to elements in the environment which would normally be harmless. Scientists have found that people with atopic dermatitis have a low level of a cytokine (a protein) that is essential to the healthy function of the body's immune system and a high level of other cytokines that lead to allergic reactions. For example in atopic dermatitis, the immune system may fight against common house-dust mites or pollen allergens causing the skin to become red, itchy and inflamed.

In most cases, the severity of this disease fluctuates with sometimes the disease being worse (called exacerbations or flare-ups) followed by periods of time when the skin improves or clears up (called remissions). In some cases, the itching and redness is so serious and intense sufferers scratch themselves until they bleed, increasing the risk of secondary infection.

Commonly, eczema can produce a vicious cycle. Something irritates the child's skin, making it red and inflamed and because it itches, the child scratches it. The outer protective layer of the skin is lost. The affected area is even more sensitive to irritants, and dries out easily. The child's skin continues to be exposed to whatever it was that triggered the initial episode and the rashes develop. The cycle perpetuates itself.

Several studies suggest that atopic eczema has a more profound effect on the quality of life than other skin diseases, such as acne and psoriasis. Children may experience sleep disturbance due to the "itch-scratch-itch" cycle and lack of confidence due to low self-esteem. Families of sufferers also experience sleep loss. If eczema runs in the family, it is more likely to be a lifelong condition. Even so, it is often worse in the first years of life and therefore is important to treat at this time.

Stages of Atopic Dermatitis (Eczema)
Distribution and morphology (described above) of the lesions of eczema vary with age.
Infantile Phase (up to 18-24 months): When atopic dermatitis occurs during infancy and childhood, it affects each child differently in terms of both onset and severity of symptoms. In infants, atopic dermatitis typically begins around 6 to 12 weeks of age. It may first appear around the cheeks and chin as a patchy facial rash, which can progress to red, scaling, oozing skin. After this, the skin tends to become thick, dry and scaly. Once the infant becomes more mobile and begins crawling, exposed areas such as the inner and outer parts of the arms and legs, may also be affected. At this stage, the severity tends to fluctuate with a number of factors including: acute respiratory disease, teething, bacterial infections, emotional stress, climatic changes, diet and immunization (sometimes this is when it first appears). Fewer than half of these cases will clear by 18 months. The infant is often restless and irritable because of the intense itching and discomfort of the disease at this stage.
Childhood disease (18-24 months-puberty): In childhood, the rash tends to occur behind the knees and inside the elbows; on the sides of the neck; around the mouth; and on the wrists, ankles, and hands. Another Chinese name for atopic eczema is Si Wan Feng which means "Four Flexure (or Bends) Wind". This name indicates that TCM recognizes the tendency of this disease (at this stage) to occur behind the knees and inside the elbows. Often, the rash begins with red, bumps (i.e. papules) that become hard and scaly when scratched. The face is less frequently affected at this stage. Due to the chronic nature of this disease at this stage, problems with schooling may occur. The eczematous lesions tend to be replaced by lichenification.

Treatment of Atopic Dermatitis Based on TCM Patterns
In TCM, the symptoms of pediatric atopic dermatitis are divided into three different patterns or groups of symptoms. The treatment principles are different for each pattern. The two main patterns described are wet, 'weeping' (i.e. damp heat) eczema and dry, scaly (i.e. blood heat with wind or spleen vacuity/blood depletion) eczema. The third pattern mentioned in TCM literature is called Foetal heat. Note that all forms of eczema are related to heat/dryness, which emphasizes the prominent superficial inflamed or red nature of the skin that is so common in atopic dermatitis. TCM treatment is based on differentiating whether the lesions are dry or damp, the stage of the eczema and what areas are affected.