TCM Psoriasis Treatment – 1 Effective Method You Should Not Rule Out!

If you are looking at this page, you probably are considering the use of Traditional Chinese Medicine (TCM) to treat psoriasis.

Traditional Chinese medicine is under-rated as a treatment for common skin conditions like acne, eczema and psoriasis, so this article should shed further light on how Chinese medicine is very helpful for treating diseases in dermatology, especially as it relates to a condition like psoriasis.

Psoriasis according to Western Medicine

Psoriasis is a systemic skin disease characterized by chronic inflammation of the skin. There is an abnormality in the rate of maturation of keratinocytes, resulting in dry, thickened and silver-scaled plaques.

Up to 50% of psoriasis start on the scalp, with most people seeing it as dandruff and an inconvenience, rather than a medical condition that can flare up if not monitored and managed.

Modern medicine will almost always include the use of steroids in the treatment of skin conditions; psoriasis is, after all, a disease of inflammation.

In addition, there are vitamin D derivatives (like calcitriol) as well as vitamin A acid derivatives (retinoids) that come in handy. Immunosuppressive agents like cyclosporine and methotrexate (MTX) are also commonly prescribed.

Psoriasis as a skin disease is largely linked to the vagaries of one’s immune system, and conventional therapy clearly DOES address the mechanisms that create the immune imbalance in the first place.

Support for TCM treatment of Psoriasis

Still, it is worth exploring approaches to dermatology from the traditional Chinese medicine perspective.

Browsing through a systematic review (SR) or meta-analysis (MA) will show that treatment with Chinese herbal medicine can

  • Ameliorate clinical symptoms
  • Decrease the psoriasis area and severity index (PASI) score
  • Delay recurrence
  • Reduce the side effects of Western medicine; as well as
  • Enhance one’s quality of life.

Is Psoriasis a Yin Yang imbalance?

Psoriasis often presents as excessive Yang Heat crowding out insufficient Yin Fluids; this is so because of internal health conditions that are built into one’s body constitution.

From an immunological perspective, the Yin Yang imbalance in the psoriatic body is a condition of excess levels of Th1 and Th17 (yang) relative to Th2 (yin) that causes abnormal growth of skin cells.

That said, psoriasis is certainly more complex than Yin and Yang. The more fitting way to view it is in terms of the pathogens like wind-heat, blood-heat, damp-heat, heat-toxins and etc.

Each of these pathogen has a different presentation of signs and symptoms. Because of this, there are an exclusive range of herbal ingredients that are always appropriate to use depending on how the psoriatic flare is presenting.

Therefore, while psoriasis is a condition of systemic inflammation, the choice of herbs for each individual patient is going to be different depending on the individual’s signs and symptoms.

Traditional Chinese Medicine Perspective on Psoriasis Treatment

In Chinese Medicine, internal health conditions are often mapped to external representations like the state of the pulse and tongue. The converse is true, that one’s skin condition has an underlying cause.

In psoriasis, this ‘underlying cause’ actually differs depending on which phase of the skin disease you are in, or where your lesions are showing up.

Some patients may come in in the early stage of mild psoriasis, often without too much accumulation of heat or toxins; others may come in with harden plaques, usually representative of a blood stasis pattern.

Some patients may present only with reddened lesions with silver flakes around the hairline; others present with stubborn inverse psoriasis around the armpits and genitalia.

The TCM treatment plan focuses on how the patient’s symptoms show up, and not on the disease labelled ‘Psoriasis.’

Psoriasis TCM Singapore

The traditional Chinese medicine perspective is that Psoriasis is made up of different pathogenic elements, for example, wind, dryness, heat, toxin, etc.
Chinese medicine TCM Doctors assess the relative weight of these ‘pathogenic elements’ by looking at signs (like the level of redness) as well as symptoms (like how hot the patients feels or how itchy the lesions are).

The practitioner then proceeds to decide on customized oral medicine aimed to reduce the intensity of these pathogenic elements.

For example, for a person with a heavy weight on toxin accumulation, a comprehensive skin treatment plan will involve heavy focus on clearing out heat-toxin and its accompanying symptoms.

A person who is exhibiting Blood dryness at the end stage of a flare will be treated in a manner that support the Spleen and Stomach, so that new Blood can be generated that lubricates the body’s surface, taking away symptoms like dry-heat or dry-itch.

In Singapore, while the preponderance of psoriasis is nowhere near that of eczema, it is widespread enough to have many local Singaporean seeking TCM treatment for psoriasis.

Two Different Skin Conditions: Eczema vs. Psoriasis

Skin conditions are sometimes difficult to differentiate from one another. Patients always have problems differentiating eczema from psoriasis.
In Singapore, eczema is the most common skin conditions that plague a subset of our population.
Eczema is actually a blanket term that people use to refer to atopic dermatitis, and atopic dermatitis can be seen as the immunological opposite of psoriasis, which we will touch on later.

Differentiation by presentation on body

Many people who suffer from psoriasis think it is eczema, but these are actually two skin conditions with different etiologies. One common way to differentiate eczema from psoriasis is to look at elbow or knee lesions.
Lesions in the inner elbow or back of the knee are most likely eczema lesions; scaly lesions on the pointy part of the elbow, or around the knee cap are most likely indicative of psoriasis.

Differentiation by age and ethnicity

Eczema is more common in children, even showing up as early as the first month of birth. For psoriasis in children, the incidence in Asia (read: Singapore too) is almost zero.
Only about 25% of psoriasis develops before the age of 20, and for those children who contract psoriasis, it is often guttate psoriasis or psoriasis triggered by an upper respiratory infection.
While psoriasis is more common in Caucasians, we are seen enough Asians coming in to our clinic in Singapore with a psoriasis diagnosis and wanting TCM treatment.

Differentiation by Geography

Also interesting to know is that for skin disorders like psoriasis, prevalence increases as we move further away from the equator. The converse is true for acute and chronic eczema, which is rampant in equatorial regions with high humidity.

We have seen adults with little to no skin sensitivities suddenly flaring up with eczema after coming to equatorial Singapore. These same people are also very aware of the close relation between aggravation of signs/symptoms and the humid climate.

Case Study: Patient Receives TCM Psoriasis Treatment

Psoriasis is a skin condition associated with chronic inflammation in the body. There is an abnormal rate of maturation of the keratinocytes on the body’s surface. This results in silver-scaled plaques that when peeled off leave a pinpoint streak of blood (Auspitz sign).

A quick search online for systematic reviews or meta-analyses will show that treatment with Chinese herbal medicine can ameliorate clinical symptoms as well as decrease the PASI (psoriasis area and severity index) score. Those on Chinese herbs also may experience delayed recurrence in addition to an improvement in quality of life.

If you are suffering from Psoriasis, do give yourself a chance to give Chinese herbs a chance. You don’t have to believe it to try it. You can do some research online first, but think about it, it is worth a try even if there is only 30% improvement!

 

tcm psoriasis treatment 1 - initial flare - chinese doc singapore

Psoriasis can start in in the scalp, but also on the face and the outer surface of joints, e.g. the angular part of the elbow or the knee caps. It is a medical condition that should be monitored and managed.

The picture above shows how psoriasis might present in a flare situation.

For this patient in particular, the skin lesion started as a small patch in front of the ear. This is actually quite a common presentation in many patients.

Due to stress at the patient’s workplace, the skin lesion expanded and even moved downwards toward the neck.

tcm psoriasis treatment 2 - flare dispersing - chinese doc singapore

Many people are suspicious about how effective herbal medicine can be for a stubborn condition as psoriasis. That said, if you suffer from psoriasis, it can be rewarding to consider the traditional Chinese medicine approach to treatment.

In the image above, the patient has been on two rounds of herbal treatment.

The lesions are mostly flatter, and have dispersed a bit. The redness has also reduced significantly, and the patient is happy with the results.

tcm psoriasis treatment 3 - lesions cleared - chinese doc singapore

After four and a half months of treatment using Chinese herbs only, these lesions have disappeared completely. For some of our patients, this type of recovery is not enough, but for others, it is life-changing.

Many people give it a try, use herbs for one or two weeks, and usually continue if they feel that the herbs are helping.

Over time, many people arrive at a 80-90% clearance of the psoriatic lesions, and that is considered to be a huge improvement, considering that psoriasis is a usually long-standing and really reduces your quality of life.

Location of Lesions

Psoriasis is categorized by location of lesions, with each location having particular characteristics. Below is a quick summary of some of the common locations and how they present.

Psoriasis on different parts of the head

Scalp: Psoriasis often begins on the scalp of the head, and may remain there for a long time before spreading to other parts of the body. It is a fallacy to ignore scalp lesions at the early stages, because this is the best time for treatment intervention, before it has the potential to spread to other parts of the body.

Face: Lesions at the frontal hairline may appear together with lesions on the forehead, often as mild and diffuse lesions.

Eyelids: If the eyelids are affected, it can be a mild erythema without too much scaling. Rarely, it cause the edges of the eyelids to become dry and crusty, and this is a much more painful to bear.

Ears: Lesions may often appear around the ears, but also occurs in the external ear canal. Ear lesions may feel a little more itchy lesion on the other parts of the body.

Palmoplantar Psoriasis and Nail Changes

Palmoplantar psoriasis is chronic and recurrent, involving cracking, blistering and swelling on the palms of the hands and soles of the feet.

It is difficult to differentiate palmoplantar psoriasis from pomphloyx eczema, and the biggest clue would be the Auspitz sign (if it is apparent, that is).

The auspitz sign is bleeding that occurs upon removing the deepest layer of scale from the surface of psoriatic plaques.

Nail changes often occur in psoriatic patients, and commonly appear in the form of pitting, onycholysis and discoloration. While these changes are not specific to psoriasis, they can be used as a means to finesse the diagnosis.

Common forms of Psoriasis

Psoriasis can also be categorized into different forms that it will manifest. Here below, we will do a brief summary of the main form, as well as other forms that it may be good to know about.

Psoriasis Vulgaris

Psoriasis Vulgaris is also known as Plaque Psoriasis. This is the most common presentation of psoriasis, where smaller scaly bumps grow bigger into plaques, and these plaques merge into one another to form even large plaques to form hardened red plaques. The skin usually itchy and there is usually the Auspitz sign.
Plaque Psoriasis is classified into 3 phases. There is the active progressive phase (described above) and the stable phase (where old lesions are covered with thick whitish scales, but new lesions do not appear) and the regressive phase (where the plaques flatten, turn pale and decrease in size). This regressive phase is what Chinese herbal treatment attempts to bring about in a natural and safe way.

Other forms

We shall not cover too much more here, but there is the guttate type, which is often seen in young children, the erythrodermic type, which is also known as Psoriatic Exfoliative Dermatitis, as well as the pustular type, characterized by non-infectious yellow blisters, often congregating around the hands and feet.
Psoriatic Arthritis (PA) can be understood as a psoriatic skin condition combined with joint pain of autoimmune origin.

TCM treatment for Psoriasis may not need too long a time to see effect

Contrary to what many may think, psoriasis treatment with customized oral herbal medication can commonly deliver results within a week or two.

Even if it is feeling 10% better after a week of TCM treatment, most sufferers of psoriasis are able to still appreciate when redness, itch or scaling is reduced.

For such people, it is clear that while the improvement is marginal, it makes sense to continue TCM treatment to improve the condition even more.

Limitations to the speed and extent of TCM treatment for Psoriasis

We need to manage expectations though, because there will always be the outlier patient whose body may take a longer time to respond to the treatment.
There are also cases where the TCM approach is able to clear out 90%, but somehow is unable to clear the remaining 10% of the psoriatic lesions.

Psoriasis Treatment – Acupuncture

Acupuncture is actually very good for skin health, and is also known to be useful treatment for skin diseases like acne and eczema as part of a comprehensive skin treatment plan.

However, most patients with mild to moderate eczema do not require acupuncture, and we mostly recommend acupuncture only if the effect of the herbs have reached a plateau, or if there are local flares, psoriatic arthritis or erythrodermic psoriasis.

Psoriasis Treatment – Chinese Herbal Medicine

We use customized oral herbal medication as the mainstay of psoriasis treatment.

Psoriasis is largely linked to an imbalance within the immune system. To put it simply, this chronic skin condition is associated with a relative excess of type-1 and type-17 T-helper cells.

Modern clinical research tells us that TCM herbal formulas act to rebalance one’s immune system. When we implement treatments for psoriasis, the TCM treatment plan focuses on balancing out your body from inside out, in the most natural way possible.

This involves both treating your body constitution and treating the way your body is manifesting a flare. There is also a component of treating the blood, whether it is blood heat, blood deficiency, or blood stasis.

Place your bets more on Internal medicine than on acupuncture

One’s immune system is what we want to change, and customized oral herbal medication can be most useful for that.

For some patients, we also recommend external medicinal application on the skin lesion. Each topical we create is a botanical formula inspired by ancient TCM texts, and backed by modern clinical research.

Triggers for one’s immune system

It is known that having a family history of this skin condition makes you more susceptible to experiencing your first outbreak. In genotype psoriasis, something needs to happen in order to trigger a visible outbreak on the skin.

Patients with subclinical psoriasis may present with minimal silvery white dandruff on the skin, or minimal scaling on the elbows and knees. They are safe, but only until their system is overwhelmed.

Once triggered, the skin will flare, and the body may or may not return to its earlier immunological state. There may also be symptoms that include an increase in heat in the body, difficulty sleeping or digestive upset.

Environmental Triggers for Psoriasis

Psoriasis can be triggered by external factors, that include environmental or dietary triggers. It doesn’t need to even be three days out in the jungle; a hot water shower will already aggravate an existing psoriatic lesion.

That said, at our clinic, it does seem that atopic dermatitis is more easily triggered by the environment, while psoriasis is more easily triggered by the emotions (see below).

Dietary Triggers for Psoriasis

Psoriasis can also be triggered by dietary excesses, and the liver systems may end up congested because patients are eating all too richly. This is why diet therapy is a good point of intervention and a natural and safe way to mitigate a psoriatic condition.

Diet therapy may include cutting down on sugar and dairy intake. Many of the patients who come by our clinic already are seeing a Naturopath to incorporate diet therapy to treat a psoriasis flare.

Do note that while signs and symptoms of mild psoriasis can also be brought under control, some psoriatic conditions are difficult to bring under control even if you follow dietary health’s guidelines to the T.
This is because there is often an underlying emotional trigger.

Emotional Stress as a trigger for Psoriasis

TCM believes that emotional stress can also trigger psoriasis. Emotional triggers may happen due to work, but also surfaces due to difficult life transitions like the passing of a loved one, or the stress of managing a household.

Such will commonly throw the body out of balance, producing visible aggravation to a chronic skin condition. Worse yet, there are adult-onset psoriasis patients with normal skin health, but suddenly experience a tipping point in their life, resulting in them making their first visits to the dermatology department.

This is why dietary health’s guidelines can help to a certain point, but, especially for severe psoriasis, it can be useful to look into possible emotional triggers for a psoriatic flare.

Traditional Chinese Medicine to treat Chronic and Severe Psoriasis

TCM Dermatology believes that psoriasis is a persistent and chronic condition, and as the disease progresses, there will be increased blood heat and toxin accumulation, which often show up as inflammation and internal heat. With time, there will also be a layering on of blood stasis and pathological dryness.

In such a situation, the approach to treatment will be more complex. As in all other conditions in TCM Dermatology, the Chinese medicine TCM Physician will have to decide on which aspects to put a heavier weight on.

While psoriasis is normally a condition of inflammation, in chronic psoriasis, there is a subset of patients with a predisposition to deficiencies like ‘cold stomach’ or ‘weak blood.’ Such patients are treated by modifying an existing formula with herbs that support the gut or build the blood.

TCM Psoriasis treatment – How do we know if it is effective?

What is an effective treatment? If your skin feels better after treatment, if your symptoms are reduced or disappear, the TCM treatment is effective.

The body does not lie; it is the best judge on the effectiveness of the psoriasis treatment.

Chinese medicine TCM treatments at our clinic employ the use of herbal medicine internally and externally:

  • After customized oral herbal medication, the patient should see positive changes between 5 -15 days of being treated. This is especially so when using traditional Chinese medicine to treat guttate psoriasis, or at the onset of a mild flare of plaque psoriasis. It can be more complex when treating inverse psoriasis, erythrodermic psoriasis or psoriatic arthritis.
  • After external medicinal application, the patient should feel reduced inflammation and even softening of plaque lesions.

Effect of acupuncture on Psoriasis

If you do decide to use acupuncture to treat your psoriasis, you should see improvements in your skin as early as 1-2 days after treatment.

If you don’t see improvement in your skin after one session of acupuncture, consider that the marginal effect of acupuncture is not significant enough, but do not rule out the efficacy of TCM herbal treatment!

How long do I continue treatment for?

People often ask how long must they come for TCM treatment for psoriasis. The answer is that it really depends on the severity of the condition, as well as the patient response.

Some patients may have suffered with psoriasis for years, and after being treated with TCM for two weeks, they experience improvements that are beyond surprising.

Others have severe psoriasis and do not respond as quickly; this is just how it is, and we may have to support your Spleen a little more, or cool your Blood more strongly to see significant effect.

Whether the TCM treatments are solely through the consumption of herbs, or in tandem with acupuncture, the final treatment outcome we are looking for is an immune system that is more balanced, skin inflammation that is more manageable, and a body that can manage on its own.