Stages of Acne

All of us have in one form or another have encounter acne.  Let’s break it down by stages

Acne at 12 to 20

Acne usually starts at puberty.  The surging and fluctuation of hormones becomes a bane of any teenager’s life.  Types of acne ranges from a few pimples during, before or after the menstrual cycle to deep cystic, angry acne on the forehead, cheeks, jawline, neck and/or on the back and shoulders.  At this stage of acne, most common prescription from your doctor would be to go on the pill or Roaccutane.  The pill is used as a band-aid solution to hormonal acne, painful periods, endometriosis, polycystic ovarian syndrome (PCOS), severe premenstrual syndromes and etc.  This is also a stressful period for young boys with surging testosterone hormones that can affect their confidence and emotional well-being. As age progresses, the severity of it usually starts declining.  However, some will persist until adulthood. 

Acne at 20-35

Those that were blessed with clear skin throughout their teenage years then suddenly, acne starts popping out in adulthood are due to fluctuation of hormones caused by stress, lifestyle and diet.  Another type of acne that I commonly see in the stage is women with PCOS.  This type of acne are a continuation from puberty where menstrual cycles are irregular that had not been diagnosed until later stage into adulthood.  In addition, women at this stage are thinking of coming off the pill for fertility purposes or a decision to address issues of hormonal changes that affected you in your teens such as hormonal acne, irregular cycles, painful periods, severe premenstrual syndrome, endometriosis and etc. Coming off the pill may cause the hormones to fluctuate as there is no longer a controlled mechanism derived from the pill. The body often revert back to where it was before you started on the pill. As mentioned before, the pill is often a band-aid solution.

Acne at 45+

This stage of acne is commonly seen in women that are peri-menopause.  In addition to typical peri-menopause symptoms such as hot flashes, day/night sweats, irregular cycles, weight gain, insomnia etc, acne and dry skin may be present.  This is caused by increase in luteinising hormones which increases androgen levels.  In addition, stress and poor lifestyle choices may be a contribution to late onset acne.

What is common amongst the stages of acne is the fluctuation of hormones.  This fluctuation can be due to the imbalances of hormones during teenage years, gyneacological problems (PCOS, Endometriosis etc), stress, emotional challenges, lifestyle and diet.  In Chinese medicine, we look at the body holistically in terms of Yin and Yang.  Yin provides softness and cools the body down and Yang provides energy and warmth to the body.  This delicate balance can often be displaced due to factors outlined above.  Can Chinese medicine and acupuncture re-balance this?  Absolutely!

Chinese herbal medicine and acupuncture can reduce and manage the symptoms and the root cause of acne .  In essence, acne from Chinese medicine perspective is caused by Heat or Damp Heat.  The source of Heat or Damp Heat can arise from hormonal imbalances, emotional factors, stress, poor diet of spicy, deep fried, greasy foods, sugar and etc. Organs that affects acne are Lungs, Stomach, Large Intestines, Small Intestines and Conception vessels.  To determine what may cause the breakout of acne, a detailed consultation is carried out.  From my clinical experience, each person presented with acne have different diagnosis and treatment.  Therefore, the treatment is tailored towards your constitution and overall state of your body and health.  To find out how I can help you reduce and manage your flare ups, BOOK ONLINE for a consultation to begin your journey in rectifying the root cause of your acne.

Psoriasis - A Chinese Medicine Pespective and Approach

What is psoriasis?

Psoriasis is a skin problem caused by the rapid growth of new skin cells faster than normal.  This new growth overlaps forming a thick scaly skin on top of the old dead cells that is unable to shed.  It is presented as a well-defined demarcated inflamed, scaly, thicken plague lesions.  Psoriasis occurs on the legs, elbows, scalp, under the breast, nails and in severe cases the entire body is covered.  The cause of psoriasis in western medicine is unknown however, there could be a link to genetic predisposition. 

How is it defined in Chinese medicine?

Psoriasis is known as ‘Sliver Scale’ – named after the layers of scales commonly found in this skin condition.  The root cause is due to the pre-existing deficiency in Qi and Blood that failed to nourish the skin.  However, as the skin condition progresses without proper nourishment and replenishment, it can lead to more wide spread, inflamed, scaly lesions that is transformed into Fire or Heat Toxin type of psoriasis.  There are different stages of psoriasis with different presentation of lesions:

Wind-cold - often initial/early stage of the skin problem that is is usually seen in children or adults.  Lesions are pale red with thick white scales that are easily shed upon scratching with minimal itching.  Often occurs during winter months and disappears in summer

Blood-Heat – increase in red macules or papules and rapid proliferation of scales that are easily shed when scratched with occasional intense itching.  This psoriasis is more severe during warmer months.

Blood Dryness – the course of psoriasis is slow with pale red macules and is covered with a thin layer of tightly adhering scales with lesions appearing sporadically

Blood Stasis – this is usually at a chronic stage with dark or hyper-pigmented macules covered by thick, hard and adherent scales.  There may be thicken or leathery skin and lesions starts to overlap like map-like-appearance.  In addition there is pain or fissuring at site of the presentation

Damp-Heat – typically dark red macules with uneven sizes covered with greasy thick, crust like scales.  When scratched, there is moist or weeping exudate.  There may be pustules presented in some cases and condition is worse in humid conditions.

Fire or Heat Toxins – very red macules or pustular lesions that develop and spreads rapidly often merging together.  It is covered by fine scales that shed easily accompanied with itching, burning and pain sensation.

How does Chinese medicine treat psoriasis?

Chinese medicine treat your body holistically, not just the symptoms.  I ask detail questions about your body.  I look for signs and symptoms.  I observe your skin presentation, the degree of inflammation, where is it presented and how is it manifesting.  This gives me clues to where your body is at and, the degree of impact it has on the body systems.  This will form the basis of diagnosis which inform me which acupuncture points to use and herbal formula to be prescribed.  Each psoriasis case that I see are different.  Therefore, there is no ‘one rule fits all’ type of treatment.  The treatments are aimed at clearing out inflammation (Heat and Toxins), replenish Dryness, minimise itching and nourish and rejuvenate overall skin health.  Herbal medicine is a must when it comes to treating any skin conditions as it is considered an internal imbalance.  Using both modalities is encouraged.

How long does it take to reduce and manage psoriasis?

Depending on the severity of the skin condition, it may take a minimum of three months, or up to six months to a year to resolve and manage it.  This correlate to the number of years you have been battling with this.  The longer you have had it the longer it will take for it to be treated.  Patience is key in treating this skin condition.

You can start to see minimal changes to the skin within a month such as less inflammation, scales and healthier overall general well-being.  However, the skin is quite volatile to external and internal exposure, there may be some flare ups during the course of the treatments.  This is not uncommon as the skin and body system begins to re-calibrate itself.  One of the biggest contributing factors in flare ups is stress.  Stress can cause myriad of symptoms that impacts the recovery of the skin.

Will my psoriasis come back again after the treatment?

Generally no however, some circumstances it may flare up depending on lifestyle, stress and diet.  In addition, if the course of prescribed treatments are not followed and is stopped abruptly, there may be some residual inflammation that had not been resolved or cleared.  In order to have a good outcome and to keep the psoriasis at bay, it is advised to keep the recommended course of treatments to see a lasting effect

What can I do in terms of diet and lifestyle to manage my psoriasis?

Firstly, if you are stress, find ways to manage your stress levels such as daily yoga, pilates, meditations, etc.  Exercise in whatever form whether gentle walking to cardio work outs are encouraged.  In addition to exercising, creating health boundaries especially if you are working from home to allow relaxation times.

Secondly, eating a well-balanced diet consisting of protein, vegetables, fruit and grains.  In Chinese medicine, cooking your food and consuming your food warm is paramount in building of good Qi and Blood to treat the underlying cause of psoriasis. A good healthy gut and digestive function ensures a good supply of Qi and Blood.  It provides good nourishment and maintains healthy skin. Try to minimise and avoid raw and cold foods such as smoothies, raw veggies, cold salads, cold beverages, ice-cream etc.  Reduce processed, deep fried and greasy foods and, minimise or avoid sugar as much as possible.

Where do I go from here?

Simply BOOK ONLINE for a consultation and we can start reducing and improving your psoriasis.

Eczema - An approach from Chinese Medicine

Eczema, also known a dermatitis is a debilitating skin condition that affects 1 in 3 Australasian (Eczema Association of Australia). Eczema can occur in any stages of life starting as young as early childhood from the ages of 2 to 6 months and in adulthood. There are many types of eczema ranging from atopic eczema, to phomphylox eczema, seborrheic eczema and so forth.

Eczema can present in many different forms and symptoms. There may be -

• Moderate to severe itchy skin

• Red rash occupied by either dry, patchy, weepy, thicken, cracked skin, bleeding and/or scales

• Papules, vesicles, crusting

• Areas that are commonly found are on the flexors of the knees and arms however, it can occur on the hands, feet neck, face and any parts of the body

Accompanying symptoms are -

• Fatigue

• Stress, irritability and mood swings

• Depression and Anxiety

• Thirst

• Poor digestive and bowel function

• Insomnia

• Poor concentration and focus

Chinese medicine perspective -

• What cause eczema?

  In Chinese medicine, any skin condition is an indication of an imbalance of yin and yang in the body. The principle of yin and yang is to create an equilibrium between these two polar opposites within the body to function harmoniously. In the case of eczema, there is no one definitive answer to what cause this debilitating skin condition, rather the answer lies within the presentation of the individual itself. The cause of eczema from Chinese medicine perspective are Wind Heat, Damp Heat, Toxic Heat and/or Blood deficiency causing Dryness and Wind.

• How do we diagnose eczema?

  The body, especially the skin is an amazing diagnostic tool. In Chinese medicine, there are four method of diagnosis - observing, questioning, listening and palpating. We observe for signs and symptoms of the skin condition and ask detail questions into the body’s health. This will give us clues to what is out of balance in the body through observation and gathering of information. Therefore, helping us form a holistic diagnosis of the root cause of eczema. For example, itchy skin from Chinese medicine perspective can be caused by Heat, Wind and/or Dryness as a result of an internal imbalance of the body. In addition, we look at what levels the eczema is presented. For example, if the eczema is presented with mild itching with pinkish tones, it would be at a superficial level (Qi level). If the eczema is red, angry, weeping and intense itching with bleeding, it would be at the deeper level (Blood level). We also look at the tongue and perform pulse analysis as part of our diagnostic tool to determine the condition of the body. Thus making it a holistic treatment.

• How do we approach eczema?

  There is no one-size-fits-all approach from Chinese medicine perspective. Each person presented with eczema will most likely be looked at differently in terms of acupuncture and herbal medicine. In eczema, herbal medicine is often prescribed as the symptoms are a result of an internal imbalance. Herbal medicine targets the root cause of the imbalance whilst resolving symptoms derived from it. External application such as ointment or salve made from Chinese herbs may be recommended to aid the skin condition symptomatically.

• When will I see some results?

  Generally, it will take 3-6 months. The duration often depends on the severity of the eczema. However, the skin will see some form of improvements such as reduction of flare ups, itchiness and redness within 3 months of consistent acupuncture and herbal medicine. In addition, accompanying symptoms listed above will greatly improved as well.

• What ingredients do you use in the herbal medicine?

  Majority of the Chinese herbs we use are derived from roots, twigs, leafs and flowers, and occasionally we may use the shells of cicadas which are collected after the cicadas had shed them naturally (the insect is not used).  The shells of the cicadas have a effective anti-itch property. However, if you are a vegetarian or vegan, we have many other anti-itch herbs that are just as effective.

• How does Chinese medicine help with getting off topical corticosteriods?

  We would go through it very gently and slowly. Firstly, the potency of topical corticosteriods will be reduced while taking Chinese herbal medicine and acupuncture to help manage the symptoms. Over time, the use of topical corticosteriods will be reduced and, be completely eliminated, then to be replaced with Chinese medicine and acupuncture. Going off topical corticosteriods abruptly will cause an intense flare up therefore, to manage these flare ups a cautious and sensitive approach is adopted.

• What can you do to help yourself?

  Majority of eczema sufferers find that by avoiding certain types of food and using a natural skin care product can help reduce the severity of their skin condition.

  Foods to consider avoiding are gluten, sugar, dairy, alcohol, processed food, deep fried and greasy food. Warming spices such as turmeric, ginger, cloves, cinnamon, cardamon should be used minimally to avoid adding Heat to the body. Part of the approach and strategy to eczema in Chinese medicine is to clear Heat from the body. Redness and inflammation are seen as Heat. Heat can dry out fluids that moisturise the skin, therefore causing dry, cracked and itchy skin.

  Natural skin care are recommended to keep the skin moist. As there are many natural skin products available in the market today, it is important to read the ingredients used in the product. Ingredients such as shea butter, jojoba oils are good at moisturising dry skin. Avoid any synthetic scent which can cause irritation to the skin, this include perfume and cologne. It is best to go scent free if possible however, some essential oils derived from plants such as chamomile and lavender can be added to sooth the skin, which also has a calming affect on the mind.

• Where do we from here?

  Chinese medicine approach and strategy to addressing eczema is to look at each presenting symptoms individually. There is no “one-size-fits-all” approach. If you would like to find out more about how Chinese medicine and Acupuncture can help with your eczema, we have a Complimentary Consultation or simply BOOK ONLINE for either an Acupuncture or Herbal Medicine Consult. We look forward to hearing from you.

Acne - Western Medicine vs Chinese Medicine

Acne is one of the most common form of skin problem faced by many teenagers and sometimes persist into adulthood for some people.  There are countless of commercial and natural products, and prescribed medications and ointments to help counter the growing rate of people facing acne problems.  There are varying degrees of acne presentation - from big angry red and painful pimples presenting all over the face right to the neck, chest and at the back of the skin to mild small pinkish bumps that are presented on the chin, jawline, cheeks or forehead.  Whatever the presentation is, having acne can be frustrating, embarrassing and it can affect your confidence.  I have listed below the different approach and views by Western and Chinese medicine perspective so that you can be informed with which treatment option is best for you.

---

Western medicine perspective

The most common trigger of acne is due the onset of puberty when the surge of androgen stimulate sebum production and hyperproliferation of keratinocytes.  Other triggers are hormonal changes occurring with pregnancy or menstrual cycle; types of cleansers, lotions and clothing used; and high humidity and sweating. 

Diagnosis of acne is via examination.  Differential diagnosis of acne includes rosacea, corticosteroid-induced acne, perioral dermatitis and acneiform drug eruptions.  The severity of acne is graded as mild, moderate or severe based on number and type of lesions. 

Treatment for acne:

• Comedones - topical tretinoin
• Mild inflammatory acne - topical antibiotics and/or benzoyl peroxide
• Moderate acne - oral antibiotics
• Severe acne - oral isotretinoin eg. Claravis, Sotret
• Cystic acne - intralesional triamcinolone

How Various Drugs Work In Treating Acne

Common side effects of topical ointments prescribed for the skin are:

• Mild burning, stinging or tingling sensation
• Mild chapping or slight peeling
• Mild redness, dryness and itching
• Mild sensation of warmth or irritation

In addition, doctors are quick to prescribe oral contraceptive pills (OCP) to teenagers to help control/reduce acne.  This seems unnatural as the primary use of the drug is for the prevention of pregnancy.  There is also the question of what long term effects does OCP have on women's fertility and emotional stability.  There are a few interesting studies and articles in the resource section below on the long term effects of OCP on fertility and the emotional impact it has on women.  

Chinese medicine perspective

Acne is caused by an internal imbalance of the body which cause excess Heat and/or Damp that manifest in the face, neck, chest or the back of the skin.

Causes of internal imbalance are often related to:

• Poor diet of spicy, greasy, damp foods such as junk food, excessive chili consumption, and deep fried food
• Stressful lifestyle, lack of exercise
• PMS and other emotional upsets such as anger, irritability and frustration
• Excessive alcohol consumption

Diagnosis often require:

• Questioning the function of the body as a whole 
• Accessing the lesions ie. the severeness of the acne, areas where the lesions are presented ie. chin, jawline, forehead, cheeks, neck or back of the body, and other symptoms such as dry, greasy, itchy skin or painful to touch. 
• Evaluation of the emotional/state of the mind, lifestyle and diet. 
• A comprehensive questioning of women's gynaecology and reproductive systems

In Chinese medicine, both the root cause and presentation (acne) are treated at the same time.  There are five differential diagnosis/patterns that can cause acne.  Each pattern are presented differently in terms of lesions and overall internal imbalances.  Therefore, treatments are individualised based on the presenting signs and symptoms. 

Treatments include:

• Acupuncture and herbal medicine to re-balance internal imbalances
• External topical ointment, herbal facial wash or herbal masque to tackle acne on the outside
• Dietary and lifestyle changes to further strengthen the treatment process

There are little to no side effects in treating acne with Chinese medicine.  Some common complaints are the herbal medicine can be a little difficult to digest or the taste can sometimes be off putting.

---

In conclusion, it is important to be aware of which modality will have the biggest benefit in the long term without harming or upsetting the body's natural system.  Western medicine treatments for acne is often good for a short term purpose however, I question what these drugs do to the body in the long term and the one-size-fits all approach.  Chinese medicine is a natural medicine therefore, progress of treatments does take time.  However, the long term benefits of this individualised treatment which targets both the root cause and the lesions are - 1) the presentation of acne is reduced and 2) future flare ups are minimised and can be prevented.

Resources

Balfour, A., 2014.  Why Chinese Herbs Are Great For Treating Acne.

McKoy, K., 2013.  Acne Vulgaris.

National Institute of Arthritis and Musculoskeletal and Skin Diseases, 2010.  Acne. 

NPS Medicinewise, 2013.  Oral Antibiotics: An Option In Acne But Consider The Risks

Ryan. M., 2016.  I Stopped Taking The Pill And Changed My Life.

Grigg-Spall, H., 2016.  The Pill Is Linked To Depression - And Doctors Can No Longer Ignore It.

Talukdar, N. et al., 2012.  Effect Of Long-term Combined Oral Contraceptive Pill Use On Endometrial Lining.

Farrow, A. et al., 2002.  Prolonged Used Of Oral Contraception Before Planned Pregnancy Is Associated With A Decreased Risk Of Delayed Conception.