SIOM Western Clinical Medicine Systems IVMay 6, 2013 nancy
welliver nd
Slide 2
Protection Mechanical Immunological Photoprotection Absorption
of nutrients Vitamin D Others Detoxification Sweat, etc
Slide 3
3 Layers of tissue Epidermis-most external Stratum
corneum-Protective keratin lives here Cellular stratum keratin is
made here melanocytes (pigment) and Langerhans (immune cells)
Dermis-in the middle Proteins: Collagen and elastin Fibroblasts
Ground substance-the extracellular matrix Subcutaneous
tissue-deepest layer Fat-insulating
Slide 4
Slide 5
The outermost layer of the skin with two sublayers Stratum
Corneum Cellular Stratum Production of Keratin is its primary
purpose Keratin, a protein, is responsible for the tough, mostly
impermeable nature of our skin, found in the first sublayer, the
stratum corneum Keratin is produced in the deeper sublayer, the
cellular stratum. It takes 14 days for the precursor of Melanocytes
(melanin) and Langerhans cells (immunologic), also reside in the
epidermis
Slide 6
Contains two fibrous proteins Collagen-strengthens
Elastin-flexibility and resilience Ground substance- fascinating
tissue! See the book The Extracellular Matrix and Ground
Regulation- Provides a bridge between bioscienceand energetic
medicine Composed primarily of mucopolysaccharides Sweat and oil
glands, hair follicles, nerves, capillaries, erector muscles all
run through dermis
Slide 7
The fat layer insulates, cushions and nourishes Nerves, blood
and lymph vessels run throughout Fat soluble toxins can be stored
here, as well.
Slide 8
2 Kinds: Apocrine and Eccrine Apocrine: Primarily in axilla and
around genitalia Associated with body odor Stimulated by stress
Become functional after puberty Eccrine: Throughout body Stimulated
by muscular activity and stress Helps with temperature regulation
and detox Not on lips, ears or genitalia
Slide 9
Slide 10
On most of body except palms, soles of feet, and parts of
genitalia Basically a shaft of keratinized cells Melanin produced
at the base of the hair follicle determines color of hair. Erector
pilae muscles are associated with hair follicles, and are
responsible for goose bumps in response to cold or sudden
stress.
Slide 11
Slide 12
Epidermal cells covered in hard keratin Nail bed highly
vascularized Nail grows from the crescent moon (lunule) at the base
of the nail Certain disorders can be diagnosed from the appearance
of the nail Strength of nails is a good sign of vitality and
health
Slide 13
Slide 14
Use good lighting, natural light is the best. Use your eyes,
nose and hands Magnifying glasses and rulers help to see and
describe the lesions Notice the color and tone of the skin/lesion
Be conscious of the clients pain or discomfort level Consider any
meridians Notice any indication of scratching
Skin issues can often be systemic issues or manifestations of
internal conditions Skin issues can also be emotionally based, and
cause emotional distress Anything internal or external can affect
the skin-foods, internal meds, supplements; also lotions,
detergents, bathing water, etc A good history for skin issues can
make all the difference in understanding cause.
Slide 20
Generally infectious immune related/allergy benign,
precancerous/cancer General treatments: Cut it out suppress it with
corticosteroids or biologics kill it with
antivirals/antifungals/antibiotics Leave it alone/watch and
wait
Slide 21
Detox expression, i.e. discharge Vital expression of internal
environment Vital part of healing process Liver, Kidney, or lymph
issues In homeopathy, may be an energetically inherited trait-i.e.
a miasm
Slide 22
Detox regimens with fasting and herbs Hydrotherapy
techniques-internal/external External application or herbal or
mineral based medicaments Addressing food allergies, leaky gut,
poor digestion, constipation Treating the liver and or kidney/lymph
with herbs and nutritional supplements Balancing immune system or
adrenals/nervous system with herb/nutrients
Slide 23
A superficial inflammation of the skin, characterized by
redness, edema, oozing, crusting, scaling, and sometimes vesicles.
Pruritis is common. Eczema is a term that is often used
interchangeably with dermatitis. Merck Manual 18 th ed.
Slide 24
Dermatitis-means inflammation of the skin Can be acute or
chronic A generalized term that can be made more specific Atopic
Contact Seborrheic Stasis Exfoliative
Slide 25
Usually first seen in childhood, 85-90% before 5 years old
Very, very common (10-20% of children), and becoming more common,
esp for children in urban areas. According to the Merck Manual, the
cause is cleaner indoor environments, and early use of vaccinations
and antibiotics [that] deprive children of early exposure to
infections and allergens
Slide 26
It is an immune mediated inflammation of the skin that has a
genetic component. Often parents or other family members will have
hay fever, asthma, eczema, or sensitive skin Common food triggers
include: dairy, eggs, soy, wheat, peanuts, fish, and shellfish
Enviromental triggers include dust mites, animal dander, and
molds.
Slide 27
Slide 28
Slide 29
Acutely (1-2 mos): red, oozing, crusted inflammatory lesions
that are itchy. They may start as macular, become papular and
pustular. Scratching and rubbing can create more lesions As lesions
become chronic, they become dried out (xerosis) and become cracked
and fissured Diagnosis most often done based on history and
appearance, occasional IgE testing done
Slide 30
Topical corticosteroid creams are the #1 therapy,
Antihistamines are often prescribed if itching is intolerable A
prednisone burst (60 mg x 7-14 days) is often recommended for a
very bad case Immunomodulating drugs are used for more severe cases
Antiobiotics for infections related to breaks in the skin
Slide 31
Anti-inflammatory/steroid drugs 2 types of topical
coricosteroids used 1% hydrocortisone cream (Cortaid) used
2-3x/day- considered mild corticosteroid 0.05-0.1% betamethasone
(Beta-Val)cream Antihistamines 2 po(by mouth) types commonly used
Diphenhydramine (Benadryl) Hydroxyzine (Atarax)
Slide 32
Immunomodulators-Commonly 3 to choose from used singly or
possibly in combination for short periods of time Tacrolimus
(Protopic) cream (.03 or.1%)- suppresses humoral immunity
Methotrexate (Folex or Rheumatrex)-a folic acid inhibitor-taken
orally Cyclosporine (Neoral, Sandimmune) Antiviral for atopic derm
with herpes (Eczema herpeticum) :Acyclovir (Zovirex)
Other treatments that have been tried include the following:
Probiotics Ultraviolet (UV)-A, UV-B, a combination of both,
psoralen plus UV-A (PUVA), or UV- B1 (narrow-band UV-B) therapy
Acyclovir
Slide 35
Allergy testing, especially food allergies Stool
testing-Complete Stool Analysis (CSA or CDSA) checking local gut
immunity, flora, digestive capability, etc. Amino acid profiles
Essential fatty acid profiles
Slide 36
Elimination diet especially dairy, wheat/gluten, soy, egg,
peanuts, simple carbs, Essential fatty acids including fish oils,
Cod liver oils, flax oil, borage oil Good fats in diet Good fluid
intake Good bowel function Addressing stressors
Slide 37
Probiotics Avoid allergic triggers Address emotional stress
Consider UV light (sunshine) exposure (Caution: some contact
dermatitis folks will be sensitive to the sun, making the skin
lesions worse) Consider salt water bathing and salt air At European
spas, sulfur bathing or tar treatments used-used to be
standard
Slide 38
Licorice root- Glycyrrhiza glabra-helps extend the half life of
cortisol (exogenous or endogenous) in the body. Useful to use with
or instead of topical corticosteroids In TCM GanCao which is
Chinese Licorice root, Glycyrrhiza uralensis May be used.
Slide 39
Silybum marianum-a liver and kidney herb, helps protect tissue
and modulate histamine production. Allows for a more functional
kidney and liver while detoxing.
Slide 40
Johnny Jump-Up/Wild pansy-traditionally used as a skin remedy,
as a wash and internally. Its cousin viola odorata can also be
used-it is a lymphatic cleanser
Slide 41
Nettle-mineral rich feeds the skin and kidneys Burdock-works to
protect and enhance activity of liver Horsetail-excellent source of
minerals Artichoke leaf-stimulates liver and biliary system
Chamomile-wonderful anti-iflammatory, anti- allergen
Calendula-antiinflam, lymph cleanser Chickweed-soothes itch, lymph
cleanser Comfrey-soothing, accelerates skin repair
Slide 42
Acute inflammation of the skin due to irritants or allergens
Very common in atopic patients as their skin is hyperreactive
Irritant contact dermatitis can happen upon direct contact with an
irritating substance, most commonly chemicals, plants, soaps, and
occasionally, even body fluids Phototoxic ICD is a variant. A
topical agent plus sunlight causes an irritation
Slide 43
Allergic Contact Dermatitis is a two step process. First
exposure is the first step which primes the immune system of the
skin (Langerhans cells) Second exposure leads to a response
Examples include poison ivy or poison oak Topical products such as
perfumes, lotions, sunscreens There can be a photoallergic variant
to allergic contact dermatitis-sunlight plus allergen triggers the
reaction.
Slide 44
More painful than itchy. Atopic dermatitis is usually more
itchy than painful in the first stages Redness, erosions, bleeding,
crusting, pustules, blisters or bullae, and swelling are common
Specific sites of exposure are usually affected-i.e around a wrist
for an allergy to a watchband
Slide 45
History of exposure Pattern of dermatitis Patch test may be
done with suspected irritant or allergen
Slide 46
Patch Test for Contact Dermatitis
Slide 47
Avoiding exposure to allergen or irritant Can take 3weeks to 6
weeks to clear completely Sensitivity is often lifelong Sometimes
exposure to sunlight will cause a flare up of past exposure
Pharmaceutical treatment is the same as for Atopic derm, except the
immune modulators are usually not used Cold compresses are often
suggested
Slide 48
Avoid contact with allergen or irritant High dose buffered
vitamin C (1-3000 mg 2-3x/day or to bowel tolerance) and or
quercitin Baking soda bath Cold wraps
Slide 49
Commonly seen May or may not have an easily identifiable cause
Can be dishydrotic, pustular, nummular, or thickened plaques Often
exacerbated by exposure to water or even mild soaps, or sweating
while in gloves or socks May be an atopic or contact derm
component
Slide 50
Slide 51
Eczema caused by chronic scratching Can be an anxiety disorder
Often gets set up from initial patch of dry, itchy skin, especially
in winter, and person will scratch it and scratch it, and then it
becomes chronically inflamed and itchy and occasionally sore with
boils Often see this on the ankle, shin or bilaterally on
thighs
Slide 52
Lichen Simplex Chronicus Treatment is to stop scratching, and
apply corticosteroids, sometimes with taping, to decrease the
scratching. NDs look at detoxing.
Slide 53
Inflammation of the skin that has a high number of sebaceous
glands Upper trunk, face, scalp The cause is unknown, it might be a
local flora issue Composition and flow of sebum is normal Worse
when its cold, with emotional or physical stress Fairly common, but
folks with HIV and Parkinsons can get very bad cases Seen in
children as cradle cap.
Slide 54
Slide 55
Often accompanies psoriasis Symptoms usually come on gradually
as a greasy or dry sometimes yellow scaling of the skin or scalp.
It will cause dandruff, but not generally hair loss. Along the hair
line, in the mustache, beard or eyebrows, in the nasolabial fold,
behind the ear, in the ear these are common places to see it
Diagnosis is by appearance
Slide 56
First line treatment usually includes shampoos or soaps with
zinc, selenium, sulfur or salicylic acid. Tar soaps or shampoos are
used as well Further treatment includes the standard corticosteroid
lotions and creams or occasional antifungal creams (fluconazole or
ketococonazole) For cradle cap, combo of baby shampoo, olive oil
and corticosteroid cream is recod
Slide 57
An inflammation of the skin of the lower legs due to chronic
venous insufficiency and chronic edema. In the first stages
hyperpigmentation occurs and a mottled red brown or dusky red
discoloration is seen. Next the skin starts to break down and
becomes inflamed, weepy, scaling Secondary bacterial infections are
common, as is cellulitis and ulceration
Slide 58
Slide 59
Diagnosis is by appearance Treatment is treating the venous
insufficiency, usually with compression stockings and farrow wraps.
Antibiotics will be given orally and applied topically when
ulcerations or infection appears In natural medicine hydrotherapy,
and venous supporting herbs can be used (Hawthorn, Butchers broom,
horsechestnut)
Slide 60
This is a more generalized dermatitis which may come on for a
variety of reasons Drug reactions-antibiotics, barbituates
Malignancies-leukemias, adenocarcinomas, Preexisting skin issues
25% have no identifiable cause Diffuse skin inflammation that may
start in patches and then spread
Slide 61
Slide 62
Symptoms include fevers, chills, protein and fluid loss due to
sloughing of skin which can lead to a hypercatabolic state, and
irregular heart rythms and heart failure Can be life threatening:
refer Treatment is with emoillients, oatmeal baths and systemic
corticosteroisds, as well as fluid and nutrient replacement
Slide 63
An inflammatory scaling or plaquing skin disease Lesions are
usually well circumscibed red patches with silver or whitish
scaling No known cause but predisposing factors include stress,
trauma, infection or as a drug rxn Minimal itching or pain
Diagnosis is by appearance or occ scrapings
Slide 64
More on psoriasis next week, the Google images gods said no
more for now!!
Slide 65
Me-atopic and contact and autoimmune Patient x with eczema on
foot and eyelids Patient y with history of chronic
appendicitis
Slide 66
http://www.acupuncturetoday.com/mpacms /at/article.php?id=32503
an article about an Integrative View of Atopic Derm.
http://www.acupuncturetoday.com/mpacms /at/article.php?id=32503
http://www.niams.nih.gov/Health_Info/Atop
ic_Dermatitis/default.asp#b a fact sheet from the NIH on Atopic
Derm http://www.niams.nih.gov/Health_Info/Atop
ic_Dermatitis/default.asp#b
http://emedicine.medscape.com/article/10 49085-overview Overview on
conventional approach http://emedicine.medscape.com/article/10
49085-overview
