So what is eczema and why do people often get LED down the wrong treatment pathway? Eczema is a chronic inflammatory skin condition, often with an allergic underpinning, and there are many different forms of eczema, so it's hard to do anything too broad strokes.

In that regard. But the standard protocol for this in the allopathic or conventional medicine model is to treat this by using topical steroids that suppress inflammation. And at the end of the day, the vast majority of eczema cases are internally generated and start very young, often from infancy and need to be addressed.

Internally and get after the factors that are driving it rather than trying to suppress the inflammation that is a natural immune response. Why is eczema so common now as opposed to 30 years ago, is largely environmental atopic or allergic conditions.

Didn't have this prevalence. Prior to the introduction of thousands of different chemicals that we interact with for personal care products or, how we make furniture and industrial compounds and things that we've never had to interface with before and the prevalence has exploded and we can't always control our environment and everything external to us.

We can do what we can. But Chinese medicine has had answers and good solutions for this condition. For millennia. It was just far less common, and these principles still apply today even in the face of, uh, industrial world. Some of the biggest misunderstandings about eczema that I see, um, from patients and practitioners alike is that this is just a skin condition and it needs to be addressed topically through the skin. It is not, this is systemic. Most of the time. And yes, there are situations where you can get something like contact dermatitis and just be sensitive to something that you touch, but the population that I see we're dealing with chronic, often recalcitrant or like difficult to treat, stubborn long-term cases.

And it's not just because you brushed up against something or came into contact with something in the environment. There has been an accumulation internally and that needs to. Be addressed. And unfortunately that is the standard of care is steroid cream over and over and over again. Um, which can be hugely problematic for people in a lot of ways.

There are so many different forms of eczema. The most common that I see in my practice is chronic atopic or allergic eczema. That often starts as something we call the wind of the four crooks. In Chinese medicine, they. Coined this swan fun or the wind of the four crooks thousands of years ago, which is interesting because it would show up on the crooks of the front of the elbows and behind the knees, and, um, will often really start on the cheeks at infants, these form of infantile eczema.

And then it'll migrate and morph into the form that you get. Um. On the four crooks and then can become more widespread. And this is probably the most common variation and it can come and go and fluctuate throughout teens and into adulthood, but this is the one that's often. Left unchecked with few other good solutions and people, um, do long-term damage themselves with steroid creams.

There are many other forms of eczema. We've got, uh, something that responds particularly well to treatment with Chinese medicine and very quickly in interestingly, is a form called POM or DYS hydrotic eczema that shows up on often the palms of the hands and sometimes the soles of the feet with all of these little blister.

Um, quite easily infected can become quite debilitating, but the solutions here are, are wonderful and often they use a really potent form of steroid cream because the skin here is a bit thick, um, and they can become very damaging. There is also, um, nummular eczema, or also known as microbial or bacterial eczema that can show up in little circles all over the body and is notoriously.

Stubborn, not only stubborn to treat, but can come back really easily if you don't really knock it on the head. And there's this really common complication of, uh, often staph bacteria and then there's stasis eczema that can show up with people who have compromised circulation in the lower extremities.

And that's. Complicated by this lack of blood flow. In Chinese medicine, we call it blood stasis. There's different reasons why we can have that. Um, and then of course, in Chinese medicine, each of these different forms of eczema that are recognized in the conventional model, that are visually different across the board and behave differently, have multiple different patterns of imbalance from a Chinese medicine standpoint, often overlapping patterns of imbalance that need to be addressed.

One by one. I've mentioned a couple of times that steroid creams can be damaging and.

You know, how much damage and what kind of complications can be caused varies significantly across the spectrum of everything from long-term, you know, thinning of the skin where it redeposits fat and tissue. And, um, I. Uh, there's a very distinct form when we know somebody's been using steroid creams for a long time.

When they come in and they've got what we call a cigarette paper neck, you can see that the skin is very, very thin and susceptible to breakage and therefore infection, and the skin has its own. Little immune system in there. And so that's compromised. So beyond just the barrier itself being compromised, you have a decreased capacity to mount an appropriate immune response, even at a superficial level.

So increased risk for infection cuts, breakage, and then it can have systemic impact long term, and something called topical steroid withdrawal, which is often as a result of. Uh, quote unquote injudicious or use of topical steroids, um, or laying it on too thick and heavy for too long and can put people into an erythrodermic state.

You stop using this stuff. You go into a rebound effect. And it can become a medical emergency. It can become very serious and debilitating for people trying to recover from this, where the bodies become reliant on these steroids to get the inflammation under control, and I've seen people suffer badly with this.

Again, Chinese medicine has formulas that can really help pull people out of the woods when they're in a state like this. But it can lead all the way to hospitalization and death. And it's not, uh, it's gaining more traction. As you know, since the eighties, the rate of incidence of these conditions has increased significantly, and the limitations of the traditional treatments are becoming more widespread and well known.

And, um, really the smart money is to get treated early, genuinely, holistically. And hopefully avoid some of this long-term fallout and have a, a better quality of life as a result. Are people being told or given adequate informed consent about the long-term consequences of these medications? In my experience, not so much. And I think things are coming. There's more widespread awareness of the long-term complications that are possible and, you know, potentially probable, especially if the condition is really widespread.

Um, I had the pleasure of attending. A large scale immunology conference where my professor was actually invited to present because the clinicians and the researchers from some of these big, you know, university hospitals back east, recognize the limitations of these steroid creams, and there's actually warnings on them in the, the proper use is use these for two weeks and discontinue if it's not doing the trick.

And there is no other trick unfortunately, in that model. So people are often put on them for a long time and not given, um, access to other options. And of course, you know, something like Chinese medicine has a often a lot of stigma attached to it and there. Our, you know, practitioners from every color of the rainbow out there with different levels of experience and education and, um, it's unfortunate.

In terms of understanding. Eczema through a Chinese medicine lens and the different patterns that are at play. I mean, this is a very big topic and it took me a long time to start to get a handle on the translations and what they actually meant. And I'll do my best to break it down a little bit. Um, but without proper graphs and pictures and this and that, in translations, it's gonna be a little bit challenging.

But let's take a. A big topic like atopic eczema, for example, this allergic type of eczema. And even as we're assessing the appearance of the skin, we are looking at, you know, is it a, a dry hot type? There's a type called hot blood with wind. Is it the skin takes on a, a silvery, scaly. Sheen to it, and there's lots of flaking and scaling and shedding, and the lesions are dry and widespread and not particularly well delineated.

And people are often a little bit, you know, warm and there's a certain, you know, color of the tongue that is associated with it. And it, a pattern starts to form. And then we look at how the skin is presenting. And how it changes over time when we take a a bit of a history, but I'm also looking at how are the bowels behaving at the same time?

Does the formula need to be modified to address any kind of. Concurrent digestive issue. Is the menstrual cycle affected? Is the mental emotional health affected? Are people able to adequately sleep and have the body's repair mechanisms kick in? Do we need to address that piece? Um, which is often a complicating factor, and that's one pattern from for atopic eczema, for Chinese medicine.

Then another very common one is what we call damp heat. And we look at this concept of dampness as kind of an umbrella term for yeast and fungus and mold sticky things, mycotoxins. And these lesions will often be more well demarcated. They can have yellow oozy, cresty bits, they can show up in our folds, our intertriginous regions under the armpit and the groin, under the breasts.

Um, often with more. Night sweating. We have to adjust the formulas if there's sweating or not in the picture. Um, but it's a distinctly different pattern that's happening and it's observable. When you look just at the skin, let alone the other factors that play into that pattern. Then, you know, is it presenting primarily in the lower body or just the upper body?

We have herbs that can direct the action of the formula to these different. Parts of the body. Is it a mix of dry hot with damp heat? There's a formula for that. Is it this erythrodermic or more allergic state where the Chinese say that the heat has entered the ying and the blood level where it is a potentially life-threatening situation.

You need these very strong formulas to kind of pull you back from the edge. Has this been going on for such a long time in somebody's maybe, you know. Postmenopausal or into their sixties and seventies, and the skin is very dry. It's not running as much inflammation That is potentially more what the Chinese would call a yin or fluid deficiency or a blood deficiency pattern where there needs to be nourishment to the system to help it heal.

That being said, even these deficiency patterns, especially in this day and age. People usually have some degree of inflammation, and we need to help clear out the things that are driving the inflammation first before we go in and nourish. If we do that prematurely, it can worsen the whole picture. So you really do need to talk to someone who knows what they're looking at, and it's not an overnight journey.

Sometimes we peel back one layer of the onion and then. Underneath that there's something that we couldn't see before and it's a step-by-step process.

So earlier I mentioned that these conditions are on the rise and they're now, you know, upwards of 20% of visits to the dermatologist where it didn't used to be such a problem and that there's a big environmental component I, we think has contributed to this overall.

And what can you do to help mitigate this or, or. Take care of yourself at home and for sure you can try and clean things up as much as you can and not expose yourself to chemicals in your environment. Try to limit the amount that's in your personal care products and your food sources, your environment, you know, furniture, things that are offgassing around you.

And that being said, I've seen a lot of people work really hard to. Clean themselves up and, and we can't live in a perfect world ever. And it often needs to be addressed still internally and need treatment. So I don't want people to beat themselves up too much. And certainly there are a good many number of people in the world that are exposed to all the same things, if not more, that don't develop this condition.

So it's not just environmental and it's not just dietary. And you know, I see people take out, you go on these very restrictive elimination diets. I don't like to really look at food like that. In Chinese medicine, we look at food through a lens of food cures. What can we add into the system that can help heal and nourish the body?

What is this food doing to us on a physiological level beyond its macronutrient profile? How is it helping? And if it's not helping, it's potentially a hindrance. But again, this, you know. I am gluten-free, I'm dairy-free. I use all natural body care products. It's organic everything, and that's all wonderful.

And we've still got eczema, so there can be inborn factors. There's a genetic piece at play, but we're not just a slave to our genetics, especially with things like this. And there are real world solutions here. Chinese medicine. Is exceptional at treating all manner of chronic inflammatory conditions, and I'm aware of the limitations of the herbs as well.

So over time, I've brought in more diet, more supplements, some homo toxicology, which I used to think was a bit wild. Homo Toxicology is a branch of homeopathy, but it can certainly help to peel back a layer and. By the time we address all of these layers and we've got all these tools working on the system, uh, we can often produce some pretty good results.

. So. What is the root cause of eczema? And we've talked a little bit about some environmental implications, a bit of a genetic piece, but what else is. Uh, playing a part here and it's a big question and there can be a lot of different answers and a lot of different things playing into this, and that's a departure from even the idea of.

I need to find the root cause, you know, what's causing this? What is it? And there's this kind of obsession with all these fancy tests, which I now have access to that I still don't ever think is pointing at. You know, one magic bullet. We would love that. Our analytical minds would love to just grip on to the one thing and make it easy.

But that's not how systems biology works. And we're looking at often a multifactorial picture and there's often bacteria. And viral load driving. This, if not complicated, with those damp pieces of the yeast, fungus, mold kind of mycotoxin picture. Often they're combined. By the time we can help back some of these things out, the pressure on the immune system lessens and then immune dysfunction or chronic inflammation often comes as a result, which is a very good way of going about it.

My. Professor's, a very smart man wrote a paper for a Chinese medicine journal called The Importance of Addressing Fire Toxin When treating eczema with Chinese medicine and fire toxin translates Lucy to infection, and there's different levels of it, you can have superficial infection, which very commonly complicates an eczematous picture with things like staphylococcus aria, you get, aria means is a root.

Latin root word is gold, so it gets this very distinct golden hue to these lesions, and it's a particular form of bacteria. I don't need to swab it to know that that's staphylococcus aureus. We need to help back that out of the picture because that will keep driving the problem, and that's very common again, in this more microbial eczema, very commonly complicates.

Atopic eczema. So bacteria is a big one with this. There can be heavy metals driving the picture. Um, this is often where I like to start with people, is helping to drain off the backlog, but then you have to know where is it lodged up in the first place? Which level of tissue is it, is it at? And this is where Chinese medicine is so brilliant because there's.

Signs, like a map on the body of what level it's at. Where do we need to start getting this out? And, and even a lot of, um, functional medicine models saying, everything's the gut. Everything's the gut. Well, not always, you know, some people can consider the liver a piece of the gut, but that's really the way I look at it.

Is it the liver acting as this repository? Is it in our intestines? Chinese medicine? We're looking at Young Ming. Is it the stomach and the intestines? Is it the liver? Is it a certain strain that's lodged up in the heart? We have formulas that drain heat out of the heart. It's fascinating and there's telltale signs on the skin and with whatever else other symptoms people have going on that can tell us kind of where to start.

Backing these things off. Um, you know, cleaning up your environment, using the right topicals, bringing in the right supplements at the right time, in the right dosage for the right people, which is complicated enough. And these complicated herbal formulas that need to change and adjust over time, um, is this multimodal approach.

I've mentioned formulas a few times, so I wanna expand on it a little bit. And how we do this in Chinese medicine is really where this skill of a clinician can shine or not.

It's. A beautifully sophisticated thing that happens. And usually a formula is constructed about, in my practice, 12 to 14 different individual ingredients in a very specific dosage and specific ratio to each other based on exactly how that person is presenting for from their skin and their, their other concomitant symptoms.

And. Uh, then over time that formula is changed based on how the person changes. So for example, if I give somebody a wind heat formula and now the inflammation has calmed, their skin isn't as red, their sleeping better, you know, I will eventually dial back that formula, make it a little bit less potent, and then we'll start working on addressing the root after.

The branch or the symptoms have been managed to an acceptable degree and whatever that underlying root is, whether or not there's some digestive dysfunction, hormonal issues, or whatever it is, we'll start changing the formula over time. And if there's multiple overlapping reasons that people are inflamed in the first place, it's like peeling an onion and it changes over.

Time will address the wind, heat, we'll address the damp pieces, we'll get that under control and then usually kind of stabilize and pamper the liver as they say, which I like.

So how do you start weaning off steroids if you're on them, or medications like Dupixent for example? Um, for sure. When you're dealing with more potent medications, that needs to be a conversation between you and a prescribing physician and come up with the best strategy possible. Um, hopefully they're open to what I'm up to over here.

But, um, with steroid creams, the smart money is on what we call a judicious step down approach, where you don't just come straight off them to avoid this rebound effect You've. Push down the inflammation for so long and then you take that outta the equation and things spring up more aggressively than they would otherwise be.

You want to do what you can to not destabilize the system quickly, and if I can get in there and get started treating whether or not I'm treating eczema or something like asthma where people are on inhaled steroids. As the inflammation calms down, you become less reliant on these things. You need less and less of them.

And then, you know, you go from using them twice a day to once a day to once every other day, and slowly, slowly bring them out of the picture. But you know, ideally do everything that you can to get yourself less reliant on these things before you even come to see somebody like me if you're able to. If not, I'm still happy to have that conversation.

But it does throw another complicating factor into the works and often. When you're not on the steroids anymore, it's not suppressing the inflammation. Now we can see the manifestation of this condition without any interventions, and it's often more serious than it otherwise would be. So the steroids can cloud certain markers and make my differential diagnosis a little bit more difficult.

But it's so common that it's certainly something that I deal with. But you. Ideally would wanna be working with somebody that can help you get off of these things. Because if you come off them on your own too quickly, you can put yourself into Erythrodermic. It can be a dangerous thing.

Here's some eczema myths that I'd like to debunk. Is eczema genetic? I mean partially. And also, you're not a slave to your genetics. Do flareups mean the treatment isn't working? Not necessarily. There are so many complicating factors to this piece that you just need a good clinician to guide you through it.

Is diet enough to fix eczema? I'd say yes, but to do it is potentially a herculean effort, and what I do can help speed things up. Are elimination diets helpful or harmful? Long term elimination diets are technically meant to be used as a diagnostic tool, and I think can add a great deal of mental strain to people.

So looking at food through that lens I think can be harmful and we can do better. Are kids destined to grow out of eczema? Absolutely not. I see people all the time in my practice that have had eczema since infancy and it has gotten nothing but worse into their adult years.

In this episode, we've talked about what eczema is, why the prevalence is on the rise, and my clinical perspective. We also talked why conventional methods often fall short and how Chinese medicine addresses eczema.

We talked about the root causes that people don't often know about and the formulas in Chinese medicine and how they're constructed. And we talked about some common myths and I am hopeful that one day people come to seek out treatment with Chinese medicine as the first order of business rather than the last line of defense. Thank you for listening. I look forward to bringing you more information on these topics

If you'd like more information, you can follow me on Instagram at Dr. Kelly Smick or shoot me an emailKelly@drsmick.com if you would like to book a program consultation. All of my links are in the bio on IG, and I'd love to talk to you.