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Ask an expert - body - skin conditions

49 questions

Q:  I am very slowly recovering from Shingles around an eye, forehead and scalp. Male aged nearly 77 can you advise me if acupuncture can help the pain, nerve tingling and general discomfort. If so a member practising near CM24 8RW. Stansted Essex.

A: Shingles is one of the conditions where the evidence is not yet sufficient to be conclusive, as our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/herpes.html

but where there is sufficient clinical experience for us to believe that where we can treat early in the presentation of the condition there may be some good possibility for reducing the severity of the outbreak. This parallels the western approach where the use of acyclovir as soon as possible is often the best way to contain an outbreak.

Once the condition has settled into the more long term chronic presentation the focus of treatment is more on trying to reduce the discomfort of the residual symptoms. The use of acupuncture for chronic pain is well documented, and in fact was one of the most significant areas of research after Nixon's visit to China in the 1970s which saw an explosion of interest in the West. The key question with pain relief or pain control is exactly how much relief the treatment gives and how sustainable this is. This is unanswerable without looking at the individual case, and indeed, Chinese medicine is all about treating the individual as much as the symptoms, and how well someone can respond depends to a degree on how well their overall system is functioning.

We certainly think it would be worthwhile chatting to one of our members local to you. Most are willing to give a little time without charge to prospective patients to let them get a sense of what might be possible. 

We cannot give individual referrals, but we have tried your postcode in the search facility on our home page www.acupuncture.org.uk and it generated a number of hits close by.

Q:  I am 61 years old female and I have had a non scaly erythemous rash for about a year. It started on one inner thigh and has spread to the other, the abdomen and under my arms. It can be sore and itchy at times. I have seen a dermatologist but there is no diagnosis. Can you recommend acupuncture and/or a local acupunctuist.

A:  We are always intrigued by problems such as this. As you may already know from more general reading on the website, traditional acupuncture is based on a theory of energy called 'qi', and its rhythms, flow and balance across the body. The energy flows in distinct patterns on the surface of the body, and each channel or meridian, as they are called, is connected to one or more Organs, the functional units within the system which overlap slightly with the western concept of an organ but are understood to have far wider functions on all levels.

What this means is that when someone develops a rash which spreads over time, there are several ways of looking at what is happening. It could be a problem in a specific channel, and the pattern of the rash's development may well outline the path of a channel and its successors, or it may point to an underlying pathology in the Organ which is generating Heat in this case which is being directed away from the Organ to the outside. The skilled practitioner will then be doing their own detective work to see whether the pattern involves just the Organ which is possibly generating the symptoms, or whether it is reacting to patterns of disharmony elsewhere. Chinese medicine is a great deal more than simply a correspondence between a symptom and the use of a number of points, and the sophistication of the understanding of aetiology and pathology which leads to the unique and individualised treatment is not as well understood yet as it might be. That is out continuing challenge!

The one additional point we would make is that the received wisdom inside our profession is that Chinese herbal medicine is often the preferred modality for treating skin problems. CHM gained some considerable exposure in the 1980s and 1990s when one particular London clinic had queues going around the block for skin problem treatments, many of which we successful. The reality is that any trained Chinese herbalist belonging to the Register of Chinese Herbal Medicine or the Association of Traditional Chinese Medicine will offer the same standard of care. Most RCHM members are also BAcC members, and this may offer the best option.

On balance, based on what you have told us there may be straightforward acupuncture treatments which can help with what you have. We cannot make individual recommendations, mainly because we take the view that all of our members are equally well qualified in what they do to offer the same level of quality service. Our postcode database search on the home page will identify at least half a dozen practitioners in close proximity to you.

 

A:  As our factsheet shows

http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/acne.html

the evidence for the use of acupuncture, while limited, is fairly good. In particular there is a systematic review from 2009 which combines the data from several studies which appears to be very positive. As always, though, there is not enough research for us to be able to give an unequivocal recommendation.

That said, acne can present in many areas of the body and to varying degrees of severity, so it is quite difficult to give an all-purpose response like this. Someone who has had the condition for thirty years and tried every medication under the sun is going to be a different proposition from someone who has a small but recent outbreak. In all cases the advice we usually give is that someone visits a BAcC member local to them for a short face to face assessment which many members offer without charge. This will enable them to give you a slightly more balanced view of what might be possible for your specific case.

We often suggest that a prospective patient considers adding Chinese herbal medicine to the mix. There is a considerable amount of anecdotal evidence in the profession that herbal medicine can greatly add to the treatment of skin conditions, possibly because the daily regimen based on the same diagnostics principles adds weight to the treatment. Members of the Register of Chinese Herbal Medicine are very often also members of the BAcC, and members of the Association of Traditional Chinese Medicine often use both modalities as a matter of course, so it may well taking this into account as you look for a practitioner.

Q:  How long will it take for treatment of keloids with acupuncture? I have keloids on my chest. 

A:  There isn't a great deal of information about the time scales for trying to help keloid scar tissue on the body, and more to the point there isn't a great deal of formal research which would enable us to make a specific claim that acupuncture works. Most of us have treated people with keloid scarring, and there are many anecdotal reports of considerable help and improvement. There are equally as many reports of trying to help and having no effect at all, as this expert has found on a number of occasions. There are also cases where the scarring remains but the blockages which they can create in the flow of energy, or qi as we call it, are helped considerably by the use of acupuncture treatment. We find this particularly in the case of horizontal scarring after a C-section or hysterectomy, and in the rarer cases of heart surgery or emergency surgery leaving large vertical scars in the midline.

There are occasionally short studies published about specific individual cases, and one such is

 http://aim.bmj.com/content/29/1/2.full

with some interesting photographs for what is deemed to be a good outcome. There are a number of others, but these are probably the exception rather than the rule.

The bottom line, though, is that a great deal depends both on the nature of the scarring (why it is there, how long it has been there, whether it has changes at all) and also the underlying reasons for it. If these are post-operative scars, for example, the condition which required surgery may itself be fairly serious and need to be factored in to any estimates of whether acupuncture might be able to help.

The only advice which we can give is to visit a BAcC member local to you for a brief assessment based on a sight of the scarring and the causes of it of whether they think that acupuncture treatment might be beneficial.

Q:  I have, in the past had localised alapeisha. I believe  this was caused by stress, which unfortunately my character is prone to. However,  new responsibilities at work have lead to better pay and I am reasonably happy with my 'lot'. Just wondering whether acupucture could be beneficial to me?

A: The evidence for the treatment of alopecia with acupuncture is a bit thin. We were asked by a Portuguese doctor some time ago about treating alopecia as a primary condition, and the answer we gave her was:

There is not a great deal of literature to assist you, we're sorry to say. We tend to undertake the same sorts of literature searches which you might do using the 'ncbi' resource to access most of the Pubmed resource, mainly because we are constrained under UK advertising law to be very clear about the existing evidence for the treatment of specific conditions and extremely clear about what level of certainty this generates. Given that traditional acupuncture and randomised control trials are not a happy mix, the evidence is generally scant. In the case of the acupuncture treatment of alopecial there are only two or three articles in English and these date back to the 1980s and 1990s. There are undoubtedly hundreds in Chinese but we do not have the resources to translate them and assess them carefully for their methodological soundness.

 
There are a number of articles available in the traditional acupuncture press, such as
 
http://www.jcm.co.uk/product/catalog/product/view/6412/the-treatment-of-alopecia-with-acupuncture-and-related-techniques/
 
but if your training is in medical or western acupuncture, as we suspect it might be, then much of what these articles say will be largely incomprensible.
 
Certainly from an eastern or traditional acupuncture perspective we would be likely to see what else was happening in the patient's system which might place the symptom of alopecia in a wider and more informative context. Although the problem might be a local one the chances are that there are wider patterns of disharmony and imbalance, and correcting or addressing these patterns might offer the best chance of sustainable improvement. That said, there are a number of treatments which do involve the insertion of a number of needles both within and on the margins of the affected area. From an eastern perspective this is seen as encouraging the local flow of 'qi', and from a western perspective is understood in neurophysiologial and segmental terms, and there is an outside chance that this may help to reduce or reverse the condition. Our experience, however, is that alopecia is not very easy to treat, and we tend to ensure that patient expectations are as realistic as possible.

The fact that you can track your alopecia to stress, however, suggests that treatment may well be of benefit. We have a great many more studies for the use of acupuncture with anxiety and stress, and the factsheet on anxiety


http://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/anxiety.html

while falling a long way short of conclusive is certainly very encouraging.

As always, we believe that you are best served by arranging to see a BAcC member local to you for a brief chat and face to face assessment of the potential benefit. Most members do this  without charge,  and this  also gives you a chance to meet them and see where they work.

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