Ask an expert - body - skin conditions

51 questions

As you might expect there is very little published research on the treatment of lichen planopilaris (LPP) with acupuncture. We are sure that there are many reasons for this, not least of which is that it is quite a rare condition and collecting enough cases for a study may prove difficult. There isn't even a great deal of published research on the commoner varieties of alopecia.

From a conventional medicine perspective treatment, usually heavily steroid led, is aimed at reducing or slowing down the spread of the condition by reducing the inflammatory responses which characterise its spread. We suspect that insofar as we use acupuncture to treat many forms of inflammation there may be some possibility of replicating or augmenting the effect of conventional treatment.

However, we are always keen to point out that the Chinese medicine perspective is a very different one from what most people think of as medicine. The idea of named conditions is not really at the heart of the system, and each patient is seen as a unique combination of energies whose patterns, rhythm and flow are the basis for understanding why symptoms appear. The blockages and changes of flow which create symptoms are sometimes local and directly related to the problem as it appears, but more often than not there are systemic problems which need to be addressed for local problems to have any chance of being properly removed.

The language of Chinese medicine is often quite literal, and will talk of Heat, Cold and Damp as factors within the system, so someone with an inflammatory response would be seen as manifesting Dry Heat or Damp Heat, and the treatment would be aimed at expelling this, and at the same time treating the system to ensure that it does not flare up again. This may all sound a little airy fairy but with 2500 years of history behind it Chinese medicine is a very sophisticated diagnostic and treatment tool.

We often find that with skin problems Chinese Herbal Medicine can be used to great effect, and BAcC members who are also members of the Register of Chinese Herbal Medicine may be the ones to approach for advice. Most RCHM members belong to the BAcC, so using their practitioner search function will almost certainly generate a hit near you. We always advise people to visit a practitioner for an informal chat because as is obvious from what we have said about individual treatment there really is no substitute for having a direct look at a problem. Most members are happy to give up a little time to prospective patients without charge to assess what the best treatment options may be.

We think, though, that you might have to accept that where hair has been lost the chances of regrowth are slim, and that the best treatment might be able to achieve would be a slowing down of the disease progress together with a lessening of some of the discomforts associated with it. 

 Interestingly enough, the issue of treating children is very much a live one in the BAcC at the moment. Our members have always treated children, but over the years there has been an increasing recognition that children are not the same as little adults. Specialist courses have developed, and the BAcC has now recognised that there are expert levels of practice which might entitle a member to advertise themselves as an expert in treating children. The guidelines which will underpin this are not quite ready for publication, and so at this point we cannot give out the names of members who might meet these standards.

 However, if you use google with your location, 'acupuncture' and 'children' we are fairly confident that you will quickly identify someone local to you who has undertaken specialist postgraduate training. That is not to say that the ordinary BAcC member cannot treat children, only that someone who makes the treatment of children a focus in their practice is likely to have greater experience about dealing with children and recognising the patterns of disease unique to children.

Using google will also very rapidly identify the two or three major course providers for paediatric acupuncture, and some of these provide drop down lists of practitioner by area.

It is also commonly held view in the profession that skin problems are particularly benefited by herbal medicine, and finding someone with this additional string to their bow might be an advantage. Our members are often very helpful at directing prospective patients to members within their area whom they know personally and trust as experts in their field, and if all else fails you could almost certainly get a good steer from a practitioner local to you.

This remains the best advice that we can offer. We have checked the research databases to see if anything further has been published than the studies reported in our factsheet

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/eczema-and-psoriasis.html

but the evidence is a little thin. However, it would be fair to say that the trials which have taken place are not always accurate reflections of how we treat people, so the fact that results are not that impressive doesn't surprise us.

We often find that there are complex reasons for someone having eczema, but the crucial thing is finding something which breaks the cycle leading to a flare-up. If this can be done then it can stop the feeling that once it appears a little it will become a full-blown attack, as the worry of a possible recurrence can sometimes do.

We hope that you manage to track down a suitably qualified practitioner. In our experience children are great responders; if treatment is going to work it usually does so quickly.

 

Q:  I have had  PHN for over more than ten years, it is affecting my left leg..the pains is still ongoing... I wonder if acupuncture can help?

A:  As you might imagine we have been asked about this many times over the years; shingles can be a terribly distressing condition whose after-effects can persist for months or even years. The treatment of post herpetic pain is an area which has been heavily researched in China, as our factsheet

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

says, but the quality of trials is not that great. There is a comprehensive systematic review of all available trials, but this was only announced last year and has not yet been published. We ourselves have treated many cases of shingles, and we have to be honest and say that there has been a significant number of cases where it has been very difficult indeed to reduce the pain, which as we are sure you know can be excruciating.

However, there is no point in being unduly pessimistic. There have been cases of post-herpetic pain where the acupuncture treatment has made significant inroads into the symptoms from a mixture of constitutional treatment to bring balance back to the system as a whole and local treatment to reduce some of the irritation and inflammation. Generally speaking, it is better to start treatment as soon as possible after an attack, just as the use of conventional anti-viral medicines is favoured as early as possible. However, the reality is that most patients present with post-herpetic pain long after they attack and usually because the side-effects of the long-term medication are becoming a problem, so we are used to adopting a slightly different approach from that used in China, where needling often commences with days of an attack starting.

The best advice that we can give is that you visit a BAcC member local to you for a brief face to face assessment. The one caution we always voice in these cases is that if you decide to go ahead with treatment you set review dates for assessing progress and also try to set specific outcome measures, objective evidence that the condition is improving. This can be quite difficult with chronic conditions like this which can still have acute episodes, but it is really important to try to find a marker which can show that there has been progress. We would feel confident, though, that acupuncture treatment might offer some benefit in pain relief and recovery. The only question to resolve is how much and how sustainable the relief is, which is why we are always cautious in setting clear outcomes measures and review periods.

The great strength of Chinese medicine, though, is that each patient is unique and different, even though their symptoms be the same. This means that a skilled practitioner, and all of our members are, would be able to make links that we cannot do at this distance, and may be able to recommend other things that may help alongside acupuncture treatment. We would strongly recommend that you visit a local BAcC member for advice, and hope that it puts you on a path to finding some relief.

The one confounding factor about your problem is that it has now persisted for ten years. There is a kind of received wisdom that treatment becomes more difficult the longer a problem persists, and there used to be a line that treatment of a problem took as many months as the years it had persisted. Most of us don't take this too seriously, though; we have seen thirty year problems sometimes vanish within weeks. The key issue will be to determine what is happening in energetic terms. This may give some very useful pointers to what has caused the problem to persist and similarly pointers to what might make things improve.

 

Q:  I have colitis, hayfever and dust allergies, psoriasis and recently some new pain and swelling in my thumb and toes. I am aware that auto immune diseases can cluster in this way in individuals and now with the new symptoms am wondering if acupuncture could help me and if there is an NHS practitioner in my area of Gloucestershire? 

A:  You are right to think that the approach inherent in traditional Chinese medicine may offer possibilities for the treatment of some of the problems which you have. We don't want to quote great numbers of studies at you because you have clearly done your research, but if you want further details then you need look no further than our website where you will find under the 'research' tab a further button for fact sheets which cover many of the problems which you mention. Indeed, if you use the 'site search' facility on the home page you will find dozens of answers which we have given over the years about many of the problems which you have.

 The great strength of Chinese medicine is that the practitioner is trying to make sense of all aspects of a person's health and well-being by using a theoretical framework which draws on 2500 years of understanding of the whole body, mind and spirit as an energy system. This means that interconnections are very naturally a part of this understanding, whereas conventional medicine tends to address each aspect separately and in isolation. This is often not quite so pronounced as some of our colleagues argue; we know of many GPs who are proud of their genuine holistic approach to health. The system itself, however, does not lend itself to this kind of approach.

 We think, however, that you may find it very difficult to identify any traditional acupuncture provision in your area. What acupuncture treatment there is can most often be provided by doctors and physios within their normal scope of practice, and usually only on conditions for which there is a substantial and persuasive evidence base in western terms. This does not extend to many of the problems you have.

 On the assumption that you want to find treatment free at the point of delivery, it might well be worth asking a BAcC member local to you (whom you can find using the postcode search facility on our home page) if they are aware of anything local to you in NHS provision. We know of one member who was heavily involved in NHS work but we think it may have been in another field of medicine. If this doesn't turn anyone up you may well be pointed to someone who is prepared to treat you at highly reduced fees. Many of our members are as concerned with helping people than making a mint, and are usually prepared to help people find what they need.

 There is also a growing number of multibed clinics trying to provide acupuncture at reduced rates for work in group settings. A list of these can be found at this website http://www.acmac.net/, and this may offer possibilities.

Q:  I have alodinya feels like permanent sunburnt but also results in pain in different areas. I have had an MRI scan and the  results they don't think are anything to do with spine damage. They think it is difficult to associate it with sensory symptoms.  Would acupuncture help?

A:  We are very sorry to hear that you have this problem; it can be very disheartening to have something for which no clear-cut cause can be found.

We have searched the literature for any evidence of acupuncture being used to treat this, but weren't at all surprised to find nothing of significance. The condition usually presents itself as a feature or symptom of something which is already named and classified, and treatment usually focuses on that specific problem.

However, the great strength of Chinese medicine is that it has a 2500 year history of treating problems not by name but by how things appear, and understanding them within a system which is based on energy flow. This has evolved to use a great many classifications based on observation and lived experience, like feelings of heat and cold in the body, and also a complex understanding of the inter-connectedness of parts of the system. Once one steps aside from the disease label and asks more specific questions about where the sensations are, how they feel, and what makes them change this can often point to a series of possible causes, many of which are treatable.

It has long been received wisdom in the acupuncture and Chinese medicine world that skin problems are often best treated with a combination of acupuncture and Chinese herbal medicine. Since most of the practitioners on the Register of Chinese Herbal Medicine are also BAcC members too this may be the best option to pursue. However, herbs are to everyone's taste, and we are pretty confident that acupuncture alone could be just as effective.

The best advice that we can give, and often do give, is that seeing a problem face to face is always the best way to establish whether something is treatable. Most BAcC members are more than happy to give up a few minutes without charge to have a look at the problem and give more specific advice, and this also gives you a chance to meet them and see where they work before committing to treatment.

 

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