Ask an expert - body - skin conditions

53 questions

We are sorry to hear of your father's problem. We are aware from clinical experience just how much suffering this can cause because of its relentless nature.

There isn't a great deal of published evidence for the treatment of itching as such, although what there is is quite positive, as this systematic review shows: 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4430643/

Most of the research which would prove relevant is buried away in studies of diabetes and kidney problems where the itching is a part of a wider clinical picture.We suspect that there is no easy fix for this problem. There is a very strong chance that the changes in blood chemistry caused by the diabetes and kidney disease are the drivers for the itching, and these are not likely to relent as his age increases. What acupuncture may be able to do, though, is to break the cycle of discontent which can mean that the anxiety and distress caused by the problem become one of the factors which ensures that it escalates. Many conventional medicines are prescribed in this way to stop thins building on themselves, and there are certainly points used in Chinese medicine which would accomplish relief both from itching and anxiety at the same time. The only major question is now much relief and how sustainable it is.However, Chinese medicine looks at the whole person, not simply at the condition which someone has, and there would be a great deal of questioning about where the itching was, what made it better or worse, and so on, and looking at this within the context of the overall functioning of the body. There is a tendency sometimes to ascribe any symptoms to the headline conditions which people have, and this may not be the case. There may be all sorts of treatable reasons why someone develops itching, and a skilled practitioner might find something eminently treatable.The best advice as always is to try to get your father to visit a local BAcC member for an informal chat. Most are more than happy to give up a little time without charge to prospective patients, and this will allow someone to give your father a much better idea of what may be possible.  

You may well find that acupuncture treatment is effective for you not simply because of the treatment for eczema itself but also for the treatment of the stress which seems to make it worse. As our two factsheets show

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

https://www.acupuncture.org.uk/a-to-z-of-conditions/a-to-z-of-conditions/stress.html

there is research on both which is mildly encouraging, and even more research into anxiety

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

'Stress is such a wide catch-all that unless you really start to unravel what stress means to someone it is very difficult to line up their definition with the kind of data you have to hand.

If we deal in conventional medical disease labels for skin problems we often find that the research to hand is not as good as we might hope. In our clinical practice, however, we usually find that it is rare for someone simply to have a skin condition without there being some other accompanying clinical features, and because we treat the person, not the disease, we almost always find that the wider context enables us to work with the root cause of the problem, not simply its manifestation. This may sound a bit pompous, but it really is the most effective way to work in our view, by understanding what the patient experiences within the context of their overall health picture.

The one factor which we invariably mention with treating skin conditions is that the received wisdom inside the profession is that Chinese herbal medicine treatment used in conjunction with acupuncture is often seen as the most potent combination for addressing chronic skin complaints. Most members of the Register of Chinese Herbal Medicine are also on the BAcC register, and it might well be worth your while to see if someone near to you is able to offer this combination of treatments. If not we are are sure that acupuncture alone may be able to offer some real progress, especially with the management of stress.

In all skin conditions, though, the real challenge is measuring progress, and we would always urge someone to try to establish a measurable outcome to assess whether treatment is really working. It can take a while for skin conditions to relent, and it is very valuable to have some sort of marker for improvement to judge whether treatment is starting to take root.  



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.

 

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