Supported by multiple clinical trials and systematic reviews
Eczema (Atopic Dermatitis) & Psoriasis
Eczema (atopic dermatitis, AD) and psoriasis are chronic inflammatory skin diseases that share some management principles (moisturization, anti‑inflammatory therapy, and trigger control) but differ in immune pathways, clinical appearance, and many treatment choices. In Western medicine, diagnosis is clinical: AD often begins in childhood, with pruritic, eczematous patches in flexural areas and a relapsing course, accompanied by xerosis and personal or family atopy. Validated criteria include Hanifin–Rajka and the UK Working Party. Psoriasis typically presents with well‑demarcated erythematous plaques with silvery scale on extensor surfaces, scalp, and sometimes nails or joints; severity and response are tracked with tools like PASI and DLQI. Standard care emphasizes barrier repair (emollients), topical anti‑inflammatories (a potency ladder of corticosteroids; non‑steroidal options like calcineurin inhibitors or PDE‑4 inhibitors), phototherapy (narrowband UVB), and systemic/biologic agents as severity escalates. For AD, newer small‑molecule JAK inhibitors have expanded options for moderate‑to‑severe disease. For psoriasis, highly targeted biologics against IL‑17 or IL‑23 pathways have transformed outcomes for many patients. These approaches are guideline‑driven and supported by strong evidence, but they are not curative, responses vary, and long‑term safety, cost, and access are practical constraints. Eastern and traditional modalities frame these conditions differently. In Traditional Chinese Medicine (TCM), eczema and psoriasis reflect internal imbalances such as “blood heat,” “blood dryness,” or “damp‑heat,” inferred from the lesion character (weeping vs dry), color, and systemic patterns. Therapy aims to clear heat, resolve dampness, nourish blood, and calm wind, often combining individualized herbal formulas with acupuncture and dietary guidance. Several randomized trials—including classic UK studies of standardized CHM formulas for atopic eczema—suggest short‑
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.
Western Medicine
Diagnosis
Eczema (AD): Clinical diagnosis based on chronic/relapsing pruritic dermatitis, typical morphology and distribution (age‑dependent; flexural in older children/adults), and personal/family atopy; Hanifin–Rajka or UK Working Party criteria often used. Severity tracking: EASI, SCORAD, POEM. Psoriasis: Clinical recognition of sharply demarcated erythematous plaques with micaceous scale on extensor surfaces/scalp; nail changes (pitting, onycholysis), special sites. Consider biopsy when atypical. Severity: PASI, BSA, DLQI; screen for psoriatic arthritis.
Treatments
- Skin barrier repair with liberal emollients (ointments/creams; fragrance‑free) as foundation for both AD and psoriasis (adjunctively in psoriasis)
- Trigger identification/avoidance (irritants, infections; in psoriasis: trauma/Koebner, medications; stress reduction)
- Topical corticosteroids using a potency ladder (low: hydrocortisone; mid: triamcinolone; high: betamethasone dipropionate; super‑potent: clobetasol). Site‑ and age‑appropriate selection, fingertip‑unit dosing, intermittent/maintenance regimens to minimize atrophy
- Topical non‑steroidal anti‑inflammatories for AD: calcineurin inhibitors (tacrolimus ointment, pimecrolimus cream) for sensitive areas/long‑term maintenance; PDE‑4 inhibitor crisaborole for mild‑to‑moderate AD
- Topical psoriasis agents: vitamin D analogs (calcipotriol), combinations with corticosteroids; keratolytics (salicylic acid)
- Phototherapy: narrowband UVB for moderate AD or psoriasis; excimer for localized plaques; PUVA less favored due to long‑term risks
- Systemic therapy for moderate–severe AD: JAK inhibitors (upadacitinib, abrocitinib), dupilumab/tralokinumab (IL‑4/IL‑13 pathway; not asked but standard), cyclosporine short‑term in select cases
- Systemic therapy for moderate–severe psoriasis: biologics targeting IL‑17 (secukinumab, ixekizumab), IL‑23 (guselkumab, risankizumab, tildrakizumab), TNF (adalimumab, etanercept, infliximab); traditional agents (methotrexate, cyclosporine, acitretin)
- Infection management (e.g., Staphylococcus aureus in AD), wet wraps for severe AD flares, and patient education programs
Medications
- Emollients (petrolatum‑based ointments, ceramide‑containing moisturizers)
- Topical corticosteroids across potencies (hydrocortisone, desonide, triamcinolone, mometasone, betamethasone dipropionate, clobetasol)
- Calcineurin inhibitors (tacrolimus, pimecrolimus) for AD
- PDE‑4 inhibitor for AD (crisaborole)
- Vitamin D analogs +/- steroids for psoriasis (calcipotriol/betamethasone)
- Systemic biologics for psoriasis: IL‑17 inhibitors (secukinumab), IL‑23 inhibitors (guselkumab), TNF inhibitors (adalimumab, etanercept, infliximab)
- JAK inhibitors for AD (upadacitinib, abrocitinib)
- Phototherapy (narrowband UVB; excimer) as a modality
Limitations
Neither approach is curative; relapse is common. Long‑term topical steroid overuse risks skin atrophy, telangiectasia, striae, and tachyphylaxis; adherence can be challenging. Systemic immunomodulators/biologics carry infection risk, laboratory monitoring, and high costs; access and insurance barriers exist. Phototherapy requires frequent visits and may be impractical. Some patients prefer steroid‑sparing options or seek complementary care for holistic goals.
Sources
- American Academy of Dermatology/National Psoriasis Foundation guidelines for psoriasis (2019–2021)
- British Association of Dermatologists guidelines for biologic therapy in psoriasis (2020)
- AAD Guidelines of care for atopic dermatitis: topical therapies, phototherapy, and systemic agents (2014; updates 2023)
- British Association of Dermatologists guidelines for atopic eczema (2021)
- Guidelines and systematic reviews on narrowband UVB for psoriasis and AD (AAD/BAD phototherapy guidance)
Eastern & Traditional Medicine
Traditional Chinese Medicine (TCM)
Interprets eczema/psoriasis as imbalances such as blood heat (red, inflamed lesions), dampness‑heat (weeping, exudative eczema), wind‑dryness or blood dryness (chronic, lichenified, dry lesions). Treatment individualizes internal patterns to clear heat, resolve dampness, nourish and move blood, and dispel wind; aims to reduce itch, inflammation, and recurrence.
Techniques
- Individualized internal herbal formulas (decoctions/granules) targeting patterns (e.g., heat‑clearing, damp‑resolving, blood‑nourishing herbs)
- Topical herbal soaks/washes; occasionally ointments/creams
- Acupuncture to modulate itch and stress
- Dietary and lifestyle advice aligned with pattern diagnosis
Ayurveda
Frames eczema/psoriasis under kushta/ekakushtha with doshic imbalance (often vata‑kapha with pitta involvement). Therapy emphasizes shodhana (detoxification, e.g., Panchakarma) and shamana (pacification) using herbal formulations, diet, and lifestyle to reduce inflammation, itch, and scaling.
Techniques
- Topical botanicals such as neem (Azadirachta indica) or turmeric (curcuma/curcumin) preparations for antimicrobial/anti‑inflammatory effects
- Internal herbs/mineral‑herb formulas individualized by dosha
- Panchakarma (e.g., virechana/purgation), medicated ghee, and dietary modification (avoid triggers, emphasize easily digestible foods)
- Yoga/breathwork for stress modulation
Dead Sea climatotherapy
Intensive controlled sun exposure and bathing in mineral‑rich Dead Sea water; combines heliotherapy with unique atmospheric/UVB profile and balneotherapy. Used for moderate–severe psoriasis and sometimes chronic eczema.
Techniques
- Supervised graded sun exposure at the Dead Sea
- Daily balneotherapy (high‑salinity soaks)
- Adjunctive emollients; occasional topical corticosteroids for focal lesions
Probiotics (AD prevention)
Maternal and/or infant probiotic supplementation in high‑risk families to modulate gut‑skin immune crosstalk and reduce AD incidence.
Techniques
- Perinatal maternal probiotics
- Infant probiotic supplementation (Lactobacillus/Bifidobacterium strains)
Sources
- Sheehan MP, Atherton DJ. Randomized, double‑blind trial of Chinese herbal therapy in atopic eczema. BMJ. 1992.
- Cochrane Review: Chinese herbal medicine for atopic eczema (updates through 2013/2021)
- Reports/guidance on safety concerns: MHRA Drug Safety communications on illegal skin creams adulterated with potent corticosteroids
- Systematic reviews of acupuncture for chronic pruritus/eczema (mixed, low–moderate quality)
- Systematic reviews of curcumin in dermatologic inflammation suggest potential benefit with low–moderate quality evidence (e.g., Panahi Y. Phytother Res. 2015, curcumin gel RCT in plaque psoriasis)
- Narrative/systematic reviews of Ayurvedic interventions for psoriasis/eczema (overall low‑certainty; heterogeneous methods)
- Harari M et al. Int J Dermatol. 2000: Dead Sea climatotherapy in psoriasis improves PASI and quality of life
- Observational cohorts and controlled studies comparing Dead Sea therapy to phototherapy (consistent short‑term benefit; relapse common without maintenance)
- World Allergy Organization (2015; 2022) guidelines suggest probiotics may reduce AD risk in high‑risk infants (conditional, low–moderate certainty)
- Cochrane Review (2018/2020 updates): Probiotics reduce eczema incidence modestly in infants at risk; strain‑ and timing‑dependent
Integrative Perspective
Practical integration often pairs guideline‑based topical care with selected traditional/internal strategies while prioritizing safety and quality control. For AD: maintain daily emollients and appropriate‑potency topical corticosteroids for flares, with steroid‑sparing calcineurin inhibitors for sensitive areas. Where desired, consider a time‑limited trial of individualized TCM internal herbs under a qualified practitioner, with dermatology oversight and baseline/periodic liver function monitoring. Avoid unregulated “herbal” creams because multiple surveys have found adulteration with potent corticosteroids; this can cause skin atrophy and HPA‑axis suppression. For moderate disease, narrowband UVB can be combined with mindfulness‑based stress reduction to improve itch and coping; avoid photosensitizing botanicals during light therapy. For infant AD prevention in high‑risk families, discuss probiotics (per WAO guidance) as an adjunct to breastfeeding support. For psoriasis: continue evidence‑based topicals/phototherapy/biologics as indicated; Dead Sea–style balneophototherapy blocks can be used as a non‑pharmacologic adjunct with good short‑term clearance, followed by maintenance emollients/vitamin D analogs. Mind‑body strategies (MBSR, CBT) may reduce stress‑triggered flares and improve adherence. Omega‑3 fatty acids and Ayurvedic botanicals (e.g., curcumin) have mixed but suggestive data; if used, monitor for interactions (e.g., anticoagulants with high‑dose omega‑3 or curcumin). Shared decision‑making, documentation of all products used, and outcome tracking (EASI/SCORAD, PASI/DLQI) help ensure that complementary measures add to—rather than replace—effective medical therapy.
Sources
- AAD/NPF Psoriasis guidelines (2019–2021): biologics, phototherapy, topicals
- BAD guidelines for psoriasis biologics (2020) and AD (2021)
- AAD Atopic Dermatitis guidelines (2014; 2023 updates on topicals, phototherapy, and systemic/JAK inhibitors)
- Sheehan MP, Atherton DJ. BMJ. 1992. Randomized trial of Chinese herbal therapy in atopic eczema
- Cochrane Reviews: Chinese herbal medicine for atopic eczema (2013/2021); Probiotics for preventing eczema (2018/2020)
- World Allergy Organization 2015 and 2022 guidelines on probiotics for allergy prevention
- Harari M et al. Int J Dermatol. 2000. Dead Sea climatotherapy in psoriasis
- Panahi Y et al. Phytother Res. 2015. Curcumin gel RCT in plaque psoriasis
- MHRA Drug Safety communications on adulterated herbal skin creams containing corticosteroids
Health Disclaimer
This content is for informational purposes only and does not constitute medical advice. Always consult a qualified healthcare provider before starting, stopping, or changing any supplement or medication regimen.