Nummular dermatitis(ND) is chronic, recurrent, itchy dermatitis that can occur anywhere on the body. At first, small blister like macule or papule appear, and ooze gradually form. After scabs from and can spread throughout entire body in irregular shapes, itchiness can be much worse at night.
The cause of nummular dermatitis(ND) is still unknown. It frequently present in people with hay fever(allergic rhinitis) and asthma. Sometimes certain bacterial infection(colonization of bacteria on the skin) appears to be the cause of the nummular dermatitis. Allergic reaction to a certain allergen can be a possible trigger but sometimes the spots appear on other part of the body where the allergic reaction first started. Due to complexity of our immune system, and as it is hard to pin point out exact cause, most treatment is eventually either steroid or anti histamine.
ND usually affects middle aged and older peoples. It starts with round spot of red, itchy, scaly lesion that are coin shaped. These can spread and become more noticeable on the back of the arms or legs, buttocks, but also it appears on the torso.
It is easy to distinguish when condition is more advanced and has its particular character, but when it is just like a blister at the initial stage, it is difficult to make proper diagnosis whether it is simple eczema or ND. Usually, most of you came to me after using steroid cream for a certain period of time .
In the case of a weak percentage of steroid application, or when used for a brief period of time, the rebounding phenomenon is not severe, however, it is frequently observed that it is hard to tolerate when extreme case or rebounding event, especially dermatitis on the face.
So When starting treatment with TCM, it is important to understand steroid rebound that occurs when steroid use is reduced or stopped.
Likewise every skin problem, ND is not just a skin disease. Especially if it is chronic recurrent dermatitis, we have to look in to cause that lies within. If you have chronic bowl issues like IBS or chronic indigestion, when solving internal gut issue, cure of ND come along simultaneously.
How you eat and how you absorb from your gut is very important factor in ND. In particular, ND is characterized by extreme itchiness and it can exacerbated by eating meat, dairy, eggs, and wheat products for particular constitution. For example, leaky gut syndrome really explain well gut-skin relationship.
In many cases of ND, TCM pattern Blood stagnation and phlegm retention, linked to heat poisoning and blood clots. It is also related to women's menstrual cycle, and symptom fluctuate with menstrual cycle. Therefore, treatment is to remove phlegm and blood stagnation form inside, using acupuncture, herb and external herbal ointment(NOT steroid).
The core treatment of ND is to treat internal imbalance that cause itchy dermatitis.
Treatment can be summarized as
Prevention of exacerbation of severe symptoms due to secondary infection by alleviating itchiness through skin cooling and detoxifying treatment.
Treatment process is followed by a period of rebounding, in the case of chronic recurrent ND, then eczema will gradually disappears and dries out.
If there is new blistering area comes up, it is judged that the internal cause has not been fully resolved, and treatment should be focus on internal pathogen.
Alcohol, coffee, gluten, and too much dairy should be avoided in the case of dietary intolerance related symptoms.
Each case is being treated individual constitutional treatment/
It start with thinning and it gets wider once started TCM treatment, and it is natural progress of healing and scab forming with thinner and wider look as the ooze decrease.
Scratching the lesion cause secondary bacterial or fungal infection, and resulting in more severe itchiness. Please consult with the Well to get some help with itchiness.
The Well is working hard to treat skin disorder by treating inside and out. :)