Dermal hypoimmunity diseases (first part) – Sweat stains, tinea cruris
(免疫能力底下性皮膚病(上) – 汗斑 . 股癬)
The AIDS virus can cause human acquired immunodeficiency. Besides direct infection causing neural pathologic changes or exhaustive syndromes of unknown origin, human CD4 cells when infected may lead to functional disorders of the immune system and eventually to the production of infections and tumors under different conditions. This is a typical kind of virus which is known to be able to cause loss of resistance in the human body and can jeopardize life. But in clinical practice, when treating chronic hepatitis patients, we also found that patients with “hepatophilic virus disease” often showed hypoimmunity. Regardless of other medical disease, chronic hepatitis may be associated with bacterial or mycotic infections of mucous membrane or skin or prolonged obstinate scabies and these are conditions frequently encountered.
In clinical practice, the most commonly seen dermal disease of hypoimmunity are pustular skin disease such as impetigo, boils, infected acne, mycotic infections such as dermal fungus, onychomycosis (甲癬), sweat stains, monilial onychitis, vaginitis and scabies. But every time when the “hepatophilic virus disease” is clinically cured by systemic TCM treatment, the dermal disease of the patient is comparatively easy to handle. Therefore, the existence of obstinate and repeated infections like mycosis should lead one to think of the possibility of the co-existence of hepatophilic virus disease. If it is confirmed that there is chronic hepatitis or the presence of abnormal margin of liver dullness, treatment with TCM drugs is the first choice and the result would certainly be double while the effort used is half.
In the present group of patients, those with typical generalized sweat stains (mild cases not included) amounted to 66/2758 cases, occupying 2.39%. When patients with liver disease are examined physically, it is found that not few of them have various degrees of skin dryness or sweat stains, especially when patients have kidney deficiency which can cause darkness of skin and this condition makes sweat stain lesions more prominent. Therefore, hidrotic dermatitis and swat stains caused by skin dryness should be one of the causes of pruritus (especially after sweating) in liver disease patients. Other cases of skin disease caused by hypoimmunity in patients with abnormal margin of liver dullness are not included in this statistical group because of the limited volume.
| Case 19
Li (code number 2085) male, age 39 years. His first visit was in March 2000. He complained chiefly of hyperhidrosis since childhood and the perspiration was spontaneous, associated with repeated dermal pruritus. He was diagnosed as eczema by the attending dermatologist and treated accordingly but the drug treatment led to vertigo and sleepiness. Now, he felt repeated itching of the skin every time after sweating, especially at the scalp and back of the body where the itching did not disappear in spite of disruption of the skin by scratching. Physical examination: prominent skin stain lesions all over the body, skin of the back already lichenified with significant pigmentation. Both groins showed tinea cruris and pigmentation; lower limbs revealed venous varicosities. Liver enlarged to 3 cm, with percussion tenderness. The diagnosis was chronic hepatitis, with TCM classification as wetness-heat vaporization complicated with generalized sweat stains and tinea cruris. Treatment was the application of Baixianpi Yinchen Soup (Soup with Cortex Dictamni and Herba Artemisiae Scopariae) (白癬皮茵陳蒿湯) for 3 parcels. After TCM therapy, the liver returned to normal and the stools were smooth. He had still acne on the chin, showing redness, edema and pain, and also had dysphoria with smothery sensation. Pruritus over the back increased. Pruritus gradually subsided as the TCM treatment was going on and up to the third week, it was not necessary to apply drugs externally to stop the itching. Pigmentation at the back faded gradually and the sweat stain papules become flat. At the fourth week, pigmentation at the back could be barely seen and the tinea cruris was cured. At the 6th week of TCM therapy, the lesions at the back healed and pruritus and pigmentation disappeared. Edema at the lower extremities was (+). Because beriberi had not been ruled out, the patient was told to continue taking vitamin B1, B6 and E. Systemic treatment lasted for 8 weeks, at which time clinical cure was attained and treatment was stopped for observation.
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| Case 20
Wu (code number 2685) female, age 52 years, her first visit was in October 2001. She complained that her skin was always dry since childhood and she experienced repeated itching of the skin but there were no dermal lesions. She received many times of special treatment because of dermal hypersensitivity and housewife hand. Eight years before, she was attacked by “herpes zoster” (帶狀疱疹) at the right abdomen and had vertigo because of imbalance of auricular fluid. In the recent year, the back of her palms showed symmetrical neurodermatitis and she also experienced repeated pruritus of the whole body. She had frequently insomnia, dreaminess, vertigo, fatigue, diarrhea, backache and pigmentation of face.
Physical examination: skin dark color, generalized sweat stains, tongue enlarged with teeth prints, lower extremities (+) edema, percussion tenderness over hepatic region, hepatomegaly of 1.5 cm. Diagnosis was chronic hepatitis (herpetic not ruled out), with TCM classification as wetness-heat vaporization, deficiency of Qi and blood, weakness of liver kidney, wind originated pruritus, neurodermatitis, sweat stains.
After taking 3 parcels of TCM drugs, she had no uneasiness and the liver was normal. Another sever parcels were taken and the pruritus, wondering all over the skin of the body, decreased and the neurodermatitis over the back of the palms became atrophic and thin, increased in pigmentation and showed significant desquamation. Edema of the lower extremities lessened. As the TCM treatment continued, the dermal pruritus ceased, lesions over the back of the hands regressed and decreased in area and pigmentation. Clinical cure was attained after 6 weeks and the treatment was stopped for observation.
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By WONG Kwok Hung
published on 22nd January 2002
(translated by Professor ZHENG Hua En in March 2004)