Psoriasis Vs. Atopic Dermatitis: Traditional Korean Medicine Sees Them As Completely Different

Aren't they the same skin disease? — Two completely different conditions in terms of lesions, constitution, and immune response

Hello, everyone. This is Baekrokdam Korean Medicine Clinic.

Today, we're going to talk about two of the most easily confused skin conditions: psoriasis and atopic dermatitis. On the surface, they might look similar: red skin, scaling, itching... However, from a Korean Medicine perspective, these two diseases develop differently, and the body reacts to them in entirely distinct ways. In particular, we'll delve into the Korean Medicine answer to the question, "Why do some people develop atopic dermatitis, while others develop psoriasis?"

1. Two Diseases Similar on the Surface, but Different in Nature

First, let's summarize their commonalities. Both conditions are chronic, recurrent, inflammatory immune diseases of the skin. Modern medicine views both as resulting from an overactive or malfunctioning immune system. Korean Medicine shares a similar perspective, categorizing both under "seonjeung (癬證)" – a general term for various skin diseases – but within this category, their pathological mechanisms, constitutional types, and symptom patterns operate completely differently.

2. Psoriasis – Distinct Scales and Red Patches

In Korean Medicine, psoriasis is called baekbi (白疕) or eunseolbyeong (銀屑病). It is characterized by lesions covered with silvery, scale-like keratin. The skin lesions have distinct borders and primarily appear in areas of frequent friction, such as the elbows, knees, and buttocks. A distinctive feature is that itching may not be severe or might be completely absent. This often leads to confusion with atopic dermatitis. From a Korean Medicine perspective, it is primarily explained through pathologies like Blood Heat (Xue Re), Blood Dryness (Xue Zhao), Blood Stasis (Yu Xue), and Liver and Kidney Deficiency (Gan Shen Bu Zu).

• Blood Heat (Xue Re): A state where blood is hot and inflammation easily occurs.
• Blood Dryness (Xue Zhao): A state where blood is dry and skin regeneration is abnormally rapid.
• Blood Stasis (Yu Xue): A state of stagnant blood circulation, leading to fixed lesions.
• Liver and Kidney Deficiency (Gan Shen Bu Zu): A state of weakened immune function and slow recovery.

It's common for scales to accumulate in layers, and lesions often appear brownish or dark red. The tongue may be red or show petechiae/ecchymosis, and the pulse may be rapid or rough.

3. Atopic Dermatitis – Indistinct Borders and Severe Itching

Atopic dermatitis, on the other hand, is different. In Korean Medicine, it is known by various names such as Taeyeol (胎熱), Yuseon (乳癬), Samanpung (四灣風), and Seupjin (濕疹). Common characteristics include indistinct skin borders, profuse weeping and scratch marks, and, most notably, severe itching. Atopic dermatitis primarily appears in flexural areas like the inner elbows, behind the knees, neck, and face. As scratching continues, lichenification (thickening of the skin) progresses.

From a Korean Medicine perspective, it is typically approached with diagnoses such as Damp-Heat (Shi Re), Blood Deficiency with Wind Dryness (Xue Xu Feng Zhao), Wind-Heat (Feng Re), and Spleen and Stomach Weakness (Pi Wei Xu Ruo).

• Damp-Heat type (Shi Re): Characterized by profuse weeping and inflammation.
• Blood Deficiency with Wind Dryness type (Xue Xu Feng Zhao): Characterized by dryness and lichenification.
• Spleen and Stomach Weakness (Pi Wei Xu Ruo): A case where intestinal immunity is weak, leading to frequent allergic reactions.

The tongue may have a sticky yellow coating or feel very dry, and the pulse is often slippery and rapid (활삭맥) or deep and wiry (침현맥).

4. Why Do Some Get Atopic Dermatitis While Others Get Psoriasis?

Now, let's address the question many of you are curious about: "Why do some people develop atopic dermatitis, and others develop psoriasis?" From a Korean Medicine perspective, this isn't simply a matter of luck but depends on how the immune system reacts and which stimuli an individual's constitution is sensitive to.

People prone to atopic dermatitis often:

• Have a weak skin barrier and sensitive intestinal immunity, making them prone to allergic reactions.
• Are individuals where Dampness (濕) and Heat (熱) easily accumulate in the body.
• React to environmental stimuli with weeping, itching, and swelling.

People prone to psoriasis often:

• Have excessively rapid skin regeneration and easily stagnant blood.
• Have a constitution where Liver and Kidney function is weak, making the immune system prone to autoimmune malfunctions.
• React to external stimuli with excessive scaling, dryness, and well-demarcated lesions.

Thus, even with the same stress or environmental stimuli, the way the skin reacts differs depending on the constitutional type. This is the biggest difference between psoriasis and atopic dermatitis.

5. Diagnosis is Different, and So is the Approach

In Korean Medicine, diagnosis doesn't just involve examining the skin. We look at the tongue, take the pulse, and comprehensively evaluate the patient's constitution, medical history, and accompanying symptoms. For psoriasis, the tongue is often red, with a thick coating, and the pulse is rapid (삭맥) or choppy/rough (삽맥). For atopic dermatitis, the tongue is often sticky or dry, and the pulse is frequently slippery and rapid (활삭맥) or deep and wiry (침현맥). Based on this comprehensive assessment, even with the same disease name, the treatment approach can be completely different.

6. Korean Medicine Treatment Strategy – Treating Both the Exterior and Interior Together

Korean Medicine offers a wide range of treatments, including herbal medicine, acupuncture, topical applications, and lifestyle management.

Psoriasis Treatment:

• For excessive heat: Hwangnyeonhaedok-tang (Coptis Chinensis Decoction to Resolve Toxin)
• For excessive Blood Stasis (Yu Xue): Gyejibokryeong-hwan (Cinnamon Twig and Poria Pill)
• For dry and weak skin: Dangguieumja (Angelica Sinensis Decoction), Saenghyeolyunbu-eum (Decoction to Generate Blood and Moisten Skin)

Acupuncture often uses points like Gokji (LI11), Hyeolhae (SP10), and Sam-eumgyo (SP6). Topical ointments like Jaungo (Lithospermum Ointment) are also applied to lesions.

Atopic Dermatitis Treatment:

• For acute Damp-Heat (Shi Re) type: Jesupwiryeong-tang (Decoction to Eliminate Dampness and Fortify Spleen), Hwangnyeonhaedok-tang (Coptis Chinensis Decoction to Resolve Toxin)
• For chronic Blood Deficiency with Wind Dryness (Xue Xu Feng Zhao) type: Saenghyeolyunbu-eum (Decoction to Generate Blood and Moisten Skin), Yukmijihwang-tang (Six-Ingredient Rehmannia Decoction)
• For severe itching: Sopung-san (Eliminate Wind Powder)
• For individuals with weak digestion: Formulas to strengthen the Spleen and Stomach (Pi Wei) may be included.

Acupuncture treatment can sometimes be more effective than antihistamines.

7. Don't Just Look at the Skin, Look Within

To summarize today's discussion, while psoriasis and atopic dermatitis may appear similar on the surface, their constitutional types, directions of immune response, and disease patterns are completely different. The strength of Korean Medicine lies in its ability to deeply analyze the underlying causes that lead to skin manifestations and to approach them in a personalized manner. It's not just about covering up the skin; it's about regulating the body's internal Dampness, Heat, Blood, and organ functions to reduce recurrence and aid recovery.

So, if you are currently struggling with skin symptoms, please remember that a diagnosis considering not only the visible symptoms but also your body's reaction patterns and constitution is essential.

Thank you!

#AtopicDermatitis #PsoriasisDifferences