Adult Atopic Dermatitis Integrative Medicine Guide

Written & medically reviewed by 최연승 대표원장 · Last reviewed 2026.07.01 · 30 min read

Definition

Adult Atopic Dermatitis is a chronic, relapsing inflammatory skin disease that either persists from infancy or develops newly in adulthood. In modern medicine, the focus is on the decline of skin barrier protein (filaggrin) function and an excess of type 2 immune responses (IL-4, IL-13, IL-31, etc.). In Korean Medicine, it is categorized as 'Naeseon' (internal lichen), 'Samanpung' (four-bend wind), or 'Taeyeol' (fetal heat), where wind (風), heat (熱), dampness (濕), and toxins (毒) disrupt the circulation of Qi and Blood (氣血) and the balance of the Zang-Fu organs (臟腑), manifesting on the skin.

Adult atopy is a systemic disease that impairs sleep, emotions, and social life beyond skin lesions, and it is difficult to prevent recurrence through short-term symptom suppression alone. Therefore, integrated management is necessary: stabilizing inflammation and itching in the acute phase with modern medical targeted therapy and topical therapy, and restoring barrier recovery, immune rebalancing, and the stress-sleep-digestion axis in the chronic phase through Korean Medicine pattern identification (辨證) treatment. Baekrokdam Korean Medicine Clinic aims to connect these two lenses into a single clinical flow to restore the patient's self-healing power as its core goal.

What Patients Actually Experience

Adult atopy is not simply a "disease of bad skin." What appears on the skin is the result of a complex entanglement of the body's immune, digestive, hormonal, and nervous systems, and the suffering cannot be fully captured by skin lesions alone. Many patients go from hospital to hospital saying the same thing: "They say my tests are normal, but I don't know why it's so hard."

In this section, we explore the time that adult atopy patients actually experience and the medical, psychological, and social gaps hidden within it.

1. Time Beyond the Skin: A Long Day

The first thing felt upon opening one's eyes in the morning is the itch. Patients check if new scratch marks appeared overnight or if clothes stuck to oozing sores are peeling off. When the face, neck, inside of the elbows, or behind the knees are red and hot, going out becomes a burden. On days with important meetings, even basic skincare—let alone makeup—becomes stinging and painful. The anxiety of a patient asking, "My face suddenly flared up; can it get better quickly?" is not just about appearance. It is a sense of helplessness because their skin "speaks" first at a time when they need to be recognized for their professionalism as a young adult.

Office workers with frequent overtime find it difficult to make time for hospital visits. They go for treatment on weekends and cannot take their medication on time. When treatment is interrupted, recurrence is a foregone conclusion.

2. The Problem of the Night: Itching Steals Sleep

The most distressing symptom of adult atopy is not erythema or oozing, but pruritus (itching). It becomes particularly severe at night. A cytokine called IL-31 makes the nerves sensitive, and fluctuations in body temperature and stress hormones stimulate the scratching reflex at night. A vicious cycle repeats: difficulty falling asleep, inability to reach deep sleep, and waking up to scratch.

Sleep deprivation reduces concentration the following day. An IT developer patient said, "I've tried every treatment, but it eventually gets worse again." Long-term recurrence goes beyond physical pain to create skepticism toward treatment, fear of steroids, and a sense of helplessness, wondering, "Will I be like this for the rest of my life?"

3. Social Skin: Invisible Constraints

Atopy is a visible disease. Therefore, it is accompanied by social stigma. The summer when one must wear long sleeves, the daily life of giving up makeup, and interpersonal relationships where one is conscious of others' gazes. A freelance designer patient says, "I want to sleep soundly without scratching for just one day." This sentence contains the desire not just for sleep, but to dress, date, and socialize normally like everyone else.

Depression and anxiety are not just comorbidities but part of the disease process. As the cycle of itching-scratching-sleep disorder-fatigue-depression repeats, treatment compliance also drops.

4. "Tests are Normal": The Gap in Residual Symptoms

Modern medical tests show IgE levels, allergens, and whether skin lesions are infected. However, the following states cannot be fully captured by test values:

• The skin has mostly calmed down, but it still feels tight, itchy, and hot.
• Symptoms recur immediately when steroids are reduced.
• The skin has healed, but digestion is poor, fatigue persists, and sleep is shallow.
• There are no lesions, but the patient feels depressed and is afraid to meet people.

Traditional Korean Medicine views this point as Residual Pattern Identification (殘存辨證). Heat (熱) partially remains, dampness (濕) is stagnant within the body, Qi and Blood (氣血) are deficient, and the circulation of Ying and Wei (營衛) is blocked. In other words, the flames on the skin have been extinguished, but the ashes inside the body are still burning. Unless these ashes are completely cleared, the next recurrence is only a matter of time.

5. The Weight of Comorbidities: The Atopic March

Adult atopy does not come alone. Allergic rhinitis, asthma, conjunctivitis, indigestion, sleep disorders, and depression often appear together. In modern medicine, this is called the Atopic March. A sales manager patient describes it as, "My nose is blocked and my skin is itchy; it's driving me crazy." When work-related drinking is frequent, sleep deprivation repeats, and stress accumulates, the skin protests by oozing across the entire body.

What this patient needs is not just skin ointment. A systemic approach is required to stabilize the respiratory, digestive, and neuropsychiatric systems together.

6. The Dilemma of Treatment: Between Suppression and Recovery

Modern medicine's steroids, immunomodulators, and biological agents are powerful for quickly suppressing acute inflammation. However, the rebound phenomenon, where symptoms return once the medication is stopped, is frequent, and long-term use carries risks of skin atrophy, vasodilation, and infection. This is because the treatment is closer to "suppressing the disease."

Traditional Korean Medicine presents a perspective of fundamental recovery at this point. By clearing the heat and dampness of the skin, replenishing Qi and Blood, and restoring the balance of digestion and immunity, it helps the body stabilize itself. This does not compete with rapid symptom removal but works toward widening recurrence intervals and lowering drug dependency.

7. What Patients Truly Want

The questions adult atopy patients ask most frequently in the consultation room are as follows:

• "Why is this happening only to me?"
• "Do I have to take medicine for the rest of my life?"
• "Will it be inherited by my children?"
• "Can I really get better?"

These questions do not just represent a demand for information; they contain the psychological desire to regain control over one's life. An integrative medical approach provides a path instead of short answers to these questions. In some stages, modern medicine leads the control of inflammation; in others, Traditional Korean Medicine refines the constitution and residual symptoms, while management of psychology, sleep, diet, and gut microbiome fills the gaps.

A complete cure is difficult. However, it is entirely possible to reduce symptoms, delay recurrence, and restore quality of life through management. This document specifically presents that path.

The Lens of Modern Medicine

Adult atopic dermatitis is not just a simple skin disease, but a chronic relapsing inflammatory state where the skin barrier, immune system, and nervous system are compromised together. Modern medicine explains this through an excess of type 2 immune response and a decrease in skin barrier protein function.

The core pathophysiology consists of three axes.

• Skin Barrier Dysfunction: Decreased filaggrin expression leads to reduced ceramides, increased transepidermal water loss (TEWL), and easier allergen penetration.
• Type 2 Inflammation: Excessive secretion of IL-4, IL-5, IL-13, IL-31, TSLP, etc., from Th2 cells, ILC2s, and basophils.
• Itch-Scratch Cycle: IL-31 induces neural sensitization, leading to sleep disturbances, depression, and anxiety.

In the chronic phase, Th22 and Th17 cells increase, and IL-22 and IL-17 cause skin thickening (lichenification), leaving behind pigmentation and dryness. Nakashima et al. (2024) Frontiers in Medicine explains that targeted therapies for IL-4/IL-13 and IL-31RA directly aim at this mechanism.

Diagnosis is primarily clinical. Hanifin-Rajka criteria or UK Working Party criteria are used, and severity is assessed using EASI, SCORAD, POEM, DLQI, IGA, VAS pruritus, etc. IgE or patch tests are auxiliary means to find comorbid allergies.

Standard treatment is organized in steps.

• Basic Treatment: Moisturizers, avoidance of irritants, patient education
• Topical Treatment: Moderate-potency TCS, TCI (tacrolimus/pimecrolimus), PDE4 inhibitors (crisaborole), JAK inhibitors (ruxolitinib), aryl hydrocarbon receptor agonists (tapinarof)
• Phototherapy: NB-UVB, UVA1
• Systemic Treatment: Cyclosporine, methotrexate, dupilumab, tralokinumab, lebrikizumab, nemolizumab, upadacitinib, abrocitinib, baricitinib

The 2024 AAAAI/ACAAI and AAD guidelines explicitly state to avoid systemic steroid use and prohibit the overuse of antibiotic ointments/disinfectants and indiscriminate dietary restrictions.

However, modern medicine also has clear limitations. It is difficult to control moderate-to-severe cases with topical treatment alone, and long-term use of TCS causes skin atrophy and telangiectasia. Biologics or JAK inhibitors are effective but costly, and concerns about residual symptoms, recurrence, and infection remain. Bacci et al. (2023) Journal of Dermatological Treatment reported high treatment dissatisfaction and humanistic burden among adult AD patients. Dermatology and Therapy (2026) pointed out "clinical inertia," where 30% of moderate-to-severe patients do not receive systemic treatment.

This gap is where integrative medicine fits in. A fundamental restorative approach is needed that addresses residual itch, sleep disturbances, indigestion, and stress sensitivity together, rather than just suppressing symptoms.

The Lens of Traditional Korean Medicine

In Traditional Korean Medicine (TKM), adult atopic dermatitis is viewed not simply as a "skin disease," but as a systemic condition where the balance of Qi, Blood (氣血), and Zang-Fu organs (臟腑) has been disrupted. Redness, oozing, and itching appearing on the skin are signals that Heat (熱), Dampness (濕), Toxins (毒), and Deficiency (虛) within the body have surfaced. The approach of Baekrokdam Clinic is to read these signals and restore the body's self-healing power according to the individual's constitution and disease stage.

Four Faces of Adult Atopic Dermatitis through Pattern Identification (Bian Zheng)

The core of TKM is pattern identification. Even with the same atopic dermatitis, the form it takes varies from person to person, and that form determines the direction of treatment. Common pattern types seen in adult atopic dermatitis are as follows:

• Damp-Heat Type (濕熱型): The skin is red and hot, with significant oozing or yellow crusting. Itching is extreme, corresponding to the acute phase. In modern medical terms, this can be seen as a stage where Type 2 inflammation is active and the skin barrier damage is severe.
• Blood-Heat Type (血熱型): Erythema is vivid, the heat sensation is distinct, and itching worsens at night. This is a state where heat enters the Blood (血) and irritates the skin.
• Spleen-Deficiency Type (脾虛型): Digestion is weak, energy is low, and the skin is dull with slow healing. This occurs when the function of the Spleen (脾) is weak, leading to the stagnation of Dampness (濕).
• Blood-Deficiency and Wind-Dryness Type (血虛風燥型): Common in long-standing chronic cases. The skin becomes dry, scaly, and shows pigmentation, with recurring nightly itching. This corresponds to the chronic stage involving skin lichenification (thickening) and IL-22/Th17.

These patterns often overlap. For example, Damp-Heat may be prominent during the acute phase, but it may transition into Blood-Deficiency and Wind-Dryness over time.

Mapping Pattern Identification ↔ Modern Phenotypes

This mapping does not simply list Western and Eastern medicine side-by-side but shows that the same clinical phenomena are being explained in different languages.

Representative Prescriptions and Modern Research Evidence

Depending on the pattern identification, the following prescriptions are utilized:

• Hwangryunhaedok-tang (黃連解毒湯): Used for Damp-Heat and Heat-Toxin types. Anti-inflammatory, anti-allergic, and immunomodulatory effects have been confirmed through research. The double-blind, placebo-controlled, multi-center RCT protocol for adult AD by Kim et al. (2011) was designed to validate this prescription. "Hwangryunhaedoktang in adult patients with Atopic Dermatitis: a randomised, double-blind, placebo-controlled, two-centre trial - study protocol" (BMC Complementary Medicine and Therapies, 2011)
• Yukmijihwang-tang (六味地黃湯): Used for Blood-Deficiency and Yin-Deficiency types. It can contribute to immune regulation and skin barrier recovery.
• Bojungikgi-tang (補中益氣湯): Used for Spleen-Deficiency type. Improvements in symptoms have been reported in AD patients with anorexia, along with improvements in the gut microbiome. Evidence from an RCT by Jung et al. (2025) shows that Bojungikgi-tang improved the gut-skin axis. "Effect of herbal medicine Bojungikgi-tang on gut microbiome and symptoms in anorexic patients with atopic dermatitis: a randomized controlled trial" (Frontiers in Pharmacology, 2025)
• Danggui-eumja-tang (當歸飲子湯): Used for Blood-Deficiency and Wind-Dryness type. This prescription nourishes the blood and moistens the skin.

Recent meta-analyses also confirm the efficacy of herbal medicine. Cai et al. (2022) analyzed 8 high-quality placebo-controlled RCTs (662 patients) and reported that herbal medicine significantly improved EASI-90 response rates, SCORAD, itching VAS, and sleep scores. "Efficacy and safety of Chinese herbal medicine for atopic dermatitis: Evidence from eight high-quality randomized placebo-controlled trials" (Frontiers in Pharmacology, 2022)

Furthermore, systematic reviews and meta-analyses by Amatto et al. (2024) and Dermatitis (2024) showed that internal and external herbal medicine had significant effects on improving SCORAD, EASI, and itching.

Evidence and Mechanisms of Acupuncture and Moxibustion

Acupuncture and moxibustion do not merely suppress symptoms; they contribute to breaking the itch-scratch cycle and regulating sleep and stress. In the BMJ Open meta-analysis by Liang et al. (2024) and the Acta Dermato-Venereologica meta-analysis by Jwo et al. (2022), acupuncture was evaluated as beneficial for AD symptoms, itching, and quality of life.

In domestic research, an RCT by Park Jung-gun (Kyung Hee University) on adults with mild to moderate AD showed that verum acupuncture was significantly more effective than sham acupuncture in relieving symptoms, and a correlation between AD severity and indigestion was also confirmed. This suggests that acupuncture may act through the brain-skin axis and the regulation of the autonomic nervous system and immunity.

Sasang Constitutional Medicine: Deeper Personalization for Adults

In chronic and refractory adult atopic dermatitis, Sasang Constitutional Medicine becomes an important lens.

• Soyang-in (少陽人): Characterized by "Stomach-Heat" (胃受熱) internal heat disease, with abdominal bloating, constipation, and exacerbation after stress. Prescriptions like Sohyoho-tang and Cheongsangbangpung-tang are utilized. A KCI case report showed improvement with Soyang-in prescriptions, with SCORAD decreasing from 88.4 to 21.9 and IgE from 1406 to 897.
• Soeum-in (小陰人): Characterized by "Ulgwang-jeung" (鬱狂症 - Depressive Heat), with indigestion, anxiety, and skin dryness. Prescriptions like Palmungunja-tang and Hyangsayangwi-tang are considered.

The Sasang constitutional approach goes beyond simply eliminating symptoms; it understands why a person is vulnerable to atopy from a constitutional perspective and aids in recovery.

The Value Added by Traditional Korean Medicine

While modern medicine leads in controlling acute inflammation and severe cases, TKM plays a role in filling the following gaps:

• Residual Symptoms: Restoring remaining itching, dryness, and pigmentation from the perspective of Qi, Blood, and Ying-Wei (Nutritive and Defensive Qi) when tests are normal.
• Prevention of Recurrence: Aiming to reduce rebounds and recurrences after stopping medication by restoring the body's balance.
• Comorbid Symptoms: Addressing sleep disorders, indigestion, depression, and anxiety together.
• Gut-Skin Axis: Regulating the connection between the gut microbiome and skin condition through herbal medicine, diet, and lifestyle.

The TKM treatment at Baekrokdam Clinic aims for fundamental recovery by helping the body find its own balance rather than just suppressing symptoms. This is further completed when collaborating with the targeted therapies of modern medicine.

Integration — Where Two Lenses Meet

When understanding adult atopy, modern medicine and Korean medicine look at the same patient but describe them in different languages. One observes the dialogue between the skin barrier and immune cells, while the other observes the flow of Qi-Blood (氣血) and Zang-Fu (臟腑) organs within the body. Integrative medicine synthesizes these two lenses into a single clinical frame.

Table 1. Granular Mapping: Modern Mechanisms ↔ Korean Medicine Pattern Identification

7-Step Dual-Lens Flow

"Why is it so hard when tests are normal?" — Integrated interpretation of the gap

Many adult atopic dermatitis patients experience this situation. EASI scores have decreased, IgE levels have dropped, and skin lesions have diminished, yet itching remains, sleep is poor at night, and concentration is difficult during the day. In modern medicine, this is explained as residual symptoms, the itch-scratch cycle, and central sensitization. In Traditional Korean Medicine (TKM), it is viewed as Residual Pattern Identification (殘存辨證).

• Disharmony of Qi (氣): Inflammation has subsided, but the body's energy flow has not recovered, causing the skin to react sensitively.
• Deficiency of Blood (血): Nutrients are consumed due to chronic inflammation, leading to dry skin and easily triggered itching.
• Residual Heat (殘熱): Although surface redness is gone, remnants of heat remain inside the body, serving as seeds for recurrence.
• Neurological and Emotional Scars: IL-31 and sensitization of the brain-skin axis can be interpreted as forms of 'Wind (風)' and 'Heat (熱)' remaining in the nervous system.

At this stage, TKM does not simply suppress the skin further but helps harmonize Qi and Blood, clear residual heat, and assist in the joint recovery of the nervous, digestive, and immune systems. This is the difference between symptom suppression and fundamental recovery.

Clinical Decision Signals — When and What to Add

• When modern medicine should lead: Acute severe redness (erythroderma), extensive secondary infection, systemic steroid dependence, and moderate-to-severe cases with significant life disruption. In these cases, topical/systemic treatments, biological agents, and JAK inhibitors are necessary first to stabilize inflammation.
• Value added by TKM: Prevention of recurrence after the acute phase, management of rebound during the process of tapering or discontinuing steroids, residual itching, sleep disorders, indigestion, regulation of the gut-skin axis, and constitution-based long-term management.
• Combination method: In the acute phase, suppress inflammation with modern medicine while simultaneously supporting itching, sleep, and digestion with herbal medicine and acupuncture. In the stable phase, modern medicine is gradually tapered while shifting toward recovering self-healing power centered on TKM. This process is determined by evaluating both the individual patient's Pattern Identification and modern severity assessments (EASI/SCORAD/POEM/DLQI).

Key Summary

When looking at adult atopic dermatitis integratively, skin lesions are not just a 'skin problem' but a superficial signal of a systemic state where immunity, barrier, nerves, digestion, and emotions are intertwined. Modern medicine clarifies the biological mechanisms of these signals, while TKM interprets how those signals originated from the individual's constitution and the state of Qi, Blood, and Zang-fu organs. When using both lenses simultaneously, patients can reduce the pain of the acute phase while building a body that does not recur in the long term.

Integrated Pathophysiological Flowchart

Integrative Medicine Treatment Approach

Adult atopy is approached in stages, but skin barrier restoration and immune balance must be addressed simultaneously at any stage. Modern medicine has strengths in suppressing acute inflammation and managing severe cases, while Korean medicine contributes to reducing recurrence and recovering from residual symptoms by interpreting the individual's constitution and pathogenesis. Baengnokdam Korean Medicine Clinic coordinates these two approaches according to the patient's condition.

7-Step Dual-Lens Treatment Flow

Korean Medicine Approach by Pattern Identification and Modern Phenotype Mapping

This table is not a simple classification. Even in the same patient, the pattern can change depending on the stage of the disease, and multiple patterns often overlap at once. For example, if Damp-Heat persists, it can transition into Spleen Deficiency, and if Spleen Deficiency continues, it can turn into Blood Deficiency and Wind-Dryness. Reading this flow is the core of Korean medical treatment.

Signals for Collaborative Care: When Modern Medicine Leads and When Korean Medicine Adds Value

Fundamental Recovery (Self-Healing Power) Perspective vs. Symptom Suppression Perspective

Targeted therapy in modern medicine suppresses specific cytokines or signaling pathways such as IL-4, IL-13, IL-31, and JAK. This is essential for rapid symptom control. However, symptoms often return when the medication is reduced or stopped. This is because the root of the disease remains.

Korean medicine focuses on changing the internal environment that created the symptoms while simultaneously suppressing them.

• If Damp-Heat (濕熱) remains, inflammation will recur.
• If Spleen Deficiency (脾虛) is not recovered, nutrient supply and barrier regeneration will be slow.
• If Blood Deficiency and Wind-Dryness (血虛風燥) is not resolved, chronic dryness and itching will not disappear.
• If Soyang-in/Soeum-in constitutional predispositions do not find harmony, recurrence will occur with every stress or seasonal change.

Therefore, the treatment goal of Baengnokdam Korean Medicine Clinic is not the definitive expression "complete cure," but rather extending the remission period, lowering the intensity of recurrence, reducing drug dependence, and restoring the quality of life. This is viewed as the recovery of self-healing power (自生力).

The Role of Acupuncture and Moxibustion Treatment

Acupuncture and moxibustion are independent interventions in Korean medical treatment, not merely auxiliary. In adult atopic dermatitis, acupuncture acts on the following three axes:

• Itching-Sleep Axis: Reduces nocturnal itching and scratching to restore sleep.
• Stress-Immune Axis: Stabilizes the inflammatory response by regulating the HPA axis and autonomic balance.
• Digestion-Barrier Axis: Simultaneously addresses Spleen Deficiency (脾虛) and the gut-skin axis.

In recent RCTs, verum acupuncture was significantly more effective than sham acupuncture in relieving symptoms in patients with mild-to-moderate adult atopic dermatitis, and studies have shown a correlation between AD severity and indigestion. "Effectiveness of Acupuncture Treatment in Patients with mild-to-moderate Atopic Dermatitis: A Randomized, Participant- and Assessor-Blind Sham-Controlled Trial" (Kyung Hee University, DBpia). This study suggests that acupuncture does not simply act on the skin but integrates the regulation of the digestive, immune, and nervous systems.

Integrated Management of the Gut-Skin Axis and Psycho-Skin Axis

For adult atopic dermatitis patients, gut microbiome imbalance and stress are not independent issues. The gut is an organ where 70% of immunity resides, and the skin is a window that reveals its state.

• Intestinal dysbiosis → Increased intestinal mucosal permeability → Systemic low-grade inflammation → Aggravation of skin inflammation
• Stress → HPA axis activation → Increase in IL-6, TNF-α, IL-31 → Aggravation of itching
• Sleep disorders → Nocturnal scratching → Barrier damage → Fatigue/Depression → Decreased treatment compliance

This flow is difficult to completely block with targeted therapy of modern medicine alone. Korean medicine addresses these axes simultaneously through the balance of the Gut (腸) and Spleen/Stomach (脾胃), Heart (心) and Kidney (腎), and Ying (營) and Wei (衛). For example, there are RCT results showing that Bojungikgi-tang (補中益氣湯) simultaneously improved the gut microbiome and symptoms in AD patients with anorexia. "Effect of herbal medicine Bojungikgi-tang on gut microbiome and symptoms in anorexic patients with atopic dermatitis: a randomized controlled trial" (Jung et al., 2025, Frontiers in Pharmacology)

Calm Explanations for Patient Questions

• "The tests are normal, so why am I suffering so much?"

  • Even if the objective scores of skin lesions are normalized, itching, sleep issues, fatigue, and indigestion can remain as subtle imbalances in Qi-Blood (氣血) and Ying-Wei (營衛). Korean medicine focuses on recovering during this stage.

• "Can I be treated without steroids?"

  • This may be possible in mild or early stages. However, in moderate or higher cases, modern medical treatment is often necessary, and Korean medicine approaches it in a way that reduces the duration and intensity of that dependence.

• "When will I get better?"

  • A complete cure cannot be guaranteed. However, if treatment appropriate for the stage and pattern is continued, the remission period generally lengthens, and the intensity of symptoms tends to weaken upon recurrence.

• "I am currently receiving biologics; can I take Korean medicine at the same time?"

  • Concurrent treatment is possible after consultation with a specialist. Korean medicine does not interfere with the effects of biologics and is prescribed to complement residual symptoms and constitutional recovery.

Key Summary

Integrative medical treatment for adult atopic dermatitis is not simply listing Western and Korean medicine side by side. Modern medicine leads the control of acute phases and severe cases, while Korean medicine reads the individual's pattern and constitution to support recurrence prevention and fundamental recovery. Baengnokdam Korean Medicine Clinic arranges these two lenses according to the patient's condition, aiming for the recovery of self-healing power beyond symptom suppression.

Evidence

The evidence base for adult atopic dermatitis is rapidly accumulating in both modern medicine and Korean medicine. The important point is that the two systems merely describe the same clinical phenomena in different languages, and their efficacy and safety are being increasingly verified through objective data.

---### Evidence in Modern Medicine: From Pathophysiology to Targeted Therapy

The core mechanisms of adult atopic dermatitis are skin barrier dysfunction and overactive type 2 immune response. When ceramide levels decrease due to reduced filaggrin expression, transepidermal water loss (TEWL) increases, facilitating allergen penetration. Subsequently, excessive secretion of IL-4, IL-5, IL-13, IL-31, and TSLP from Th2 cells, ILC2s, and basophils triggers the itch-scratch cycle. In the chronic phase, an increase in Th22/Th17 cells leads to skin thickening (lichenification) and residual pigmentation. These mechanisms are supported by the efficacy of recent targeted therapies. Evidence shows that dupilumab (IL-4/IL-13 inhibition), nemolizumab (IL-31 receptor inhibition), and JAK inhibitors improve SCORAD, EASI, itch, and sleep in adults. ^[1]

Major 2024 guidelines present a stepped approach.

• Basic treatment: Moisturizers, avoidance of skin irritants, patient education
• Topical treatment: TCS, TCI (tacrolimus/pimecrolimus), PDE4 inhibitors (crisaborole, roflumilast), JAK inhibitors (ruxolitinib)
• Phototherapy: NB-UVB, UVA1
• Systemic treatment: Cyclosporine, methotrexate, dupilumab, tralokinumab, lebrikizumab, nemolizumab, upadacitinib, abrocitinib, baricitinib

However, systemic steroids should be avoided, and the overuse of antibiotic ointments/disinfectants or indiscriminate dietary restrictions are not recommended. AAAAI/ACAAI 2024 Atopic Dermatitis Guidelines; AAD 2024 Focused Update

Unmet needs in treatment are also clear. Reduced quality of life, treatment dissatisfaction, residual symptoms, recurrence, and high costs are continuously reported in adult patients. In particular, the issue of clinical inertia, where 30% of moderate-to-severe patients do not receive systemic treatment, is also raised. ^[2]; ^[3]

---### Evidence in Korean Medicine: Pattern Identification-Based Prescription and Modern Validation of Acupuncture and Moxibustion

Korean Medicine differentiates adult atopic dermatitis into patterns such as Damp-Heat type (濕熱型), Blood-Heat type (血熱型), Spleen Deficiency type (脾虛型), and Blood Deficiency and Wind-Dryness type (血虛風燥型). These significantly map to modern phenotypes.

• Damp-Heat Type: Exudate, yellow crusting, erythema, severe pruritus → Acute/exudative lesions
• Blood-Heat Type: Red and hot skin, nocturnal pruritus → Active inflammatory phase
• Spleen-Deficiency Type: Indigestion, decreased vitality, dull skin → Decreased organ function, gut-skin axis abnormality
• Blood-Deficiency Wind-Dryness Type: Dryness, scaling, pigmentation, nocturnal pruritus, skin thickening → Chronic dry-type AD

Based on these pattern identifications, Hwangryunhaedok-tang, Yukmijihwang-tang, Dangguieumja-tang, Takrisodok-eum, Sopung-san, etc., are utilized. ^[4]; ^[5]

Recently, the efficacy of herbal medicine has been demonstrated in high-quality RCTs and meta-analyses.

• In a systematic review including 51 RCTs and 3,763 participants, oral and topical herbal medicine improved SCORAD, EASI, and itching. ^[6]
• In an analysis of 8 placebo-controlled double-blind RCTs with 662 participants, it showed EASI-90 response rate RR 3.72, SCORAD -10.20, VAS itching -1.90, sleep score -2.16, and IGA improvement RR 2.94. ^[7]
• Systematic reviews and meta-analyses of herbal medicine and topical agents also confirmed improvement effects on SCORAD, EASI, and itching. ^[8]

There are also domestic studies. A double-blind, placebo-controlled, multi-center RCT protocol for Hwangryunhaedok-tang in adult AD patients was designed, and an RCT reporting that Bojungikgi-tang improved the gut microbiome and symptoms in AD patients with anorexia has also been reported. This is an example of a Korean medicine intervention targeting the gut-skin axis. ^[9]; ^[7]*

There is also evidence for acupuncture treatment. In a systematic review and meta-analysis published in BMJ Open, acupuncture was evaluated to be beneficial for AD symptoms, itching, and quality of life. In an RCT from Kyung Hee University involving 36 Korean adults with mild-to-moderate AD, verum acupuncture was significantly more effective in symptom relief compared to sham acupuncture, and a correlation between AD severity and dyspepsia was also confirmed. This is an example of modern research supporting the perspective of Korean Medicine, which views the skin and digestion as one. ^[10]; ^[11]; ^[12]

Personalized approaches based on Sasang Constitutional Medicine have shown effectiveness through case reports. A case of adult AD, categorized as Wisu-yeol-ri-yeol (Stomach-Heat-Interior-Heat) disease in a Soyangin individual, showed improvement with SCORAD decreasing from 88.4 to 21.9 and IgE from 1406 to 897, and a case of adult AD diagnosed as Ul-gwang (Depressive-Heat) syndrome in a Soeumin individual, which improved with Sasang constitutional prescriptions, were reported in KCI and Korea Science. KCI: "A Case Report of Adult Atopic Dermatitis Treated with Soyangin Prescriptions"; Korea Science: "A Case Report of Adult Atopic Dermatitis Diagnosed as Soeumin Ul-gwang Syndrome"

Q1. How severe is the pain after surgery? Immediately after surgery, you may feel pain as the anesthesia wears off. However, pain is currently managed effectively through painless injections (patient-controlled analgesia devices) and analgesic adjustments. Most patients say it is "more bearable than expected," and pain decreases noticeably 2 to 3 days after surgery.

Q2. Will there be a large scar after surgery? Currently, scars are very small as minimally invasive surgical methods such as laparoscopic or robotic surgery are primarily performed. @@link_01@@ Surgery is performed through small incisions of about 0.5 to 1 cm, and over time, the scars become almost unnoticeable. If you have a keloid-prone skin type, please inform the medical staff in advance so we can assist with scar management.

Q3. When can I start eating after surgery? Generally, water intake is possible from the day after surgery, and progress is made from thin rice gruel to porridge and then a regular diet, depending on the recovery of bowel function. @@link_02@@ As this may vary depending on the type of surgery, it is important to start eating in stages according to the guidance of the medical staff.

Integrative and Functional Medicine Evidence: Gut-Skin Axis, Psychology/Sleep, and Nutrition

Adult atopic dermatitis is not just a skin problem but is linked to the gut microbiome, the stress-hormone axis, sleep, and nutritional status.

• Gut-Skin Axis: In adult AD, gut dysbiosis, a decrease in beneficial bacteria, and increased intestinal mucosal permeability are observed. An umbrella meta-analysis on probiotics suggested the potential for reducing the risk and severity of adult AD. ^[13]; ^[14]; Discover Food (2026) umbrella meta-analysis, 1,511 participants
• Psychology, Stress, and Sleep: Stress activates the HPA axis, increasing IL-6, TNF-α, and IL-31, which exacerbates itching. Sleep disorders worsen barrier damage due to nighttime scratching. There are also commentaries suggesting that mind-body therapies (meditation, cognitive behavioral therapy, relaxation response training, acupuncture) have integrative value in AD management. ^[13]
• Nutrition and Lifestyle: In adult AD patients, lower intake of animal-derived iron, riboflavin, cholesterol, DGLA, and eggs was associated with higher SCORAD scores, while ceramide 2 and vitamin C showed an inverse correlation. Studies also indicate that modifiable lifestyle factors (sleep, exercise, smoking, alcohol consumption) affect severity. ^[12]; ^[15]## Frequently Asked Questions

Q1. My face suddenly flared up; can it be cured quickly?

Acute redness and itching are usually signals of the acute activation of Type 2 inflammation. In modern medicine, this is seen as a surge in cytokines such as IL-4, IL-13, and IL-31 causing skin vasodilation and nerve sensitization. In Korean Medicine, it is viewed as a state where Wind (風), Heat (熱), and Dampness (濕) have rapidly risen to the surface layer of the skin.

While rapid soothing is possible, a "complete cure" is realistically difficult. During the acute phase, an integrative approach is effective: first stabilizing inflammation with modern medical topical steroids or immunomodulators, while simultaneously using herbal medicine to lower heat and dampness to reduce the likelihood of recurrence. The usefulness of combined therapy during the acute phase is also mentioned in Clinical practice guidelines for the diagnosis and treatment of atopic dermatitis with integrative traditional Chinese and Western medicine (Du et al., Journal of Integrative Medicine, 2025).

For those with active social lives, the facial localized type is common; therefore, it is important to start by reducing irritating cosmetics and cleansing and changing your moisturizer first.

Q2. I've tried every treatment, but it keeps getting worse. What makes Korean Medicine different?

This question is most frequently asked by patients with chronic relapsing types. Targeted therapies in modern medicine strongly suppress inflammation, but immune imbalances often resurface when medication is reduced or stopped. Korean Medicine simultaneously pursues "suppressing symptoms" and "restoring the body's balance."

For example:

• If the skin becomes thick and itchy at night → This is identified as a Blood Deficiency (血虛) Wind-Dryness (風燥) type, and Yin-Blood is replenished using formulas such as Yukmi-jihwang-tang or Danggu-eumja-gamibang.
• If the skin is dry and cracked from long-term scratching → This is viewed as a disharmony between Ying and Wei (營衛).
• If it spreads throughout the body after stress → It is diagnosed as Soyangin (少陽人) Stomach Heat (胃受熱) or Internal Accumulation of Heat-Toxin (熱毒 內擁).

Herbal Medicine in Children and Adults with Atopic Dermatitis: A Systematic Review and Meta-Analysis (Dermatitis, 2024) analyzed 51 RCTs involving 3,763 participants and showed that herbal medicine improves SCORAD, EASI, and itching. The difference in Korean Medicine is that prescriptions vary for each individual, even for the same diagnosis of "atopy."

Q3. I want to sleep soundly without scratching for just one day. How are itching and sleep managed?

Itching is not just a skin problem. The "itch cytokine" called IL-31 stimulates the central nervous system, making it worse at night, and scratching creates a vicious cycle by damaging the skin barrier and triggering further inflammation. In Korean Medicine, this is viewed as a phenomenon where Wind (風) caused by Blood Deficiency (血虛) becomes more active at night.

The treatment approach consists of three pillars:

• Modern Medicine: Anti-itch agents, sleep hygiene, and if necessary, PDE4 or JAK inhibitors.
• Korean Medicine: Pattern-based prescriptions such as Yukmi-jihwang-tang or Danggu-eumja-gamibang for Blood Deficiency Wind-Dryness, and Hwangryun-haedok-tang for Heat-Toxin types.
• Mind-Body Therapy: Relaxation response training, cognitive behavioral therapy, and acupuncture.

Acupuncture for atopic dermatitis: a systematic review and meta-analysis (Liang et al., BMJ Open, 2024) reported that acupuncture is beneficial for improving itching and quality of life. Baekrokdam Clinic also considers regulating the brain-skin axis by incorporating acupuncture.

Q4. My test results are normal, so I don't understand why I'm struggling so much.

This is a representative "gap" in adult atopy. Even if IgE or dermatological tests are within the normal range, factors such as decreased skin barrier function, nerve sensitization, low-grade inflammation, gut dysbiosis, lack of sleep, and stress are often not captured by test values. Korean Medicine views this as "Residual Pattern Identification (殘存辨證)."

Specifically:

• Normal tests + dry skin/night itching → Blood Deficiency (血虛) Wind-Dryness (風燥)
• Normal tests + indigestion/fatigue → Spleen Deficiency (脾虛) Dampness (濕)
• Normal tests + aggravation after stress → Qi Stagnation (氣鬱) Fire (火) or Soyangin (少陽人) Stomach Heat (胃受熱)
• Normal tests + depression/insomnia → Heart-Spleen Non-interaction (心脾 不교) or Depressive Syndrome (鬱症)

Gut Dysbiosis and Adult Atopic Dermatitis: A Systematic Review (Díez-Madueño et al., Journal of Clinical Medicine, 2025) suggests that gut dysbiosis can sustain symptoms even in patients with normal test results. Korean Medicine interprets this "discomfort not captured by numbers" through the flow of Qi-Blood (氣血), Ying-Wei (營衛), and Zang-Fu (臟腑) organs.

Q5. My nose is blocked and my skin is itchy; it's driving me crazy. Should the "Atopic March" be treated together?

Yes. The co-occurrence of rhinitis, asthma, and atopy means that Type 2 inflammation is affecting multiple organs simultaneously through a single common mechanism. In Korean Medicine, this is often a case where functional imbalances of the Lung (肺), Spleen (脾), and Kidney (腎) manifest at the same time.

Examples of an integrative approach:

• Rhinitis + Acute Atopy → Treating Lung Wind-Heat (風熱) and skin Damp-Heat (濕熱) together.
• Asthma tendency + Dry skin → Simultaneously replenishing Lung-Spleen weakness and Blood Deficiency (血虛) Wind-Dryness (風燥).
• Systemic aggravation after alcohol or smoking → Focusing on Liver-Spleen disharmony and Internal Accumulation of Heat-Toxin (熱毒 內擁).

Integrative Treatment Approaches with Mind–Body Therapies in the Management of Atopic Dermatitis (Yosipovitch et al., Journal of Clinical Medicine, 2024) emphasizes that lifestyle, stress, and sleep management are essential for patients with multi-organ involvement. Baekrokdam Clinic identifies patterns not only for the skin but also for respiratory, digestive, and psychological symptoms.

Q6. Is it possible to receive treatment without steroids?

It is possible in some cases, but it cannot be guaranteed. Depending on the severity and stage, a realistic approach is to temporarily use modern medical treatments while increasing the proportion of Korean medical treatment.

The options are as follows:

• Mild to Mild-Moderate: Topical immunomodulators (tacrolimus, pimecrolimus) + Herbal medicine + Acupuncture + Moisturizers.
• Moderate or higher: Modern systemic treatments such as biologics or JAK inhibitors + Herbal medicine to alleviate side effects and prevent recurrence.
• Chronic dryness and pigmentation focus: Herbal medicine-centered + Moisturizers + Phototherapy.

According to Understanding Clinical Inertia in Atopic Dermatitis (Dermatology and Therapy, 2026), 30% of moderate-to-severe patients are not receiving the systemic treatment they need. While steroid phobia is understandable, rather than unconditional refusal, it is important for modern and Korean medicine to work together to establish a "de-escalation" strategy to reduce them step-by-step. Baekrokdam Clinic respects patient preferences while prioritizing clinical safety and recommending collaborative care.