Case Series - (2021) Volume 10, Issue 9
Received: 17-Aug-2021
Published:
16-Sep-2021
, DOI: 10.37421/2327-5162.2021.10.352
Citation: Nomoto, Mayumi. “Kampo Treatment for Facial
Redness: An Approach Based on Five Underlying Causes.” Alt Integr Med 10
(2021): 352.
Copyright: © 2021 Nomoto M. This is an open-access article distributed
under the terms of the Creative Commons Attribution License, which permits
unrestricted use, distribution, and reproduction in any medium, provided the
original author and source are credited.
Kampo medicine is a medical system that specializes in balancing the human body and enhancing its natural healing power. Kampo medicine has been used in Japan since ancient times. Facial redness associated with chronic inflammatory skin diseases such as atopic dermatitis, rosacea, rosacea-like dermatitis, acne vulgaris, and seborrheic dermatitis is sometimes difficult to resolve with Western medicine alone. In these cases, the inclusion of Kampo medicine in the treatment can enhance the therapeutic effect of conventional drugs while avoiding side effects. According to the Kampo medical system, the causes of facial redness can be classified into five categories: (1) heat and inflammation, (2) microcirculation disorders and telangiectasia, (3) autonomic nerve disorder (stress), (4) dry skin, and (5) oily skin (endocrine imbalance). We aimed to elucidate how to choose the suitable Kampo medicine for facial redness caused by each of these causes.
Red face • Atopic dermatitis • Rosacea • Acne vulgaris • Kampo medicine
The facial redness associated with chronic inflammatory skin diseases, such as atopic dermatitis, rosacea, rosacea-like dermatitis, acne vulgaris, and seborrheic dermatitis is difficult to treat. In some cases, the cause of the red face can be identified and treated by Western medicine. However, for cases of constitutional and age-related facial redness, Western medicine alone is often not enough to solve the problem. These cases may benefit from incorporating traditional Japanese medicine, Kampo medicine, into the treatment. According to the Kampo medical system, the causes of facial redness can be classified into five categories: (1) heat and inflammation, (2) microcirculation disorders and capillary dilation, (3) autonomic nerve disorder (stress), (4) dry skin, and (5) oily skin (endocrine imbalance). We aimed to elucidate how to choose the suitable Kampo for each of these causes. Please refer to Standards of Reporting Kampo Products (STORK, https://mpdb.nibiohn.go.jp/stork) for basic information on all of the following Kampo.
Causes and treatment of facial redness according to the Kampo medical system
Heat and inflammation: Although Western medicine has methods to improve red papules and pustules on the face; it is difficult to improve diffuse facial flushing and heat sensation (hot flashes). In such cases, Kampo can be used in combination. In Kampo medicine, the condition of heat and inflammation is called the "heat pattern". For this condition, anti-inflammatory and antipyretic Kampo called "Seinetsu-zai" are used. Orengedokuto [1], a Seinetsu-zai, should be used when flushing and a feeling of heat are the main symptoms. Byakkokaninjinto [2] should be used when dry skin and dry mouth are also present along with facial redness. Eppikajutsuto should be used when edema is observed. In the case of acne vulgaris with papules and pustules, use Keigairengyoto or Seijobofuto and in the case of deep abscess formation, use Hainosankyuto. Acne with poor skin barrier function and dermatitis should be treated with Jumihaidokuto [3].
Microcirculation disorders and capillary dilation: The face is an area with abundant blood flow but it is also prone to microcirculatory disturbances. There are few treatments to improve blood flow and vasodilation; laser or phototherapy is often used in this regard. In Kampo medicine, microcirculatory disturbances are called "blood stasis” and a series of Kampo to improve these are called "Kuoketsu-zai” [4]. The aforementioned Seinetsu-zai is expected to improve facial flushing to some extent, but if flushing does not improve, the presence of blood stasis should be suspected. In particular, chronic inflammatory skin diseases tend to cause blood stasis. Therefore, Kuoketsuzai is often used for chronic facial redness [5].
A typical prescription for Kuoketsu-zai is Keishibukuryogan. In cases where blood stasis is accompanied by “qi counterflow”, Kamishoyosan may be used. Qi counterflow refers to the reverse flow of qi (vital energy) from the three components of the body, namely, qi, blood, and fluid, to the upper part of the face, causing facial burning, itching, excessive sweating, and irritability. It is important for cosmetic dermatologists, who often examine the face, not to overlook this finding of qi counterflow. If the patient has edema or anemia, Tokishakuyakusan should be used. If the patient has rough hands and an ovulation disorder, Unkeito should be used.
Autonomic nervous system disorder (stress): It is our opinion that the number of patients complaining of facial redness has increased steadily over the past 10 years. Moreover, it is often intractable, and the severity of the disease is increasing. One of the reasons for this may be the disturbance of autonomic nerve balance due to lifestyle disturbances and psychological stress [6]. In Kampo medicine, there is a method of regulating the autonomic nerve balance of patients by using "Saiko-zai”, a series of Kampo which contain Bupleuri radix. Traditionally, many of the best doctors in Japan have been using Saiko-zai since ancient times to cure incurable diseases.
One of the famous Saiko-zai is Hochuekkito. A placebo-controlled, double-blind, comparative study confirmed that it has an ameliorative effect on intractable atopic dermatitis [7]. Although it does not contain any herbal medicine that strongly suppresses dermatitis, it is expected to be effective in balancing the autonomic nervous system of atopic dermatitis patients suffering from stress caused by itching. In addition, Saireito can be used to treat intractable acne, hypertrophic scars, and keloid formation on the face, which is stress-related. In menopausal women with sudden skin problems caused by cosmetics, recurrent facial eczema, anxiety and insomnia, Kamikihito can be used. The aforementioned Jumihaidokuto and Kamishoyosan are also Saikozai, making them an easy choice when stress management is needed.
Dry skin: Symptoms such as dry skin, brittle nails, and fine hair are considered to be “blood deficiency” in Kampo medicine. Dry skin is one of the causes of atopic dermatitis and the facial redness associated with menopause. When accompanied by hot flashes, it is tempting to prescribe Seinetsu-zai, but if they are unsuccessful, treatment for blood deficiency should be considered. After taking sufficient measures to prevent dryness with skincare guidance, Shimotsuto, Unseiin, and Tokishakuyakusan can be recommended.
Oily skin (endocrine imbalance): Since the secretion of sebum depends on androgen, endocrine imbalance may cause excessive sebum secretion, which may lead to facial redness. Shakuyakukanzoto is a typical Kampo with anti-androgenic effects [8]. Although oily skin is often improved in a relatively short time, it should not be administered for a long time because it is prone to pseudo hyperaldosteronism due to Glycyrrhizae radix, a constituent crude drug. If sebum secretion is to be suppressed for a long time, it is recommended to use Jumihaidokuto, which contains cherry bark and has been reported to have estrogen-like effects [9].
The following are clinical photos of patients who visited our clinic complaining of facial redness and were treated with Kampo. Clinical photos were modified from the literature [10].
Case 1: Male, teenager
The patient had atopic dermatitis since he was a child. His face continued to be red and hot. He was treated with 6 capsules/day of Orengedokuto and 3 weeks later, his heat and erythema improved (Figure 1).
Figure 1. Case 1: Male teenager (a) Before treatment and (b) After administration of Orengedokuto 6 capsules/day for 3 weeks.
Case 2: Female, in her 50s
The patient had been diagnosed with rosacea 10 years ago. She complained of diffuse flushing and heat sensation. After administering 7.5 g/ day of Eppikajutsuto, her heat sensation and erythema improved in 3 months (Figure 2).
Figure 2.Case 2: Female in her 50s (a) Before treatment and (b) After administration of Eppikajutsuto 7.5 g/day for 3 months.
Case 3: Female, in her 20s
The patient suffered from acne vulgaris with erythematous papules on the face and oily skin. After 2 weeks of treatment with 5.0 g/day of Shakuyakukanzoto, the facial redness and pore size improved (Figure 3).
Figure 3. Case 3: Female in her 20s (a) Before treatment and (b) After administration ofShakuyakukanzoto 5.0g/day for 2 weeks.
Case 4: Female, in her 50s
Five years ago, the patient developed dermatitis around her eyes and mouth and was treated with topical steroids. It gradually developed into diffuse erythema, and she developed rosacea-like dermatitis. After 3 months of treatment with Saireito (8.1 g/day), her erythema improved, and there was no relapse after discontinuation of the steroids (Figure 4).
Figure 4. Case 4: Female in her 50s (a) Before treatment and (b) After administration of Saireito 8.1 g/day for 3 months.
Case 5: Male, in his 20s
Acne vulgaris occurred when the patient was in his teens. He was treated with oral antimicrobials and topical benzoyl peroxide but had repeated flareups. He had seborrheic dermatitis in the central part of his face. After a year of treatment with 6.0 g/day of Jumihaidokuto, seborrheic dermatitis improved and there was no new acne (Figure 5).
Figure 5. Case 5: Male in his 20s (a) Before treatment and (b) After administration of Jumihaidokuto 6.0 g/day for 1 year.
Case 6: Female, in her 40s
The patient had been suffering from rosacea for 13 years. She made repeated visits to the dermatologist but her condition was refractory to treatment. She had strong edema and sensations of heat, and her erythema was dark red due to microcirculatory disturbance. Therefore, she was treated with 7.5 g/day of Eppikajutsuto and 6.0 g/day of Keishibukuryogan. Her edematous erythema decreased markedly after 2 weeks of treatment, and the heat sensation disappeared within 3 months (Figure 6).
Figure 6. Case 6: Female in her 40s (a) Before treatment and (b) After administration of Eppikajutsuto 7.5 g/day and Keishibukuryogan 6.0 g/day for 3 months.
Case 7: Female, in her 30s
Two years ago, the patient developed rosacea. She repeatedly visited a dermatologist. However, the disease was refractory. Edematous erythema and erythematous papules were frequent. Edematous erythema decreased in 4 months after the administration of 7.5 g/day of Eppikajutsuto and 6.0 g/day of Jumihaidokuto. After changing the dosage to 6.0 g/day of Jumihaidokuto and 7.5 g/day of Kamishoyosan, based on dysmenorrhea and blushing, her condition resolved. The patient has been cured for 14 months (Figure 7).
Figure 7. Case 7: Female in her 30s (a) Before treatment and (b) After administration of Eppikajutsuto 7.5 g/day and Jumihaidokuto 6.0 g/day for 4 months, and Jumihaidokuto 6.0 g/day and Kamishoyosan 7.5 g/day for 14 months.
The five categories of causes of facial redness according to the Kampo medical system have been described. In particular, underlying causes of heat, flushing, and stress are difficult to treat with Western medicine. Therefore, we believe that Kampo should be actively incorporated into the treatment of these conditions. I hope that this article will help the readers and patients who are suffering from facial redness.
No data were used to support this study.
All study participants provided informed consent.
The author declares no conflicts of interest.
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