The difference between psoriasis and atopy; from the perspective of Korean medicine, they are completely different

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

Hello everyone. This is Baekrokdam Korean Medicine Clinic.

Today, I would like to talk about two of the most easily confused skin diseases — psoriasis and atopic dermatitis. On the surface, they all look similar. The skin becomes red, there is dead skin (scaling), it's itchy... However, from the perspective of Korean medicine, the way these two diseases develop and the way the body responds are completely different. In particular, I will also explore the Korean medicine answer to the question, "Why does it manifest as atopy in some people and as psoriasis in others?"

1. Two diseases that look similar on the outside but are different in essence

First, let's summarize the commonalities. Both conditions are chronic, recurrent, immune-mediated diseases that cause inflammation in the skin. Modern medicine views both as resulting from 'immunity being hypersensitive or malfunctioning.' From a similar perspective in Korean medicine, both are included in the category of skin diseases called 'seon-jeung (癬證),' but within that, the pathological mechanisms, constitutions, and symptom patterns operate completely differently.

2. Psoriasis – Red patches and scales with distinct borders

In Korean medicine, psoriasis is called baek-bi (白疕) or eun-seol-byeong (銀屑病). It is characterized by lesions covered in keratin that look like silver scales. This disease has distinct borders of skin lesions and commonly occurs in areas with frequent friction, such as the elbows, knees, and buttocks. A peculiar point is that itching may not be severe or may be completely absent. Therefore, it is quite often confused with atopic dermatitis. In terms of Korean medicine, it is explained around pathologies such as blood heat, blood dryness, blood stasis, and deficiency of the liver and kidney.

• Blood heat:a state where the blood is hot and inflammation occurs easily
• Blood dryness:a state where the blood is dry and skin regeneration is abnormally fast
• Blood stasis:A state where blood circulation is stagnant and lesions have become fixed
• Liver and Kidney Deficiency:A state where immune function has declined and recovery is slow

It is also common for dead skin cells to accumulate in layers, and for lesions to take on a brown or dark red color. The tongue may appear red or show blood stasis spots, and the pulse shows characteristics of being fast or rough.

3. Atopic Dermatitis – Ambiguous Borders and Severe Itching

On the other hand, atopy is a bit different. In Korean medicine, it is called by various names such as Taeyeol, Yuseon, Samanpung, and eczema; the common characteristics are that the skin borders are ambiguous, there is a lot of discharge and scratch marks, and above all, the itching is severe. Atopy mainly occurs in folding areas such as the crooks of the arms, behind the knees, the neck, and the face, and lichenification, where the skin thickens the more it is scratched, progresses.

From a Korean medicine perspective, it is mainly approached with diagnoses such as damp-heat, blood deficiency-wind dryness, wind-heat, and spleen-stomach deficiency.

• Damp-heat type:much exudate and inflammation
• Blood deficiency-wind dryness type:dry and lichenified appearance
• Spleen and stomach deficiency:Cases where intestinal immunity is weak, leading to frequent allergic reactions

The tongue often has a sticky yellow coating or feels strongly dry, and the pulse is often slippery-rapid or deep and wiry.

4. Why do some people develop atopic dermatitis while others develop psoriasis?

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

People prone to atopy are:

• Those with a constitution where the skin barrier is weak and intestinal immunity is sensitive, making allergic reactions more likely to occur
• In the body, dampness (濕) and heat (熱)People in whom this easily accumulates
• Shows reactions such as oozing, itching, and edema to environmental stimuli

People prone to psoriasis:

• People whose skin regeneration is excessively fast and whose blood is prone to stagnation
• A constitution where liver and kidney functions are weak, making the immune system prone to malfunctioning as autoimmunity
• Reacts to external stimuli with excessive keratinization, dryness, or borderline lesions

As such, the fact that the skin's reaction method differs depending on the constitution, even for the same stress or environmental stimulus, is the biggest difference between psoriasis and atopy.

5. The diagnosis is different, and the approach is different

In Korean medicine, we do not simply look at the skin when diagnosing. We comprehensively evaluate the tongue, feel the pulse, and assess the constitution, medical history, and accompanying symptoms. In psoriasis, the tongue tends to be red with thick coating, and the pulse is often rapid or rough. In atopic dermatitis, the tongue tends to be sticky or dry, and the pulse is often slippery-rapid or deep-wiry. Based on this, the treatment method differs completely even for the same disease name.

6. Treatment Strategy of Korean Medicine – Managing both the exterior and interior together

Korean medicine has a wide range of treatments, including herbal medicine, acupuncture, external applications, and lifestyle management.

What about psoriasis treatment?

• Hwangryeon-haedok-tang for those with excessive heat
• Gyeji-bokryeong-hwan for those with excessive stagnant blood
• Danggui-eum-ja or Saenghyeol-yunbu-eum for dry and weak skin

Acupuncture points such as Gokji, Hyeolhae, and Sameumgyo are used, and external ointments like Jaunggo are also applied to the lesions.

What is the treatment for atopy?

• For the acute damp-heat type, Jeseup-wiryeong-tang and Hwangryeon-haedok-tang
• For the chronic blood deficiency-wind dryness type, Saenghyeol-yunbu-eum and Yukmi-jihwang-tang
• When itching is severe, Sopung-san
• For those with weak digestive systems, prescriptions to strengthen the spleen and stomach may be included.

Acupuncture treatment may be more effective than antihistamines in some cases.

7. Do not look only at the skin; look inside

To summarize today, although psoriasis and atopy may look similar on the surface, their constitutions, immune response directions, and disease patterns are completely different. The strength of Korean medicine lies in deeply analyzing the cause that created the result called the skin and approaching it in a customized manner. Rather than simply covering the skin, it adjusts the dampness, heat, blood, and organ functions inside the body to reduce recurrence and aid recovery.

Now, if any of you are currently worried about your skin symptoms, please remember that a diagnosis is necessary that considers not only the symptoms appearing on the surface but also the body's reaction patterns and constitution.

Thank you!

#AtopicDermatitis #PsoriasisDifference