TCM-Induced Remission of Steroid-Rebound Hand Eczema: 14-Month Case Report 中药缓解激素反弹手湿疹：14个月病例报告

Patient Profile and Initial Presentation

A 60-year-old lady, arrived at our Traditional Chinese Medicine (TCM) clinic in early 2016, seeking relief from persistent hand eczema that had plagued her for a year. Her hands bore a stark reminder of her struggle: a thickened, hyperpigmented plaque, blackened and scaly, sharply demarcated against relatively unaffected surrounding skin. Two months prior, a dermatologist had prescribed a 9-day course of oral prednisone, which briefly tamed the lesions. However, the respite was short-lived. After discontinuing steroids, her hand eczema roared back, accompanied by a new eczematous rash on her neck, signaling a deeper imbalance. Frustrated by the relapse, she sought a holistic alternative through TCM. We present a 14-month photographic case series evidencing TCM-mediated remission after steroid rebound.

Pathophysiological Context

From a TCM perspective, her eczema condition reflected a complex interplay of Damp-Heat (湿热), Blood Stasis (血瘀), and Qi Deficiency (气虚), exacerbated by the immunosuppressive effects of steroids. The post-steroid rebound suggested that the underlying pathogenic factors had been suppressed rather than resolved, leading to an immune overreaction upon cessation.

Tailored TCM Intervention

We initiated a customized twice-daily herbal medicine, meticulously crafted based on syndrome differentiation. Monthly follow-ups allowed dynamic adjustments to align with her evolving clinical presentation. Oral antihistamines were advised for sleep in the first month only; no topical steroids were used. Lifestyle counselling focused on gentle cleansers and cotton gloves.

Progress and Milestones

Baseline (M0): Deep erythema with violaceous tinge on palms and dorsal knuckles; diffuse oedema; fissuring; VAS-itch 9/10.

Month 2-4: Marked rebound: darker hue, vesicles with oozing; fissures deepen; VAS-itch 10/10.

Month 6: Erythema pale; extensive desquamation revealing pink new skin; oedema ↓70 %.

Month 8: Near-normal colour; residual dryness in interdigital spaces; VAS-itch 2/10.

Month 10: Even pigmentation; palmar creases distinct; no fissures.

Month 12-14: Complete clinical remission; barrier intact; patient resumed household chores with gloves; no relapse.

Results

• Photographic evidence demonstrates peak inflammation at month 2-4 and stepwise resolution by month 8, culminating in normal texture by month 14.
• Symptom metrics (sleep quality, VAS-itch) paralleled visual improvement.
• Safety. No hepatic or renal abnormalities were noted on biochemistry.

Discussion

TSW steroid withdrawal after short-course systemic steroids is under-recognised outside dermatology. Rebound may signify hypothalamic-pituitary-adrenal axis disequilibrium and heightened skin cytokine activity. The present case supports two insights:
1. Temporal TSW rebound can crest within 4–10 weeks post-cessation, providing a predictable window for intensified support.
3. Patient adherence. Monthly photographic feedback fostered trust, mitigating dropout risk during distressing rebound.

Privacy

In situations where the disease information had already been made publicly available (as evidenced by prior articles), genuine names of individuals have been utilized. Conversely, in instances where there was no pre-existing public disclosure or at the explicit request of patients for privacy, pseudonyms have been employed. Furthermore, identities have been deliberately obscured, and certain contextual details and diagnoses have been modified to hinder any attempts at identification. It is essential to emphasize that the patients and encounters described in this work are authentic, and their consent for publication was duly obtained. As responsible authors, we earnestly implore all our readers to honor the privacy and confidentiality of these individuals. Additionally, certain scenarios, assessments, and clinical interventions have been altered to safeguard the anonymity of both patients and healthcare providers.