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Strep Throat

Dermatology – Strep throat can be more than a sore throat: Herbs for Guttate Psoriasis

By Dr. Carol Goldman and Samantha Burris, October 7, 2023.

 

It’s that time again, when sniffles, coughs, and sneezes abound, plaguing our children, and of course, parents, teachers, and caregivers too. In preparing for cold and flu season parents should consider herbal medicine, not only in the anticipatory stocking of the family medicine cabinet, but also in finding a practitioner licensed with the State’s Board of Medicine, to recommend specific herbal remedies for symptoms and diagnosis when ailments present.

 

From the kitchen table to the medicine cabinet, household remedies are common. We all grew up with at-home remedies such as saltwater gargles, honey ginger tea, and eucalyptus rubs.  These timeless solutions came from family tradition, passed down from one generation to the next. Expanding on this know-how, licensed herbalists are experts poised to improve conditions or resolve our modern minor illnesses, with an ability to dispense any of over 180 herbal formulas, or over 365 traditional herbs. Single herbs and those combined into synergistic formulas can have antipyretic, antiviral, antispasmodic, anti-inflammatory, antimicrobial, and antioxidant effects. Strep throat is often a repeat offender among school-age children and when presented, there is a need for an herbal composition containing these qualities.

 

Once contracted, most children complain of a scratchy raw sore throat, but in some cases, strep throat isn’t as obvious. Strep can present with an itchy unrelenting rash, diagnosed as guttate psoriasis.

 

The rash, called Guttate Psoriasis, can take months to settle or clear. Guttate psoriasis involves the activation of T cells, white blood cells whose function is to defend the body from foreign invaders. T cells produce cytokines to manage the inflammatory response to a foreign invasion. Dysregulated T cells mistakenly attack healthy skin cells, disrupting the natural balance of the anti and proinflammatory feedback loop, leading to an intensely itchy rash with scaly dry skin.

 

In these cases, topical steroids and systemic medications are often prescribed.

 

Western medical treatment depends on the severity of the condition, the extent of the rash, and individual factors. Here are some common treatment options for guttate psoriasis:

1. Topical Corticosteroids: topical steroids reduce inflammation and relieve symptoms.

2. Topical Calcineurin Inhibitors: topical inhibitors suppress the immune response and reduce inflammation.

3. Phototherapy: exposing the affected skin with controlled doses of ultraviolet (UV) light can help slow down rapid skin cell growth and improve symptoms.

4. Systemic Medications: oral or injectable medications suppress pro-inflammatory cytokines and anti-inflammatory cytokines. Balance between these two factors is crucial since anti-inflammatory cytokines such as interleukin-10 and transforming growth factor-beta, help modulate the immune response and inhibit the production of pro-inflammatory cytokines.

5. Moisturizers: moisturizers can help soothe the skin, reduce dryness, and alleviate itching by acting as the mortar the skin needs to maintain its seal.

6. Managing Triggers: identifying and managing triggers, such as streptococcal infections, stress, or certain medications, can help prevent flare-ups.

 

Parents may be reluctant to give their children immune-suppressing drugs such as steroids. Many herbal combinations are available to quell the residual side effects from a strep infection while boosting the immune system's balance to resolve the rash.

 

Treatment approaches for guttate psoriasis must involve the restoration of immune balance, calming the immune response from attacking healthy tissue. Traditional Chinese Medicine addresses the internal immune imbalance in the body and the need to assist in establishing a return to homeostasis to mitigate the symptoms.

 

Traditional Chinese Medicine (TCM), guttate psoriasis is seen as a manifestation of an underlying imbalance in the body. TCM views the condition as a combination of external and internal factors, such as heat, wind, dampness, blood stagnation, and toxic heat. Treatment in TCM aims to address these underlying imbalances and promote overall well-being. Herbal remedies may be prescribed to clear heat and toxins, resolve blood stagnation, and strengthen Qi and blood. Acupuncture, cupping, and other modalities may also be utilized to promote the flow of energy and blood throughout the body.

 

The main principles involved in understanding guttate psoriasis from a TCM perspective include assessing the following underlying conditions:

 

1. Heat and Toxins: guttate psoriasis may be the result of excess heat and toxins in the body. These pathogenic factors can accumulate and disrupt the flow of Qi and blood, leading to skin manifestations.

2. Blood Stagnation: impaired blood circulation can lead to accumulations and stagnations, blocking proper substance flow and resulting in characteristic skin lesions.

3. Wind and Dampness: external factors such as wind and dampness have influence over the development of guttate psoriasis.

4. Deficiency of Qi and Blood: underlying deficiencies in Qi and blood weaken the body's ability to fight off pathogenic factors. A weakened immune system and imbalances in the body's energy can make an individual more susceptible to guttate psoriasis.

 

TCM Herbal Treatment Strategy:

 

Patients with guttate psoriasis suffer from intense itching and dehydrated peeling skin. The first task to treat involves lowering the level of itch to make the patient feel more comfortable. It is important to prescribe a combination of herbs that not only expels wind but also assists in re-establishing the balance within the patient's immune system.

 

Combining (creating a soak) of Bai Ji Li (Tribulus), Ku Shen (Sophorae Flavescentis Radix), Bai Xian Pi (Dictamnus Root Bark), Jing Jie (Schizonpeta), Fang Feng (Saposhnikovia), Di Fu Zi (Kochia), She Chuang Zi (Cnidium Seed) as a wash is a great way to topically resolve the itch.

 

An internal remedy should include a combination of heat-clearing, balance-modulating, and anti-inflammatory herbs targeting not only the direct symptoms but also addressing the root of this condition, an immune system that is out of balance. The following herbs are known to have a positive effect on resolving guttate psoriasis.

 

One such herb, Ban Lan Gen (Radix Isatix) has powerful anti-bacterial properties.  It clears heat while detoxifying the body.  Ban lan gen has been shown in studies to be effective against streptococcus pyogenes, the bacterium associated with strep throat, and other various respiratory infections. This herb has anti-inflammatory and immune modulating properties as per several research studies.

 

Huang Bai (Cortex Phellondendri) is also known for its anti-inflammatory and anti-bacterial properties but is very useful against the symptoms of guttate psoriasis in that it is very helpful in its ability to cool the skin.

 

Ku Shen (Radix Sophorae Flavescentis) possesses antimicrobial and anti-inflammatory properties. It is believed to have a purging effect on heat and toxins in the body, potentially assisting in the management of guttate psoriasis.

 

A few other important herbs, Lian Qiao (Fructus Forsythiae), Jin Yin Hua (Flos Lonicerae), and Xuan Shen (Radix Scrophulariae) have been found to inhibit the production of inflammatory cytokines while modulating immune balance.

 

Traditional formulas, created thousands of years ago, addressed patterns of disharmony.  In our current times, with Western medical technology, we find that these herbs have properties that address the very biomedical mechanisms involved in many of our modern diseases.

 

 

 

The authors of this article are trained, licensed acupuncture herbalists with the state board of medicine.

Dr. Carol A Goldman DACM, LO.M, - Director Herb Department at The Won Institute of Graduate Studies, private practice in Narberth and Phila PA.carolgoldmanacupuncture.com carol.am.goldman@gmail.com 415-758-1057

 

Samantha Burris LAc – Awaiting PA  Board of Medicine licensure for herbal designation, a recent graduate of The Won Institute Herbal certificate program, Licensed Acupuncturist in Corning, NY, Owner of Essence Healing www.essence-healing.com

 

 

References:

  • Dupire G, Droitcourt C, Hughes C, Le Cleach L. Antistreptococcal interventions for guttate and chronic plaque psoriasis. Cochrane Database Syst Rev. 2019;3(3):CD011571. doi:10.1002/14651858.CD011571.pub2. Journal

  • Gananandan K, Sacks B, Ewing I. Guttate psoriasis secondary to COVID-19. BMJ Case Rep. 2020;13(8):e237367. doi:10.1136/bcr-2020-237367. Journal

  • Jindal R, Chauhan P, Sethi S. Dermoscopic characterization of guttate psoriasis, pityriasis rosea, and pityriasis lichenoides chronica in dark skin phototypes: an observational study. Dermatol Ther. 2021;34(1):e14631. doi:10.1111/dth.14631. PubMed

  • Makhecha M, Singh T, Khatib Y. Dermoscopy differentiates guttate psoriasis from a mimicker-pityriasis rosea. Dermatol Pract Concept. 2021;11(1):e2021138. doi:10.5826/dpc.1101a138. PubMed Central

  • Maruani A, Samimi M, Stembridge N, et al. Non-antistreptococcal interventions for acute guttate psoriasis or an acute guttate flare of chronic psoriasis. Cochrane Database Syst Rev. 2019;4(4):CD011541. doi:10.1002/14651858.CD011541.pub2. Journal

  • Pfingstler LF, Maroon M, Mowad C. Guttate psoriasis outcomes. Cutis. 2016;97(2):140–4. PubMed

  • Rouai M, Rabhi F, Mansouri N, Jaber K, Dhaoui R. New-onset guttate psoriasis secondary to COVID-19. Clin Case Rep. 2021;9(7):e04542. doi:10.1002/ccr3.4542. Journal

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