A Case of Chronic Nummular Dermatitis Improved by Hwangryunagyo-tang

Article information

J Korean Med. 2024;45(1):213-222
Publication date (electronic) : 2024 March 1
doi : https://doi.org/10.13048/jkm.24014
1Department of Medical Support, Imsil-gun Medical Center, Imsil, Jeollabuk-do, Republic of Korea
2Bugang Korean Medicine Clinic, Bucheon, Gyeonggi-do, Republic of Korea
3Department of Acupuncture and Moxibustion, Wonkwang University Korean Medicine Hospital, Deokjingu, Jeonju, Jeollabuk-do, Republic of Korea
4Research Center of Traditional Korean Medicine, Wonkwang University, Iksan, Jeollabuk-do, Republic of Korea
5Department of Korean Medicine Ophthalmology, Otolaryngology, and Dermatology, Wonkwang University Korean Medicine Hospital, Iksan, Jeollabuk-do, Republic of Korea
Correspondence to: Eun-Heui Jo, Department of Acupuncture and Moxibustion, Wonkwang University Korean Medicine Hospital, 99, Garyeonsan-ro, Deokjin-gu, Jeonju-si, Jeollabuk-do, 54887, Republic of Korea, Tel: +82-63-270-1022, Fax: +82-63-270-1199, E-mail: freezo@wonkwang.ac.kr
Corresponding author: Min-Cheol Park, Department of Korean Medicine Ophthalmology, Otolaryngology, and Dermatology, Wonkwang University Korean Medicine Hospital, 895 Muwang-ro, Iksan-si, Jeollabuk-do, 54538, Republic of Korea, Tel: +82-63-859-2821, Fax: +82-63-841-0033, E-mail: spinx11@wonkwang.ac.kr
Received 2023 December 13; Revised 2024 February 9; Accepted 2024 February 16.

Abstract

Objectives

This study aims to report a case of chronic nummular dermatitis improved by Hwangryunagyo-tang.

Methods

The patient in this study was a 15-year-old female, who visited our hospital with symptoms such as redness, erythema, papule, excoriation, scale, exudation, crusting, lichenification, and pruritus of the extremities and trunk. Considering that the skin lesions were coin-shaped and persisted for more than 6 months, the patient’s symptoms were diagnosed as chronic nummular eczema. Based on the patient’s symptoms and overall condition, Hwangryunagyo-tang was prescribed.

Results

Approximately 4 months after administration of Hwangryunagyo-tang, the exudate disappeared, and overall skin symptoms improved, from objective score 33.7 to 6.6, leaving only slight scale, dryness, and pigmentation. As the pruritus of the skin lesion decreased from numeric rating scale 8 to 1, the patient’s sleeping condition also improved from numeric rating scale 9 to 0.

Conclusion

This study is significant in that the symptoms of chronic nummular dermatitis were effectively improved after administration of Hwangryunagyo-tang.

Fig. 1

Treatment Timeline

Fig. 2

Clinical Progress of Nummular Dermatitis

Symptom Evaluation Index

Prescription of Hwangryunagyo-tang

Symptom Progress of Nummular Dermatitis

References

1. Robinson C. A., Love L. W., Farci F.. Nummular Dermatitis. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2023. Jan. [cited 2023 Dec 11]. Available from: URL:https://www.ncbi.nlm.nih.gov/books/NBK565878/?report=printable.
2. Fukaya M.. 2000;Why do patients with atopic dermatitis refuse to apply topical corticosteroids? Dermatology 201(3):242–245. https://doi.org/10.1159/000018495.
3. Mang W. J.. 2015. Sanghanron Commentary Iksan: Wonkwang University Press Office. p. 296–297.
4. Leem K. H., Kim T. Y.. 2022;Hwangryunagyo -tang on sleep onset and total duration of sleep induced by thiopental dodium in mice. J Physiol & Pathol Korean Med 36(1):7–10. https://doi.org/10.15188/kjopp.2022.02.36.1.07.
5. Lee G. E., We Y. M., Seong J. W., Kim D. Y., Kang H. W.. 2014;A clinical report about a patient suffering from social phobia and treated by herbal medicine with neurofeedback. J of Oriental Neuropsychiatry 25(2):154–164. https://doi.org/10.7231/jon.2014.25.2.153.
6. Lee S. Y., Yoon H. D., Shin O. C., Shin Y. J., Park C. S.. 2006;Effect of Hwangryunagyotang water extract on endothelial cells by free cholesterol. J Int Korean Med 27(3):589–602.
7. Lee J. H., Oh M. J.. 2018;A case study of four hemorrhoid patients treated by Korean medical treatment. J Int Korean Med 39(2):209–216. https://doi.org/10.22246/jikm.2018.39.2.209.
8. Jin H. S., Yoon H. J., Ko W. S.. 2021;A case of nummular eczema treatment improved through Korean medicine : Focus on Hwangryeonagyo-tang and Mahwangbujasesin-tang. J Korean Med Ophthalmol Otolaryngol Dermatol 34(1):89–100. https://doi.org/10.6114/jkood.2021.34.1.089.
9. Hanifin J. M., Thurston M., Omoto M., Cherill R., Tofte S. J., Graeber M.. 2008;The eczema area and severity index (EASI): Assessment of reliability in atopic dermatitis. Exp Dermatol 10(1):11–18. https://doi.org/10.1034/j.1600-0625.2001.100102.x.
10. European Task Force on Atopic Dermatitis. 1993;Severity scoring of atopic dermatitis: the SCORAD index. Dermatology 186:23–31.
11. Kim H. J.. 2001;A case of atopic dermatitis accompanied by acute nummular eczema. J Korean Med Ophthalmol Otolaryngol Dermatol 14(1):111–116.
12. Kim H. G., Kim J. Y., Kim S. A., Lee J. W., Lim S. H.. 2019;Review of Korean medicine treatments for nummular eczema in Korean journals. J Korean Med Ophthalmol Otolaryngol Dermatol 32(4):116–129. https://doi.org/10.6114/jkood.2019.32.4.116.
13. Rho E. J.. 2018. Gobangyuchwi Seoul: Barun Herbal Medicine. p. 795–799.
14. Ju Y. S.. 2013. Jeungbo Ungok Herbology Wanju: Wooseok. p. 452–457. p. 1319–1321.
15. Yoon K. R., Kim Y. J., Lee E., Lee J. M.. 2009;Anti-inflammatory effect of Coptidis Rhizoma. Kor J Herbol 24(3):79–86.
16. Jeong A. R., Ahn S. H., Jeong H. S., Kim K. B.. 2019;Effect of Coptidis Rhizoma extract on atopic dermatitis-like skin lesions in NC/Nga mice. J Physiol & Pathol Korean Med 33(2):102–18. https://doi.org/10.15188/kjopp.2019.04.33.2.102.
17. Xiao L., Liao F., Fan Y., Miwa N.. 2020;Enzyme-digested Colla Corii Asini (E’jiao) accelerates wound healing and prevents ultraviolet A-induced collagen synthesis decline and wrinkle formation in three-dimensional skin equivalents. Human Cell 33:1056–1067. https://doi.org/10.1007/s13577-020-00405-y.
18. Wang D., Liu M., Cao J., Cheng Y., Zhuo C., Xu H., et al. 2012;Effect of Colla Corii Asini (E’jiao) on D-galactose induced aging mice. Biol Pharm Bull 35(12):2128–2132. https://doi.org/10.1248/bpb.b12-00238.
19. Lee H. I., Kim E. J., Son D., Joo B. D., Sohn Y., Kim E. Y., et al. 2022;Effect of Paeonia Lactiflora Pallas on atopic dermatitis-related inflammation in HaCaT cell. Korean J Acupunct 39(2):43–53. https://doi.org/10.14406/acu.2022.007.
20. Mok J. Y., Jeon I. H., Kim H. S., Shin J. H., Park Y. G., Jang S. I.. 2013;Synergic anti-pruritic and anti-inflammatory effects of Scutellariae Radix plus Flos Loncerae extracts in rat peritoneal mast cell and chemical antigen-induced mice. J Physiol & Pathol Korean Med 27(1):83–91.

Article information Continued

Fig. 1

Treatment Timeline

Fig. 2

Clinical Progress of Nummular Dermatitis

Table 1

Symptom Evaluation Index

Symptom Level
Objective Symptoms Severity Redness 0=Absence
1=Mild
2=Moderate
3=Severe
Erythema
Papule
Excoriation
Scale
Exudation
Crusting
Lichenification

Area 0 ~ 100 (%)

Subjective Symptoms Pruritus 0 (None) ~ 10 (Severe)
Sleep Loss

Table 2

Prescription of Hwangryunagyo-tang

Name of Natural Medicine (Herbal Medicine) Weight(g)
黃連 Coptis chinensis Franch. 4
阿膠 Colla corii asini 3
黃芩 Scutellaria baicalensis Georgi 1
芍藥 Paeonia lactiflora Pall. 2
鷄子 Gallus gallus domesticus 3
Total Amount 13

Table 3

Symptom Progress of Nummular Dermatitis

2022.05.25 2022.08.05 2022.09.14
Objective Symptoms Redness 2 1 0
Erythema 2 1 1
Papule 3 1 0
Excoriation 2 1 1
Scale 3 1 1
Exudation 3 0 0
Crusting 2 1 1
Lichenification 2 1 0

Area 14.7 7.5 2.6

Subjective Symptoms Pruritus 8 2 1
Sleep Loss 9 1 0

Total 50.7 17.5 7.6