The reflex nature of skin conditions
PART ONE THE UNDERLYING PRINCIPLES
Howard Beardmore, December 2006
The skin and nervous system share an intimate relationship, which stems embriologically from the ectoderm, one of the first three germ layers in the developing foetus. This connection allows us to interpret the reflex nature of skin and visceral conditions.
Understanding the reflex nature of skin conditions with its vaso-motor visceral relations holds the key to explaining the curative treatment of a whole range of distressing complaints from dry skin to atopy and acne.
The prevailing medical view of skin conditions, particularly those that fall under the heading of 'atopy' and acne, is that they are local. The suggested causes of these conditions ranges from bacterial or fungal influence, allergy or autoimmune.
The osteopathic view is that whilst all of these factors may to some extent play a part in the symptomatic picture, the cause is in fact reflex from primary irritation elsewhere in the autonomic nervous system maintained by osteopathic lesioning. This leads to changes in vaso-motor control to the capillaries of the skin and then affects secretor motor function. This is a clever adaptation that signals compensatory adjustments, alerting us to visceral disturbances and should therefore not be treated as an isolated, local event
Ostensibly any disturbance in the circulation of fluids leads to various levels of toxaemia and the skin is often called upon to support by extra elimination, especially when major organs like the bowel, lung liver and kidneys are not doing their share of work. It is therefore possible to formulate a clear causative that is particular to each case. The symbiotic reasoning of the traditional osteopathic approach is to get behind the presenting symptom and identify the maintaining reflex lesion pattern.
Physiologically the sympathetic nervous system is intimately associated with the vaso-motor system, which is considered to be constrictor in its controlling action.
'The sympathetic ganglia are the true vaso-motor centres, from which pass out not only the visceral gray fibres to their distribution in the blood vessel walls, but also the grey rami communicantes, which pass to the spinal nerves to be distributed along with them to the skin and blood vessels of the superficial tissues.
This means that by increasing or decreasing sensory stimulation in the superficial skin and muscles, the vaso-motor centres can be influenced so as to alter the functioning of the vaso-constrictors to the visceral organs and vise versa.
J M Littlejohn the vaso-motor system original 1985 yearbook MCO
The circulation to the skin and underlying muscles shares a collateral relationship with the underlying viscera. This relationship, which exists anatomically, can be proved physically by placing hot/cold packs on the skin and reflexly dilating/constricting the blood vessels to the skin and producing anaemia or congestion in associated organs. This principle is used in hydrotherapy to affect circulatory changes between the skin and the viscera. The following diagram illustrates this well and is taken from Kellogg's rational hydrotherapy 2nd edition 1903.
So often we see presentation in clinic of 'skin conditions' distributed symmetrically, in a dermatonal pattern. This must point to a central disturbance and when we tally the distributed pattern with the anatomical connections of related spinal segments as shown by traditional osteopathic centres a clear pattern of visceral relationships begins to emerge.
These diagrams show us the related nerve supply to areas of the skin.
This diagram is used by traditional osteopathic practitioners to explain the various connections between levels of the spine and physiological functioning.
There are many authors of note who recognised that the skin could be used as a diagnostic. Henry Pottinger wrote the following:
Those (reflexes) through the sympathetic are commonly expressed in sensory, motor, and trophic disturbances in the skin, subcutaneous tissue, and muscles of those areas of the body surface which are in segmental relationship with the afferent fibres of the sympathetic system (dermatomes).
Those of the para-sympathetics show in tissues supplied by the vagus, pelvic and certain cranial nerves (In relation to the skin the three branches of the trigeminal are notable).
Pottinger's symptoms of visceral disease page 172.
This book explains the connections between visceral symptoms and their reflex causes. With regard to skin conditions the above two paragraphs can be interpreted as follows:
- When we see trophic skin changes like eczema, acne, dry or greasy on the body dermatones we can assume that it is a vaso-motor reflex condition from related visceral levels as shown on the chart of osteopathic centres earlier.
- When we see skin changes like eczema, acne, dry or greasy on the facial parasympathetic, which is the trigeminal nerve, dermatome we can assume that it is a reflex parasympathetic phenomena. Commonly in practice I have found that upper GIT disturbances like gastralgia and poor diet affect the upper trigeminal area on the forehead. Likewise mid digestive disturbances affect the cheek and pelvic reflex vagal irritations like those in suppressive menstrual cycles tend to affect the jaw branches of the face. Incidentally the trigeminal connections usually present contra-laterally (opposite side to organ involved) as the nerve tract crosses in the brain stem. That means that liver reflex issues usually affect the left mid trigeminal and pancreatic the right. Because these two organs are connected especially in their relation to glycogenisis both can present together.
We can see here that the autonomic nervous system is fully represented in reflex, by reflex disturbances to: sympathetic / vaso-motor and parasympathetic / peristaltic /secretormotor expression. We already accept that there are central nervous system reflex relations so it makes sense that this also applies to the complete nervous system.
'Various skin diseases have been treated osteopathically with varying success. So much depends upon the cause of the disturbance and its removal, in skin diseases, that the cure does not rest so much with the mere treatment, as with the necessary skill in locating the disturbing factor.'
'The leading objective of osteopathic treatment is to free the circulation and thus promote a healthy and unobstructed flow of blood; in no other class of diseases is this more essential than in skin diseases.'
The practice of osteopathy Mc Connell and Teal Journal printing co Kirksville 1906.
Studying the similarity rather than the difference
The common factors present with many skin conditions also give a clue to constitutional involvement, that is the segmental distribution. We also find that the patient has elimination issues with regard to the bowel, lung, liver kidneys and uterus when a case history is taken.
Sometimes the condition is a reaction to seemingly unrelated drug therapies that have skin conditions listed as side effects. This may be because most drug therapies demand increased excretion via the skin kidneys liver and bowel. If the patient is already slow in these areas the skin is often called upon dermatonally to support the struggling organ. In essential fatty acid deficiency we see dry skin on the upper arms and upper outer thigh areas so the skin can also have nutrients 'borrowed' as part of a seamless continual triage. In a way the body is able to continually adjust itself and place the most important demands foremost, sometimes temporarily giving up some of its reserve for greater need.
Here is a case of dermagraphia that appeared 24hours after a contraceptive injection. This was confirmed by a biopsy on the right calf. The condition was distributed from the base of the skull to the heels. If you look at the photo you will see bigger foci radiating out from D4 and in the lumbar area centralised at L3.
The lumbar dermatome and 'biopsy'
The upper skin lesioning area is commonly disturbed reflexly in hormonal surges and this may be because here the vasomotors to the head and pituitary gland are controlled at this level. The secretion of any gland is dependant upon the flow of blood. The lumbar and leg dermatomes skin lesioning relates to vasomotors to the uterus.
The symmetry of the distribution of the pattern gives the key to the central nature of the irritation.
Any lifestyle issues that irritate the sympathetic system, stress, imbalanced refined carbo-hydrate diet, alcohol and patients with a poor adrenal reserve can all manifest compensatory eliminative skin conditions. This is because increased adrenal tone produces dilation of the skeletal muscle with constriction of the eliminatory organs and therefore the skin is called upon to excrete on their behalf.
It is now obvious why attempts at reductionist Randomised controlled trials cannot test this approach - in twenty patients with the same presentation of say eczema they may all have completely different causative factors. As such each patient would have the treatment directed at removing the maintaining factors, Randomised Controlled trials only allow for one variable to be tested and unfortunately nature is a symbiosis that is by definition multivariable.
Reductionism was a Middle Ages phenomenon that is reducing something to the sum of its parts to understand it. The human Genome project championed as the final bit of the jigsaw in understanding disease won't change much either; it's a bit like putting a pile of building materials on the front lawn and then saying that you now know how to build a house!
In this patient the case history revealed poor bowel function. The leg dermatomes relate to the nerve roots from the L4 and L5 region. On the osteopathic centres chart this segmental level has vaso-motor relations with defecation and the circulation to the lower and superficial body.
Retained bowel waste becomes more irritating the longer it stays and this is the stimulus for irritation of the vaso-motor dilation of the leg dermatomes. Thus the irritation of the bowel is moved to the surface for diagnosis as part of a healthy reflex to tell us that there is a problem.
I find it incredulous that unscientific therapies have come to the conclusion via randomised controlled trials that this case could be caused by 'lack of steroid cream!'
The patient was a 'sway back' posture with posterior rotated pelvis and this postural type tends to produce stasis in the GIT. This is because the posterior collapse of the spine squeezes the front of the disk, pushing it backwards and this produces an inhibitory pressure on the spinal nerves that control circulation to the bowel. This takes account of the sympathetic reflex to the legs, the vagal outflow from the sacrum, which is the parasympathetic component, inhibits the peristalsis of the bowel and reflexely produced 'bad skin' on the jaw. The posterior lumbar spine also tends to cause a collapsed diaphragm by pulling the lower attachments of the diaphragm back thus flattening it. This also affects venous return from the lower body. Patients tended to eat 'on the hoof', and the meals were unbalanced and afternoon tiredness/stimulant drinking patterns indicated that the patient was generally dehydrated.
All of this enervation would make the patient sympathetically (adrenally) dominant and this would also tend to make the bowel relatively dry.
Treatment is addressed to restore the posture, improve the diet and not to give laxatives. The following paper came to some very interesting conclusions about the reflex nature of psoriasis and rheumatoid arthritis
Modern research supporting the reflex nature of skin conditions
Re-emergence of psoriasis and improvement in Rheumatoid arthritis
This patient had a dramatic improvement in the level of pain and stiffness from a rheumatoid joint with the re-emergence of her psoriasis. She used to put steroids on it as a teenager and this with the above article must be evidence that the suppression of the original skin condition had a direct role in the rheumatoid development.
This I have experienced in many patients, for some this is a re-emergence that was suppressed when they were much younger, with hormonal creams. This does support the traditional osteopathic observation that the suppression of the superficial acute skin condition pushes the condition deeper into a chronic, more destructive presentation. Another core traditional osteopathic observation is that continual palliation of acute conditions has a tendency to lead to chronic sequelae.
Re-emergence of eczema and improvement in asthma C8 to D4 in extension
The above case is another example of viscerally related reflex asthma/eczema. The anterior collapse of the spine here affects vasomotor to the lung and also affects the breathing mechanism by disturbing the way that the rib cage moves during respiration. At the level of the 4th dorsal spine the ribs move up and out above and down and out below.
The patient presented with asthma and no eczema, as the spine softened up through treatment the asthma abated and the eczema reappeared. Continued improvement in the spine saw an end to the eczema.
The patient used to get eczema (at D4) here and used to put cream on it all before the asthma presented. From an orthodox perspective this is seen as part of the 'atopic pathway' but in this case, 'in reversal' because treatment is directed at the underlying cause rather than just trying to give symptomatic relief.
23-year case of severe asthma and eczema
During the first session it was obvious that the body was saturated with waste. The oedema, lack of mobility and thickening give clues to this. The steroid treatments and immune
suppressant drugs force a reverse transport of excretion, followed by water absorption in a desperate attempt by the body to reduce the irritation.
When there is a long standing case of atopy that has also been taking immuno- suppressants in order to control symptoms the treatment necessary to bring the patient back to health is a long committed program. It can take one tenth of the time that the illness has persisted to unravel this kind of case and the work is not to be undertaken lightly. As each pattern of the contracture in the spinal lesion
Patterns unwinds a period of relief is followed by a healing crisis as the constitution starts to take responsibility for cleaning and repair.
This patient had very poor bowel function; undeveloped spinal arches in a collapsed reverse pattern and took no less than eight sympathomimetic drugs to control extremely distressing eczema and asthma. The patient had been previously hospitalised on many occasions.
In the first instance the asthma improvement was followed by what can only be described as an explosion in the eczema. Over a period of 5 years the bowel function became daily and the skin began to heal without the use of topical creams or herbal preparations as the spine began to integrate with the pelvis.
The adrenal fragility cannot be over emphasised and any sudden change in the weather or emotional stress needs the right kind of support and preparation to limit the impact. This is because all of the pharmaceutical support is directed at the adrenals and in a sense there is suspension of maturity in the adaptive response. The patient has to be gradually re-introduced to the stimulus of stress in order to fully recover.
Now the main time for very mild relapse is the autumn and spring as it takes two to three weeks to respond to the stress. The cold constricts the skin and forces the liver, kids and bowel to do a cleaning purge and sometimes the jolly old common cold appears followed by settling and further improvement.
Five years on we can see that the healing of the leg ulcers is well on the way, now the skin, which has no scarring, is finally repigmenting.
The hands are now delicate, dextrous and fully functional.
This was achieved entirely without the use of any topical application whatsoever.
The final push for recovery was completed by 4 months of the Gerson diet, under proper supervision, based mainly on the consumption of green vegetable daily juicing and coffee enemas. Both of these adjuncts are known for the supportive effect that their use has on liver function.
So from a traditional osteopathic perspective we can see that skin conditions can be used as a diagnostic for possible visceral disturbances rather that as distinct and separate conditions.
In part two we will review cases of reflex skin conditions in liver disturbances, thyroid disorders, fertility, poor bowel function, lung disorders and more; all treated within traditional osteopathic practice fully illustrated up to date from modern work.
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