Culture-Bounded Skin Lesion - A Case Due to Chinese Gua Sha.

Sir,

I would like to share my experience in a case involving an interesting skin lesion. This was a consultation case pertaining to a 41-year-old Thai patient. The skin lesion [Figure 1] was observed during a general medical examination for a routine checkup program for health certification by a general practitioner. This case was brought in for diagnosis. The patient had no other problems and his vital signs were normal. Laboratory results from the health checkup program showed that the complete blood count was normal. In this case, many elongated reddish ecchymosis skin lesions could be seen on the patient's back. The patient's in-depth medical history revealed that he had had Gua Sha, a traditional treatment for myalgia, a day before. In this case, “an unusual pattern of reddish skin lesion on the back” was a unique finding as previously described by Aprile et al.[1] and Odhav et al.[2] There are few reports on this specific skin lesion, and the cases are usually accidentally detected.[123] The Gua Sha culture is rooted in Chinese medical practices and refers to the use of a blunt object such as a coin or a spoon to scratch at the skin. “Repeated strokes of a smooth spoon or a coin edge over skin until redness is observed” has been described as the main procedure of Gua Sha. It is a specific technique of “traditional East Asian medicine used to treat conditions that have features of blood stasis, pain, and/or inflammation”[4] According to the clinical trial, Gua Sha has been confirmed to have short-term effects on pain and a functional status in patients with chronic muscle pain.[5] The mode of action of Gua Sha on back and neck pain is very interesting. A change of microcirculation in surface tissue is reported. Nielsen et al. used Laser Doppler imaging to study the change after Gua Sha had been applied and found that the treatment “increases microcirculation local to a treated area, and that increase in circulation may play a role in the local and distal decrease in myalgia.”[6] According to the clinical trial, Gua Sha is confirmed for having short-term effects on pain and functional status in patients with chronic muscle pain.[5] How Gua Sha acts on back and neck pain is very interesting. A change in the microcirculation of surface tissue is reported. Nielsen et al. used Laser Doppler imaging to study the change after Gua sha and found that the treatment “increases microcirculation local to a treated area and that increase in circulation may play a role in local and distal decrease in myalgia.”[6] A change in heme oxygenase-1 (HO-1) gene expression after the procedure is also reported. Upregulation of HO-1 is observed and might induce cytoprotection against oxidative stress. Kwong et al. proposed that the upregulation of HO-1 is the mechanism that could explain the “antioxidative response to circulating hemoglobin products released by Gua Sha.”[7] In the present case, the patient received no treatment. Three days later, all skin lesions had completely disappeared by the follow-up visit. In the previous case reports, the problems are also self-limited.[123] Focusing on a differential diagnosis, the practitioner has to differentiate this cultural dermatosis from injuries and forensic conditions. The present culture-bounded skin lesion might be observable anywhere among the Chinese ethnic case. Practitioners have to recognize this group of culture-related problems to make a correct diagnosis.

Figure 1

Observed skin lesion

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