Aug. 2024
(Q) I am currently going TSW and NMT, but yellow exudate solidified (like a scab) is sticking to some parts of my skin. This can be easily softened in the shower and can be removed without too much pain or irritation.
Is it better to remove this mass of exudate frequently or leave it as it is without removing it?
(S) You need to wait for it to come off naturally.
(Q) Thank you for your reply. I'll do that.
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(Q) I heard that some hospital recommends no steroids, general treatment with antihistamines, ointments, and staying away from ticks, but I was wondering if Hannan Chuo Hospital has the same treatment procedure. My 5-year-old boy has MRSA infection from shingles, severe eczema, and a mixture of Antebate and Vaseline all over his body. I am not sure which hospital to go to for TSW.
(S) At Hannan Chuo Hospital, The use of steroids are gradually stopped. No moisturizing is also involved. Antihistamines are used. Ticks are not really a problem. FYI.
(Q) Thank you for your reply. I will consider it.
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(Q) About the exudate
When yellow exudate comes out from the erosions after the pressure ulcer is removed, or when it changes to clear exudate and dries up quickly after a while, I know that I should not wipe off the clear exudate but stick a gauze on it gently and let it dry up.
If the exudate is yellow, should I wipe it off or rinse it off and gauze it so that it does not spread to other area?
I would like to know how to deal with yellow exudate. Thank you in advance.
(S) You can use the same method as the clear exudate.
(Q) Thank you.
Jul. 2024
(Q) Itching and desquamation
Dear Dr. Sato and experienced-TSW person It has been 10 years since I de-stayed and de-moisturized. I still have some areas that are still oozing, but I am getting by with gauze protection. Other parts are still itchy and I scratch them as much as I want, but I am glad that my skin has not been damaged so much. I would like to ask you and others with experience how long this will continue. Right now, most of the flakes are about powder size, say, about a size larger than a grain of pepper.
Thank you in advance.
(S) It is difficult to predict. What will affect the speed of getting better will be how you bathe, exercise, eat, and drink water. Give it a try and consider it.
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(Q) Valerian (Japanese valerian) makes it worse.
Hi, again. Today I am reporting and sharing information.
I tried valerian for 2 nights, which is regularly used abroad as an herbal sleep remedy, to deal with insomnia and itching from the effects of menopause. The quality of my sleep improved, but from the second night to this morning, the itching during the daytime was severe and the affected area spread and worsened. I can be active during the day because I sleep better than usual and I am more energetic than usual, but it seems to have a negative effect on my atopic disease.
By the way, it's been a year since I've been CORECTIM-withdrawal and NMT. You saw me in May and prescribed an anti-itch medication that made me sleepy. At first I felt a little better, but lately I don't feel much effect. I don't like to use benzodiazepine sleeping pills because they didn't agree with me, so I tried herbs this time, but I found that I need to be careful because they make me itchy. I would use it on days when I really wanted to sleep that night before, but I didn't think I could take it every day. I am sharing this in the hope that it will be helpful to others with sleeplessness.
(S) Thank you for your report.
Jun. 2024
(Q) Blepharitis
In April, I had an exudate coming out of my face and it was rough, but it has healed little by little. It still sometimes rubs my forehead and eyebrows, and at a school checkup, I was told that it was blepharitis. Until now, I had never had particularly itchy eyes or redness around my eyes. If it is some kind of facial skin irritation, I will continue to exercise and see what happens, but just to be safe, if I go to an ophthalmologist, would it be a good idea to get some antibiotic drops?
Best regards.
(S) If there is eye discharge, you would need antibiotic eye drops. If it's just itching, anti-allergic eye drops would be fine.
(Q) There is no eye discharge. I will get anti-allergic drops.
Thank you very much.
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(Q) Result of changing meal times
This is about my daughter, a high school sophomore, who saw you, Dr. Sato, last Thursday. She had recovered so that she was able to sleep well without taking Polaramine. However, she has been troubled again since April, and we made up our mind and went to Osaka to see you. You worked with us to see if she was doing what she should be doing, and you suggested that she should have dinner a little earlier (around 8:00 p.m.) after returning home from club activities. (There was only about two hours between the time she took in water after dinner and the bedtime.) This week she had no club activities and came home earlier, so she was able to have dinner about an hour and a half earlier than usual, and the exudate has almost stopped over the past week.
She have always kept my water intake at 100 ml at dinner, but she was surprised to see how much difference the same amount of water can make when the dinnertime is changed. She had stopped going to school by bicycle due to the pain, but she was able to do it by putting a thin towel around her neck to protect her from the wind. I think she will be able to shorten my commute home by biking to school even after club activities start, so I think she will be able to adjust her meal times going forward.
She still wake up with an itch and often got unstable, though. However, she said, “I feel like I am getting better since I visited Dr. Sato in Osaka.
Thanks to your help, I believe she will be able to do her best again. Thank you very much.
(S) I'm happy to hear that. Keep up the good work.
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(Q) Enlargement and traveling the affected area
Dear Dr. Sato, I would like to ask you a question, I visited you at Hannan-Chuo hospital on May 9. I started CORECTIM ointment withdrawal and NMT on July 21 last year, and I told you that I am not getting better even though it has been quite a while.
During the conversation with you, I assessed that I was not getting enough sleep, and you prescribed me an anti-itch medication with a drowsiness effect.
Since then, my sleep condition has improved somewhat and I have more energy, so my quality of life is better than before and I have been exercising somewhat more. The itching also decreased dramatically during the day, and I was thinking that if I kept this up, it would improve and I would be fine.
However, over the past week or so, I have noticed that the affected area has been enlarging. Specifically, itching has started to occur in places where it had never occurred before, such as under the breasts, on the inside of the thighs, at the border between the buttocks and thighs, under the armpits, and at the border between the shoulders and arms. In addition, itching has returned to the neck and inner elbows, which had been relatively comfortable since starting NMT.
On the other hand, the itchiness of my ankles and wrists, which had been in bad condition since NMT, has decreased. Is it normal for the affected areas to move around like this? Can I consider this change as a process to heal?
Since it has suddenly become hotter, I have been drinking more water so I am trying to reduce water intake, but it seems that the affected area is spreading. I would appreciate your opinion. Thank you in advance.
(S) Traveling of the affected area is a normal occurrence. The reason for your current exacerbation is unclear. Water intake needs to be considered. Seasonal factors, sweating, lack of exercise, etc. will also need to be considered in many ways.
Please read carefully the section in my book on aggravating and improvement delaying factors.
(Q) Thank you very much for your reply. I will read the book again and consider.
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(Q) Treatment of insect bites
I have been atopic dermatitis for 30 years, and it has been 4 years since starting TSW.
In the second year of TSW, I seem to have developed an allergy to insect bites, and when I get bitten by mosquitoes and other insects, the area where I was bitten becomes red and swollen and itchy. When I scratch the area, exudate sometimes comes out. The other day, I was misdiagnosed for having herpes at the hospital. I try to avoid insect bites as much as possible, but it is difficult in the summer and outdoors. Is there anything I can do myself to minimize the aggravation of the bites?
(S) It is just to cool it down with a cold pack...
(Q) Thank you for your reply. I also hear that applying ammonia water is a good idea, what do you think about this?
(S) It would probably irritate the skin.
(Q) I see. I understand. Thank you very much.
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(Q) An ENT doctor gave my kid a steroid called prednisolone.
When I told him not to use steroids, he said it's an emergency and he should get better as soon as possible and if this did not cure the problem, your son would remain deaf forever.
It is very hard to put steroids in his body at a time when he was getting better with TSW, but I didn't want him to lose his hearing, so I posted in this forum.
We would like to stay without taking them until I hear back from Dr. Sato.
I appreciate if you give me your opinion.
(Q) If you have sudden hearing loss, you are supposed to be treated with oral stroid therapy. You would be on a reduced dose of steroids once you can hear.
(Q) Thank you very much.
It is still nothing but steroids after all...
May. 2024
(Q) First year of TSW
I am always looking at your site. It has been a year of TSW. I have heard that the order of healing is face first, then body, upper and lower limbs, and arms heal first, and then the legs follow. At what stage will the head get better? In my son's case, the situation is that his neck is getting better and his face is finally almost there. The dandruff is decreasing but the pressure ulcers on his head are still bad. The worst is under his arms and it comes back again and again.
Also, is it okay to take Chinese medicine without licorice extract if it is right?
(S) It depends on the person in the order in which the skin rash improves. But unfortunately, many people are slow in the head. As for your question about Chinese medicine, I guess so.
(Q) Thank you for your quick reply. I see. I will keep an eye on him without being too impatient.
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(Q) Thank you.
My name is F. My son was hospitalized for a short period of time in April due to a worsening of his face. Thanks to your help, he went on his long-awaited school trip. He did not have any friends because he could not go to school at all in April, but during his hospitalization, he was able to interact with many people and he became cheerful and was able to go on the trip in a good condition. I am grateful that he had the opportunity to be hospitalized, and that he was able to give me energy and make one more memory in his life.
Thank you very much!
(S) I'm happy to hear that.
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(Q) About shaving while TSW & NMT
I am 31 years old and am in my third week of TSW and NMT. I have been on topical steroids since childhood. I don't have any exudate on my face, but my face is so dry that just a little bit of scratching causes scars. I feel like shaving will damage my skin.
What is the correct treatment for my beard?
I am currently shortening my beard with clippers so as not to damage the skin.
Many thanks.
(S) I think the method you are doing now is fine. Another method that is very similar is to use the trimmer part of an electric razor, or to cut the beard with scissors.
Apr. 2024
(Q) About sublingual immunotherapy
Every year during hay fever season, I get terrible rhinitis. I also often get brown pressure sores on my facial skin. I was curious about sublingual immunotherapy, and when I looked it up, I read that it might be good for atopic dermatitis and that at first it gets worse....
Thank you in advance.
(S) I heard that it may be effective for hay fever. I have not heard of any good data for atopic dermatitis.
(Q) Thank you.
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(Q) About gauze
I would like to ask you about the treatment of applying gauze on the area where the exudate is coming out.
If you wake up in the morning and there is exudate,
⚫︎ let it dry naturally
⚫︎Before it dries naturally, I dare to put gauze on it and let it dry with the gauze.
Which is better for healing?
I have always waited until it dries naturally and when it is not sticking, I put the gauze on it to cover the affected area.
(S) Generally, I would say "you dare to put gauze on it and let it dry together with the gauze".
(Q) I will do so. Thank you very much.
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(Q) About urticaria
Dear Dr. Sato.
I have been TSW and NMT for 3 years now. I still have inflammation. I get hiaves at night. It goes away after a while, but is this also related to the TSW? I would like to visit you again for a checkup.
(S) Urticaria are not related to TSW. It can be controlled by taking antihistamines. You can also stop taking them.
(Q) Thank you for your reply.
I was under the misconception that maybe the hives were coming out as my body was getting back to normal after TSW....
I will see you again soon. Thank you very much.
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(Q) About Herpes
For the past 8 months, my son, 14, face and body have been in great shape. Two weeks after having corona in February and the flu in March, he had herpes sores spreading from his face. This was the first time he realized that his immune system was failing and that herpes was coming out. This time, he took medication and received medical attention as soon as possible after the pressure sores appeared, so his body remained in good condition. I wonder if he will get herpes every time he gets a fever or loses strength going forward.
Is it less likely to happen as an adult, or are there any measures he can take to prevent it, such as exercising on a regular basis and getting good nutrition?
Thank you in advance.
(S) It is possible that you may contract herpes every time you have a fever or lose strength in the future. To prevent this from happening, you need to exercise regularly, eat well, limit fluids, sleep well, etc. This should be a lifelong practice.
(Q) Thank you for your time and reply. He will be careful in his daily life. Right now, there is an exudate comming out from about 1 cm of the erosion on his face.
Which will help it heal faster, letting it dry or applying a little zinc oxide ointment?
(S) Restrict fluids, make artificial crusts with one layer of gauze and do not remove for a week, tilt upper body upward at night. Pillows should be lowered.
(Q) I will use it as a reference. Thank you very much.
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(Q) Thank you once again Dr. Sato.
You helped me with TSW treatment 8 or 9 years ago already. Thank you very much.
I am now making a living as a field worker in the forestry industry, which is obviously not suitable for a "TSW patient". When I asked you before if I would like to try landscaping or something similar, you told me that "office work is the safest thing to do, even though it's boring". I was interested in the environmental field and camping, so I decided to take a risk and choose a field job. At first, my skin got worse to some extent, but now it doesn't get worse unless I am exposed to rain for a long time without a raincoat during the rainy season. I don't even feel itchy anymore. Currently, I have no skin problems and I am able to enjoy the outdoor field and my life. In my opinion as having done TSW, I wish there were more doctors in other prefectures who can treat TSW patients like you do.
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I wish there were more hospitals where I could be hospitalized... I suffer a lot in the early stages of withdrawal, and I wish the authorities, who cover up the side effects of steroids, would do something about it. Your treatment gave me the opportunity to work in a field I love, even though I am not suited to the natural environment or outside work.
Thank you so much.
I know it must be difficult for TSW doctors with all kinds of patients, but please take care of yourself and keep up the good work.
(S) Thank you for reporting the current situation. I can see that you are doing your best. Take it easy.
(Q) Thank you, I will try to keep up. I've been battling injuries and illnesses my whole life for some reason, but I'm only 33, so I'll keep trying not to overdo it.
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(Q) Dear Dr. Sato, Thank you very much for your examination.
Last year, my daughter and I saw you for a consultation on September 28, and she has been able to sleep since the night we returned from Osaka. I will never forget the look on my daughter's face the next morning when she woke up impressed that she was able to sleep through the night. Her skin symptoms and itchiness come and go, and she still has atopic skin, but it is better than it was six months ago, and we no longer have to wash her uniform, which is covered in blood and leachate. Most importantly, my daughter has regained her mental energy. Thank you very much. I just wanted to write a quick note of thanks to you....but it has been a long time coming. She is taking care of fluid management, head tilted upward, exercise, and sleep in my daily life.
Today, I would like to ask for advice on Chinese herbal medicine.
We had wanted to avoid anything with licorice as much as possible, but my soon-to-be 17-year-old daughter's menstruation has been slow, so we went to see a gynecologist, who prescribed TSUMURA Unkeito (#106). She has always had an unstable menstrual cycle and had to go to the hospital when there was an interval of six months or more, but since she is young, I just kept an eye on her. Since she has not had a period since last July, a blood test revealed that her thyroid gland is fine and her LH level is a little lower than the standard level, which led to this prescription. This Chinese herb contains 2.0 g of licorice for a daily dose (3 packets). I am not sure if she should take the prescription for one month or find another way. I would appreciate any advice for us.
(S) Why don't you ask your dermatologist if there is anything else? Tell your dermatologist that licorice is not good for you and say no.
(Q) Thank you for the reply. I should have asked about other options. I will ask him! Thank you very much.
(S) 1. Is the daily amount of water (including in food) excessive?
2. moderate salt intake.
3. If the gauze is not sticking to the affected area, have you tried taping it?
4. Have you tried oral medications such as Kalonal for pain?
5. Sleep with your upper body tilted up from the waist, with your head about 10 cm above the floor. Keep the pillow low.
6. Take antihistamines.
Mar. 2024
(Q) About Pruritus
It has been 10 months since I started TSW and NMT. Although my skin is still dry overall, the itching has subsided and it has become more comfortable, but I am still getting itchy rashes here and there, mainly in the areas where the itching was strong. The affected areas are my shoulders, the inside of my elbows, the bottom of my feet, and about 3 or 4 other places, but suddenly I have about 15 eczema on my buttocks and many more on my scalp. They are very itchy, and I have been bothered by the eczema that rises up, so I repeatedly scratch and scab over them. I have never known it to be prurigo, but I have had one or two spots on various parts of my body. It seems to have somehow healed while scratching. But this is the first time that I have had so many itchy rashes.
What I would like to ask you is whether the itchiness will continue to get better even if it is repeatedly scratched and scabbed over, and what is the cause of the sudden appearance of so many itches in places where there were none before.
Also, I am careful about the amount of water and exercise, but is there anything else I can do?
Feb. 2024
(Q) Cracked, Rough fingertips
Dr. Sato, I'd like you ask again. My fingertips are rough and sometimes cracked, and rubbing or scratching my face with those fingers sometimes results in scars. In Numajiri's book, it is stated that only the fingertips can be applied, but is it safe to apply zinc ointment only to the fingertips?
(S) It's ok for fingertips. Vaseline would be easier to use.
Jan. 2024
(Q) Trouble with my face skin.
I have now been TSW for 3 months. The exudate from my face has been still coming out. There are many cracks oozing on my face. My whole body is settled but only my face is not showing any progress, which makes me worried.
I would appreciate any advice you can give me.
(S) 1. Are you doing NMT at the same time?
2. Aren't you taking in excessive amounts of water?
3. Haven't you been taking water from after dinner to the next morning?
4. Do you sleep with your head elevated 10 cm from the waist, which doesn't mean using a high pillow.
5. Haven't you removed the exudate from your face? Aren't you peeling off the crusts on your face?
(Q) Thank you for your reply. I will keep trying again based on your advice.
By the way, the area where the exudate hardens into a pressure sore itches and I scratch it, and then the exudate comes out again, and so on and so forth.
Is it inevitable that I can't help scratching it?
(S) The wound will get better little by little as you repeat the process. Keep it up.
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(Q) desquamation and redness on face
I saw you at Hannan Chuo Hospital last year. It has now been 3 months since I have been TSW and NMT. As a result of following your advice I received at the consultation and changing my lifestyle, my symptoms on my face, neck, and back are gradually recovering.
However, the redness and desquamation on my face (eyelids and forehead) have not changed at all. I have had very little itching since last month.
Is the face the hardest part to heal?
I mentioned that I don't itch, but technically every few days I suddenly get a huge itch that doesn't help even if I take anti-itch medication. Is this a common part of the healing process? Although I scratch it, it hardly scratches.
(S) I think it is getting much better. The itching will get stronger before the scab is about to fall off. I think it will continue to heal slowly, so just do what you should do and wait. In the meantime, the itching will occur with some periodicity.