Dec. 2020
(Q) I understand that the Hannan-style TSW and NMT do not cure atopy but cures dermatitis due to the side effects of steroids. Is this correct?
(S) You're right. But I think it is also effective for atopy.
(Q) Thank you for your reply, Mr. Sato.
I've been doing TSW and NMT for 6 years now, but my neck and back of my elbows are getting worse. Should it be considered as an inflammation of plain atopy rather than an inflammation of steroid dermatitis?
Also, does the use of inhaled steroids for asthma cause steroid dermatitis?
Please answer these two questions for me.
(S) It is suspected that the original atopy has deteriorated.
Even inhaled steroids for asthma may improve the rash when used, and may worsen the rash when discontinued.
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(Q) Let me talk about my 2-year-old daughter.
Eczema began to appear on her face around 10 days after birth, and it worsened, and I started using steroids prescribed by pediatrics from one and a half months after birth.
Since her skin condition was bad, I conducted a blood test at the pediatrics department when she was 5 months old and found that she had many food allergies. She now has received treatments for atopy and food allergies.
For atopy treatment, normal to strong-level of steroids (such as Kindabate) and Protopic are applied, Propet is applied as a moisturizer, and Allegra and Chinese herbs are prescribed as oral medicines.
For the treatment of food allergies, she avoid the foods with high values in the blood test (eggs, milk, wheat, soybeans, which are level 6 each) and started the oral stress test from 10 months after birth, but in all foods she got eczema on the face and vomiting when she took a small amount of food and the skin condition does not improve, all foods have been completely removed from one year and 2 months old. (In addition, peanuts and crustaceans are not eaten because her allergy level is high for these foods.)
I was skeptical about steroid treatment and elimination diet, so we went to a local pediatric department that does not use steroids and taught that she should gradually reduce the use of steroids for atopy and continue to eat even a small amount of food with allergic reaction. (The doctor taught me carefully referring to Dr. Sato's "Atopy treatment for babies and children"), but it is the opposite of the treatment policy of the doctor in the general hospital. If anaphylaxis occurs it will be handled at this general hospital, so it is very difficult to decide how to treat it. Therefore, I first consulted with Dr. Sato and would like to hear your opinion.
Normally, I would like to have a medical examination, but considering that it is far away and the current situation of COVID-19, I first ask a question here.
If necessary, we are considering consultation, hospitalization, etc.
I would appreciate it if you could tell me.
(S) Mr. KAZU, I read your comments and wonder how to deal with it.
Even if I say that now it can’t be helped, but I wonder if the rash from the 10th day after birth was really atopy. Newborn acne is the overwhelming majority of facial rashes seen on babies around one month old. Of course this does not work with steroids. However, it may be atopy after that, though.
As for steroids and Protopics, I think it's best to reduce them slowly and slowly without suddenly stopping. At the Department of Dermatology, Hannan Chuo Hospital, it is said that an ointment with a ratio of Locoid 1: Vaseline 4 is applied on the red rash at first. When it’s better, you’ll apply less. After that, you apply once every two days for about two weeks. Next is once every three days.
Regarding food allergies, if it doesn't improve even if you apply it to her skin, can you ask the hospital to take care of her, insisting that she'll be in trouble in the future without saying about decreasing the use of steroids?
At Hannan Chuo Hospital, there is a part-time teacher who is in charge of food allergies, but since he hasn't been there for a long time, I think he probably can't take care of her during being hospitalized.
First of all, I think it is important to clearly recognize the symptoms of food allergies. Eczema is unrelated to allergic symptoms. If you have frequent vomiting immediately after eating vomiting, you may have allergies, but if you vomit once, it may be different. I can't say for sure because the details are unknown. The allergic symptom that appears on the skin is "urticaria". Moreover, it appears on the whole body.
In my clinic, there are quite a few children who can start with a very small amount of allergic food (in the case of urticaria) and gradually increase it, and in about half a year they can eat mayonnaise for eggs and wheat normally. However, when it comes to laryngeal edema or anaphylaxis, we cannot handle it because there is no hospitalization facility here. I'm asking the hospital now.
If she tries to eat allergic food at home and gets a heavy reaction, you have to go to the general hospital. The hospital takes the responsibility for removing allergic food completely.
Is there anything you are eating right now?
If you do not mind, please email me.
horiage123.satou.p.c@polka.ocn.ne.jp (Address of Sato Pediatrics)
Please attach what are the test results, a list of what she are eating now, what did she eat and what symptoms did she get?
Sato Pediatrics Mitsuko Sato
(Q) Thank you for your reply immediately, Dr. Sato. I have read the contents carefully and understand it in my own way.
We went to pediatrics and dermatologists because her eczema got worse soon after she was born. Every doctors prescribed steroids and moisturizing cream, and I didn’t think there was other choices. I was reluctant to apply steroids, so I applied a small amount of it to her, but I didn't realize that the medicine was working and getting worse.
Regarding food allergies, she had a red rash only on her face (not on her body) within an hour after she ate a small amount of allergic foods in a stress test. She vomited only taking the ham (egg, milk) in the test.
Reading your comments and the book you wrote, I think that it was not the reaction caused by foods but it was caused by the adhesion of allergens to the rough skin.
I’m regretful and sad that I continued to apply the ointment that she didn't really need to apply and deprive her of the possibility of eating them, but I would like to do my best to move forward.
I would like to prepare for them and send you an email as soon as possible. Thank you for your reply.
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(Q) I have a question for you, Dr. Kenji Sato.
I haven't been able to go to Hannan Chuo Hospital since spring because of coronavirus, but I’d like to ask a question for you. I’ve been doing TSW for 2 years and 5 months, my body has improved. I don't have to take any anti-itch medicine. I feel better than before, but the forehead and around the eyes are dry and the itch doesn't go away. It's better not to wash my face. If I put even a little water on my face, it will become dry and tattered. But considering of the COVID-19 spreading, I wonder it's unsanitary not to wash your face, but are there any other good ways? Thank you.
(S)
1. Resumption of anti-itch medicine.
2. Raise from the waist to the head during sleep. Raise about 10 cm above the plane with your head. Don't raise the pillow.
3. If you feel itchy during the day, cool it down with an ice pack to control itching.
Isn't it unavoidable to wash your face at this time of year?
(Q) Thank you for your reply. I’ll do it in that way.. Anyway, my condition has improved dramatically since I started TSW and NMT. I don't believe in God but you are God for me (laughs).
Actually, it's more profitable to prescribe steroids (laughs).
I am grateful that you persevere to help us in the right way among enemies (anti-TSW and NMT people). There may be a possibility of what only one person says is correct even if hundreds or thousands of people in the world have objections. We have to make a clear decision by myself so that you won't influenced by others, have we?
We look forward to seeing with you in the future. Have a great year, Dr. Sato.
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(Q) I’m sorry to bother you.
Perhaps because of wearing a mask for a long time or a runny nose, I've been sick under my nose since around November. The yellow exudate is dry with being lightly hardened.
There is no sign of exudate coming out and it is solid.
I apply Vaseline and occasionally Gentamicin, but it doesn't heal.
Is it okay to leave it as it is without applying anything?
Thank you.
(S) Applying Vaseline or Gentamicin is not a good idea. Try not to wear a mask as much as possible.
(Q) Thank you for your prompt reply.
I will shorten the time to put on the mask and see how it would turn out..
Thank you very much
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(Q) It's the third year since I've been doing TSW. I have a question about the frequency of bathing, but now my skin is just dry and whitish. I like bathing and want to take a bath every day to be honest, but when I take a bath, it always feels drier than usual. How often and how long is good to take a bath in winter?
(S) In general, it is better to have less frequency and shorter time in winter, but there is no fixed frequency or time. The most important thing is that as much sebum as possible on the surface of the skin should not be removed. However, there are various points to be worried about depending on the people, such as the smell, the personality that prefers warmth, and the amount of dirt, so considering of these things it is necessary to try yourself and find the best bathing method that won't cause itching. Please consider it for yourself.
(Q) Thank you for your reply, Dr. Sato.
After all it is better to take a bath less frequently. I will try to find a suitable bathing method, thank you!
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(Q) I'm sorry if I couldn't post well and ended up with double posts.
Until around summer, we went to Hannan Chuo Hospital from Nagoya City and my eldest daughter, in the first year of junior high school student, was taken care of you. Since then as you said, she got better, and the eczema on her arms and thighs, which had been spreading, had disappeared before she knew it. Eczema no longer appears on the back of the knee. The exudate on the face has stopped coming out, and the skin color has become the same as before. Other than that, the dryness around her mouth only left, at the same time acne began to form on her cheeks, between my eyebrows, and around my temples.
She used to just shower her face for a long time, but now she washes on where acne began to develop with soap only at night. Since she started using soap, the dryness around my mouth has not deteriorated, and it seems that the area of dryness is slowly decreasing. Should she stop using soap only on acne areas?
I am truly grateful to Dr. Mitsuko Sato and you for your kindness, both when my second daughter was doing TSW and when my eldest daughter got eczema. Thank you very much. My eldest daughter will write New Year's card for you.
Both my daughters and I are looking forward to seeing you.
Please love yourself, Dr. Sato.
(S) The onset of acne means that the skin's ability to make sebum is back. It is a sign of an improvement of the skin. If this treatment doesn't make other places worse, I think you should continue with caution.
(Q) I understand. I will continue carefully and moderately. Thank you very much. My eldest daughter said, "I’ve been itching and thinking about atopy, but before I knew it, I forgot about atopy. I'm glad!" But this year, she seems to be careful not to hit the cold wind too much.
The eczema on the chest has also disappeared. The neck was sometimes dry and no longer cut or exudate. After the coronavirus pandemic is over, we will meet up to “KiraKira-Boshi” to say hello. I'm really thankful to you.
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(Q) Good evening, as the title says, I'm looking for a doctor working on TSW in Kyushu. Compared to Osaka and Tokyo, there is almost no information and I don’t know what to do. I would like to go to see you, but now I can't do it because of the coronavirus spreading. If you know a doctor who has the same idea as Dr. Sato in Kyushu area, please let me know.
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(Q) Hello, Dr. Sato.
Since you told me “It’s just nothing” at the first visit you in October, I can't take a day off and can't go to see you because of my busy schedule.
But it's slightly though but I realize that my condition is recovering very quickly.
It's been a little over 3 months now since starting TSW and NMT.
I'm really glad I did my best (* ^^ *)
Since I started TSW I has become much stronger on mental side.
I will continue to do my best!
(S) Thank you. Please keep it up. I pray you don't get coronavirus.
(Q) Good morning.
Thank you for your reply. Don't let you get on coronavirus. I pray for you, too!
Some people may think a lot about TSW but I think that each patient should be convinced the way and choose the treatment they want to do. Regardless of the case of TSW, whether it doesn't suit the person or not, you can't tell until you try it.
I'm sure TSW is hard, but I feel much better mentally than the time I was using steroids with doubts. It was really hard at first, but ^^ lol
After the first month, I used to cry a lot.
I guess that many people who visit this BBS are also suffering
I hope they, including myself, will get better as soon as possible.
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(Q) I went to see you last week.
My condition was worse and I took two-week-off. After that I returned to work this week, but the severe pain every time I move has spread. Now that I am thinking of hospitalization where I can concentrate on treatment once.
Is it available to be hospitalized now?
Is it possible for MRSA carriers to be admitted to your hospital?
We look forward to your reply!!
(S) I’m sure you can be hospitalized. Please prepare for hospitalization and see me.
(Q) Thank you for your prompt reply! I'll prepare and see you on Tuesday. Thank you in advance.
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(Q) I’d like to comment as a person experienced TSW.
I was taken care of by Dr. Sato eight years ago, but now I'm feeling better than ever. I was worried about what would it be in the first three years, but looking back, I just couldn't trust the process of slow improvement. Currently, there is no problem with just applying Jojoba oil on my face after taking a bath and doing nothing else.
However, due to the scabs on the joints that were created during TSW, white marks remain on the affected area (like after an injury). As you can see in the book Dr. Sato wrote, I think it's tough to endure, but I don't recommend the act of taking the scab. I regret that it would have been better without it. However, I am really grateful that I was able to say goodbye to the steroids, Protopics, and Hirudoids that I had been using for 30 years, which is good both mentally and physically.
I think it depends on the person, but in my case it took at least three years before I could be in front of people.
In the second half, small acne-like rashes still come out occasionally, but I think they are in the final stages. It will be less and less.
In the sense of believing in the power coming from the inside of the body to recover from injuries, I understood the word "leave as it is without do anything" in the book is appropriate.
I think it's hard for everyone, but I don't think you'll regret trying as hard as you can.
(S) Thank for your comments.
(Q-1) Thank you for your very encouraging comments.
So it will be helpful.
I'm sure there are other people who are as encouraged as I am.
Thank you for your truly valuable experience!
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(Q) I think that TSW and NMT is a fairly rare treatment. What percentage of Japanese atopic patients do you think is doing TSW and NMT?
(S) If the Dermatological Association does not hide the effectiveness of TSW and NMT (we are writing a treatise but not allowing many people to consider it), the number of patients will continue to grow.
It will be much higher than the sum of outpatients and inpatients because some people read books and do it themselves. Additionally, it's spreading all over the world. The article was published in the British Daily mail, which states that it is my opinion.
Check it out with “NMT (No Moisturizing Treatment)”.
Nov. 2020
(Q) Good evening. Please forgive my ignorance, when will the symptom of TSW start? I have been doing TSW for 2 weeks and NMT for about 4 days, but the dry and reddish areas of my skin have subsided to some extent. I don't know if this is TSW symptom, but I'm full of anxiety about when the severe symptoms will come. I'm sorry while you’re busy.
(S) The peak of TSW is one week later on average, but for some people it starts as early as about two days later, and for others it starts as late as about three weeks later. The peak of NMT is about 5 days on average.
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(Q) Dr. Sato
I have a question for you the first time. I always use it as reference.
My question is about the inheritance of atopy.
Will the effects of the susceptibility of genes on the male and female sides, such types of treatment history such as the history of steroid use and more recently Dupixent, to be passed on to future generations?
I looked back at the posts on the bulletin board, but there was nothing that seemed to be applicable, so I would like to hear your thoughts.
If you have trouble, articles written by you, pages with opinions, and references are also acceptable.
I hope you tell me.
(S) I don't think there is a gender difference in the onset of atopy.
I don't think there is any study on the transmission of treatment history to the next generation. I don't think it's a study I can do while I'm alive
Atopic dermatitis has a genetic probability of being passed on to the next generation.
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(Q) Nice to meet you. I'm in my late 30s and I'm doing TSW.
If possible, I would like to go to see you in Osaka for a medical examination, but I don't think I can go because of my work and the Coronavirus pandemic. I live in the western part of Shizuoka prefecture. Do you know a dermatologist who understands Dr. Sato's style TSW around here? Sorry for your inconvenience.
(S) Unfortunately, Doctors like you mentioned are not in the suburbs of Shizuoka. I’m sure that a doctor in Tokyo should be nearest.
(Q) Thank you for your reply, Dr. Sato.
I'm sorry I can’t ...
I will consult with my dermatologist for the time being.
Thank you very much.
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(Q) Dr. Sato.
I'm sorry again but let me ask you another question.
When I checked the dermatologists nearby, there was a dermatologist who treats without using steroids, so I am going to see there. (at Igarashi Dermatology)
The doctor seems to prescribe Chinese herbal medicine, but what do you think about Chinese herbal medicine in the treatment of TSW and atopy?
Sorry to bother you, but I would be grateful if you could give me your opinion.
(S) I don’t use Chinese herbal medicine for patients.
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(Q) The other day, you prescribed Sefcapene Pivoxil 100 mm and I took it for a week. After that, the symptoms did not change so much, and I took a skin examination nearby and diagnose Staphylococcus MRSA3 +.
I'm planning to take Unasin Tablets 375mm for a week from yesterday.
What do you think of this treatment?
Thank you m (_ _) m?
(S) You have no choice but to drink first. You'll need to culture the bacteria and find out about their susceptibility.
(Q) Thank you for your prompt reply, Dr. Sato!!
I was a little upset by the first time, lol.
As for a culture test, can I take it in Hannan Chuo Hospital??
(S) You can do it here in Hannan Chuo Hospital, but the result will take less than a week. In case of sending it to an inspection company, the period is the same.
(Q) All right. I'll go to see you soon. I’m feeling well so I'm starting a walk today.
Thank you for your reply while you are busy, Dr. Sato!!!
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(Q) I got a stye while doing TSW and NMT, and when I visited an ophthalmologist, I was prescribed steroid-containing Odomer eye drops, neomedrol eye ointment, and antibiotic Gachifuro eye drops. Is it okay to use such a medicine during TSW? For the time being, I am using the antibiotic Gatifloxacin eye drops.
(S) That's fine with the eye drop, but if you have stye on eyelids, you’ll need to take antibiotics for internal use.
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(Q) I'm a mother of a 6-year-old girl who has been TSW and NMT for less than 3 years.
Now her skin condition is relatively stable and keep good with just a little dry. What do you think about playing in the pool, Dr. Sato? My daughter wants to learn, but I wonder warm water in the winter and chlorine are not good for the skin, so I’m worried that her skin that managed to recover may get worse. Are there any children who are learning to swim while doing TSW?
(S) If she takes in the bathtub for a little longer and it doesn't get worse, why don't you try to swim for a long time little by little?
Some people have taken swimming as one of the exercises after recovering so good during doing TSW. Even children are.
(Q) Thank you so much for your prompt reply, Dr. Sato!
It was very helpful!!! She will try it in the bathtub.
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(Q) It's been 5 years since I started TSW and NMT, but after I started TSW, I started to get acne on my face, head, neck and body (mainly the upper body).
My non-steroidal dermatologist says that acne is a sign of getting better, but acne hasn't improved since coming out acne. Is this a part of the process of TSW treatment?
(S) Acne means that the sebaceous glands, which are one of the functions of the skin, have come to work. Acne can cause bacterial infections so if you get it you need to treat.
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(Q) I have a question for you, but I saw a person on Instagram who got through TSW with New Skin's lotion and got beautiful skin. Is New Skin's lotion effective in TSW? It feels like people, called "healers", are gathering members on Instagram. They contact on Line app and they cannot tell us the details such as product names etc. unless you pay a fairly large amount of money. I understand that any lotions can be moisturizing in TSW, but I wondered it would be effective when I saw the members become beautiful.
(S) I don't think it's good in principle. It's a little suspicious if they claim all New Skin's users get better during TSW treatment.
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(Q) The tip of the genital area was inflamed and rough, but he didn't do anything following the method of TSW. He didn't get any exudate, but he went to the urology department. Since the skin on the tip is hard, it was said that it is better to apply a weak-level of steroid to soften it, but this time I declined the steroid.
I'd like to hear your thoughts about it, I would appreciate it if you could answer. Thank you.
(S) I think he should apply Aznol ointment or Gentamicin ointment. If the inflammation has subsided, I think it will heal naturally without applying it.
(Q) I am glad that you responded promptly.
He was prescribed Gentamicin ointment this time, so we will try to see the progress so that it will heal naturally while applying Aznol ointment a little.
Thank you very much.
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(Q) What kind of effect does exercise have on TSW and NMT?
Which is more effective, aerobic exercise or anaerobic exercise?
Can it get worse if you skip exercise after the recovery?
I'm sorry I ask a lot. Thank you.
(S) If the heart and lungs are not strong, the skin will not be strong either. Exercising is necessary. Exercise also needs to be sustained, and it is said that it is good to continue exercising for about 30 minutes with a pulse rate of 120 beats per minute. If you can do this, it's a good idea to add anaerobic exercise (muscle training) to it. Regular exercise is good. I think this applies to everyone not just for people with atopy. Some people realize their condition is getting worse because they stop exercising.
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(Q) I know you're busy but let me ask you a question.
I am a mother of son who has been examined by you many times. His condition is really good now thanks to your TSW treatment. He has severe rhinitis, runny nose so he is wondering whether to take sublingual immunotherapy, which is a treatment that changes his constitution and take a radical cure, instead of a drug that suppresses symptoms like steroids and allergic drugs. There was also a document saying it might also be effective for atopy.
If you have any thoughts, I’d like to hear from you.
(S) It doesn't work for sure, but it seems to work for rhinitis. I think you can give it a try.
(Q) Thank you for your response while you are busy, Dr. Sato.
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(Q) I have a question for you. I got an epidemic ophthalmia.
I've been told to use eye drops containing steroids for treatment, but I'm afraid of returning of symptoms after TSW.
Is it safe to use this eye drop? The name of this is Betamethasone by the way.
(S) Betamethasone is a steroid. Isn't it just enough an eye drop containing antibiotics? Ask your ophthalmologist.
(Q) According to an ophthalmologist, the rate of steroids in eye drops is so little compared to ointments and oral medicines, and conjunctivitis must be cured with steroids. For now, I just got it and came back, but I'm afraid of return of symptoms after TSW because I supposed to use 5 times a day for almost a week.
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(Q) I have a question for you.
Would you give me your thoughts on strongly acid water? Is it effective during doing TSW?
(S) NMT is essential to overcome TSW. I don't think it's good to use acid water because it moisturizes.
(Q) Thank you for your reply, Dr. Sato. I am very grateful to be able to interact with you here. I won’t use acidic water, and I'm not going to use anything that can be moisturizing. Thank you.
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(Q) Do you think carbohydrate restricted is effective?
I was recommended to do that by a non-steroidal treatment dermatologist.
(S) I see the inpatients every day, and I don't have the sign that the rash worsened because they took sugar, or that it improved because they restricted it. It's not good to eat too much sweets and get overweight.
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(Q) Is Collectim ointment similar to Protopic?
Do you think there is a strong symptoms of withdrawal like topical Protopic withdrawal (TPW)?
(S) The way Collectim works is similar to Protopics. I don't know what will happen because I haven't seen many people applying Collectim. However, as it will be used externally, I think there is a possibility that the problem of moisturizing dependence will arise. It may be difficult to stop applying.
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(Q) Activities by Atopic group now have been stopped because of the Corona spreading, but are there any plans in the future?
A doctor who gives a speech in Atopic’s activity with you prescribes Dupixent and Collectim ointment. What do you think about it?
(S) We are just considering the form of activity under this pandemic. We'll keep on doing more..
> A doctor who gives a speech in Atopic’s activity with you prescribes Dupixent and Collectim ointment. What do you think about it?
(S) There should be various ways of thinking.
Just read my comment "Impressions about new immunosuppressants" on 9/16 on this site. FYI
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(Q) I have a question for you.
You say that water restriction is important, but how many milliliters can I drink a day?
In addition, it is said that you should not drink water at night, but from what time is it specifically?
Is it better for people with atopy not to drink too much water even after their symptoms have improved?
(S) Here is one example for an adult of normal weight.
The total amount of water in food and drinking water such as tea is 2000-2500ml per day. If you take 1500 ml with a meal, the rest will be about 1000 ml. However, there will be a difference of about 1000 ml between the time of sweating and the winter when you do not sweat. Also, if you exercise and sweat, you need to replenish it. You need to consider these. The food should be less seasoned and the moderate amount of salt is better.
It is safer not to drink water from 3-4 hours before going to bed until the next morning.
It is safer to keep the water restriction for the rest of your life. Once you get used to reducing water, it will be less tough.
Please try your best.
Oct. 2020
(Q) Hi, Dr. Sato. I would like to ask you something. Would you give me your thoughts on the "genetically modified" of Dupixent (biologics)?
Dupixent is now a new drug, and above all, it is said that it is genetically modified and it is unknown what will happen in the future in 5 years, 10 years.
(S) Since the proteins that come out of genetically modified cells are used, I think that the most problematic thing would be allergic reactions to them. As DNA is not directly inserted into human cells…. Of course, there are already various side effects.
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(Q) It's been 5 years since I've been doing TSW, NMT and TPW (Topical Protopic Withdrawal).
I still feel itchy tends to cut along the wrinkles on the neck.
Is it a common symptom to cut along the wrinkles on the neck?
Will my skin become stronger and get less splits if I continue to TSW, NMT and TPW (Topical Protopic Withdrawal)?
(S) Are you exercising, are you limiting amount of water, especially at night, and aren’t you rubbing hard when taking a bath (even in the shower)?
Do you sleep with your head raised a little at night? Aren’t you also wearing a bandage or a scarf around your neck?
There are various reasons why it doesn't improve, and isn't there anything wrong with what you just meant well? I think it is necessary to consider a lot.
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(Q) My 4-year-old daughter has eczema.
She has never applied steroids ever, but would it be okay for her to apply a moisturizer such as Vaseline only during the dry season in winter?
Also, if she doesn't use steroids, will it be completely cured as she grows up?
(S) If her itching would stop by moisturizing, use it for a short period of time.
> Also, if she doesn't use steroids, will it be completely cured as she grows up?
I think most people will get better. In order to do that, parents will need to study a lot, too.
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(Q) What do you think about Collectim Ointment? Is it okay to use it during doing TSW?
(S) Just read my comment "Impressions about new immunosuppressants" on 9/16 on this website.
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(Q) I attended lectures by you several times.
As I repeatedly read the books written by Dr. and Mrs. Sato and the blogs of dermatologists who recommend steroid-free treatment, the skin has the ability to produce steroids, so keep applying the ointment prevents it and dry skin increases steroid production. This is my understanding.
I would like you to introduce the reference that scientifically proved it.
I myself have a medical job and had been applying moisturizer every time I wash my hands for 30 years. I had to apply Besoften, which was told me to use twice a day, I can’t stop using it all year long, and I had to go to the hospital repeatedly to get prescriptions for many bottles a month. I stopped using moisturizers from the day I attended your lecture last July. At the beginning when I stopped it, it was difficult to suppress the feeling of wanting to apply it and not to worry about the dryness of my hands. My skin cut and healed repeatedly, but now I feel natural moisture even without applying it and I'm living with comfort every day. I realize "I can stop the moisturizer I've been applying for years" "I'm glad I could stop it."
I'm truly grateful for your lecture.
(S) The basis is from two treatises at the bottom, but the latter one is not yet.
It has been proven that "the skin has the ability to produce steroids". The rest part is inferred from the biochemical feedback mechanism of hormone production in the adrenal glands.
This is an article I wrote on my blog in November 2017. Please read.
In humans, all enzymes of the hypothalamic-pituitary adrenal system are known to be present in epidermal cells. In psoriasis vulgaris, this function slightly weakens, which is considered to be one of the causes of the development of rash. This can explain topical steroids are effective for psoriasis vulgaris.
Removing the adrenal glands of mice that have crushed (knocked out) the glucocorticoid receptor gene in the epidermis and setting up skin inflammation. When only the skin was taken out and the production of corticosterone (say "cortisol" in the case of humans) was examined, it was found that it was produced in large quantities.
It shows that when the skin becomes inflamed, the skin itself can produce anti-inflammatory steroids. This suggests that in humans, when the skin becomes inflamed, the skin itself can produce cortisol.
In humans, if this skin-only enzyme system of the hypothalamic-pituitary adrenal system is suppressed by topical steroids, skin-only "adrenal insufficiency" can occur.
Topical steroids for a long period of time do not cause systemic suppression of the hypothalamic-pituitary adrenal system, but severe inflammation occurs on the externally applied area. According to the guidelines of the Japanese Dermatological Assoc, this phenomenon is considered to be exacerbation of atopic dermatitis when atopic dermatitis patients with topical steroids for a long time stop topical steroid treatment.
However, one of the common complaints of long-term steroid patients is that the effects of steroids begin to disappear gradually so doctors tell them to use strong steroids. The other is that when topical steroids are stopped, severe symptoms appear and cannot be stopped.
It is very convincing that the content of this complaint assumes a symptomatology results from "adrenal insufficiency" on the skin alone.
As Cortisol production is also reduced in the skin of patients with atopic dermatitis, topical steroids are used in the basis. I would like you to consider the usefulness of topical steroids after examining how the actual long-term topical steroids affect the function of the enzyme system of the hypothalamic-pituitary adrenal system on the skin.
(references)
＊Hannan R et al. Dysfunctional skin-derived glucocorticoid synthesis is a pathogenic mechanism of psoriasis, J Invest Dermatol 2017; 137: 1630-37.
＊Slominski AT at al. Cutaneous glucocorticoidogenesis and cortisol signaling are defective in psoriasis, J Invest Dermatol 2017; 137: 1609-11
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(Q) Thank you for the medical examination the other day!
I'm still doing TSW. Almost all over-the-counter eye drops contain "glycyrrhizic acid"
I've heard "Glycyrrhizin" works the same as steroids.
The ingredient is Dipotassium Glycyrrhizinate 0.25%.
If I get a stye during TSW, should I avoid using this as well?
Do I have no choice but to request eye drops do not contain glycyrrhizic acid at an eye clinic?
I checked it myself, but I couldn't understand it. I’d like ask for you.
(S) I don't think there will be much effect if it is a small amount.
(Q) Thank you for your reply.
I was relieved to hear that. I’ll avoid as much as I can. But if unavoidable, I’ll use it as little as possible.
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(Q) I had a medical examination by you in late May last year, and after your lecture in Asahikawa in November last year, I talked with you a little. Thank you at that time.
I just wanted to have my skin examined again this year, but I think it will be difficult for me due to this Corona pandemic.
A doctor used steroids inhalation (nebulizer) to me without any explanation although I asked not to use steroids, and my condition became the same as before starting TSW and then I visited you 8 months after inhalation.
Two years have passed since doing an inhalation, and the scratches and desquamation have finally healed. Now itching and deep wrinkles remain.
The doctor doesn’t admit any causal relationship between skin condition and inhaled steroids, based on the general theory that steroids are broken down by the body and excreted from the body in 2 to 3 days. The doctor does not agree even if I propose to accompany you and listen to the explanation directly from the doctor the next time I visit the clinic. Even if I ask the doctor to read a book about TSW, the doctor doesn’t want to read it.
How can people understand that steroids cannot be used for people with TSW?
I hope this kind of thing should not happen again, and I don't want other people to have such a painful feeling. This is an episode 25 years after I stopped using steroids.
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(Q) Are there any patients who are denied hospitalization?
I am using inhaled steroids for asthma (I am not using other steroids. Now I am doing TSW) Am I available for hospitalization?
I’ve conducted many times that patients go through TSW and NMT during hospitalization while continuing to inhale steroids for asthma. So, again, people also who are using inhaled steroid for asthma will be supposed to do TSW and NMT in the hospital. Our policy is that patients reduce steroids for asthma after the skin condition improves during being hospitalized or after leaving the hospital, and if possible, take them to discontinuation.
(S) What you have to do is to practice the important points of TSW and NMT, say, water restriction, exercise, and regular life. What you shouldn't do is to drink water at night, don't get up properly in the morning, and take a long shower. It means that if you can't keep these, it doesn't make sense to be hospitalized.
We will not refuse to hospitalization due to using inhalation of steroids for asthma. If you are inhaling steroids, you may reduce or discontinue steroid inhalation after the rash has improved. In that case, asthma drugs other than steroids may be used.
(Q) Thank you for your explanation in details.
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(Q) When my son took a test for allergies while doing TSW, he was positive for many items. Rice, meat, soybeans, eggs, milk, wheat, (ranks 2-4)
He had clearly an allergic reaction to eggs but he had no reaction such as red and swollen urticaria to rice, meat and soybeans. I'm not sure which items he is reacting to because none of them seems to be immediate type allergy and he always has itching and red spots.
Will his skin improve if he removes all these foods? I was told that he didn't have enough protein, but I'm worried that vegetables will be enough to make up for it. What should I do?
(S) It's okay unless he had gotten urticaria after eating.
Only vegetables aren’t enough to intake the required amount and quality of protein. He needs to eat meat and fish.
If he removes these, his skin will get worse.
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(Q) I’ll ask you here for the first time.
My second daughter had been hospitalized eight years ago, and my third daughter was also taken care of on June 30th this year (* ^-^ *)
At that time, she got an anti-itch medicine, and became better in no time, and in a month she no longer need the medicine (* ^ ▽ ^ *)
After that, she had no problem for a while, but from nearly two weeks ago, ring-shaped scabs appeared and increase gradually, not rapidly. I don’t worry about it too much, but they are slowly increasing.
I have attached a photo to the URL below, so please refer to it and give me advice on how to deal with it.
I apologize for the inconvenience and thank you for your cooperation.
https://dotup.org/uploda/dotup.org2276225.jpg
(S) It’s possibly ringworm infection (the same mold as athlete's foot), contagious impetigo, ring-shaped eczema, etc., but it is difficult to judge without actually seeing it.
(Q) Dr. Sato
Thank you for your reply while you are busy (* ^^ *)
There are various kinds of ring-shaped eczema like this, aren’t there..
I'd like to see you again soon.
Thank you (* ^^ *)
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(S) Those who wish to be hospitalized for TSW and NMT of atopic dermatitis can now be hospitalized with almost no waiting.
The way of hospitalization is
1. See a nearby doctor, get a letter of introduction stating that you need to be hospitalized, and fax it to the Medical Cooperation Division of Hannan Chuo Hospital, or have it sent by a nearby doctor. A person in charge will call you to decide the date of hospitalization.
2. Take a medical examination in the Hannan Chuo Hospital directly and tell us your preferred date for hospitalization. You can be hospitalized soon if the bed is vacant. In this case, I may not recommend hospitalization by judging your condition.
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(Q) I am a mother of a child who has seen you for an examination several times.
Previously, we went to see you because he had scabs on his neck and leg joints, his symptoms were prolonged, and I was too anxious.
At the last moment, you said, "Ma'am, don't worry, he's getting better."
More than two months have passed since then, he is scratching here and there but as you said, his skin has become smooth.
I posted this episode to express our gratitude.
I think you are busy, but please take good care of yourself.
(S) That's great news! Thank you for letting me know. Please share your story with others.
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(Q) There are cases that Dupixent have made it unnecessary to use steroids, but is it possible to overcome the side effects of steroids and moisturizing dependence by Dupixent during TSW and NMT?
Please tell me your thoughts Dr. Sato.
(S) In principle, it would be possible, but I’m not sure how it would be without experience.
Sep. 2020
(Q) Recently, the difference in temperature between daytime and nighttime has a drastic change and my eczema has worsened. I keep limiting the amount of water and exercise about 3 times a week (about 5 km of jogging), but suddenly I had severe itching and scratched.
I’m not sure how to deal with this from this time forward. Please tell me.
(S) When it gets cold, the amount of sweating decreases. If the amount of drinking water is the same as drinking in summer, it will be excessive. If it gets cold, you may want to take a bath longer. Doing this will remove the oil from your skin and make you itchy. In addition, please study and think about what you should do in TSW and NMT treatment again reading various materials. There is no way to answer because the factors of deterioration have not been examined in the above contents. If you don't know how to consider it, you may need to see a doctor and listen to it.
(Q) Thank you for your reply, Dr. Sato. Anyway, I would like to see you.
“Bring the history of your eczema on a form for the first visit.” you said on the website, so I will try to summarize it in my own way. Thank you for the details.
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(Q) I'm thinking of going to see you in October
I’ve been doing TSW and NMT for about one month.
Encouraging me with reading the book by you at home and at work and I've managed to keep going.
This might be the same as a question from other questioner…
After considering the number of people waiting for hospitalization and in case that I am judged by you to need to be hospitalized in the hospital, would it be possible to be hospitalized? It is difficult for my family to understand how to TSW treatment, which is in trouble….
Sorry to bother you but it would be grateful if you could answer.
(S) Currently, both men and women are available for hospitalization, and some will be discharged at the end of the month, so if it is determined that you need to be hospitalized on the day of your visit, you will be able to be hospitalized on that day. Please see us on Monday, Tuesday and Thursday.
Another way is to receive a referral letter from a nearby doctor and you contact the medical cooperation section of this hospital, to receive a referral letter requiring hospitalization, and or send a referral letter directly from the nearby doctor to the medical cooperation section. It is up to you to decide the scheduled date of hospitalization.
Please be informed that if I write a message like this, many people may come and see me it in haste.
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(Q) I was hospitalized in Hannan just before last spring. Thank you very much for your kindness during hospitalization. After I was discharged from the hospital, I was able to spend my days smoothly, but my scalp has gotten worse for the first time and the exudate is oozing out (an area roughly the size of 500 yen coins), and It can't stop. I'm currently being treated by a local doctor with non-steroid treatment, and I've been using antibiotics for about a week, but the oozing doesn't stop, so I was prescribed Rinderon lotion. The doctor said that you should use it for only a few days until the exudate stops, but would it be safe to use it? ..
I don't want to get worse in other parts by using this lotion.
Also, regarding the bath, is it okay to wash the scalp with rash if it is only hot water without any soap and shampoo?
I don't know what to do because it's the first time for oozing from my scalp.
If you have any advice, Could you let me know your opinion. Thank you.
(S) Do not remove exudate during the shower.
Water restriction for drink.
No fluid intake, especially at night
Raise your head.
If possible, you should shorten my hair.
Gauze protection and so on.
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(Q) I have a question for you. I think that the atopy will remain after I went through TSW in early age but does this atopy heal as I grow up? I think that most of the atopy itself should heal spontaneously at the age of two or three, but if you still have steroid addiction, it seems that it will not recover even though it has been many years since you got over TSW. Is this common?
(S) I’m sorry to hear that you can’t get better.
Some people have a rash in infancy, have no symptoms for a while, and then relapse into it in adolescence.
Getting better, you need to do something necessary in TSW. Are you doing in a right way?
If you don't know what to do, please borrow from the library and read it. If you have read Chapter 1 many times and do not understand, please read the related items written after that.
Adult-type atopic treatment learned from patients: TSW / NMT for intractable atopic dermatitis, Tsuge Shobo Shinsha, 2015, by Kenji Sato
(Q) I will reread book by you once again. Thank you for your reply
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(Q) It’s been about 2 months since starting TSW. Can I ask you something?
About from a few weeks ago, I often get unusually hot, lazy while walking and barely able to walk. This usually happens on the way home in the evening.
Is this also considered as TSW symptoms?
There may be steroid withdrawal symptoms, but there are many other things to consider. This is true of heat stroke, and dehydration due to excessive water restriction should be considered. What if you could be screened once?
It usually happens on the way home in the evening.
Is this also considered as TSW symptoms?
(S) That may be a kind of steroid withdrawal symptoms, but there are many other things to consider. This is true of heat stroke, and dehydration due to excessive water restriction should be considered. Why don't you take a screening test once?
(Q) Thank you for your response.
Certainly, I sometimes realized that it might be a heat stroke. I would like to take a rest consciously. If that doesn't help, I'll see a doctor again.
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(S) < My view about the new immunosuppressant. >
As a treatment for atopic dermatitis, Dupixent for injection and Collectim ointment for have come out. It is expected that many similar medicines will come out in the future. For these drugs to be truly effective, they would have the same results as Protopic Ointment unless the withdrawal of steroids and the withdrawal of moisturizers at the same time as the use of these drugs. In my opinion, the use of immunosuppressants without TSW and NMT will have its limits. Physicians who develop and promote the use of immunosuppressants will have to reassess the use of Protopic.
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(Q) I had done TSW under Dr. Sato four years ago.
My condition suddenly deteriorated two months ago. I wanted to know the cause, so I checked it in a book by you, but I couldn’t find it. It's difficult to go to Osaka because I live in Hokkaido. If you know about any doctors with non-steroids treatment in Hokkaido, could you please let me know? I would like to see the doctor directly.
Dr. Kinko Sasaki, Inoke Dermatology Department, 6-chome, Minami 9-jo Nishi, Chuo-ku, Sapporo-shi, Hokkaido 011-511-5003
Dr. Chieko, Nishio Nishio Dermatology Clinic, Shiroishi Medical 3F 011-865-0671, 1-1 Kita, Nango-dori, Shiroishi-ku, Sapporo, Hokkaido
Dr. Michio Matsuda Fumizono Matsuda Dermatology Department, 4-2-10 Fumizono, Kushiro-shi, Hokkaido 0154-38-5160
Dr. Hitoshi Miyazawa, Nishisapporo Dermatology / Allergy Department 7-2-11 Nishimachikita, Nishi-ku, Sapporo-shi, Hokkaido 011-667-1199
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(S) I would appreciate it if you could compare the Dupixent data with our data. The Japanese Dermatological Association is trying to hide our data so that it is not known to general doctors and patients, so I’ll show you representative treatises here. If you have time, get it and read it.
*Hironori Minami and others
Topical steroid withdrawal in patients with severe adult atopic dermatitis
Skin 1996; 38: 440-447
*Fukaya et al
A prospective study of atopic dermatitis managed without topical corticosteroids for a 6 month period
Clinical, Cosmetic and Investigational Dermatology 2016; 9: 151-158
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(Q) May I ask a few questions?
Since last January, my child has taken anti-itch medicines (Zaditen and Atarax) alternately.
A few days ago, when he stopped taking the medicine, he had a runny nose.
Originally he had rhinitis and had a runny nose, but for the past few months he haven't had a runny nose, probably because he was taking medicine such as Zaditen.
Does this mean it was effective for rhinitis?
I used to take it every day to prevent itching caused by TSW, but is it okay to take it for a long time or more without quitting?
Best regards,
(S) Zaditen and Atarax work well for people with rhinitis rather than itching. Just look into about long-term side effects yourself.
(Q) Thank you for your reply out of your busy schedule.
I will see how it goes for a while.
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(Q) I’ve been doing TSW for 6 years and probably have adrenal insufficiency. I'm thinking of seeing Dr. Sato for the first time, but since I'm living in Akita, it's difficult to visit many times, and I hope I can finish the examination in this one time as much as possible. For that reason, are there any tests that should be done at a hospital in Akita Prefecture or data that should be obtained in advance?
(S) If you are worried about adrenal insufficiency
You should check data of ACTH and cortisol. If you are worried about food allergies, the RAST test for worried foods is needed. If you're worried about your general condition, it would be better to just a little more detailed test than screening test at your health check. The data of total protein and albumin in the blood are necessary. You should also have a urine test.
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(Q) Hi. Recently, therapeutic drugs other than steroids have appeared. What do you think about Dupixent?
Is Dupixent effective with TSW and NMT?
(S) I will share the contents of the meeting (called Tomarigi) held on June 15, 2018.
<Comment from Dr. Sato>
・ About the new atopic dermatitis drug "Dupixent" published in the morning edition of the Mainichi Shimbun 6/10/2018
This new drug, which is marketed by Sanofi, a major French pharmaceutical company, blocks the transmission of information from skin cells.
For those who do not respond to the standard treatment of topical steroids, protopic ointment, cyclosporine, etc., it is administered by subcutaneous injection once every two weeks in combination with ointments.
The problem is high drug prices.
The inject price is about 80,000 yen for one dose. Approximately 24,000 yen for a person who bears 30% of the cost due to the application of public medical insurance.
It costs about 600,000 yen if administration is continued once every two weeks for one year.
In addition, those who are covered by health insurance need the following treatment.
① People who did not respond to steroids and protopics
② Treatment with steroids or anti-inflammatory agents in combination
③ Treatment with moisturizer
Comments from Dr. Sato
We should think more about why steroids and Protopics have stopped working.
TSW and TPW, and NMT should be done before this treatment.
It seems to have an anti-inflammatory effect. The clinical trials are conducted except for critically ill patients so the effect should be evaluated calculating this.
It is a treatment that can only be done with steroids and Protopics, and does not combine with TSW treatment.
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(Q) I'm Shinobu Tanaka, who had a medical examination by you. After that, I took a day off from work as a nursery teacher, and although I didn't touch the water as much as possible, the swelling and inflammation can’t heal easily. Also, the front neck, face and ears where maybe I got a sunburn during Obon season in August became red and swollen and they are very itchy.
The atopy itself of the inner elbow and back neck is swollen red and exudate comes out without doing anything, and my body is irresistible and itchy. I have a dry rash on my legs, arms, etc. that looks like a coin, and it itches, so I don't know what it is.
I went to see two dermatologists nearby. I was diagnosed with deterioration of atopy symptom caused by sun allergies, only anti-allergic agents and steroids are prescribed.
In the acute case, can’t it heal without taking or applying steroids?
It's getting worse and worse, and I feel so pressured because I want to get back to work sooner. Is it because the rough hands are swollen and the bacteria have entered? Or is it caused by sunlight? It has never been so bad. I haven’t used steroids for a long time. It's not a kind of TSW symptoms again, right?
(S) Mr./Ms. Tanaka, I'm afraid, but I can't tell without seeing you directly.
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(Q) It's been almost 2 years since I started TSW and NMT at Tarao Dermatology Department in Gifu. Currently, the back of the elbow, the back of the knee, the shoulder, and the waist are only dry, not oozing any more.
I took a shower most of the time and didn't take a bath soaking in the bathtub while I was doing TSW and NMT. Last August, I started bathing and washing my body with soap about 2 ~ 3 times a week, and now I have many pimples on my face, neck, and shoulder blades.
I just used sunscreen and something like that only once this year, but would it be usual that the change like clogging of pores happen suddenly by taking baths more often? Or, I would like to know if the stress under the coronavirus spreading or wearing a mask has little effect with the process of TSW or not. I would like to take a bath in the future, so please tell me.
(S) If the skin function improves, pimples are likely to appear. The rash called “fukidemono” seems to be pimples considering from its area.
There is a possibility that you wash the rash too much when you take a bath. I can’t say more than that.
Applying sunscreen even once can make it worse.
There are many people who get dermatitis by moisturizing or rubbing with a mask.
I can't make a further discretion.
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(Q) Excuse me for asking questions.
When I go to bed at night, my back touches the futon and I rub it on my back, which easily causes exudate and blood to come out, which makes me uncomfortable, and I can't sleep for a long time.
For ease the pain, I tried applying gauze to my back, but I have stopped it now because it may come off when I turn over or the gauze itself may be tingle for me.
I would like to know if there is better way to deal with it.
(S) It can't be avoided in the early stages of TSW and NMT. That might be a possibility of excess water-intake, if it's been a while since you started TSW and NMT.
(Q) Thank you for your reply.
It's still been about two months since doing TSW and NMT, so I'll keep on doing.
Aug. 2020
coming soon..
