(Q) Hi again, Dr. Sato. I would like to ask for your advice.

Since I consulted with you two months ago, my daughter's symptoms have been worseing. Itching wakes her up many times. so she is still having trouble sleeping. She is able to go to school, but has temporarily stopped getting her bike to school because she doesn't want the pain of the wind blowing on her. Her eczema is all over her body, but the exudation from her neck is so bad (about the size of a palm) that she says it smells bad, so she took a shower to wash it off.
We were determined and prepared to go in Osaka this evening to visit you as an outpatient tomorrow, but I have a fever as my escort and I am unable to go, so I am so frustrated.

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(1) I heard that if there is a smell, you need to take an antibiotic, but would it be okay to use the Kefral that she already has?
If so, when should I stop taking it? When the exudate stops? When the odor has stopped?

(2) Also, she usually showers once a week, but should she increase the frequency? Normally she does not want to go in the shower much due to itching and pain.

Thank you in advance.

(S) Smelling itself is not evidence of an infection. If there is an infection, Kefral would be a good idea, but I doubt the dose is sufficient. It is hard to tell here if it is infected or not without actually seeing it. It is also difficult to see when to stop. I can't explain it in simple terms. Showering to remove the odor is probably not a good idea. Showering once every 2-3 days would be fine as long as there is no pain and exudate.

(Q) Thank you for your reply, Dr. Sato.

The exudate is ao much when I wake up in the morning, but is mostly dry by the time I go to bed at night. Some of it has not stopped or has come out again. She will keep the showers to once a week as usual.

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(Q-1) I know the pain when the erosive surface is exposed to wind or water is painful. When my child's eczema gets worse and she is in the same situation as your daughter, I try to increase her protein more than usual. I feel that this helps the wound to dry faster and the pressure sores to form more quickly. I hope that your daughter's situation is as mild as possible.

(Q) Thanks for your advice about protein.
I try to be conscious of high protein for her, but there are days when I'm a bit lazy, I am also aware of how difficult it is to make a menu every day. My daughter is doing her best, so I will do my best too. Thank you very much for your kindness.

We visited Dr. Sato today. He told us that there is no infection now and that my daughter is on the way to being cured properly, and advised her not to try to push herself to go to bed early, but to read her study books that she is not interested in, as she will fall asleep, After leaving the consultation room, she was in tears with happiness. We both cheered up and will do our best again from tomorrow. Thank you very much

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(Q) Crack on Fingertip 
Hi, I jointed your lecture yesterday on Zoom. I would like to ask about the cracks on my fingertips that were mentioned in the Q&A session. Now, my finger has a crack in some places and exudate is coming out from it. I have some Dolmicine cream on hand and have just recently started applying it, but would it be better to dry them without applying anything or to apply a small amount of Vaseline as mentioned in the lecture?

I always have learned from Dr. Sato's book, this site, and past posts on mixi.

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(S) In my book I mention that it would be okay to moisturize the fingers, but I don't recommend it. I think it is safe to just apply Vaseline to the cracks. It would be safe to just apply Vaseline to the cracks. I bet you don't wash your hands a lot. I assume you don't use alcohol disinfection to prevent coronavirus.

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(Q) Thank you for your reply, Dr. Sato.

I applied Dolmicine because coming out the "yellow liquid", but I should not apply anything, right?

Is the yellow liquid not a bacterial infection?

There is no hospital that understands TSW here, I am groping in the dark.

(S) If it's a finger, dolomycin can be applied.The expression "yellow liquid" is used for both exudate and pus. The latter is cloudy.

(Q) > The latter is cloudy. That is very clear. Thank you for your repeated replies. I will continue to make it my goal to be able to spend time without applying anything.

 

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(Q) TSW and NMT for 8 months.

 I have read your book. I'm on the fence about whether to be admitted to the hospital because it is so far away. I've been TSW and NMT for 8 months. It is getting better at a very slow pace (no more exudate), but I still have scaling and redness all over my body, and I have been itching every night for the past 6 months or more and can't sleep!
Even though my stomach and back are smooth, they itch and scratch and go right back to being scratchy again. Is there anything I can do to control this itching?
Anti-itch meds are almost ineffective and I can't sleep without sleeping pills. My face is still a little red and dry, but one day I would like to apply lotion and enjoy skin care like I used to. My skin used to be soft and chewy, but now it is dry and wrinkled and I feel like a different person. Will I be able to use moisturizer for a long time?
I recently stopped menstruating. I am hoping to get pregnant again someday in the future. Should I wait for TSW's over and my menstrual cycle to return to normal?
A lot of powdery scabs are all over the floor, I can't face people, and I am sick of my looking like a different person. I am a woman in her 30s and have been on steroids and protopic for about 3 years after childbirth. I had mild eczema as a child.

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(S) 1. When patients are hospitalized, they usually can sleep at night within a month or so. In your case, there must be some reason why it doesn't get better.
2. Basically, moisturizing is not good. So makeup is not good either. Some people try it and it doesn't get worse, though
3. Possibly crusty and wrinkled skin can be considered to be on the way to getting better.
4. Menstruation may stop during TSW. If a patient has not had a period for three consecutive cycles, I recommend a gynecological examination. 
5. It seems that patients who use Protopic are a little less likely to get well than those who do not use it.
6. Please read my book more carefully about what you want to know.

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(Q) Maou-tou Extract (麻黄湯)

 I was infected with COVID-19 and was prescribed Maou-tou extract and Calonal.
Is it okay to take Maou-tou extract?

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(S) If possible, avoid it because it contains glycyrrhizin acid.

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(Q) Thank you.

 

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(Q) Aggravation after childbirth

 Hi. I would like to ask you about skin rash worsening after childbirth. I apologize for not being able to get to the point, but I would appreciate it if you could answer. 

First of all, I will briefly describe my TSW history.

Around the spring of 2022 (age 33) - I started TSW and NMT with Dr. Sato's books.
(I developed severe atopic dermatitis when I was in the third grade of junior high school, spent about three years without steroids thanks to spa therapy, and started using steroids when I entered university. Since then, I used steroids and protopic for about 15 years).
Despite withdrawal symptoms, I became pregnant in the fall of 2022 and managed to get over it while working and recovered enough to lead a daily life by the time of delivery.
The symptoms were severe on the inside of both elbows, neck, décolleté, and scalp. The scalp was especially bad, and the exudate was coming out constantly.
I had a baby in May this year and for a while there was no change of symptoms, but suddenly around the end of June a skin rash started appearing on my breast, neck and elbows, and over time it spread to my face line, décolleté, underarms, face and scalp.

So far only part of my scalp and décolleté have exudates, the rest is rough, reddish-black skin and scratching with bleeding. Sometimes erosions occur. Itching and pain are intense.
Contrary to my expectation that withdrawal symptoms would worsen and heal all at once, I feel that this worsening is gradually going against the healing route, and I am wondering if I can continue to live the way I am now.

I am taking no ointments or moisturizers, bathing only in the shower for a few minutes, controlling the air conditioning, limiting my water intake (since I am breastfeeding, it is difficult to measure, so I do it by feeling), and trying to keep a balanced diet as much as possible.
The challenges for me are as follows
1.Raising three children, including an infant
2.Lack of exercise
3.Feeling depressed easily (scratching myself to look good, not wanting to see anyone)
4.Guilt of having to burden the family with housework and childcare due to physical inactivity.
I feel that it may be withdrawal symptoms and worsening of my original atopic dermatitis, but I cannot be sure. Is it possible that the healing process is delayed due to postpartum hormone imbalance and breastfeeding? By switching from breast milk to formula, will my recovery be quicker?
Although I think that time is the only medicine, I cannot find any of recovering, and I feel depressed and anxious so I posted it here.

I would be very grateful if you could give me some tips on how to heal.
Thank you very much in advance.

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(S) Some people get worse after childbirth. The cause of aggravation seems to be overhydration. You may need to change breast milk to formula and adjust fluid intake.

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(Q) Thank you very much for your reply!

I had thought that I might not be getting enough water based on the color of her urine, but I wasn't sure at all because I wasn't able to measure it accurately. I will retry the fluid restriction by switching to formula.

I don't know how much worse it can get, so the only thing I can do is just endure. I wonder how everyone is overcoming mentally....
By the way, the other day I went to a dermatologist for my child and asked about treatment without steroids. Then maybe I didn't communicate well enough but he didn't accept it at all and asked me "Which hospital is it doing such TSW?" I told him that I didn't need it, but he forcibly prescribed me steroids. I was disappointed that he couldn't even accept our opinion. It was an event that made me think that even if it was not atopic dermatitis, I would be too reluctant to go to see a doctor....

I am very grateful that I am able to connect with Dr. Sato like this, even if it is such a long way away.

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