Dec. 2022
(Q) About swimming and chlorine
Could you tell me about swimming and chlorine. This is about an elementary school boy. He started NMT since last summer. This summer, the second summer after NMT, it got worse and has remained rough all fall and winter. The backs of his elbows and knees are especially bad. (scratching and scraping). Is it possible that the chlorine in the pool is irritating to NMT skin? I suggested to him to stop swimming, which he has been doing for 5-6 years, but he cried a lot because he loves swimming. He is careful about the rhythm of my life, the amount of water, exercise, bathing restrictions, and nutritional balance, and he always read your book, so I can't think of any other factors that could be aggravating his condition at the moment. How about a measure to apply Vaseline to the backs of his elbows and knees only on the days he goes to the pool (once a week) to protect them, and let him go swimming? Would this delay the improvement? Would it be better to stop him for a while?
(S) Not many patients have gotten worse from chlorine in the pool. If he wants to swim, why not let him? If he gets worse, he will think about it at that point. It is necessary to wash them properly with tap water after swimming in the pool, though. Vaseline is not recommended. Please respect his wishes.
(Q) Thank you. I was worried that I would have to stop the swimming lessons at school in the future, but as long as he continues to want to do it, I will respect his wishes. I don't think he is taking good care of himself after swimming among other students, so we will take measures such as rinsing him off again at home.
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(Q) Could you tell me about this ointment : Molzerto(difamilast)phosphodiesterase IV inhibitor that became available in June 2022.
I was prescribed it today by my nearest dermatologist, is it safe?
(S) Item Information : Familast inhibits the activity of phosphodiesterase (PDE) 4, which is present in many immune cells and specifically degrades cAMP. Based on this mechanism of action, this compound suppresses skin inflammation by increasing the intracellular cAMP concentration in inflammatory cells and regulating the production of various cytokines and chemokine.
(Kenji Sato) The cautionary note that concerns me is pregnancy-related.
Women of childbearing potential should be instructed to use appropriate contraception during administration of the drug and for a certain period of time after termination of administration.
(Kenji Sato) There do not seem to be any serious side effects. Since it is a topical application, the dependence on moisturizer is a problem.
(Kenji Sato) It is not a drug that seems to be very effective.
(Q) I understood. I appreciate your reply.
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(Q) Skin irritation in newborns
We used to see you when my older child was TSW and NMT and you took care of us. I gave birth to my second child in August and it's been 3 months. The part of his neck where the skin wrinkles has become red and exudate. When I carry him, I make his neck stretched out, and if I let his neck dry for a while, the redness and rash goes away, but when the skin overlaps again, the exudate is coming out there. After a long time, such as when waking up, there may also be something white accumulated. In such cases, is it OK to leave the juice as it is without wiping it off? Is it better to cover it with gauze even for the newborn? I am afraid that the gauze will peel off and get into his mouth. Also, how should I bathe the baby?
I am still giving him a bath and using only hot water, no soap. I am not using soap and hot water on the reddish and exudate area to wash off. I try to shower quickly and stroke it gently with gauze to remove away the white stuff, but is that enough?
Is it better not to wash off the exudate? I am raising my baby on a mixture of baby formula and breast milk. He drinks 120 to 160 ml of milk three to four times a day. I read in Dr. Sato's book that there is a way to reduce the amount of water used to dissolve the milk, but is this necessary? Would it be better to increase the amount of milk? He currently weighs about 5.2 kg. Sorry for asking so many questions. Thank you in advance for your cooperation.
(S) The symptoms on the neck are known as intertrigo. This is a skin rash caused by rubbing. Azunol ointment works well for this and should be applied 1-2 times a day. Gauze may not be necessary.
The white crust that forms in the wrinkles is a mixture of plaque and exudate. If it accumulates, take a shower once a day for 1-2 seconds. Do not scrub. Soak in the bathtub for no more than 30 seconds. No soap is used.
Allow one more milk to be given. Stop breastfeeding at an early age and start all formula and weaning from 4 months of age. The standard formula concentration is fine, although a 10% increase is also acceptable. Since the skin rash area is small, it is not serious, so there is no need to be too concerned about the concentration of the milk.
(Q) Dr. Sato, thank you very much for your detailed information.
With my older son, he was only breastfed and weaned a little late, and his skin became rough from around 5 months of age, and I had to keep using steroids and moisturizers. Based on your advice, I will first ask for a prescription for Azunol ointment and will be careful about showering, milk, weaning, etc.
My older son started TSW and NMT and saw you at age 5 and is now 9 years old. He sometimes scratches and cracks the back of his knees, the backs of his hands, and the fingers of his hands due to dryness, but he is able to live without steroids or moisturizers. Thank you very much. I look forward to working with you again in the future.
(Q) Dr. Sato. After that, we went to a nearby dermatologist, who prescribed Azunol ointment, but also prescribed zinc oxide ointment, and told us to apply zinc oxide ointment to the areas that are the exudate-area and apply Azunol ointment to the areas that aren't coming out exudate. What is your opinion about zinc ointment?
Also, the area around his anus is also red and a little bumpy, so which should I apply to that area for himl? Sorry for asking again.
(S) I think Zinc oxide ointment is hard to apply for that area. Azunol is fine for the buttocks as well.
(Q) Dr. Sato, thank you very much for your reply. I will see how it goes with Azunol ointment.
Nov. 2022
Oct. 2022
(Q) Lichenification? About rough and itchy feet
Hi, Dr. Sato. I have read your book and it has been 2 months since I started TSW & NMT by myself.
I would like to ask a question here because there is no hospital nearby that specializes in TSW that I can consult. Almost all areas on both legs are covered with stiff, hard skin that looks like lichenification from the early rebound phase. Am I correct in assuming that this is a rebound symptom on its way toward healing? It did not itch at first, but recently it has been itching intensely. The skin looks reddish and white powder is clinging to it. When I scratch it, it doesn't make a big scratch, but when I scratch it a little harder, it breaks off and a little exudates out. When scratched, a large amount of white powder falls out instead of scabs. Is this itchiness caused by dryness, which can be seen during the healing process? Other parts of my body are still itchy and large scabs keep forming and peeling off, but the situation is changing day by day, so I feel that it is making progress. Only my feet have been in the situation I mentioned since the beginning, and I am worried that my crusty skin will really heal...
(S) "Almost all areas on both legs are covered with stiff, hard skin that looks like lichenification from the early rebound phase."→ It is difficult to say that your condition is improving.
"When scratched, a large amount of white powder falls out instead of scabs."→It is likely that the condition is improving.
"It did not itch at first, but recently it has been itching intensely."→This condition may indicate a possibility of improvement.
"Other parts of my body are still itchy and large scabs keep forming and peeling off." →This is not improving and seems stagnant.
I think you need to think a little more in general and do something to improve.
(Q) Thank you for your reply. Lack of exercise and drinking more water on a daily basis may be resulting to the stagnation. (I am currently breastfeeding, so I do not use my own judgment in restricting my water intake.)
Should I also consider my bathing method? I now wash my head with hot water, my face with lukewarm water, and my body only in areas that get dirty easily. When I showered my body, it felt very tight and I was not feeling well, so since then I have been trying to avoid getting my body wet as much as possible.
Could this be having the opposite effect? Should I shower and rinse the whole body off a little more?
I visited a local dermatologist the other day and was told that there seems to be no bacterial infection at present, but the exudate has not hardened on my armpits and groin area, and they feel sticky rather than oozy.
(S) I think the bathing method is fine as it is now, but it is important not to scrub the skin when "washing". In some cases, protection with gauze could be effective for the armpits and groin area.
(Q) I would like to follow up with gauze protection. Many thanks.
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(Q) NMT for 14 year old
Dear Dr. Sato, My 14 year old child has been going through TSW since June. Would you recommend No Moisture Treatment for her? Can we do it at home or check in at your clinic? We live in the US and looking to get my daughter treated for TSW. She is already missing school this full year.
Regards,
Sara
(S) Yes, I would recommend NMT for her. We treat fourteen years old child as an adult. We are very sorry that our hospital is not ready for hospitalization of non-Japanese speaking patients.
Please look at the following URL.
How to get over Topical Steroid Withdrawal asap!
(Q) Thank you! We will follow the instructions from the link. My friend lived in Tokyo and fluent in Japanese. Can she stay with my daughter during the treatment to translate?
(S) We are sorry that your friend is not allowed to stay with your daughter.
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(Q) Hospitals where you can get TSW treatment in Okayama
Hi, Dr Sato. Around May this year, I was told by my dermatologist to apply RINDERON-VG mixed with Zinc oxide ointment and Hirudoid cream all over my body due to severe inflammation all over my body caused by allergies. I continued to apply them to my face and other parts of my body for about 5 months until October. Even though I told the doctor that I was afraid to keep applying them, he lightly reprimanded me every time saying, "If you don't apply them, you won't get better! I was shocked and honestly complied with the doctor's advice. After doing some research on my own, I learned about Dr. Sato, and in October I stopped going to the clinic I had been going to and stopped applying steroids and moisturizers. I would like to go to Hannan Chuo Hospital to see you, but I live in Okayama and it is very difficult due to work and other reasons. Are there any dermatologists in Okayama Prefecture that can provide TSW treatment? I would like to know if you know of one.
(S) Unfortunately, I don't know of any hospitals in Okayama Prefecture that offer TSW treatment. You said the skin rash is still there only on your face. Since the face is where you can see it, you will want to remove it when you see white fine scabs, etc. If I do this, the same thing will repeat itself no matter how long it takes. Other things you should do are to not take in water from after dinner until the next morning, and what you should do is to elevate your upper body from the waist when you sleep so that more of the water from the face is transferred from the waist down. I wish you had a bed that would recline, like a bed in hospital.
(Q) Dr. Sato, thank you for answering my question. I did look into but couldn't find it, so it is not available in Okayama Prefecture, actually. I will try what you have taught me as much as possible! I have severe desquamation on my face, especially in the areas where I shave. Sorry again.
(S) Shaving is not good even with the normal method of electric razors. If it has razor to trim, it can be shortened so much without damaging the skin like clippers.
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(Q) One year after TSW. How long does the rebound or worsening last?
My 16 year old daughter was hospitalized last summer. She started TSW at 10 years old and had a hard time going to school all year long and had decided to NMT and underwent treatment at hospital. She sometimes enjoys her school life, but last fall/winter for a month, in the spring for 2 months, and again this fall/winter, it worsened and she has not been able to attend school for 2.5 months now. Since she was hospitalized last year and was held back, if she continues to miss classes this year, she will not be able to repeat a year again and will be dropped out of school, so she feels quite stress. She loves his friends and school life and wants to return as soon as possible, but even after 2 months, she is still suffering from the deterioration. She says that she applied a little sunscreen cream when she was in good shape, but I wonder if that will have such an affect on her.
◯Does it get worse as she gets to adulthood, or does it take longer to recover?
◯How many more times should she keep in mind the possibility of this kind of deterioration?
She is following the below.
Do not use shampoo soap and take a short shower, every 1-2 weeks, lukewarm water.
Restriction of water-intake.
She has no energy when her skin is rough and is frustrated with herself because she understands the need for exercise but is unable to carry it out. Her father has told her to give up TSW in order to graduate from high school, and both she and I are in a difficult situation physically and mentally. I would appreciate any advice you can give us. Sunscreen cream is a strong moisturizer and has a strong effect on the skin.
(S) Adolescence can worsen skin rashes. If you do not do what you should not do and do what you should do properly, it will not get worse too much. I hope you read my book carefully. If that is difficult, please visit me once.
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(Q) Effects of alcohol disinfection?
I know someone asked the same question on a previous forum. Corona pandemic started and forced me to use alcohol everywhere, my fingers and wrists have become rough and eczema has developed. I have been doing TSW and NMT for many years, but only my hands were so rough that I could not work, so I saw a local dermatologist 6 months ago. As a matter of course, I was given steroids and moisturizer. I was told to moisturize adequately, but I do not use moisturizer and only apply a little steroid to the wound. I would like to quit steroids eventually because I had improved with TSW and NMT following your methods, but I still wonder if I shouldn't have applied steroids. I am still worried and depressed every day wondering if I should have kept only moisturizer instead of steroids.
(S) You need to make sure your hands are ready to work because if you can't work, there is nothing you can do. Moisturizers may help to some extent, but there will be limits. I suppose that using steroids may not be an option in some cases. If possible, using topical application intermittently is preferable, not daily applying.
It would be better you could talk to your boss at work and not disinfect with alcohol, but only wash my fingertips with tap water.
(Q) Thank you for your reply, Dr. Sato.
I can't continue TSW and NMT, and I'm too worried to moisturize, so I'm making my own decisions, I was applying steroids with a sense of guilt, and it was getting hard on my heart. Now that I have no choice, I will try to reduce topical application intermittently and alcohol use.
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(Q) About taking shower
Regarding showers, you advised me to take a shower once every two days during my hospitalization in summer, but since I don't sweat much in the fall and winter, would it be okay to take a shower once a week? Also, should I wipe my armpits and buttocks every day? If it doesn't bother me, can I just shower once a week?
Now I have inflammation and scratches on my collarbone and elbows.
(S) Once a week is fine in the dry fall/winter season, but is there a problem with smell at work? I don't see a problem with wiping the armpits and privates every day, as long as there are no wounds in those areas. You should take a very short shower (1 second or so) for the collarbone and elbow wounds, especially if there is exudate.
(Q) Thank you for your reply.
My family has never complained about the smell, but I will be careful. My skin has been very dry lately, so I avoid taking a shower as much as possible because it is very drying afterwards. Is it ok to shower once a week to prevent infection?
(S) It would be fine as long as there are no exudative wounds.
(Q) About new drugs other than steroids
I know there have been new non-steroidal medications in the last few years, but what is your opinion on the use of those and others? I know that Corectim ointment and Moizerto ointment are not for people who are during TSW and NMT, but are they ok to use for people who have never used steroids before? I would also like to know Dr. Sato's opinion on Dupixent. Thank you.
(S) 1. Corectim and Moizerto are supposed to use in cases that do not improve with existing treatment.
2. Dupixent may be effective for short-term use if it is effective for intense itching in the early stages of TSW and NMT. Current guidelines says its use while using topical steroids and moisturizers.
(Q) Thanks for the reply.
1. By "existing treatment" do you mean treatment with steroids?
If the existing treatment does not help, does it mean that it is more effective than steroids or does it mean that it works differently from steroids?
2. "Short-term use" means you think that long-term use is not a good idea.
I would also like to know the side effects of Corectim, Moizerto, Dupixent, etc.
Sorry for repeating many times.
(S) 1. Steroids, Protopic, Moisturizers, etc. They work in different places.
2. Short term use of any medicine is better.
You can check about the side effects on the Internet.
(Q) Are oral immunosuppressants (Cyclosporine, RIVNOQ) ok during steroid withdrawal?
(S) No. Immunosuppressant withdrawal occurs.
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(Q) How to wash a wounded part
I have been hospitalized at Hannan Chuo Hospital. This is the second aggravation since May-June this year, and there are erosions on the back of my head, front of my neck, palms of my hands, and upper chest area, and I have not taken a bath for about a week and have stuck gauze on them. However, I would like to wash only those parts once, because I began to smell (it seems to be close to the smell of rotten cabbage) from the hardened hair on the back of the head and the chest area. For example, should I not use a towel soaked in warm water and wipe them with a light patting motion? The back of the head and chest are generally dry during the day, and more exudate is coming out during sleep at night. I feel that it is still too early to wet with lukewarm water. Thank you in advance for your help.
(S) I suspect a bacterial infection where the smell is coming from. It sounds like you need to take antibiotics internally.
I think a weak shower for 2-3 seconds is better than patting it with a wet towel. Use a dry towel to absorb the water.
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(Q) Aggravated by a long flight after corona infection?
I asked about my scalp a few days ago. I have a question about another symptom I have. I have been doing NMT for about 2 years and this summer I finally realized I was cured. However, I had a fever with COVID-19, which caused my neck to be rough and peel large crusts, and my face skin turned to red. The skin healed quickly, but I continued to feel tired and lose my appetite. And two weeks after the corona infection, I was just about cured. I came to Europe on a long flight, which was 20 days ago. Now I have large white patches of skin all over my face, thick yellow skin around my eyes, and I can't open my eyes properly and have trouble with tearing. My whole face may be a little swollen. At night in bed, my face feels like it is throbbing. My neck skin is rough as a tree trunk, and when I sleep, the exudate comes out along the wrinkles. It looks like a snake woman. Exudate comes from everywhere while sleeping and hardens in the morning (except the scalp). There is no pus. Not much redness. My scalp started producing a lot of exudate the morning after I washed it, and the juice is now extensively on my pillow. Is this inevitable because my head is pressed against the pillow?
I have had a lot of crusty skin for over a year after I started NMT, but this time I suspect it may be something a bit different in nature again, as I have been infected COVID-19. First of all, my scalp has not been this rough and exudate
Also, a mild inflammation with small irritation gathered to it has spread to my stomach and back, where it does not usually appear. What does it mean that the symptoms spread throughout the body in this way?
If the symptoms are of a different nature, I am worried that I may have to do something different in addition to the usual fluid restriction, regular lifestyle, etc. to get better, alone in a foreign country. I am sorry for writing at length. Thank you.
(S) 1. The rash may worsen when you move from place to place.
2. It may worsen by other diseases.
3. It may get worse when you feel anxious.
4. Considering of your symptoms, it might be excessive fluid intake. Be careful not only drinking water but also water in food. In addition, high salt content can cause water to accumulate in the body.
5. you will probably need to eat more protein if you have a lot of exudate.
I can't give you more advice about this.
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(Q) TSW & NMT for about 12 years.
Over 10 years ago, I was admitted to Hannan Central Hospital for TSW and NMT.
I have continued this treatment believing that one day my skin will naturally produce sebum, but my dry skin has not improved yet, and with aging, it has become even more dry. My skin is dry and itchy all year round, and it has become dark and sallow due to constant scratching.
Should I continue to NMT, even though normal people dry out and moisturize as they age?
My skin has always been dry from the beginning and does not exudate much. Is it necessary to continue NMT even for me?
If I were younger, I might be able to produce sebum, but as I get older, I am beginning to think that it might be difficult and that I should moisturize. I also exercise and shower (for short periods of time).
(S) I am glad to hear that you are exercising and taking shorter showers. Thank you very much. Do you use soap or body soap? If so, please refrain from using them. Do you sweat during exercise? If so, do not rinse it off clean, but leave it lightly rinsed off.
Many people who become dependent on steroids also become dependent on moisturizers. This dependence is hard to get rid of. Short-term topical use does not cause relapse, but long-term (which varies from person to person), the skin often recalls and becomes red. We do not know under what conditions the skin would not remember its dependence on moisturizer. If you have any ideas, I would be grateful to hear them.
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(Q) TSW & NMT, for 14 years.
I was admitted to Hannan Central Hospital in 2009. I have been doing TSW and NMT for 14 years, but the atopic dermatitis on my face has not healed at all. I have gotten over the condition of exudate just after steroid withdrawal, but my skin is still dry, bumpy, itchy, red, and has desquamate. I have not moisturized for 14 years and am wondering if I should resume moisturizing again. Isn't NMT to speed up the healing process right after TSW and not to continue it for 10 years or more? Fourteen years is a long time and I am exhausted.
(S) The most common reasons why facial erythema does not heal are followed.
1. ingestion of water at night after dinner.
2. rubbing off the white powder to make the skin smooth.
3. Use a high pillow and apply pressure to the anterior neck.
4. Rash caused by hats or helmets.
See a doctor if possible.
(Q) Thank you for your reply, Dr. Sato.
There is no problem with #3 and #4.
Regarding #1, am I correct in thinking that if I don't peel off the scabs and scales, the skin barrier will be formed and the atopy will heal, and the redness on my face will go away?
I can't help scratching my face because it itches so much.
(S) If you don't peel off the scabs and scales, there is a possibility that it will get better. Are you doing anything else to make it better? It may be surprising to find that what you do for the best of your intentions may actually have a negative effect on your skin, so you may need to recheck.
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(Q) How often to wash scalp with exudate
I would like to ask about symptoms on my scalp. I have exudate coming out from some places, but when I press the areas where the exudate has hardened and the pressure sores are thickened with my fingernail when they are itchy, some areas are sticky and some areas have silky liquid coming out.
How often should I wash my hair (with hot water for about 2 minutes) when the exudate is coming out. Usually when I have no symptoms? I wash my hair once a week or once every 10 days when it gets itchy,
Should I wash more frequently to prevent infection in this condition?
Do I need the differnt way in washing or care because the scalp is moisturized by hair all the time?
(I sometimes don't wash other parts for about a month) Thank you in advance.
(S) You should not press on the scab. If the skin under the scab is dry, you can take the scab off. If there is purulent exudate, you need to take antibiotics. Washing hair with hot water should be done once every 2-3 days for about 10 seconds at a time. The skin should not be scrubbed during washing. Only the hair should be washed with a brush.
(Q) I should instead wash my hair more often when exudate on the scalp.
I haven't washed the hair for a week and my hair is damp with exudate and smells and feels uncomfortable, so I just shampooed my hair with hot water, but only by showering it off, and I feel refreshed.
Thank you very much!
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(Q) About Chinese Herbal Medicine
After a year and a half of starting TSW, my skin is much better and I am back to health. I took “Kakkonto” for 2 days for a cold. There is no particular change in my skin or physical condition. After taking it, I remembered that I had read that Chinese herbal medicines should be avoided for TSW. I thought I had read that Chinese herbal medicine should be avoided.
Should I also avoid “Kakkonto” ever after?
If I have cold symptoms, would I be better off with a general cold remedy?
(S) You should not take it so much because it contains licorice. In general, I don't think oral medication is necessary for colds, just rest. Licorice has mineralocorticoid behavior and also has a little glucocorticoid behavior. Please be careful.
Sep. 2022
(Q) Should I continue or try to stop steroids?
I live overseas. I have checked and it's unlikely to have a dermatologist in this country who would be able to support TSW, so I am writing to ask if I could consult with you here. Please accept my best regards.
About a year ago, I was diagnosed with contact dermatitis, which started with eczema on my eyelids, then spread to my face and swollen eyes. I have been using a strong class steroid cream called Elocon (mometasone furoate) on my face (mainly cheeks) and neck about once every 3 or 4 days. I did a patch testing (tested over 90 chemicals) and eliminated from my life all products containing chemicals that tested positive. I have not used any products containing cocamidopropyl betaine, linalool, fragrances, preservatives such as MCI, for over a year. I check the ingredients of all shampoos, hand soaps, cleaning detergents (bath, toilet, etc.), laundry detergents, anyway, before I buy them. I bring my own hand soap when I go out. I don't use rinse, and I don't wear makeup. I don't even keep flowers in my house because I am afraid of linalool, and I don't use herbs like basil or mint in my cooking. I have removed everything anyway, but I continue to have eczema, redness, and itching on my face; if I don't apply topical steroids for 4 days, the redness and itching appear, and by the 5th day, the redness on my face is more obvious and my eyes are swollen. The dermatologist says that applying steroids to the face twice a week is not a problem, even if it is for a long period of time. I have also been prescribed Elidel cream, a topical calcineurin inhibitor (TCI), which is weaker than protopic, and have been told that this is safe to use daily. I rarely use Elidel cream now because I don't feel it is very effective. I think it is a "proactive therapy" to gradually reduce the frequency of steroid use, but I am not sure when I can reduce the frequency since my eyes start to swell after extending the interval by just one day. I have been suffering from atopic dermatitis for about a year now, and I am very anxious about it, so I decided to consult with you. I have weak skin, but not so much as atopy, except when I was a child. I have had allergic reactions to insect bites twice in the past and have applied steroids. Both times I stopped after about a week. Is it possible that I am steroid dependent? Should I try to quit the steroids? Thank you in advance for your help.
(S) I think you have become steroid-dependent. I think it would be a good idea to stop slowly. The method of slow withdrawal is similar to "proactive therapy." The difference is that proactive therapy keeps the condition that the eczema from getting worse. In the slow-stopping method (gradual reduction method), after stopping the topical application, let the eczema get worse for a while, and then apply a little steroid. This is repeated and the interval between applications is gradually increased. For other things that need to be done, please read "<New Edition> Adult-onset atopic dermatitis treatment learned from patients: Steroid-Withdrawal and Non-moisturing therapy for refractory atopic dermatitis, Tsuge Shobo Shinsha, 2015, Kenji Sato.
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(Q) About leachate and erosions
Hi, I am 32 years old and have atopy and asthma since childhood. I have used Nerisona, Myser, and Locoid ointment for my face. I have been trying TSW and NMT while reading Dr. Sato's book after running out of medication during the Golden Week holidays.
(1) I have no leaching at all, but what is the difference between those who have leaching and those who do not?
(2) The redness has disappeared and the skin has become dry and desquamated, and there was not much scratching, but recently the itching has become even stronger and erosions that never happened before. Is this a kind of worsening?
Thnak you.
(S) (1) It is considered to be less dependent and to have a healing power.
(2) It seems to be a condition that is getting better.
Please check my book, Chapter 15, Progress of Skin Rash During Steroid and Moisturizer Withdrawal 3. "Poor Appearance" and "Poor Subjective Symptoms" (p. 136), which patients misunderstand.
(Q) Thank you for taking the time to reply.
My skin is scarred and my sleep is not enough again so I was getting worried but now I 'm sure that I am in the process of healing. I believe in my own healing power and will do my best. Thank you so much for your answer.
Aug. 2022
July. 2022
(Q) Hi, Dr. Sato. I would like to ask your opinion on the atopic symptoms of my 7-year-old girl.
She was hospitalized in emergency because of an asthma attack at the age of 1. Since then, she has visited the pediatrician once a month, and takes Pulmicort inhaler and Singulair every day at home.(She stopped Pulmicort inhaler at her age 6 and Singulair this August)
Eczema also began to appear at about 1.5 years old, so Locoid and Hirudoid were applied daily.
She started TSW last September (age 6). At the beginning, her wrists were only a little red, but from January this year, her arm joints, elbows, backs of knees, and neck became worse. The pediatrician said, "I wouldn't have kept said anything if the atopy were not so severe, but this child's atopy is in a very severe. TSW is not something she should do until she is in this condition. I think you are doing like abuse." I felt uneasy, so we went to a local dermatologist. , who prescribed a non-steroid medication and an anti-inflammatory, and continued TSW (he was not a TSW doctor, but when I told him that we don't want to use steroid, he agreed). I also informed the pediatrician that she was seeing a dermatologist and that she wanted to continue TSW.
Her blood tests for allergies are followed, 2016 (age 1) lgE 43, 2017 (age 2) lgE 55, 2018 (age 3) 610, 2019 (age 4) lgE 1400, 2020 (age 5) lgE 950,
2021 (age 6) lgE 1400, 2022 (age 7) lgE 9000. The doctor said, "I have never seen a number of 9000 in a child. It is probably due to the effects of TSW. Now, if an asthma attack occurs, it could be quite severe. At that time, she will be putting many times the amount of steroids into her body that you doesn't want her to apply. I think that would be the end of the world, so why don't you heal her eczema with steroids once?" I was told.
(1)Is it true what the pediatrician said?
(2) How can we find a pediatrician or dermatologist who recommends TSW?
(3) It has been almost one year since she stopped steroids, but we do not see any signs of improvement, and I am worried. How long will it take for my atopic symptoms to get better?
I apologize for the confusing comments. I would appreciate any advice you can give me. Thank you in advance.
(S) You have follwed what doctor's saying over five years like...try to apply steroids to calm eczema once, right? After once healing her skin with steroids, where is the guarantee that she will be able to live without steroids? She has been doing this for five years ever. How many more years will her pediatrician tell her to continue?
I have seen plenty of people with IgE of 20000-30000. Even so, they get better with TSW and NMT.
NMT is also necessary for successful steroid withdrawal.
If the "non-steroids protective medication" is an ointment, cream, or lotion, it will work as moisturizing. In this case, it most likely won't go healing.
It would be hard to get your child's eczema to get better as long as you are watching your child, worrying like when it will heal.
(Q) I have a question regarding the last phrase in your answer. Why is it that "It would be hard to get your child's eczema to get better as long as you are watching your child, worrying like when it will heal."
Why is that? I seem to recall that Dr. Mitsuko also talked about something like that. Does the mental stress received from their parents hinder the improvement of eczema?
(S) I think you are right. Even small children seem to intuitively understand how they are being treated by seeing the difference in their parents' facial expressions. Please be careful.
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(Q) How to deal with pain
I've started TSW since June 2017, and NMT since January 2018. Until about October 2021, my skin condition was not bad to some extent, but suddenly, around November 2022, it started to worsen, and now I am scarred all over and in a lot of pain, and I am taking Loxonin to get by. I manage to get some sleep by taking Silece. I believe that the reason it got worse was because I was sweating, had a terrible itch all over my body, and scratched myself.
Is there nothing I can do but take painkillers and wait for it to get better? Any other suggestions for dealing with the pain? I couldn't find any comments about the pain in past forums, so I jumped in with a comment. The skin condition is a large area of erosion. I sometimes have to live with bandages because of the pain.
(S) It is recommended that gauze be applied to the sore surface. The gauze used should not be used as it was purchased, but should be washed with tap water and hung to dry before use. The gauze stick to the skin should be left on for a week if possible, without removing it. After one week, however, remove only the gauze without removing the crust as much as possible; if the skin is dry after one hour, there is no need to apply the gauze after that. If the skin is moist, reapply the gauze. When showering, it is not necessary to remove the gauze. The wet gauze should be soaked up with a dry towel.
(Q) Thank you for your reply, Dr. Sato. As your book says, that's so-called "one piece of gauze method " One piece of gauze hurts~ lol Crying won't cure it, so I'll keep trying! Thank you.
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(Q) About NMT
Why is NMT effective? What is wrong with moisturizers? I'd like to know about it.
(S) When the skin is on steroids, the skin seems to adapt to a moist environment. In this state, inflammation will continue and the skin will not get better forever. It seems that in order to get better, the skin needs to be forced into a dehydrated environment and then remolded into skin adapted to a dry environment. Moisturizers keep the skin moist and keep it moist, which is why no moisturizers are good. This is an empirically acquired theory.
For people who have never used steroids, it is a good treatment to use moisturizers to control itching caused by dry skin. However, long-term use can cause problems.
(Q) What is the benefit of drying the skin?
(S) "Drying the skin" seems to trigger the normalization of the skin.
(Q) How does skin adapt to a dry environment?
(S) "How does skin adapt to a dry environment?" I’m not sure. The fetus in the belly is surrounded by water, but when it emerges from the womb, it is surrounded by air. I think the phenomenon of the skin turning over like molting in the first few days after birth is the skin adapting to the environment. I have not studied the literature in detail.
(Q) I have heard that dry skin tends to become alkaline, and that alkaline skin is more prone to bacteria and prone to infection.
what do you think about that?
(S) I think that as the skin improves, it will become more acidic, since it is NMT to dry it out and make it normal.
(Q) Is the reason why none of the moisturizers are good is because they are oils? Is it because the ingredients are bad?
(S) As I mentioned before, all moisturizers are bad because they moisten the skin.
(Q) Can't I use a moisturizer that puts liquid into the skin without moistening it?
(S) "Moisturizers that put liquid into the skin without moistening it" are also no good. The whole skin is the problem, not just the surface.
(Q) I often hear that petroleum-derived moisturizers are not good, but I would like to know your opinion.
(S) Petroleum-derived or not, anything that moisturizes is a no-no.
(Q) You say that NMT is an empirically acquired theory, but does that mean there is no medical evidence?
(S) I don't think that everything is bad because it is derived from petroleum. Vaseline, for example, is quite safe. This has nothing to do with NMT.
NMT is as hard a treatment as TSW, so once you start, you will need to endure and work very hard. It requires a strong determination and should not be done casually.
(Q) Is there any medical evidence or theses on NMT, the moisturing skin is not a good idea, and therefore moisturizers are not good, or that drying the skin triggers normalization of the skin?
(S) I do not know the mechanism by which "drying the skin triggers normalization of the skin." I don't see anyone doing research that disagrees with the policy of the academic society. The paper is "Hironori Minami et al, Withdrawal from topical steroids in patients with severe adult-onset atopic dermatitis, Skin 1996; 38: 440-447.
(Q) Is it still easy to get an infection until the skin becomes slightly acidic? What measures are taken at your hospital, and what do you do if infection occurs?
(S) It is easy to get infected. The most important thing is to exercise to build up physical strength and to reconsider the frequency of showering. I guess one of the things I do is to try to keep the hospital room and bed clean.
(Q) Vaseline is safe, but in terms of NMT, it can cause a dependency on moisturizers and keep moisturing on skin, so that is not good. Am I understanding correct?
(S) Yes, that is correct.
(Q) Does your hospital also hospitalize patients for NMT treatment? Will I have to stay longer in the hospital during that time?
(S) Of course, there is hospitalization for NMT. There are many patients who get worse when they stop moisturizing. Once admitted to the hospital, we ask patients to stop using topical steroids and moisturizers altogether. Some patients are admitted to the hospital only to stop steroids, some to stop steroids and moisturizer at the same time, some to stop moisturizer only, and in rare cases, some to stop Protopic. We do not have statistics for each of these groups, so we do not have data on the length of hospitalization. The term does not seem to be a significant difference. The average length of hospital stay is about 50 days.
If you have any other questions, please read <New Edition> Adult-onset atopic dermatitis treatment learned from patients: steroid withdrawal and non moisturizing therapy for refractory atopic dermatitis, Tsuge Shobo Shinsha, 2015, Kenji Sato.
(Q) Thank you!!!
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(Q) Do you take patients from overseas for NMT ?
Hello, I am Angela. I am a pharmacist from New Zealand, going through topical steroid withdrawal for 23 months now. Do you take patients from overseas? If so, what is the process and the cost involved? Thank you.
(S) Dear Angela:
We do not take foreign inpatients with TSW yet. We examine foreign outpatients with TSW. If you want to see Dr Sato, please contact personnel of Hannan Chuo Hospital at renkei@hannan-chuo-hsp.or.jp. However, it is hard for you to enter into Japan because of CORONA virus problem.
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(Q) Exudate from all over the body
Good evening, Dr. Sato. It has been raining all day today and my husband's face, back, buttocks... his whole body is covered with exudate and his sheet is soaking wet. He is not in a condition to exercise and he seems to be mentally distressed. He is eating three meals a day. During the daytime, he sleeps because it is hard for him to stay awake due to the uncomfortable exudate. I can't say anything, I just watch him. I wonder if there is any way to stop it other than exercising and reducing water intake. I feel that it is really a difficult disease because the condition changes from day to day....... Today he seems to be in a lot of discomfort. I wonder if it is related to the humidity outside? I want to do something to stop it for him.
(S) It could be related to low pressure. Other possible causes include bacterial or viral infections. Now you also need to consider COVID-19. It's hard to say without examining directly.
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(Q) Water restriction
Hello, I am a woman over 45 years old. I started water restriction and exercise a month and a half ago after watching Tokuko-san's YouTube channel and blog. I've been doing TSW and NMT for a long time, but my neck and inner elbows were having a hard time healing, so I started. At first, I used to take 1,000ml of water every day, but after a week, the eczema worsened and the leachate started to appear, so I started to reduce the amount of water and now use 850 to 900ml. The color of the urine is a dark yellow. Since I have been doing less water, the exudate has decreased and dry. However, my skin condition is terrible and I have eczema like never before, appearing behind my knees and on my face.
I am wondering if it is because I started exercising? I posted to ask if it is safe to continue with this amount of water.
(S) It seems that there are other factors that aggravate your skin rash. Please consider. It would be safer not to reduce fluids any more than you are doing now. Additional fluid intake is necessary during exercise and excessive sweating. Be careful.
(Q) Thank you for your reply. Understood. I will not reduce water intake any further.
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(Q) About Living Environment
I always check your book and blog. I'm going through TSW & NMT for 5 years. I have been struggling intense itching at the edge of my eyes (the mucous membrane area inside my eyelashes) for the past year, which has turned into peeling, wet erosion, and when I wake up, my eyelids stick together with scab, but the dampness does not go away during the day, making me uncomfortable. I have lived in a very humid environment (frequently over 90% and the last few days about 98%) for 3 years now, could this affect it?
(S) Eyelids should be moist by nature. I don't think humidity has anything to do with it. It is still probably an eyelid itch problem. I think you probably have allergic conjunctivitis, so I would suggest oral antihistamines and antihistamine eye drops.
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(Q) Swollen hands
Thank you Dr. Sato for all your help. I am glad you continue to answer on this new forum. I have been NMT for a year and a half now. I have one concern. About 30 minutes after eating dinner last night, my left hand suddenly became itchy and swollen. About an hour later, my left thigh, buttock, and inguinal area became bright red, hot, and itchy. I don't know why but it was only on the left side. I thought it was hives caused by the spices I had for dinner that had herbs and garlic in the seasoning (first time eating them), so I took the Epinastine that you had prescribed before.
During the night I had a fever and the swelling in my hands did not go down and my arms became tense. My right hand also seems to be a little swollen. I also had some antibiotics, which I started taking yesterday before bed. I don't think the eczema on my arm is too bad, but I keep scratching it during the night and can't sleep. Since yesterday morning, the lymph fluid from my right finger has not stopped and I thought it was strange. Probably it might be an infection if it is on the right side, but it is my left hand that is very swollen. I also thought about taking too much water. I sweat a lot at work so I might have taken a little too much. I thought it might be cellulitis, but that doesn't seem to be it. The swollen hand doesn't have particularly badly scarred. I took antibiotics at night and the fever seems to be going down. However, the swollen hand has not gone down at all. Is it still an infection? When I had my hand swollen before, I was told that it was due to excessive water content. Is that one of the causes?
(S) I would consider cellulitis most likely. I think you should see a dermatologist.
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(Q) TWS & NMT (5 year-old child)
Around the age of 1, he had been repeatedly applying LOCOID and moisturizer for about 4 years for infantile eczema around the mouth and mild atopic symptoms on his hands and feet.
In October 2021, he started TSW and went to moisturizer only, without significant rebound until March 2022.
In March 2022, the forehead and eye area suddenly started to get flaky and worse. It spread to his cheeks and neck and became so itchy that he could not sleep at night. After that, he had used Chi-no-Ike Ointment by Beppu Onsen containing pine tar and other cream.
July 2022: Started NMT
Inflammation around the eyes, neck, and cheeks is calming down. The inflammation on the forehead remains persistent, and the process of redness, scratching, juices, and skin peeling off is repeated forever. Also, the original atopy on his elbows and knees is not getting better.
Question 1) There was a 5 month period before the rebound symptoms of steroids began to appear, is this common and is there any reason for this? I was very upset now because he had no rebound symptoms for the first 5 months with no worries.
Question 2: Is the Chi-no-Ike ointment good or bad?
Question 3) Is there anything that he should be doing at the same time as he continue to TSW and NMT?
Sorry for the long post. Thank you in advance.
(S) How old is your child, 5-6?
Answer 1) It doesn't sound like a rebound.
The cause of the sudden deterioration in March 2022 is not clear, but it may have been a strong dependence on moisturizing.
Answer 2) It would be moisturizing.
Answer 3) Although not specific to children, sleeping with the upper body slightly elevated at night is sometimes effective. Exercise is also generally effective.
(Q) Thank you for your reply. I believed it was a rebound because it was a worsening of an area that had never had inflammation before or had never been treated with steroids, but I was wrong. I am surprised that it could be a dependency on moisturizer. He will try to sleep with his upper body slightly elevated. I will have him to take up exercise as soon as he can. Thank you very much.
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(Q) Sweat after exercise
Dr. Sato, thank you for your help on the previous forum. After exercise, should I wipe sweat off with a wet towel or something? If the itchiness subsides, is it better to dry the sweat and leave it as it is? The inflammation on my elbow is red, thick skin, itchy and scratchy. Before hot summer it was dry, scratchy and itchy. Is sweat changing these symptoms? Thank you.
(S) If the itching calms down with sweat after exercise, you don't necessarily need to wipe it off. As for the inflammation of the elbow, it could be caused by sweat, but it's hard to say anything definitive without seeing the progress.
(Q) Thank you for your reply. I will shower etc. according to my skin condition.
(Q) Spread of skin rash
Thank you for all your help. I had a consultation about 2 weeks ago. I had a severe skin rash and exudate from my buttocks and inner thighs to the back of my legs and was prescribed antibiotics. Currently, the rash has subsided from the top and the exudate has decreased to the middle of my inner thighs. However, the rash is slowly but surely spreading to my ankles and the back of my legs. Also, my ankles are always oozing. Some areas are getting better, such as the buttocks and upper inner thighs, and the ankles are getting worse. Should I just continue to apply gauze to the ankles and keep them as dry as possible? Will it go away when the time comes? Thank you in advance.
(S) You may try sleeping with your lower leg slightly elevated at night. Only the periphery is difficult to heal, which is inevitable to some extent because water collects downward when you are in a standing position. I think it will get better slowly. If things do not go well, you will need to see me.
(Q) Thank you for your reply, Dr. Sato. I will try sleeping with my legs elevated. Some parts are getting dry, so I will try to be patient. Thank you very much.
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(Q) Exercise and Shower in summer
I have been TSW and NMT and I'm getting better little by little, but now that summer is here, when I sweat, the inside of my arms and chest get itchy and scratchy, and it hurts. Should I still exercise outside even if there is scratching? When I exercise outside, the redness and itchiness increases with sweat. When I exercise indoors, I sweat slightly. Also, I used to take a shower once every two days, but in the summer or when I sweat during exercise, is it okay to take a shower every day even in case that scabs are came off by scratching?
(S) Exercise does not necessally have to be outside. In the summer, doing a series of radio calisthenics in an air-conditioned room is also a good exercise.
If the exudate is low, everyday shower will not cause much of a problem.
(Q) Thank you for the reply. I am mainly exercising indoors, and if showering is okay for me, I may be able to exercise outside. Will the more exercise I do, the faster it will heal?
(S) Do as much as you enjoy.
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(Q) How to cope with menopause
I'm currently recovering aggravation of postpartum and post-breastfeeding. I've been trying to NMT during taking care of my baby putting sunwhite cream on my rough arms. I've been reading Dr. Sato's book and referring to past posts on this message board. I've had a worsening because of progesterone for fertility treatments and after each of the two births of my children. I tend to get worse when my hormones are out of balance. Since we are not having a third child, I am now worried that it will get worse next time during menopause. I am wondering if menopause lasts longer than childbirth and therefore worsens over time, or if it would happen gradually and does not get much worse, so I have hazy feeling about 10 years ahead. What tends to happen to people whose atopy gets worse during menopause?
Will exercise and water restriction be important again then?
(S) You said "I put sunwhite cream on my arms", this works moisturizer. It seems that applying moisturizer can have an effect on the areas where it is not applied. Please don't misunderstand it. Usually the skin rash gets a little worse during menstruation. However, very few patients have had it get very bad during menopause. If you have done everything right by then, you should not have too many problems.
(Q) Right, actually I got very bad.
I thought Vaseline would help so I applied it a lot during taking my children. Now I don't apply it at all. I would like to strengthen my skin by following the basics. I am relieved to hear your opinion. Thank you.
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(Q) On genital skin
It's been a while...I have been going for the first half of 6 years and have been on an ongoing TSW and stop using vaseline. Thanks to your help, I was cured until March this year. I am having trouble with the exudate in the groin or down below. How should I deal with it? The other areas, forehead, chin, ears, scalp, neck, chest, elbows, and kneecaps, which are fine. I am thinking of applying boric acid ointment for exudate around the genital area. Should I refrain from doing so? I am male, by the way.
(S) I do not recommend the application of boric acid ointment. If you have been going to the hospital, is it not too far from the hospital? If so, I think it would be better for you to see me directly.
(Q) Thank you for your respond. I will read your book again and deal with the situation because I can't go see you for my personal reasons. I am sure I will have to ask you again. Thanks.
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(Q) Water Intake Calculations
Hello, thank you. How do I calculate the amount of water I should be having each day? I am 182cm tall, 68kg, male, 32 years old. Thank you.
(S) The amount of water you need is about 1200-1500 ml in this season. When you sweat, please take additional water that is the same amount you sweat.
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(Q) GENTACIN
Excuse me for this late night. Dr. Sato, can I ask you a question? My dermatologist would prescribe GENTACIN easily if I say I have a bacterial infection, but after applying it, the affected area becomes oozing and moisturized and doesn't seem to heal well. In that case, should I stop it?
(S) If you are not steroid-dependent or moisturizer-dependent, ointments such as GENTACIN will help for a skin infection. You may need to take oral antibiotics, though. If you are steroid-dependent or moisturizer-dependent, ointments should be used cautiously. Internal medication is necessary, though.
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(Q) Sorry for the late hour.
I was in the hospital until recently and I wanted to ask you a question. I read in your book that in general, after being discharged from the hospital, the condition slowly decreases over a period of 2 weeks and then gets better over another 2 weeks. When will it get better as a result of some action? On the premise that during this period, basic fluid restriction, protein intake, moderate exercise, and healthy diet should be continued. On the contrary, will the symptom gradually get better without such actions? It is difficult for me to understand the expression "getting better," so I would appreciate it if you could tell me what you mean.
(S) What you did while in the hospital must be continued for the rest of your life. After discharge from the hospital, it seems to get worse due to the change in living environment. This means that you will need a period of time to get used to this. I guess exercise will not be as much as it was during your hospital stay, but try to make it as much as possible. Once the skin improves, there will be no need to take more protein.
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(Q) Skin Sensitivity
I am posting this because I'd like to ask you. Recently, the skin on my neck has been peeling here and there, and when I wake up in the morning and look the peeled areas in the mirror, they are oozing with coming together at night. I know that there are many reasons for this, such as the amount of water I drink before going to bed or scratching unconsciously at night, but can the skin be strengthened by keeping the skin dry or by raising the metabolism by sweating?
(S) If you do NMT and exercise enough to make you sweat, your skin will become stronger. Please read and study my book,<New Edition> Adult Type Atopy Treatment Learned from Patients: Steroid-withdrawal and Non-moisturing therapy for Refractory Atopic Dermatitis, Tsuge Shobo Shinsha, 2015, Kenji Sato, or "Cartoon, Introduction to Steroid Withdrawal, Steroid-withdrawal Diary for Everybody" by Yoshimi Numajiri.
(Q) Dr. Sato. Thank you for your reply. I had neglected to make an effort to raise my metabolism by sweating. I have learned a lot.
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(Q) Humidity
Does humidity have anything to do with skin at night and in the morning?
(S) Conditions are different if you are in the futon at night and if you are out of the futon. If you are in the futon, there will be high humidity inside the futon. If you are outside the futon, the humidity of the atmosphere will affect your skin. Just think carefully for your situation.
(Q) Dr. Sato. So if the humidity in the room is high, it may work as moisturizer. Thank you.
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(Q) About No Steroidal and No Moisturizing Treatment
Dr. Sato, Good evening. I was hospitalized before. I have a question I would like to ask you. Regarding adverse reactions, is the condition of the skin after steroid withdrawal completely different from the condition of the skin after de-moisturizing withdrawal? For example, if you continue to moisturize, your skin becomes more fragile and the risk of infection is higher than with steroid withdrawal. Of course it depends on the people, but I would appreciate it if you could tell me even if it is just a small difference from what you have seen in your patients.
(S) Is the "skin after steroids-withdrawal" you mention condition that you still moisturize? If so, it is a condition that needs to do moisture-withdrawal. This condition is quite similar to the pre-steroids-withdrawal skin. It is fragile. After moisture-withdrawal, the skin is almost normal. Of course, even in this case, the skin remembers that it has become steroid-dependent and moisturizer-dependent, so you need to be careful in your daily life.
(Q) Dr. Sato. Thank you for your reply. I also did moisture-withdrawal at the same time. There are so many things to take care of in my daily life, it makes me be mentally exhausted!
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(Q) About shower, exercise , long sleeves
My name is Yamamoto, mother of a 3rd grader who was discharged from the hospital last week. The day after he was discharged from the hospital, he started scratching and is a little depressed. I am going to let him manage his daily life, but I was concerned about his less physical activity. Because of rain, but he doesn't go outside to exercise unless I call out to him. He says he does radio calisthenics indoors, but do you think that's enough?
You told him that he should take a shower once every two days, but he won't take a shower unless I tell him, probably because he has scratched himself. He said that he won't flush the area where he has scratched. Does washing away bacteria in the shower mean washing the whole body? Is it okay not to rinse the area where he scratched? He does not want to wash his head either. I know that it is not good to wash too much, but I am afraid that he might get an infection. Can I leave the frequency of showers up to him?
I am afraid that if he is going to this life style, it will be a waste of his hospital stay. When I was discharged from the hospital, I heard that he could wear long sleeves and fasten the cuffs with tape or a supporter to prevent scratching of his elbows at bedtime, so he has been doing this since last night. he was able to prevent scratching at night, but he seems to want to prevent scratching during the daytime as well, so he spends his time wearing long sleeves and a supporter. I thought this could be the skin moisturized. I was wondering if it is safe to continue with this?
(S) Please let your son figure it out for himself and carry it out. Do not let him feel that you are concerned about it.
(Q) He has to think about it, right? He may have needed to stay in the hospital a little longer.
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(Q) I have a question about anesthesia during TSW.
Hi, Dr. Sato. My name is Yamamoto and I used to be a patient at your hospital. Thank you very much for your help at that time. I have recovered a lot after 3 years of stopping from medication. Recently, I went to a gynecologist and was told about surgery for hysteromyoma and ovarian cysts and the surgery involves two types of anesthesia: general anesthesia and anesthesia for the lower half of the body. I will also be prescribed medication to temporarily stop my menstruation in order to stop the bleeding. Is it possible to have a skin reaction if I take these medications during TSW?I am scared because I have suffered from the side effects of the medication and I am worried that my skin, which has recovered so well, will have a reaction. Any advice you can give me would be greatly appreciated. Thank you.
(S) Even a cold can aggravate a skin rash. However, considering the nature of the disease, rather than anesthesia, I think it would be better to undergo surgery. Even a cold can aggravate a skin rash. However, considering the nature of the disease, rather than anesthesia, I think it would be better to perform surgery. What you should do is to exercise and improve your physical strength before the surgery, I think. Please make preparations so that the disease will not worsen.
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(Q) About Excimer Therapy
I was discharged from the hospital two weeks ago. Thank you very much for your help during my hospital stay. I would like to ask you about excimer therapy. Is it effective for the part where the exudate has appeared though the dryness of the skin appears remarkably after irradiation? In addition, is there any problem even if I irradiate eroded and fragile skin?
(S) If the itchiness decreases, I think it is OK to continue irradiation, but if not, it would be harmful.
(Q) Thank you for your reply. I have irradiated my skin several times and the exudate has forcibly stopped, but my skin is too dry and I was wondering if I should continue with the treatment. Thank you very much.
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(Q) I'm well.
Hi, Dr. Sato. I am a mother of son who was hospitalized when he was 6 and 10 years old. When he was 10 years old, as he had an infection again, he spent his days with relaxed, MNT, and exercised moderately. Even when his neck and face were badly affected, he did not miss elementary school and enjoyed spending time with his friends. This year, when he entered junior high school, he was fully prepared for his junior high school life being allowed to use cooling agents in the nurse's office and to use a handy fan. He may have felt resistance to use both items as she became a bit of an adolescent, but he was able to go to and from school with her friends in good spirits under the scorching sun without using these stuffs during the first semester. His skin is also really good. Every year, his skin gets stronger and the roughness caused by masks decreases. I have to say it is a great way that it can be cured without medication if left alone. We can only go to see you when it gets worse, but even the time he feels better, we always want to express our gratitude. It is still hot, but we wish your good health every day.
(S) Thank you for the update. I hope things continue to look good for you.
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(Q) I have a lot of exudate
Dr. Sato, it has been a long time since I have posted. Last fall, you take care of me to a skin rash on my leg that prevented me from walking. It had been getting better little by little, but it gradually worsened again around April, and about 10 days ago, I started to get exudate in a wide area. I am currently applying gauze and restricting fluids, but instead of decreasing, the amount of exudate is increasing, and even if I apply two layers of gauze on my ankle, it comes out so much that it falls off. Is it okay if I put four or five layers of gauze on top of each other? I am not sure if it is good to keep the gauze on the ankle with wet all the time, so I am posting this question. Thank you in advance for your help.
(S) You can use 4-5 layers of gauze, but once dry, remove the rest, leaving one sheet closest to the skin. The cause of the continued exudate is more problematic than this. You say you are restricting water, but have you considered the fluids in your food? Are you eating a high-salt diet? Bacterial infections also produce a lot of exudate. One way to reduce exudate from the lower extremities is to sleep with the lower extremities elevated. If it is possible to do so during the day, elevate the lower limbs as much as possible during the day as well.
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(Q) Peat bath
I'm Mayu and I was hospitalized 12 years ago for TSW therapy. You took very good care of me at that time. Thank you very much. Recently, I tried mud called peat as a bath additive. It is said to be very similar to the ingredients of the moor hot springs in Tokachi, Hokkaido, and contains vitamins, the mineral humic acid, and fulvic acid.
I have a feeling that getting into that bath salt would reduce the itchiness, redness, and red eczema. Have you heard of any such cases? I ask this because I was hoping that if I could get a little less itching and eczema with the help of this peat. I'd like to hear your opinion.
(S) I've never heard about that. It'll be working as moisturizing.
Jun. 2022
May. 2022
(Q) About Bathing
I am going through NMT for 7 months now. As for bathing, I would like to take a shower every day to soap away the sweat because the itching is lessened if I use soap, is this a problem? Dr. Fujisawa says that soap is not so good for you in his book.
(S) Generally speaking, it is not good because it removes more sebum. However, it also depends on the condition of the skin, how you wash, whether you keep the soap on longer or scrub harder. If the skin is not getting worse with your way, there would be no problem. However, this is applicable in case of your assessment for the current skin condition is correct.
(Q) I lather it up and apply it lightly all over my body and rinse it off immediately. I work as a farmer now and my body is sticky before I go to bed because I sweat a lot. I have been itching before I go to bed, and I can't sleep much during the night, so I used the soap and ended up the itching went away. My skin has pigmentation and redness, with sebum. The desquamation is almost completely gone. However, an itchy eczema is present around the affected area. I feel Itchy caused by perspiration.
(S) If sebum is produced and desquamation is eliminated, it would a good sign.
(Q) Thank you, Dr.Sato. I'm always a kind of exercising because of my physically demanding job. I think my metabolism is good. I am sticky with sebum and sweat.
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(Q) Hi. Are there any other hospitals in Japan that offer treatment like Dr. Sato's method and can admit patients?
If you know of any, please let me know.
(S) There are no similar hospitals in Japan. There are hospitals in Osaka and Hyogo prefecture that are a bit similar.
(Q) I have looked myself but could not find it... Thank you for your time!
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(Q) Atopy of my son in 3rd grade of junior high school
I would like to ask you about atopic disease in my son who is in the 3rd grade. He has started TSW a year ago. At the end of last year, he was much better, but since March this year, it has come back and the inflammation is spreading more and more. He is currently doing hot spring therapy and moisturizing, but we are thinking of trying your TSW methods. We are in Aichi Prefecture, but there is no hospital nearby that offers NMT, and I would like him to be seen by you and hopefully be admitted to a hospital. Are there any beds available now? It might not be serious, but he is not able to go to school for days at a time.
(S) The first thing to do is to see you and think about what to do afterwards. I think one of the options is to consider hospitalization.
(Q) Thank you for your reply. I would like to see you.
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(Q) Skin irritation by touching grass
I’ｍ learning a lot on this forum. I would like to consult with you about my elementary school child's skin. He has mild atopy on his elbows and knees depending on the season, but he have been non-steroids treatment, since I, his mother, have experienced TSW. The other day, after a cleaning activity at an elementary school in the grassy area after the rain, the pores on her bare hands and feet became itchy. We believe that he probably had grass sores, but we are having trouble because "steroid" was shown in web search results when we search for "grass sore, natural cure" on the Internet. We don't want to use steroids because he is atopic by nature, but is steroid treatment the only way to treat grass sores? What kind of treatment is given for grass blisters at Dr. Sato's Hannan Chuo Hospital? Please let me know.
Continuing with my post.
It seems to have calmed down a lot this morning, but I am beginning to think this might be a caterpillar bite.
Should I have it seen by a dermatologist once....
(S) I think the grass blister is a type of rash (contact dermatitis). The first thing to do when you think you have a rash is to wash off anything on your skin with soap. If you're not atopic dermatitis, the next step is topical treatment with steroid ointment. If you're atopic dermatitis, this is difficult. The first step is ointment treatment without steroids or protopic. However, if the rash is left untreated, it is sometimes possible for the eczema to spread throughout the body. It is not possible to determine if this will happen. The probability of this happening is not very high, so it is better to use non-steroidal topical treatment and see as it is.
(Q) Thank you for your reply, Dr. Sato. I went to see a dermatologist today. He diagnosed that it is not a caterpillar, although I don't know if it is grass irritation or caused by sunburn.
I told him that he doesn't want to use steroids as much as possible, and this time he prescribed PROPETO to keep the skin moisturized.
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(Q) Ask for information about dermatology in Yokohama, Kanagawa.
Hi. I have eczema living in Yokohama. I have a problem to ask you actually. I have been a patient of Yoshizawa Dermatology in Yokohama City for a long time, which is mentioned in the introductory of cartoon by Numajiri, but it was closed at the end of last year. I knew about it in May of this year. I was unable to get a referral to a hospital that would take over that treatment method. The remaining Yoshizawa Dermatology's website does not even mention the hospital that will take over the treatment. I was just about to introduce Yoshizawa Dermatology to an acquaintance with atopic dermatitis. I remember seeing a cartoon by Numajiri in the lobby of Yoshizawa Dermatology, and I was wondering if you could help me. I remember that the cartoon mentioned a network of dermatologists who provide the same treatment, such as Hannan Chuo Hospital and Yoshizawa Dermatology in Yokohama, and that is how I ended up here. Can you tell me which clinic in Yokohama treats atopic dermatitis with Histaglobin injections, Non-steroidal, and Antihistamine drug like treatment at Yoshizawa Dermatology?
I would really appreciate it if you could let me know. I'm sure there are many local atopic dermatitis sufferers like me who are at a loss because Yoshizawa Dermatology was closed...
(S) Please see Fujisawa Dermatology. There is no such clinic in Yokohama.
Http://fujisawahifuka.com/
Check this website .
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(Q) Atopy in my 2 year and 9 month old son
Hi, nice to meet you. My son started with eczema on his face shortly after birth, and by six months the atopy spread to his body. I put him on steroids for about 3 months but stopped after I learned about Dr. Sato's book.
It has been a year and a half since then. He still has atopic dermatitis on his wrists, backs of his feet, and lower body, and it gets worse or better depending on his physical condition. He has had asthma attacks twice (not yet diagnosed as asthma since he is 2 years old), and I am worried because the pediatrician nearby prescribes a lot of medicine, so I am taking him to a pediatrician a little further away who treats allergies. Today, I had an attack from a cold, and when I went to see the pediatrician, he pointed out his skin sympton Since we are in Kanagawa, we have not yet found a doctor who treats TSW, and I am afraid to be asked "Is he always seeing a dermatologist? Once I was told by a dermatologist that this is abuse. He recommended Collectim ointment this time saying it was not a steroid. He pointed out that his wrists were scratched and a little wounded, which was pitiful for him. From my point of view, I don't think it is that much of a scratch. I don't think it's right to apply this ointment while he doesn't even moisturize, but there is no place nearby where I can talk about it, and I'm depressed because of what has happened so far. Since I can't talk to anyone about it, I sometimes think that if I am told that it is abuse, it might be so. Is there any place in Kanto where I can consult?
(S) Please contact with the following
Medical Corporation Apple Kai Fujisawa Dermatology
Address: 178-0063
2F, 1-37-14 Higashioizumi, Nerima-ku, Tokyo
TEL 03-3925-8947
http://fujisawahifuka.com/?msclkid=43aa220ccdd711eca67c10c37ff3375b
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(Q) Skin sore on nosepiece of glasses
My son, a 6th grader, has atopic dermatitis around his eyelids and eyes that tends to get worse every spring, but this year for the first time, he has sores on the part of his glasses where the nosepiece touches. The frames are plastic.
He has been wearing glasses for several years because he is nearsighted and the sores are only on the left side (the right side is okay). If he doesn't wear his glasses, it dries up and no exudate appears, but if he do, it gets worse within an hour. He tries less time wearing them on holidays, but can't do that way on school days, so he has to wear glasses to school with a thin gauze over them. He tries to keep the area around my eyes as dry as possible. I don't think there is any infection so far. Is the treatment method correct? I would appreciate your advice.
(S) I think that is the right treatment. Is it possible to wrap the nosepiece of the glasses itself with gauze?
(Q) Thank you for your reply. He tried wrapping it around the nosepiece as you mentioned, but he had to wrap the tape around it to hold it in place, and he gave up because the tape would touched with the sore. He will continue with the current treatment and wait for it to get better. Thank you very much!
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(Q) About antihistamines and sleeping pills.
Hi, I am asking this question here because I live in Tokyo and it is very difficult for me to go to your office. It's been almost 10 months since TSW and NMT. My family doctor has prescribed anti-itch and sleeping pills.
I would like to hear your opinion and thoughts about three questions below.
■I am wondering if taking an antiallergic or antihistamine will not change the term of withdrawal symptoms? I know there are some people who are even stopping from drugs and enduring them, so I am not sure if I should take them even if they are prescribed to me. I also want to get rid of withdrawal symptoms as soon as possible, so I am restricting water, exercising, and taking baths, so if taking the medication will prolong the symptoms, I would like to refrain from taking it by cooling down or something, even if it makes me itch.
■Also simply, why does any anti-itch or sleeping pills stop working during the peak of the rebound-symptom? What is happening to my body?
■What can you read from IgE and TARC?
I am currently in the midst of TSW rebound-peak. IgE is 500 and TARC is just under 12,000. If your patient wishes, would you consider a new drug and Dupixent, etc.? He didn't explain why the difference is so wide and why only TARC is unusually high, he just gave me a piece of written explanation. I did not get any details, and was told about Dupixent. By the way, my eosinophils are 14% and my white blood cells are normal.
(S) Anti-allergic and antihistamines help a little. They will not slow down the rate of improvement unless side effects occur. Cooling with refrigerant can be effective. During the peak of the rebound, the itching is too severe to be effective. I'm not sure its mechanism. Even there is strong inflammation, but it wouldn't be caused by IgE. Dupixent is not used at Hannan Chuo Hospital. The use of Dupixent is only allowed while using steroids and moisturizers.
(Q) Ask for your advice
My husband has learned and practiced your method of Steroid-withdrawal. He improved for a time a few years ago, but now he has the same symptoms and I am contacting you to discuss this. I am not the patient, but his wife. Thank you very much in advance.
First of all, he is American and lives in Japan. He had eczema and was prescribed steroids by a dermatologist, which he used (which at the time was thought to be a side effect of medication, and he wanted a prescription for Histamine). After that, he learned that the problem was the steroids themselves, As time went on, eczema appeared from areas where he was not applying steroids, and eventually appeared everywhere on his body. He has known about your TSW therapy and implemented it.
There were no doctors in the prefecture where we live who were doing TSW therapy, and at the time, our child was small and we both was working, so he'd wanted to see you many times honestly but couldn't. So he found your book and followed it. Until last year, he did not use any steroids.
The problem now is that the same symptoms are appearing as when he did TSW therapy, and he is trying the same methods as with TSW therapy, such as NMT, Non-Protopic treatment, etc., but they are not improving at all, on the contrary they seem to be getting worse and worse. Specifically, the symptoms start with the fingers of his hands, then redness, itching, etc. on my wrists and upper extremities, and the appearance is terrible because of the exudate, so he feels very embarrassed and it is very painful and he ended it up to miss work.
He thinks that it is the effect of the vaccine because such symptoms started gradually after he received the second vaccine for the new coronavirus. However, since the symptoms appeared about three months after he was taken to the emergency room with anaphylactic shock in November of last year and was given steroid medication, I believe that the effects of the steroids used in the emergency room treatment are rebounding and appearing as skin symptoms. I advised my husband to wash his skin well under running water without soap or body wash twice a day anyway, but he realizes washing seems to cause extreme pain and after washing, the symptoms seem to get worse because the exudate increases to twice as much. So he does not wash intentionally and does not want to wash. From my visual inspection, which is of course just my speculation, it sounds like he is infected with MRSA or Streptococcus or something similar. I am wondering if that skin condition is not crusted impetigo. If so, I think generally antibiotic ointment would be used, but I still think that basically washing the skin well under running water and eating a protein-rich diet would gradually improve it. What do you think about this?
He is maneged to see you directly if possible, but my son, 6 years old, was recently transported to the emergency room twice for rigid spasms, and I want to concentrate on his progress and treatment now, and I am also too busy with work at this time to take care of it. However, since the day my son was taken to the emergency room, my husband's skin condition has become even worse and he has been depressed all the time and cries sometimes due to his depressive tendencies. He is down because his finger condition is also getting worse, as it was only on the fingers of his right hand, but now it seems to be appearing on his left hand as well.
If possible, I would appreciate your advice on the treatment that can be done at home in this case. It would be great if you could give us some idea. He doesn't listen to me and has been struggling a lot and has been to many dermatologists in Miyagi prefecture, but the all doctors in Miyagi seem to recommend steroids, and he has been having a hard time with it.
The allergist we went to last week for the first time, who is familiar with anaphylactic shock, also recommended propet and instructed us not to consume foreign meat and to eat protein from tofu and rice, which has made us distrust medical care even more.
There is one doctor in the prefecture that I know of that does not use steroids, but I was told that he specializes in pediatrics and does not see adults. We have no one we can turn to. My husband won't listen to others but you, so any advice you can give us would be greatly appreciated. We are planning to see you this summer. We would be very grateful if you could tell us what we can do until then.
(S) 1. You mean the eczema was spreading from his hands to whole body. Recently I can see many cases like you because you use hand sanitaizer a lot under corona.
2. As for influence of corona-vaccine, it would be less possible to relate if it more than 2 weeks later since you got vaccinated.
3. In your case, it passed 3 months after steroid-instillation so it's also unlikely.
4. I'm not sure because I haven't seen your symptom directly.
5. In this season, washing your body to keep you clean makes your skin worse. Just take shower with room temperature water for 20 seconds and once or twice a week. Just splash some water on it, not scrubing.
6. If you want to know exactly what "Steroid-withdrawal therapy" is, please read <New Edition> Adult-onset atopic dermatitis treatment learned from patients: Steroid-withdrawal and Non-moisturing therapy for refractory atopic dermatitis, Tsuge Shobo Shinsha, 2015, Kenji Sato. Please read Chapter 1 first to get an overview.
(Q) He is going to see you during the summer vacation time, as he has had several flare-ups during the year, including occasional exudates. He is very concerned about the thinning and weakening of the skin on his hands, especially after starting TSW, and when the skin condition is good, he tries various over-the-counter creams that thicken the skin (I'm not sure exactly how it works) on his hands and seems to be very concerned. He wanted to know specific ways to get thicker skin on his hands. Many thanks.
(S) If there is little or no exudate, A daily 30-second shower would be fine this time of year. I think it will also reduce bacterial infections. I do not agree with what you said that the skin on the hands becomes thicker when it is healthy. If the skin improves from an eczema condition, the skin will be thinner. I think the only time the skin is thin in a severe eczema condition is when the skin is atrophied from long term high dose steroids. It seems you are mistaken about that.
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(Q) About my original atopy
It has been two years since starting TSW and NMT. Currently, I feel that the steroid and moisturizer dependent dermatosis seem to be healed and the original atopic dermatitis is remained. The current symptoms include light erythema and white skin disease on the forehead and around the eyes and ears, lichenified eczema and cracking on the nape of the neck, cracks on the inside of the elbows, and cracks on the toes. It's depends on seasons, my dry skin all over my body is much better with less scaling and desquamation, but it's still very itchy every day. I have endured this situation for two years, but now I am again feeling a little anxiety. So I would like to let me clear.
Is my understanding right to keep doing physical therapy and fluid restriction for a long time for the original atopic dermatitis?
(S) >Is my understanding right to keep doing physical therapy and fluid restriction for a long time for the original atopic dermatitis?
I think this approach is fine, but if your symptoms remain as described for two years, maybe you are not doing what you should or should not be doing. Please read the book carefully.
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(Q) Could you tell me?
Dr. Sato, thank you very much for your examination yesterday. I just got your book and will now peruse it. I would like to ask you two questions. As I said yesterday I do not have atopic dermatitis, but I have a lot of eczema like nummular eczema on my face. I am not atopic, but I have many eczemas on my face. Am I correct in understanding that even if the symptoms are not atopic, but such symptoms can be cured by TSW and NMT? Also, as you tell me, I started doing 30 minutes of aerobic exercise since yesterday, but my face does not sweat at all. in this case, should I continue until I do or work harder?
Please reply to the above two points.
(S) You don't have to be atopic to get better. If the skin on your face improves, you will start to sweat. You'll get better even if it's not atopic dermatitis. As the skin on your face improves, you will start to sweat. Please exercise at your own pace without getting hasty.
(Q) Dr. Sato, thank you for your prompt reply. I will keep my mind strong and do my best. Sorry, tell me two more things. Since today, eczema on my neck has been increasing, and it seems to itch where there was none, and when I scratch it, it turns red and becomes a new eczema. Some of them look swollen and don't immediately become scabby like my face, but is it correct to say that even if there is an increase in this eczema on the neck, I should try not to scratch it and wait for it to subside without doing anything?
Another is that I work for young children, some of whom may have water warts or chilblains, and I am in close contact with them as I carry them in my arms, and I have many opportunities to come in contact with germs as I have to take care of their waste, or in mud or swimming pools. Any problems with this?
(S) It will be fine as you are considering.
(Q) Dr. Sato, thank you for your reply. I will keep it up and do my best to get better.
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(Q) About ZESTAK CREAM
I'm doing and now my skin is stable. I recently had tendonitis and saw an orthopedic surgeon who prescribed an ointment called ZESTAK cream. It has adrenal extract in the ingredients, is this different from steroids? I have done a lot of research but I am not sure, so I would appreciate it if you could tell me what it is. Thank you in advance.
(S) I can't find anything that clearly states that it contains steroids, but it is listed as a side effect.
Hypertrichosis (hair growth in the area where the drug is applied)
I think it is probably a steroid effect. I don't see any description of hormones in the product, but I think you should be very careful with it. Also, if you're in TSW & NMT, I would not recommend any type of fomentation, because fomentation works as a moisturizer.
(Q) Thank you very much for your help. I am so glad to get your reply and could understand about containing the word "adrenal" in this discription. I am going to refrain from using this medication. I have to wear a supporter during work as it still hurts, it may be a moisturizer though. But I will not use compresses. Thank you very much.
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(Q) I am doing TSW & NMT, but I seem to have developed a bacterial infection and the yellow exudate won't stop.
I have taken antibiotics, but it still does not go away. Is this symptom cured spontaneously? I would appreciate it if you could tell me.
(S) Bacterial infections can heal spontaneously or become worse and worse. We cannot say it's a bacterial infection because of just the yellowish fluid. I think you need to see a doctor who can observe the skin rash closely.
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(Q) About TSW & NMT
Dr. Sato, I'd like to ask you. I do not have atopic dermatitis, but eczema started on my face in late January this year, and from February until the end of May, I have been using LOCOID, LIDOMEX, and Protopic Ointment in that order according to my doctor's instructions, but it did not recover, and I was told by an another dermatologist to weaken the medication and to use Nizoral and LOCOID (4:1) mixed cream for 2 weeks. I applied a mixture of Nizoral and LOCOID (4:1) cream for 2 weeks, but it got worse. I learned about TSW and NMT for the first time and started TSW on the night of 6/16. I expected a rebound is happening, but I am having a very hard time with my face is in terrible condition. I have a lot of scabs on my face and the worst ones are heavily heated. Today is the 5th day and I was wondering if I can continue with this even if I am not originally atopic, and if there is anything I should be looking out for or be aware of? Also, I am quite far away, but if I can get some time off from work, I am considering visiting you in person on 6/23. I look forward to your reply.
(S) It is dangerous to stop every ointments suddenly on your own. It is better to stop slowly. I cannot give more detailed instructions any more because I have not actually seen it. Please go to your local library and borrow a copy of the below. <New Edition> Adult-onset Atopic Dermatitis Treatment Learned from Patients: TSW and NMT for Intractable Atopic Dermatitis, Tsuge Shobo Shinsha, 2015, Kenji Sato. Check the parts you are concerned about.
(Q) Thank you very much for your reply. I would really like to see you, so may I visit you on Thursday the day after tomorrow? I'm living out of the prefecture, but I will leave my house early.
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(Q) How to Treat a Stye
I was previously hospitalized for TSW and NMT. Now after being discharged from the hospital, my symptoms have worsened and most of the current symptoms can be treated by myself from my experience in the hospital and from learning from you, but one symptom that I have not experienced during my hospital stay is swelling of my eyes like stye has appeared since 5 days ago and it is not going away. I have been taking Cefcapene Pivoxil Hydrochloride tablet 100mg (antibiotic) since I had a fever of 39.5 degrees Celsius due to a bacterial infection in my head 4 days ago. Here is my questions.
1. The main cause of the fever has been cured, so I am going to stop taking the antibiotic after only one more day, and I 'm gonna stop taking the antibiotic only for a stye (because it is a waste of medicine).
Is this a problem as a treatment?
2. I have heard that eye drops are prescribed as a treatment for stye, but I am not sure what is appropriate as many of them use steroids for anti-inflammation, and some non-steroidal ones are made from licorice.
I am not sure what is appropriate. Can you please tell me the names of eye drops (either over-the-counter or prescription) that can be used by people like me who have experienced TSW? Thank you in advance for your time and help.
(S) If the infection on your head is related to the stye, antibiotics should be taken until the stye is gone. If the symptoms of stye alone are severe, it is necessary to take oral antibiotics. Even if the symptoms are mild, it is better to take it orally.
(Q) Dr. Sato, thank you for your prompt response. Since I'm not sure how the infection on my head is related, I will continue the antibiotics until the stye goes away for a little while longer.
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(Q) About dried alum for the armpits
I've been TSW for 1 year and 3 months. I still have a little eczema here and there and my skin is pretty dry and always itchy except on the soles of my feet. I don't use soap on my face because it gets especially itchy. Body uses a little soap on some area. I have recently become hircismus after TSW. Even after washing with soap, I have the smell of the armpit immediately. I am afraid to use antiperspirants, so I would like to use dried-alum water. I am very embarrassed because the smell is too strong.
(S) The following is the treatment for people without atopic dermatitis or steroid dependence.
1. Bathe daily in the morning and wash the armpits with soap.
2. Wipe perspiration well.
3. Apply antiperspirants.
Surgically remove the sweat glands in the axilla. (at a plastic surgeon).
All of these are problematic for those on TSW, but they have to be tried.
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(Q) Unusual itching of the nose
It's been 8 years since I started TSW and NMT, and I'm so much better now that people don't even notice I have atopic dermatitis. Thank you so much. I am always grateful to you.
I would like to ask you something. Since spreading Corona, the surface of my nose has been abnormally itchy and I have been scratching my nose so hard every day that I feel as if my nose is going to come off. Since the inside of my nose does not itch but the surface, I thought it might be because of the non-woven mask touching my nose, so I changed it to an organic cotton mask and tried various other things. However, it did not get better, so it may be that the mask is moisturizing and making me itchy. Is the only way to deal with this symptom is to remove the mask as much as possible?
(S) If the cause is the mask, then not only my nose but also my cheeks are moisturized. So it is hard to say that it is moisturizing. I think it is because the nose is rubbed the most. I'm afraid I am not so sure.
(Q) Thank you for your reply, Dr. Sato. I understand what you pointed out. Thank you very much. Thinking about it, I have a clear runny nose all year round, so it could be an allergic cause. I will pay attention to pollen and dust. I will also pay attention to whether I am rubbing my nose without realizing it in my daily life.
Many thanks.
Apr. 2022
(Q) Worsening in spring
I always have a deterioration so much around this time of the year, mainly on my face and neck. I guess the cause is probably pollen. I used to wash my face with water after coming home to remove pollen, and it's become the worst ever. If I washed my face, it got worse, and if I left it as it was, it still got worse.
What should I do to prevent this? What is the best material for a mask? I am taking antibiotics and anti-itch medicine but I usually don't take anything. Basically, I keep to not get my face wet at all, or at the very least showering. Could you give me your opinion?
(S) People with atopic dermatitis often get worse during the spring pollen season. Many people think that pollen is the cause of the aggravation, but it doesn't look like pollen directly on the skin is making it worse. Actually the eyes and nose are affected by pollen, although allergic conjunctivitis and allergic rhinitis often cause itchy eyes and runny nose. If this symptom is accompanied by itching, the skin around the eyes and nose may be aggravated by scratching. It seems to you that the frequency and intensity of face washing needs to be carefully observed and determined according to the facial symptoms. Sometimes I ask the patients not to wash their face for a week or so. I don't think it is necessary to wash your face to remove pollen. Wearing masks leads moisturizing, so any material would be the same. I think you need to keep the skin from rubbing by mask. It would be difficult to tell you what to do now without actually examining you. I apologize for not being more helpful.
(Q) Oh, not at all. Thank you very much for your kind comment. Actually I would like to visit you for a medical examination. I always feel impatient to see you because you are so far away. I guess I'll just have to wait for the wave of deterioration to subside while taking care of my existing symptoms and keep the rhythm of my daily life.
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(Q) Blood Test
I was in the hospital until 3/12 this year, thank you very much at that time. I took medical check on 3/29 and my white blood cell count was as high as 11400. The doctor said, "Your white blood cell count may be high because of your severe atopy, but you should consult a dermatologist." I'd like to hear your opinion about this. In addition, the liver function tests showed LDH of 718 and LAP of 132, which were also much higher than the standard values, respectively.
If they are related to the worsening of atopy, am I right in understanding that the values will decrease as the inflammation subsides?
(S) That's correct.
(Q) Dr. Sato, thank you for quick response!
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(Q) Withdrawal Symptoms of NMT
Hi Dr. Sato. I am a moisturizer dependent and have been NMT for almost 3 months now. However, even though I am on water restriction (1000ml per day), I have a feeling of steaming and heat so much in my body, and I cannot sleep at night. Will these symptoms settle down to some extent? I am so anxious and worried now.
(S) If there is still redness on the body, the "a feeling of steaming and heat so much in the body" will continue. As for water restriction, you should take into account all the fluid that enters the body by various routes. 1000 ml/day, I believe, excludes fluid in food. Winter is cold and we often consume a lot of warm casseroles and soups. Isn't possible that this water content needs to be reduced a little? I would also need to reduce the salt content, as eating a lot of salty foods can cause water to accumulate in the body. Dehydration is not just about reducing water. There are many things that need to be done such as exercise, staying awake during the day, limiting bathing, etc. I think there is a reason why it hasn't gotten better in 3 months. Please read and study my book. If you are not sure, I recommend you see me.
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(Q) About Exercise
As for the time of day to exercise, is there any time of day that is effective or ineffective in calming inflammation?
Due to my work schedule, I can only find time to exercise just before going to bed.
If it is still effective, I am thinking of doing it. As for efforts to good sleep, there are anti-itch and sleep inducing drugs, so I think it would be possible to manage to sleep.
(S) I recommend that you exercise before dinner. If you do it right before going to bed, you may feel warm and have difficulty falling asleep. Is it possible to walk during your commute to work? If you can't do it on weekdays, you should do it on weekends.
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(Q) Worsening of fingers
Hi, my child has been doing TSW and NMT for about 5 years now. It is getting much better, but here comes the roughness on his fingers that has not been there before and is slow to heal, so I have a question for you. Your book also says that the healing of the fingers is slow because of the use of steroids with the fingers. I, not my son, applied steroids and moisturizers to him, so he himself did not touch them with his fingers. My fingers got worse like a rebound of TSW and NMT, but I am now recovering. However, I don't really remember applying steroids to my son's fingers, so why now? I am looking at past questions on this website for reference, are fingers also a preferred site?
Are hand sanitizers, etc. also affected under Covid-19 pandemic? I would appreciate your answer.
(S) Probably due to hand alcohol disinfection and hand washing for preventing corona. For atopic people, these two actions result hand washing. We need to figure out other better way to avoid them.
(Q) Thank you for your reply, Dr. Sato. I guess it is still alcohol disinfection. I think it is inevitable in group life.
My son's dream is to become a pastry chef, so if the roughness in his fingers does not heal, will he have to give up his dream or use steroids? I hope it will be cured while he is still a student. Please let to ask you if I have any further concerns.
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(Q) Thanks a lot
I was hospitalized at Hannan Chuo Hospital for about two months until Mar 12th of this year and was very much appreciated. About three and a half weeks have passed since I was discharged from the hospital. About 10 days later, my skin was peeling off a lot, and it's like my whole body skin peeled off once. After that, my scalp, face, and neck were sticky with exudate once a day due to scratching, but they have dried up a little since yesterday. It may have passed the peak of its aggravation after discharge. I still have a lot of hair loss.
Despite this situation, I will continue to work on the exercise, water restriction, and protein-conscious diet that I was taught at Hannan, and will make every effort to get better. Thank you very much for your help.
(S) Keep going.
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(Q) I have been experiencing TSW.
I am posting this to ask for your opinion.
I have a severe eczema on the back of my hand, with yellow exudate and pus-like things in several places, which is red, swollen and hard. My dermatologist prescribed Fucidin Leo ointment and Sahne ointment and told me to wash with soap three times a day and apply it after Sahne ointment, when itching occurs, wash with soap and apply SAHNE ointment, If that does not help, apply Rinderon VG ointment. I was told to apply Fucidin Leo, but my symptom is going back and forth, but I am not applying Rinderon because I am doing TSW. Should I apply Fucidin Leo while there is yellow exudate and pus-like discharge? Or could you please let me know if there is any other way? By the way, I am breastfeeding and cannot take antibiotics. I would appreciate your reply.
I have another question. My dermatologist told me to use Fucidin Leo and moisturizer together, but can I use moisturizer only if I get an infection during the TSW and NMT?
(S) I try to avoid using it to patients as much as possible, but sometimes I use it for short periods of time.
(Q) Dr. Sato. Thank you for taking the time to reply.
I am in the process of TSW and NMT, but pus often comes out and I am having a hard time improving the situation. I often feel like falling apart, but I will look at this site and other sites with your treatment methods and try to ensure your treatment methods once again. Thank you very much.
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(Q) What I'm concerned about.
My ears ring the other night and I could not sleep. I think one of the cause of tinnitus is the lack of sleep and hormones before my period, but the tinnitus stopped after I got my period. My father had sudden deafness a few years ago and had a week-long steroid infusion for tinnitus and severe dizziness. He was told that there was little chance of recovery if he was given steroids immediately, but he still did not recover, and he still suffers from strong tinnitus in the aftereffects. When he was on the infusion, his blood sugar level rose and he was even told that he would have to take diabetes medication. His blood sugar has been slowly dropping for about 2 years since then, but according to his doctor (physician), it seems to be due to the steroids. I thought again at that time that steroids are really nasty.
I 'm doing TSW and NMT now, but the last time I had tinnitus, I wondered what I would do if I had a sudden hearing loss or something and was told the only way was to administer steroids. Is there still no other way to deal with it other than steroids...?
If the situation is life-threatening, I think steroids are unavoidable, but I have experienced a horrible TSW rebound, so I don't want to use them easily. I may be asking the wrong question to you about my ears, but may I ask?
(S) For sudden deafness, its treatment is still using steroids only. If used, the only way to avoid severe withdrawal symptoms would be to reduce steroids with gradual decrease methods.
(Q) Understood, steroids are the only way to treat sudden hearing loss...
Thank you for taking the time to reply.
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(Q) I'd like to ask you a question again, could you tell me about infections?
Staphylococcus aureus seems to be the most common infection, but it is one of the indigenous bacteria that are always present on the skin, isn't it? I would think that an imbalance of the indigenous bacteria would cause an infection.
Is it due to an imbalance in a topical area (skin) that happens to? Or does it develop in a weak spot when the body's overall resistance falls? If it is the former, I should wash my face (usually with water once a month), and if it is the latter, it would be better that I should take a few days off from exercise to rest. I would like to be able to control it by myself somehow.
(S) Whether an infection develops depends on your health status, immune status, number of bacteria, virulence of the bacteria, and number of germs.
March. 2022
(Q) Hi, I have been NMT for about 2 years. My symptoms are all over my face, especially around my eyes. For the past month or so, the symptoms of scratching and exudate while sleeping have become worse. Before that, I didn't get exudate every night, and when I did, the scratches were usually superficial wounds enough that the exudate would dry in the morning, but now I get exudate from deep scratches extensively every night, and they are sticky and painful when I wake up. It hardens up in the evening, but I am in a vicious cycle of scratching again when sleeping. I do limit water intake and sleep with my head elevated. My stools are so solid that I wonder if I am drinking too little water. I exercise 5 days a week with long walks and trampoline.
Is it okay to continue patiently repeating scratch and dry many times?
Should I change something? Thank you very much in advance.
(S) Even with water restriction, symptoms can exacerbate if you take water during the night. Even when the head is elevated, it's not good that only the head is elevated with just a pillow; it should be raised in a straight line from the waist to the head. If the exudate hardens in the evening, it's unlikely to a bacterial infection, but be careful. If the stools are hard, magnesium oxide should be taken. Please pay attention to these points and keep trying.
(Q) Since I finish dinner between 7:30 PM and 8:00 PM, I may be consuming more water during the night. In the evening, the exudate has hardened in both the upper and lower eyelids and the corners of the eyes. However, the swelling of the eyelids and redness of the eyes in the morning have not completely subsided. Could it be also a kind of infection?
(S) It is possible that you have a mild infection. You may try antibiotic eye drops and oral medication for a short period of time.
(Q) Dr. Sato, thank you for your reply.
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(Q) Hi, Dr. Sato.
I am an allergic tendency and doing NMT now. I had not been using almost steroids, but I am dependent on moisturizer. When I was moisturizing, I did not have atopic symptoms, but after I stopped it, my arms became dry and itchy, and atopy started to appear. Should I continue NMT?
(S) I'm not sure exactly what an allergic tendency you mean, but NMT means to stop moisturizing and bring the skin to be dry. So if dryness is coming out on your skin, then it can be considered that you are heading towards NMT's goal. It would be better that the sebum comes out. You should continue a little harder.
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(Q) Face Washing
It's been a while. I was hospitalized more than 5 years ago, and afterwards, when I asked for advice about the symptoms that remained only on my face, you responded that I should try to stop using soap for a long period of time. Since then, when I wash my face with only hot water, I get white pimples and red pimples, and I end up using soap. Should I not use soap without worrying about these things? Also, I have had a treatment previously called excimer light, would it possible this may have an effect on the healing process?
(S) The formation of acne indicates that sebum is being produced, which is considered to go for the better in skin function. To reduce acne, it is necessary to wash with soap. However, washing can have a negative effect on the skin oils. You need to judge for yourself how much washing is good for removing sebum without worsening eczema.
I think the treatment with excimer light is not a problem.
(Q) Thank you for your answer, Dr. Sato. I will continue to wash my face with soap and see how it goes.
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(Q) Symptoms During Spring
Hi, I always thank you for your reply. It has been just one year since I started NNT.
Since last weekend, my face suddenly became very itchy and red, probably due to pollen and yellow sand. I also noticed that my neck and arms also became very itchy and red and had a slight fever. The eczema on my hands has also been getting worse along with rash in winter. When I moisturized for decades before starting NMT, it was always during the cypress and rice season from March to June when my face would turn bright red and my eyes would be itchy and swollen.
Now I'd like to ask you something. NMT does not cure atopy immediately and that it will get better over the years, which are my understanding. If these are correct, my current symptom saying "Atopy gets worse in spring time and at the change of seasons (I think some people do not get worse though)." is this my understanding also correct?
Also, if itching and redness gets worse when I get my face wet, like taking a bath, should I still not get it wet?
Some of the areas that were red are becoming crusty. Will it get better by repeating the process of redness, drying, and gradual peeling? I am worried that the redness and itchiness seems to be spreading. I try not to loose water-restriction.
I was concerned that I might have taken in too much water during the winter due to having a hot pot meal, etc., but it did not get worse and the dryness and itchiness have gradually calmed down.
I was trying to go for walks, but when my face started to itch or when the yellow dust seemed to be flying around a lot, I would refrain from going out. I am encouraged by the hospitalized patients who are trying their best to walk and exercise even in this kind of spring season. I have to do my best to exercise even at home.
I would like to get advice from you and if there is any incorrect understanding, I would appreciate it if you could tell me correctly.
(S) Yes, your understanding is correct.
(Q) Thank you, Dr. Sato. I'll keep in mind for my atopic dermatitis to worsen during the change of seasons, so I will keep it up on NMT.
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(Q) About Eczema
I have been TSW and NMT for 1 year and 8 months.
My atopic symptoms have now on my face (eyelids and forehead), neck and nape of the neck and whole body is dry (powdery).
Does it take a long time to heal from dermographismus albus on the forehead and the dryness all over the body?
(S) Yes, it takes time. Keep up your exercise.
(Q) Thanks for your reply. I'll keep trying my best!
February. 2022
(Q) How to deal with swelling from scratching
I have eczema and one of my hands has become swollen due to scratching. Could you tell me what to do? Many thanks.
(S) Scratching and swelling, in the worst case, is cellulitis, which may require hospitalization and intravenous treatment. It is better to have a medical examination thoroughly.
(Q) Thank you, Dr. Sato. I will go to see a doctor and have it checked out.
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(Q) Having pets
Hi, Dr. Sato. It's been 8 years since both my kid and I started TSW. We sometimes have a tough condition, however I'm grateful to be able to have a normal life. Now we're going to have a rescue dog. Would it be safe for us to have pets? Could you give us your opinion?
(S) Mostly, you don't know what's happening until you have it. In some cases, there is no problem even if the allergy test is positive.
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(Q) Vitiligo after eczema
How many years does it take for the skin to heal after it has been inflamed for years and has white colored skin in patches?
(Q) When I was in the hospital 17 years ago, I had been showing the white spots to other patients each other.
I remember the doctor said it would not disappear soon.
Actually it's on my elbow, and after about 20 years, it seems to have gone from pure white to a lighter skin tone.
(S) In general, It's hard to heal, but in some cases, skin darkening (skin pigmentation) could appears with punctiform.
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(Q) Exudate from the ears
Hi, I saw an ENT about the exudate coming out of my ears because of the weeping and itching. He said that my eardrum and hearing were fine, but that my outer ear was rough and the exudate was coming out.
A fungus test revealed Pseudomonas aeruginosa, and he was prescribed Tosufloxacin tosilate hydrate tablets. The otolaryngologist said that I was scratching my ears too much, but I've often heard that Staphylococcus aureus is caused by TSW, but is it common for Pseudomonas aeruginosa to be detected as well?
Can you give me your opinion?
(S) Pseudomonas aeruginosa is sometimes detected. As long as your body is fine, you don't have to worry about it.
(Q) Thank you for your reply, Dr. Sato. I'll take the medicine.
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(Q) How to deal with the eye area
Thank you very much for your help. We have seen you once last summer at Hannan Central Hospital.
At that time, you told us not to use steroid eye drops and I could use Patanol Ophthalmic Solution. My child was diagnosed to conjunctivitis at her school checkup. When we showed it to the ophthalmologist, he diagnosed allergic conjunctivitis and gave me Fluorometholone, GATIFLO, and Patanol, and the ophthalmologist strongly recommended standard treatment and strongly criticized TSW. The doctor is our family doctor.... and he had used it from fall to late December actually. (This may not have been a good idea.)
In the past, when he was a toddler, his right eyelid would get worse from pollen season to near summer, and it would get red and soggy, so I would put Fluorometholone on it, or he would get Predonine ointment (for the eyes) from a standard dermatologist and put it on temporarily.
In the latter half of December last year, we were told by another doctor with non-steroid treatment that he should stop taking steroids, so he stopped taking Fluorometholone and GATIFLO.
We switched to an ophthalmologist who gave me non-steroidal eye drops and now using ALESION Ophthalmic Solution, BRONUCK OPHTHALMIC SOLUTION and Trivid that I ask for. The ophthalmologist said that he should see a dermatologist about the symptoms around his eyes. Since around January this year the skin of my eyelids is peeling and red, (It's like rebound) and the skin condition looks severe.
He used to cut a piece of cloth gauze made of bamboo fiber and put it on the affected area around my eye and fixed it with an adhesive bandage, but now he's using white tape to fix it. Is this good too?
As for the eye area, if the gauze doesn't come off naturally, is it okay to leave it for a few days?
Also, does he need to apply Trivid enough bit to the eye area that is now leeching, bleeding, or oozing?
He wants to go to see you, but he has to miss school, so he went to another doctor's office now, but in February, he is going to see your wife's clinic.
(S) It looks like act-up. If it doesn't come off just by putting gauze on, leave it as it is on for one week. If there is no rebound-symptom coming out on your body, you're in good shape. Just keep on doing for a while.
(Q) Thank you very much, Dr. Sato, for taking time out of your busy schedule to reply to me.
Jan. 2022
(Q) Scalp dandruff
It's been almost a year since I went to see you and started NMT. I'm sorry to bother you, but I would appreciate it if you could answer one question for me. The dryness on my body seems to have calmed down. After washing my hair, it gets dry and itchy. In the winter, my dandruff is very much the next day. When I have to go out, I wash my hair because it bothers me. Is it possible that I have more dandruff because it's hard to produce sebum this time of year?
I wash my hair with hot water only once every three days, and with soap once a week, (when my scalp is scurfy, I wash it once every two days). If this symptom settles down as the sebum comes out, then I guess I need to be a little patient for now. I also sweat on my scalp sometimes after walking.
(S) Try to wash your hair without scrubbing the scalp. Scrubbing is the same as scratching and will make your scalp worse.
(Q) Thank you for the reply. Come to think of it, I was scrubbing my skin for sure. I will try to wash my hair without scrubbing.
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(Q) Seborrheic dermatitis
It's been a while. I was hospitalized about 5 years ago. At that time, I had symptoms on my face and body, and a part of my face was seborrheic dermatitis, so you told me to wash it with soap at the area. After that, things went back and forth until now. Even if I wash it with soap every day, it doesn't get better, and when I stopped using soap, it became more itchy, so I ended up using soap. I don't moisturize now, but I feel dry and itchy at this time of the year. Is this way okay?
(S) Now it would be necessary to stop using the soap in a long term.
(Q) Understood. I will stop it once. Thank you.
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(Q) TSW for 10 years
I've been TSW and NMT for over 10 years. It's gotten better and worse repeatedly, it's finally just dry skin, except for a few areas. The itching is still there, but the break by scratching is going away. Now, part of it is on my wrist, on the opposite side of my dominant hand, is still worse, and getting moist and weeping. It was fine until last summer, but it gradually got worse, and now it seems to past the peak in the worst.
Is it common to have symptoms in only one part of the body, even though it is not the part that has been heavily applied steroids? Also, for my wrist, Is it better to move it or not to move it in order to get better. Thank you very much for your cooperation.
(S) I am happy to hear that you are getting much better and that you have been keeping on.
The wrist is one of the most common sites of atopic dermatitis, so I can assume that the last part of atopy is still there.
It is not good if you move your wrists and get cracks, but if not, you can move them. In the cold winter season, you may want to wear a wrist supporter to protect against scratching. You can also try anti-itch oral medicine, it is not very effective though.
(Q) Thank you for your reply, Dr. Sato.
My wrist is still wet and I haven't gotten to the point of cracking yet, so I'll try to move it as much as I can. I will also try to wear a supporter to prevent scratching. I don't have any anti-itch oral medication on hand, are there any over-the-counter medicines ? Sorry for asking again.
It is very reassuring to know that "the last part of the atopy is still there." I can't believe I would reach the final stage after the long way. I will keep on TSW and NMT as always.
(S) One of the things is Restamin. It is inexpensive and makes you drowsy. Chlorpheniramine Maleate can also be used.
You can also take Fexofenadine (Allegra) and Epinastine (Alesion), which do not cause drowsiness. They are a bit expensive.
(Q) Thank you for telling me about it. I'll get it.
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(Q) Second year of TSW
Hi. I am a 21 year old woman who will soon be almost second year of TSW. I still have redness on my face even though it will soon be the second year. The skin on my face is getting thicker and thicker, and it's not just thick, it's rough and dry. I am very worried about whether this condition will ever go away or if it is normal. I would be very grateful for your answer.
(S) I'm afraid, but I wouldn't be able to say anything without examining you.
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(Q) Itching
Hi there. I would like to ask a question here. It's been 6 years now that my son has been TSW and NMT. Now his shoulders and collarbone area are dry, but since he is an adolescent, he doesn't show me much of his body, so I don't know the details. Now what I am concerned about are the bouts of itching. He is able to live a almost normal life, but when someone tells him "Do his homework," "Stop playing games," "Stop watching Youtube, etc.," he seems to get stressed out, and the itchiness comes on strongly like an electric shock, and he starts scratching his head, neck, and everywhere. The situation becomes unbearable to watch, which lasts for about 20 minutes. When it's too hot by air conditioner, or when he wants to go to sleep, he gets itchy attacks and scratch all over his body. It would be covered in blood, but surprisingly, it's fine, or sometimes it's bright red. I guess the itchiness will not go away until I get rid of it.
How about children and adults with TSW in the same situation?
(Q) Hello.
My name is Yoako, and I have a son in the fifth grade. My son's itching occurs mainly after we get home. His itching happens when he is relaxed rather than when he is out of the house or absorbed in something. It's like he's mindlessly scratching and doesn't even know he's scratching. Of course, scratching can also be triggered by being told something, when something goes wrong for him, or almost anything similar to what you wrote about.
I heard that your son is taking care of his nails by himself, so I think for parents the only thing left is to be patient and watch over him. He has to live with the fact that his skin is weak and atopic, and I don't think there is anything he can do about the fact that his skin gets dry easily and is sensitive to itching and irritation.
In such a situation, the silent pressure of parents is surely hard for the child. For parents it's hard to watch and to hear the scratching sound. But why don't you try not too much care of him? You can go to another room, or distract yourself with something else.
In my case, I'm always curious when I stay with him, so I've finally gotten to change my mind. Once I'm curious about something, I feel like looking into it, and I tend to give a good argument that "it would be better if you did this!" But I think he knows that, but the "itching" still happen.
People who have gotten better often say, "It gets better even you scratch it," which is true. It may be far from smooth skin, but my son's skin is clearly getting stronger even after scratching. This is even though he scratches for an hour every day. The only thing I could do for him was that the increase the amount of protein and eliminated the silent pressure from us. This is true even for my son who had never been any better. I don't know if the skin is getting stronger or if my son is changing the way he scratches. But it's true story. Don't worry, it's definitely getting better.
(Q) I feel reassured enormously with person in the same boat. Thank you.
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(Q) Dermatomyositis
Good evening, Dr. Sato. I had a blood test today and was told that I have dermatomyositis, immunopathy. My doctor said that I will have to start taking Prednisolone next week and eventually immunosuppressive drugs for the rest of my life. It's been less than 10 years since I started TSW, and my skin symptoms have been quite stable, but now that I'm finally back to normal, the use of steroids and immunosuppressive drugs makes me very scared. Do I have a choice to live with them or without them?
(S) I think it would be a good idea for you to get a second medical opinion from a physician or clinical immunology specializing in collagen diseases.
(Q) Thank you for your advice, Dr. Sato.
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(Q) Oozing from the ear
I am the mother of a junior high school student and we went to see you from Nagoya last December. His jaw and back of her knees are better than when we met you, and he is living happily. However, since the beginning of winter vacation, his left ear has suddenly cracked and is leaking exudate. Once it dried up and there was scaling, but since yesterday, a crack has appeared in my ear again and exudate is coming out. It seems to take a long time get dry compare to the exudate on his jaw before. I can't see the back of his ears very well, but he doesn't have any pain in his ears. Should he see a doctor as soon as possible?
(S) First of all, you should see an otolaryngologist for a diagnosis.
(Q) I understand. Thank you very much.