2023 | My Site 2

Jun. 2023

(Q) Possible infection of athlete's foot on TSW and TPW

After TSW and TPW on my face, my skin condition has been calm for a long time, sometimes it is red and rough, sometimes it is prone to acne, etc., and sometimes it gets worse. I have also been suffering from nail ringworm for many years, which has not been treated, and recently I discovered the onset of Tinea corporis in my axilla. I thought it was sweat rash or eczema in the early stages of the disease, so I scratched it when it itched and frequently touched my fingers, so it is possible that I may have spread the tinea to other parts of my body as well.

If the face area was touched, is it likely to be infected? In the case of nail ringworm, the nails can be examined, and in the case of the axilla, the hair can be examined, but the face would be more difficult to examine, in my opinion. Also, if there is a lingering infection such as mold or ringworm as a factor in the poor skin condition after TSW and TPW, will some treatment be needed for the better?

(S) Even if it is ringworm of the face, the test is very easy. You just need to do it the same way as any other place. I would assume that mold or ringworm infection has little to no effect during TSW or TPW.

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(Q) Dishidrotic Eczema
Greetings Dr Sato. Could you please advise best course of action for Dishidrotic (Pompholyx) eczema for my daughters fingers – shows as itchy blister type eczema. Also what might be causing these flares? many thanks in advance for your consideration & assistance. Kind Regards, Dina

(S) Cool her fingers. Avoid hand wash. Apply crotamiton cream. Take antihistamines.

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(Q) Itchiness

I would like to ask a question to those who are on this forum who are on TSW or had been TSW for a few years.

My son has had a few exacerbations since he has been TSW, and at times, several times a day, he gets terrible itching that seems to come up from inside his body.

It would stop for a few minutes, but within those short time, he would be scraping the pressure ulcers and new skin that had formed today.

When the flare-ups stop and the eczema is gone from his skin, the severe itching goes away, but it is very painful because that makes him to scratch the skin that has finally healed.

If you have had the same experience, I would appreciate it if you could tell me how you get over it or control the itching.
Best regards and thank you in advance.

(Q) Good evening, since I don't know your son's age it might not helpful, but, I went though TSW and NMT 10 years ago and now I'm so good. However, when I am tired at work or have a bad day mentally, itching starts from inside of my body.
When I start scratching, I can't stop it by my will. Especially around my forehead and eyebrows. I cover my hands and read my favorite comic books, play games as soon as the itch starts, grab my left wrist with my right hand and lie down to watch TV to focus on another things. When the itch subsides, I take a walk in the evening breeze.

(Q) Thanks for the reply. My son is in middle school.
When he is stressed or tired from school, etc., like you, he gets a terrible itching sensation from within his body.

My son cools his neck with an ice pack or when there is no oozing area, he takes a cold shower to calm him down, but it is getting worse now and it is very difficult to take a shower, so he tries to cool him down, taps the area. And eventually he scratches the area to let the attacks go away, but he is already covered in blood and it's painful to watch.

Thank you for your valuable input.

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(Q) TSW & NMT

Hi, I am a 50 year old man who has taken steroid ointments, antihistamines, and antiallergic medications for 30 years. After reading Dr. Sato's blog and books, I decided to TSW and NMT on my own, and six months have passed since then, beyond the days of hell. The itchiness and symptoms softened overall thanks to seasons changing, but about 3 months ago, I started to experience tinea pedis on both feet (like elephant skin) has worsened and I have been experiencing intense itching, white dandruff, oozing and pressure ulcers (but not as bad as at first). There is no hospital near me to consult, and I am getting anxious and feeling like my heart is about to break. Is there any hospital in Hokkaido that supports TSW?

(S) Please ask the following doctor. Not that they completely treat the same as me though

1 Dr. Kinuko Sasaki, Inoke Dermatology, Minami 9 Nishi 6, Chuo-ku, Sapporo, Hokkaido 011-511-5003
2 Dr. Chieko Nishio, Nishio Dermatology Clinic, 3F Shiroishi Medical, 1-1-1 Nango-dori, Shiroishi-ku, Sapporo, Hokkaido 011-865-0671
3 Dr. Michio Matsuda Fumizono Matsuda Dermatology 4-2-10 Fumizono, Kushiro, Hokkaido 0154-38-5160
4 Dr. Hitoshi Miyazawa Nishi-Sapporo Dermatology & Allergy Department 7-2-11 Nishimachikita, Nishi-ku, Sapporo, Hokkaido 3F 011-667-1199

(Q) Thank you, Dr. Sato. Just your reply gave me some relief in my heart. I will try to see a doctor of them. I would like to visit Osaka sometime if I can.

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(Q) Medication for Meniere's Disease

It has been over 2 years since I started TSW and NMT. I still have eczema.
My chronic disease, Meniere's disease, has come back and I told my doctor about TSW and he prescribed.
・Isosorbide syrup 6 packets a day
・Mecobalamin 3 tablets
・ADETPHOS KOWA 3 packets
Is it safe to take them?

(S) It is not a steroid. You can take it.

May. 2023

(Q) Eczema on palm of hand

I've been doing TSW for 8 years with the help of Dr. Sato's book. I have a problem with eczema on my palms. I get a lot of blister like spots no bigger than 1mm. It itches more when it gets crushed. Is there any effective treatment other than doing nothing?

My dermatologist told me that the bumps are made up of sweat. I feel that zinc ointment is not effective.
I was told that moisturizing is effective, so I applied the prescribed Azunol ointment on one palm for a few months, but I haven't used it recently because it doesn't look much different than when I don't apply it. I use shampoo about once a week, and as much as possible with my fingertips. I wash my hands with very little soap.

(S) Resting my hands is necessary. Besides doing nothing, it is necessary not to irritate the hands. Shampooing once a week is also irritating if you wash your entire hand, even if you wash your hands without soap. These need to be stopped.

(Q) I'm so glad to hear that the direction of treatment. I will try to rest. Thank you so much Dr. Sato!

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(Q) About Nummular Eczema

I have one more question for you. I have a large oozing nummular eczema.
Would it be a bad idea to put zinc ointment on this before sleeping?
Would it work as moisturizing?

Thank you in advance.

(S) Sometimes putting zinc oxide ointment on nummular eczema can help, but not always. It is difficult to tell.

(Q) Thank you.

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(Q) About FUCIDIN LEO Ointment
Hi. I am currently on antibiotics to treat an infection. The area is not drying out and still oozing. I got FUCIDIN LEO Ointment, which would help it heal faster, applying it or not? Thank you in advance.

(S) It depends on the sensitivity of the bacteria causing the infection, and if you have been TSW, then it could be moisturizer dependence.

(Q) Thanks for the reply. Do you mean that could works as moisturizing? I want to keep my skin dry so I will not do it. Thank you very much.

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(Q) Bleeding hemorrhoids
It's been 5 years since I've been TSW and my symptoms have calmed down a lot! I had a bleeding hemorrhoid with childbirth the day before and was prescribed Neriza ointment. I am not sure if I should apply the ointment because it contains steroids.
When I asked my doctor to prescribe something without steroids, his face turned confused and said it would be difficult.
Is it safe to apply it?

(S) It could effect for whole body. Chronic use can make the anal area worse. I can tell there are steroid-free suppositories such as BORRAZA-G.

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(Q) Dry scalp
I have a very dry scalp with large oozing areas and almost all of my hair has fallen out. (no dripping due to exudate). Normally, after taking a bath, I would think that the oozing patches would dry out and form scabs, but they did not form scabs at all and remained red and seeping, and I was worried, so I went to see a dermatologist who had treated me for an infection before. He said that is not seborrheic dermatitis and prescribed BEPOTASTINE BESILATE OD Tablets and zinc ointment (mixed with Vaseline). Personally, as a person who has been off ointment for years and had remission many times, I am very reluctant to put this cream on my body again.
Wouldn't putting zinc oxide ointment on my body be "moisturizing"?
I am at a loss as to what to do. Thank you in advance for your help!

(S) I would need you to be aware of excessive water intake and skin infections. If it's the former, you'll need to restrict fluid intake, and if it's the latter, you'll need to take antibiotics.

(Q) Dr. Sato, thank you for your reply. As for the water restriction, it was excessive, so I will carefully review the intake especially during the day/before bedtime when the thirst is worse. How can I determine if there is a skin infection?

(S) You have to learn to see skin infections over and over again. But, that must be the doctor's job.

(Q) Thank you again. The day before yesterday, I resumed exercising after a long time, and after I kept my water-intake within 1200ml, the exudate from my forehead, which had been coming out all day until today, stopped after bathing. (It was not on my pillow or bed when I turned in the next morning either.) I could see directly and by touching it softly with my finger, that both the forehead wound and the scalp area next to where the hair had fallen out were firmly dried and new skin was regenerating.

I am not sure if this is a result of the zinc ointment I applied the day before (about 3 days) or if it stopped due to fluid restriction or exercise, but I will continue to follow the water restriction and eat a good amount of protein. Thank you very much.

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(Q) TSW for children

I am the mother of a daughter who is currently in 3rd grade. This spring will be her 5th year of TSW and I was relieved that her skin was in very good condition, but since late March, she has been experiencing scratching on her extremities, around her neck, and overall skin roughness, and I have no idea why. In addition, her skin has become flaky due to the recent dry air. Has anyone else experienced a sudden deterioration this spring that is different from what it has been?
We have been following Dr. Sato's book since the beginning of the TSW and have followed what not to do and what to do.
Is it just a seasonal problem? Is it possible to have a deterioration caused by mental at this age as well? Sorry for many questions.

(S) Isn't there any stress in friendships due to class changes, etc.?

(Q) Thank you for your reply. It would be natural there is aggravation from such things after all.
It seems to her that there could be stress from class changes and friendships. In such cases, if she tries to relieve stress, will she be able to recover again?
We are at a loss as to what to do, because although the condition has not worsened significantly, it seems to be different from what it has been up to now.

(S) Even for children, it is important to reduce and relieve stress.

(Q) Thank you for your reply. We will try to think of ways to reduce her stress as much as possible.

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(Q) Progress after TSW
I am currently 25 years old. About three years ago, I started TSW and NMT, stopping the use of steroids and moisturizers that I had been using for the previous two years, and my symptoms have settled down after several rebounds. However, I am prone to redness on my face (above my ears, eyelids, and forehead) where I used to apply steroids and protopic often, and I have recently developed exudates for the first time in a long time. Before I was prescribed steroids for eczema on my back in my early 20s, I had no history of steroid use, and my eczema was almost non-existent except in my early childhood.
・After TSW and NMT, is it still difficult to return to the normal skin that I used to have?　I used to have no problems even if I stayed up late or ate or drank too much.
・Is it still unavoidable for symptoms to reappear where I have often applied steroids?

I am worried because I can't see the way forward, so I am asking here.

(S) I suppose it is easy to get worse if you "stay up late, drink and eat heavily". In that sense, my skin is not stable. However, if you do what you should do and avoid what you shouldn't do, it is less likely to get worse.

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(Q) Thick scabs

I have some erosion-like scabs that are about 3mm thick and sticking up after the herpes got worse and became infected.
Is it better to wait for them to come off naturally by not scratching them off and keeping them?
Or is it better not to guard it and scratch it off at night to make thin scabs again?
Thank you in advance.

(S) If the "infection" is a "bacterial infection" then the crust needs to be removed. More importantly, you probably need to take antibiotics.

(Q) Thank you for taking the time to answer. I am not able to judge correctly if I have an infection or a bacterial infection, so I will take antibiotics for a while and see what happens. Thank you.

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(Q) About MNT

Hi, Dr. Sato. Thank you for the other day. My name is Murata. My husband [74 years old] has been NMT for 2 months after seeing you. Recently, he seems to have a lot of itching pain, and today he is in a lot of pain and his whole body hurts so much that he feels dizzy. He has been NMT since the day he saw you, not gradually, but if he gets one moisturizer, will he go back to it? Should he not moisturize even once if possible?

(S) I told him to gradually reduce the topical application to make the pain and itching more tolerable. It is up to him to decide which method he would like to take.

(Q) Thanks for your reply. Yes, I appreciate it! He ended up not moisturizing today. He was struggling with the fact that you told him that he should cut back from twice a week to once a week and quit, and that he had stopped moisturizing for 2 months. He is pushing himself to get better as quickly as possible, so I will just tell him one more time and leave it to him.

He seems to be more itchy and sore now after 2 months than he was a month ago, and he's worried that it's gotten worse or won't heal, but is that common with TSW and NMT?
It would depend on how you spend your time, right?

He's been working especially hard lately, moving his arms and legs and walking, because he wants to feel a little better by the time he sees you. lol.

On a side note, I attended the lecture the other day at the end of the morning. Seeing you is the most encouraging thing for us. I found out after seeing you, I hope that your TSW & NMT treatment will be spread all over the world in the right way.

(S) As the skin improves, scabs form on the joints, and the pain can become more intense as the cracks form, and the itching can become more intense as the scabs try to come off. Therefore, when the skin rash improves during the improvement process, the subjective symptoms, pain and itchiness would rather worsen. It is important not to consider the worsening of subjective symptoms at this time as a worsening of the skin or stagnation of improvement.

(Q) Thank you, I am relieved. He is going to try his best not to moisturize as it is. Thank you very much.

Apr. 2023

(Q) Dermatologist in Kyoto who does not use steroids

Are there any dermatologists or clinics in Kyoto that recommend TSW treatment?

(S) Shimazu Clinic, located in Mibu.

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(Q) It has been more than six months and here is a progress report.
The progress is going well. I was free from eczema and itching in November last year, two months after I started TSW and NMT last September. As of now (April), I am doing very well with no recurrence or worsening. However, even now, more than half a year later, I still take baths and showers as little as possible and wash my face once a week. My dry skin is still as dry as ever, and although it has powderd skin after washing my face, it is not so dry that it bothers me the day after washing my face. Above all, I am relieved to be free from eczema, itching, insomnia, and also free from steroids. Without your advice, I would never have reached this point. Thank you so much.

(S) I'm pleased to hear your good progress report. Keep up the good work. Perhaps a little more exercise is needed for you. I hope you can produce more sebum.

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(Q) Water restrictions while breastfeeding

I'm currently raising a 7-month-old baby and it's been a week since TSW and NMT.
I am breastfeeding while TSW and NMT, should I limit water intake to 1000ml even while breastfeeding?

The symptom of withdrawal is only flakes all over my body (flakes on my face, worse above my eyebrows, and powdery on my body). I am currently feeding 4 times a day, about 180 ml each time. I am thirsty, so I take about 1500ml, but I would be grateful if you could help me.

(S) You will lose fluid (180 x 4 = 720 ml/day) for the baby. If your normally fluid level before breastfeeding was 1000 ml/day, you would need 1720 ml. By the way, it would be time to start baby food and stop breastfeeding.

(Q) Thank you for your reply.
As you said, my baby is currently eating weaning food 2 times/day and started going to daycare in April, so I feed him 4 times as follows.
My baby drinks 180 ml at most,
Probably 180 + 100 + 100 + 100 + 100 + 100 + 100 milking = 580 ml which is just a rough estimate.

I am relieved to hear that it is OK to drink the breastfeeding amount.

By the way, during TSW and NMT, is it common to see eye discharge as well?

(S) There is no direct relationship between TSW & NMT and eye irritation, but it can occur when the eyes and eyelids are itchy and scratchy.

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(Q) Topical Steroid Withdrawal

Hello, my name is Jono. I am from Australia. I have been on topical steroids since a child. I am now in my fourth month of TSW and I have been trialling no moisture therapy. There is little to no support in my country and I am desperate for some help and answers. I had to leave my job, I am in so much pain and swelling. I do not sleep. Any advice would be great.

(S) Dear Jono:

Please look at the following sites.
How to get over Topical Steroid Withdrawal asap! | 元気が出る徳子の部屋 (tokuko.chu.jp)
脱ステ・脱保湿サポート・グループ
The NMT Healed Club (Facebook)
NMT Education Group (Facebook)
脱ステ・脱保湿サポート・インフォ（Facebook）
Tokuko’s Room to Feel Uplifted (Facebook)

Mar. 2023

(Q) Eczema on palm of hand

(Q) I'm so glad to hear that the direction of treatment. I will try to rest. Thank you so much Dr. Sato!

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(Q) About Nummular Eczema

I have one more question for you. I have a large oozing nummular eczema.
Would it be a bad idea to put zinc ointment on this before sleeping?
Would it work as moisturizing?

Thank you in advance.

(S) Sometimes putting zinc oxide ointment on nummular eczema can help, but not always. It is difficult to tell.

(Q) Thank you.

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(S) It depends on the sensitivity of the bacteria causing the infection, and if you have been TSW, then it could be moisturizer dependence.

(Q) Thanks for the reply. Do you mean that could works as moisturizing? I want to keep my skin dry so I will not do it. Thank you very much.

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(S) It could effect for whole body. Chronic use can make the anal area worse. I can tell there are steroid-free suppositories such as BORRAZA-G.

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(S) I would need you to be aware of excessive water intake and skin infections. If it's the former, you'll need to restrict fluid intake, and if it's the latter, you'll need to take antibiotics.

(S) You have to learn to see skin infections over and over again. But, that must be the doctor's job.

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(Q) TSW for children

(S) Isn't there any stress in friendships due to class changes, etc.?

(S) Even for children, it is important to reduce and relieve stress.

(Q) Thank you for your reply. We will try to think of ways to reduce her stress as much as possible.

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I am worried because I can't see the way forward, so I am asking here.

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(Q) Thick scabs

(S) If the "infection" is a "bacterial infection" then the crust needs to be removed. More importantly, you probably need to take antibiotics.

(Q) Thank you for taking the time to answer. I am not able to judge correctly if I have an infection or a bacterial infection, so I will take antibiotics for a while and see what happens. Thank you.

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(Q) About MNT

(S) I told him to gradually reduce the topical application to make the pain and itching more tolerable. It is up to him to decide which method he would like to take.

He's been working especially hard lately, moving his arms and legs and walking, because he wants to feel a little better by the time he sees you. lol.

(Q) Thank you, I am relieved. He is going to try his best not to moisturize as it is. Thank you very much.

Feb. 2023

(Q) Steroid eye drops prescribed for sty

My 9-year-old son had a sty and his left eyelid was swollen to the point of bulging, we went to the ophthalmologist and the doctor explained that he usually prescribes Fluorometholone eye drops 0.1% steroid for sty. My son started TSW and NMT at his age 5 and saw Dr. Sato once. At that time, after about a month or two of withdrawal symptoms with lots of exudate, the skin became scabby and cracked.
Now his wrists to fingertips and backs of knees are dry and in the winter he even cracks his wrists to fingertips in several places, but he is able to live without using any moisturizers or anything else. We have told his eye doctor that he is trying not to use steroids, so we do not take his prescription of steroids and see how it goes. In your book, you also say not to use eye drops, but I wonder if using them will worsen the skin symptoms again. The ophthalmologist told me that there are methods such as making an incision under partial anesthesia because it is too large to be removed by needle puncture, but I can't imagine such a procedure for a 9-year-old child, so I guess I should just keep an eye on it until it ruptures.

(S) It should be able to give him oral antibiotics and intravenous drops. Some people's eczema got worse after steroid eyedrops.

(Q) Dr. Sato. Thank you very much for your reply.
It seems to be feeling better, but if it gets any worse, I will talk to the ophthalmologist about oral antibiotics and IV drip.

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(Q) Itching and pain after shower

Hi, I'm glad to ask you here. It has been 2 months since I started TSW and NMT.
Since the start of TSW, the intense itching and pain after taking a bath (shower) has been so painful that it brings tears to my eyes, and I have not taken a bath for the past month. I shower once a week (low temperature, 5 minutes or less). However, the dryness and itching have only gotten a little better, not much. The itching and pain is on the upper part of the body, but the area without erosion etc. is painful and itchy.
So, I have some questions.
(1) Is showering painful like this for TSW patients?
(2) If a little more time passes, will the pain and itching after showering become better?
Thank you in advance.

(S) You are right in both (1) and (2). Try not to scrub your skin while showering.

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(Q) I am Yamamoto, mother of a 15-year-old boy who was seen last week.
He's been taking antibiotics every day since then, but his symptoms haven't improved, in fact, they seem to be getting worse with the scratching. He takes Polaramine at night, but he scratches involuntarily and in the morning all the pressure ulcers have come off and there is exudate. He still takes Polaramine when he scratches, but he wants to go to bed. He showers, but how often should he take a shower? Should he bathe or not when he has an infection? Also, should he exercise at this point, he walks for 30 minutes. He doesn't want to go to school and has been out of school for 2 weeks now.

(S) You could post a photo on Mixi (below), I think.
https://mixi.jp/view_community.pl?id=1758719
Why don't you post it in Children's TSW & NMT Topic No.14.
The drowsiness could be a side effect of Polaramine. You may want to discontinue it. It sounds like a daily shower from the neck down is ok for short periods of time. As for the face, I can't judge without seeing it. Exercise would be better. He may feel better if he decides not to go to school for a while.

(Q) Thanks for your reply, I posted a picture on mixi. I would appreciate it if you could take a look.

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(Q) About Pollen
Pollen season is coming up and now my symptoms are more severe on my face. I go outside for exercise. Is there any relationship between atopy and pollen? If so, how should I treat pollen after going outside?

(S) I don't think atopic dermatitis and pollen have anything to do with each other. Although if pollen gets into your eyes or nose, you may scratch your eyes or nose because your eyes or nose get itchy. If it bothers you when you come home after going out, just take a shower on your face for one second.

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(Q) Athlete's foot during TSW & NMT

Hi, Dr. Sato. I've read your book, and have started TSW and NMT since last early December. At first, the inflammation was only on my face and part of my back. After the inflammation worsened on the whole face, the desquamation steadily decreased and now there are only some erosions on the forehead and other parts of the face.
On the body, the inflammation has worsened on the back of the neck, the entire back, the backs of both knees, and from the armpits to both fingers. My skin is almost entirely erosive, my back is like burning and itches every night, and I am having trouble sleeping, but I manage to keep regular wake-up and bedtimes. Now that my facial symptoms are completely healed, I will persistently continue to improve my lifestyle, including fluid restriction, heart rate 130 exercise, bathing, and diet, for the better.
As a preliminary note, I found out last night that a family member had a severe case of athlete's foot.
I am aware that I may have contracted it myself, so if I am diagnosed with athlete's foot by my local doctor, what kind of medication should I hope to receive, whether it be an ointment or a drink?
I have been unable to find a clinic in my neighborhood that understands TSW, let alone NMT, and when I went to see a doctor for Quincke's edema, he was offended when I asked him to look at the inflammation on my body. I would like to get some kind of medication for athlete's foot only anyway, not to see a local doctor for atopic dermatitis. I would be very grateful for any advice you could give me. Thanks.

(S) Athlete's foot is rarely transmitted unless shoes are shared or touched often. Oral medications should not be used immediately for athlete's foot because of possible side effects. If you really have athlete's foot, over-the-counter athlete's foot medications will work just fine.

(Q) Dr. Sato, thank you very much for your quick response. I suspect that sharing a bath foot wipe mat could be the cause. I am a little afraid of the local doctor, so I will stop sharing the mat immediately, buy some over-the-counter athlete's foot medicine and apply it only to my toes, and observe the change in condition. I was so anxious when I was trying such a small thing by myself. Many thanks. I am also very grateful to you for your books and other information about TSW and NMT. Thanks to you, I have had the opportunity to reflect on my past lifestyle, including my atopic disease. The comments from patients' community have also helped me a great deal. Thank you for your continued support.

Jan. 2023

(Q) Eczema treatment & TSW
How do you differentiate actual eczema patches during TSW. Also after TSW has been completed what do you do and how do you treat eczema patches that occur on hands, inside elbows, back of knees – how can this be treated without using steroids? Many thanks.

(S) We interpret "actual eczema" as atopic dermatitis. TSW is caused by decreased steroid production in the skin. Therefore, atopic dermatitis and TSW always coexist in varying degrees. As steroid production in the skin regenerates, the inflammation of the skin caused by TSW becomes milder and the degree of inflammation of atopic dermatitis becomes stronger. Even if you think TSW is over, if you continue to moisturize, TSW is most likely not over. Moisturizer withdrawal is required.
Hands, inside elbows, and back of knees should be kept dry without moisturizer. Scratching is allowed. Gauze or bandages may be used to protect the skin to prevent scratching. Fluid intake should be limited and exercise should be continued. Showering should be reduced to once every few days.

(Q) Thank you so much Dr Sato, your advice is greatly appreciated and in turn I apologise for not being able to write in Japanese. Wishing you the best.

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(Q) About Licorice (Chinese herb)
Hi Dr. Sato, nice to meet you. I would like to post about the skin condition of my 15 year old child. He had atopic symptoms since he was a newborn and was seen at a clinic in Hiroshima. He took a long time to heal, but when he was 7 years old, his skin condition worsened due to impetigo and herpes. The itching made it difficult to sleep at night, so he went to see the doctor again and improved from the start of TSW and NMT. (He used a small amount of steroids at that time for about 3 days.) He has been living my life without applying ointments, and for a few years he was doing well with only partial eczema, but around April last year, eczema the size of a 10 yen coin started to appear on his neck. And then the eczema spread to the front of his neck, elbows, face, knees, and the entire body.
I am trying to find various causes, but I suspect a licorice after reading your past comment on this forum. He has been taking Chinese herbal medicine continuously as a nourishing tonic for coronavirus and diseases.
The daily intake of licorice is 30 mg.
I am thinking that if it stimulates corticoid receptors, he should stop. Should he stop gradually, as the same as TSW?Or is it okay to stop all at once? We would appreciate a reply from you, as we are currently in a different former place of residence and do not have a medical facility where we can see or consult with.

(S) I can't tell you exactly what to do because I have no case. A safer approach would be to stop gradually. Reduce the amount per dose, or increase the interval between doses.

(Q) Thank you for your reply, Dr. Sato. He will try to reduce the intake interval little by little. The exudates have stopped since the beginning of fall and seemed to be improving a little. However, since the beginning of the new year, the itching, bleeding from scratching, and exudation have worsened again. He is trying to find the cause of the worsening, but can't do anything about it. I have not been able to find a hospital that understands TSW methods, especially NMT, and I am glad I was able to talk to you about it here.

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(Q) Symptom on my face changes due to oral steroids
I had previously been examined by you at Hannan Chuo Hospital for Protopic withdrawal. The symptom was on my face. It had been more than 5 years and I had not used any topical medication during that time. The condition of the skin on my face was not up to normal, but I did not use it. The other day, an otolaryngologist prescribed of oral steroids and Betamethasone for a short term, 4 days, to treat sudden hearing loss. In addition, he was prescribed Methycobal and ADETPHOS KOWA. After 4 days of oral steroids, the affected area on my face returned to normal. I understand that this is due to the medication and is temporary, but I am asking you because I have questions about the dramatic change in a short period of time on oral medication. I wonder if my adrenal and pituitary glands are not working properly as a result of repeated hospitalization for steroid treatment, use of topical protopic medications, and steroid withdrawal and protopic withdrawal in the past, rather than the skin itself. The secretion of steroid hormones produced by the body is no longer normal as a result of past treatment. If the adrenal and pituitary glands themselves may be adversely affected by past treatment for the initial skin disease, I would consider practicing in the internal medicine specializing in endocrinology or metabolism.

(S) During TSW, the steroid hormone secretion you mentioned is not from the adrenal glands, but from the skin. It would be necessary to consistently train your body to increase steroid hormone secretion in the skin. Steroid hormone production in the adrenal glands will not decrease unless you apply very large amounts of strong steroids for a long period of time.
Once the skin improves, see if it does not get worse. If it does not get worsened, you will know that TSW has been successful by the steroid tapering.

(Q) Dear Dr. Sato
Thank you very much for taking a look at my comment and answering my questions.
Thanks to your response, I am now able to have room in my mind for my concerns and worries. After I am no longer taking oral steroids as a treatment for sudden hearing loss, I will also pay attention to my skin for a while.

(Q) It has been 3 days since I stopped taking oral medications and I am seeing eczema and exudates in the areas where I was doing Protopic withdrawal. We take this to mean that withdrawal symptoms are occurring because the steroid medication had been working. I understand that the rebound is a natural result of the steroids, since the return to normal is temporary effects of the steroids, and when I stop taking them, the condition returns to normal, and what has not been normal for years returns to normal. As you said, I feel that the steroid hormone secretion in the skin has not become normal in Protopic withdrawal areas. In this skin condition, I think there is a possibility in the future when receiving oral steroids or intravenous steroids during treatment for other diseases, but it would be very physically and mentally painful for the Protopic withdrawal-skin area to go through withdrawal symptoms each time. What is the best way to deal with or avoid this in the case of those who have been TSW or TPW for many years and are still in the process or have not reached a radical cure?

(S) You need a basic TSW and NMT approach. It would be to put more emphasis on exercise and physical training.

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(Q) About jak inhibitors
https://www.dermatol.or.jp/uploads/uploads/files/jak_statment-AD2.pdf
In the above URL, side effects of oral jak inhibitors are reported, and the text says that they should be carefully observed especially. However, I am concerned that the same flareup may be made as with steroid medication. Could you please let me know what the recent dermatological societies and other organizations are doing about it?

(S) It is recommended for use in cases that do not heal well with steroids and other drugs. Pharmaceutical companies also advertise it.