(Q) Back of the hand

 I have blisters and exudate on the back of my hand, and I have a piece of gauze on it. It itches a lot and sometimes the gauze comes off when I scratch it. I put an elastic bandage for my finger to hold the gauze in place.
The area where the blister was crushed looks like a hardened yellow fluid, is this an infection?
I wash my hands only at the fingertips when the gauze is on, and once a day even when the gauze is not sticking to my fingers. Will it get better with gauze treatment? If it is an infection, should I get antibiotics from doctor? Is there nothing I can do but to put up with the itchiness as it is?

One more thing, the inside of my nose is dry and bleeding. It happens every winter, but this is the first time in summer. I always used to apply a thin layer of Vaseline inside my nose, but is it okay to apply Vaseline? Is the dryness of my nose also related to TSW and NMT?

 

(S) Is the gauze washed with tap water and dried? If yellow liquid is solid, I do not think infection has occurred.
Are you washing your hands too often or too hard? If your nose is dry or bleeding, please ask your ENT doctor.

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(Q) Thank you Dr. Sato.
I am relieved to hear that the solid yellow liquid is not an infection. I am replacing the gauze with washed and dried gauze every day, as long as it is not sticking. I wash my hands only the tips of my fingers, not the backs of my hands, but is it bad to not wash them for many days? As for my nose, I'll see an otolaryngologist.

(S) No need to worry if I don't wash the area for about a week.

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

Thank you for your help regarding the back of my hand the other day. The back of my hand is itchy, and I repeatedly scratch it, exudate comes out, and then stick a piece of gauze on it. Should I not apply zinc ointment?
Will it get better faster if I continue to repeatedly scratch, exudate, and apply a piece of gauze?

I would appreciate your advice on the zinc oxide ointment, as I keep scratching it and getting exudate even though the gauze helps to solidify the exudate.

(S) I haven't seen any cases of zinc oxide ointment on the back of the hand and it got better. Just try a bandage over the gauze for a short period of time to protect it from scratching.

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(Q) I appreciate your help as always.
My son is your patient. Thank you for all your help. He had been suffering from itchiness, pain, and mental health problems due to the deterioration of his whole body, is now recovering well from his wounds and his mind has become more energetic by staying in your hospital. I will refrain from writing details on this forum, but I wanted to express my gratitude.
You saved not only my son but also my family and my parents who are worried about him. We would very much like to express our gratitude in person at the next visit to you. I know you are busy, but please take care of yourself. Thank you for everything.

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(S) I am glad you are feeling better. Thank you for contacting me all the way.

 

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(Q) About Chinese Medicine

 Dear Dr. Sato

 I have been going through TSW and NMT, but I could not continue, so I went to a doctor treating steroid-free methods, which was a Chinese medicine clinic. The doctor there gave me a decoction of Chinese herbs to drink and to apply. Accordhing to the medicine book, it contains licorice and other herbal remedies. I understand you said in your book that licorice is not good for TSW, but should I stop both? I can see that licorice is in many things, but is it harmless to people who are not atopic dermatitis?

Also, I am looking for one myself, but I can't find TSW doctor in Kumamoto prefecture, do you know of any?

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(S) Licorice has the side effect of sodium buildup. Topical application would lead to moisturizing. If you can't do TSW and NMT, try to consult a Chinese herbalist to help you get better. Did you do what you should have done and what you should not have done in TSW and NMT? Just look back the way you did.
There are no TSW doctors in Kumamoto prefecture.

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

Actually, I would like to continue TSW and NMT treatment, but, I will re-read your book once again.

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(Q) Toes

 Dear, Dr. Kenji Sato.

My husband's right toe, which you examined last month, has a lot of exudate and the affected area is red since about the day before yesterday. There is a little pain. He puts a piece of gauze on it and washes the area for his right foot only once every three days, and although it used to itch, he does not seem to scratch it. He wears socks at work. Is it ok to apply a little Stockholm tar ointment? Can you please let me know if there are any aggravating factors or things I should be aware of?

(S) As for a lot of exudate and the affected area is red your husband had from yesterday, it seems to me that you need to see a local dermatologist to find out what the cause of this is. I am not sure if topical "wood tar(pine tar)" is a good idea in case the cause is not known.

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(Q) Allergic reaction

 Dear, Dr. Sato. I have been going through TSW, NMT for over 100 days, bathed every 3 days, and exercised. Lately, I have been drinking water, maybe a lot, but rarely after 7pm. Today, I got an itch that I have never experienced before.
After a bit of strength training, I drank a mixture of protein and MTC oil, which I have been drinking for the past few days, and after a while, my neck started to itch, I started sweating and thought it was because it was hot, but as that neck sweat kept coming out, the itching increased and my elbows, face and chest area also started itching intensely.
The sweaty stuff from my neck was the worst. There was no redness or eczema. It lasted about 40 minutes and subsided. During the process, I took an antiallergic drug, Bilanoa.
Would this be an allergic reaction?
I was also milling brown rice, so I also wondered if I was allergic to something from that process. I am not allergic to rice. This was my first experience and I was panicking. In this case, do I have any choice but to endure until it gets better?
I am worried that the same thing will happen again. What should I take care of going forward, and do you prescribe medicine for this kind of symptom?

(S) Were the areas that sweated this time not sweating before? If so, then skin function is on the way to improvement. Did you have urticaria when the itching occurred? It would be a good idea to take pictures of the symptom going forward. If you have strong itching, you should probably take an anti-itch medicine like Bilanoa and apply a cold pack. Your itching this time may be related to low pressure (typhoon).

(Q) Thank you Dr. Sato.

 My neck does not sweat as much as it did this time, but mainly after doing exercises, I sweat on my neck and forehead.
It is not an area that has never sweated before, but I would be happy if it is on the way to recovery. I had been taking Bilanoa for a while, but I didn't take it for the past two weeks because I didn't think it would work well. I was thinking of taking it for a week or two because I am afraid of getting it again, but is it better to take it only when I have symptoms or only during the period when I have symptoms and the low pressure is likely to last?

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(S) That's about right.

 

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(Q) Steroids and Menstruation

 I have a concern about my college student daughter. She has originally had dry atopic skin and had been able to use little or no steroids and only moisturizer, but last spring she began to have partial redness on her face, which spread to her whole body and worsened. She applied steroids to her face, hands, feet, and body until around August.
(→ Now I think that using steroids when the symptoms were first mild caused the redness and itching to spread all over my body.)
From September, she managed to keep the intervals between steroid applications as short as possible, using mainly moisturizers. (As a result, desquamation continued every day.) She started standard treatment again in January of this year, and is currently working on TSW and NMT after this summer vacation.
My concern is that her menstruation has stopped since last summer. She went to see a gynecologist, who said there were no abnormalities in my blood tests or uterus, etc. and told her to take the pill (Jemina).
You are saying in your book, "Some people stop menstruating when you start TSW." Does that mean taking the pill? Or is it another therapy or treatment?

I am very anxious and resistant to taking a medication like the Pill every day.
I think that the effects of steroids, anti-allergic drugs, and weight loss due to dietary restrictions are the cause of the irregular menstruation, but her doctor says that the steroids have no effect.
As a parent, I would like to get her body back to normal first.

I apologize for the confusing sentences. Thank you in advance.

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(S) When you start TSW, your periods temporarily stop, but in her case, have she had irregular periods since she was still using steroids? There may be an effect of TSW, but it is unknown.
For irregular periods during TSW, you can take hormonal medications and stop with them once your periods return. The principle is the same, although the medications used may vary slightly by each doctor. If you are unsure, it may be a good idea to see another gynecologist for a second opinion.

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(Q) Heat rash on the skin

 I was in the hospital last October-November. Thank you for all your support! I've been TSW and NMT for 2 years and 8 months. Under this extremely hot, withdrawal symptoms and atopic flare-ups have quickly worsened. Now in addition to that, my sweat rash has spread and its itchiness is getting worse. I work outside almost every day, during half a day, I sweat a lot. I can't take a parasol, so I wear a wide-brimmed hat at work. 
Is it possible that it could get worse due to direct sunlight or excessive exposure to UV rays? The bumps of sweat rash are spreading rapidly. Do I need antibiotics?

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(S) It can get worse if you are exposed to a lot of UV rays at once for a long period of time. A wide-brimmed hat would be fine. If there is a bacterial infection you will probably need antibiotics, but not sure if you have an infection or not.

(Q) Dr. Kenji Sato, thank you from the bottom of my heart for your prompt reply. Working outside where I have to walk a lot is good for me because I can focus my mind on something other than my skin, but this heat seems to be too severe for my sensitive skin. I will try to deal with it using a neck fan and ice packs. Water restriction is difficult this time of year, but I will do as much as I can and follw it properly again in the fall.

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(Q) Infection

 It's been a while. I was hospitalized 10 years ago. My body skin had healed and my face was a little red and dry, and my scalp was still dry. Last month I had a cold with fever, and after healing, I suddenly started to get exudates from my face, neck, and ear area, and my lymphatic system is swollen. I don't have exudate during the daytime, but I get some during sleep. It has been almost a month. Is it a bacterial infection? If so, should I go to see a doctor and get antibiotics? It is getting better little by little, so I left as it is.

(S) There is a possibility of infection. Are fluid restrictions being followed? Especially at night.

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(Q) I am keeping to the fluid restrictions. Should I go to see a doctor and get antibiotics? Or will it heal itself?

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(S) If it is an infection, you should take antibiotics, but if it is getting better gradually, why don't you wait a bit?

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(Q) I went to Tarao Dermatology the day before yesterday and received antibiotics. Thank you very much.