July. 2023
(Q) Conjunctivitis and eczema of eyelids in a first grader
Hi, nice to meet you. I am a mother of a first grader who used steroids for a couple of years from around 2 years old and started TSW and NMT around 5 years old. About 6 months ago, she seemed itchy with a red eczema from between her eyebrows to both eyelids, I thought it was one of the withdrawal symptoms and kept an eye on her, but it seemed to be getting worse, and she also seemed itchy in her eyes, so the other day we went to see an ophthalmologist. The diagnosis was conjunctivitis, and since her skin was also inflamed (with bleeding due to scratching), the following three medications were recommended for treatment.
(1) Anti-allergic eye drops
(2) Steroid eye drops
(3) Topical steroids
Although I consulted with the doctor about the absolute avoidance of steroid use for both mother and child, as I myself had developed glaucoma in my 20s due to topical steroid use, he said she should reduce inflammation as soon as possible with steroid use because the pressure caused by continued eye scratching could induce retinal detachment. Since we could not make an immediate decision, she prescribed only Alesion LX for now and she has been using for about one month, but neither the itching of her eyes nor the inflammation of her skin seems to have improved. If it was only skin inflammation, she would have continued TSW and NMT without any problems, but now there is a possibility of retinal detachment for her, and I am wondering if it is OK to continue with this treatment. I saw that you recommended anti-allergy eye drops and medication for conjunctivitis for adults in this forum, so I was wondering if the same thing should be applicable to children?
I would appreciate any advice you can give me. We are having a hard time finding a TSW doctor nearby.... Thank you very much for your time.
(S) I would first recommend anti-allergic drops and medication for conjunctivitis. Is there any emotional stress that is causing the itching? Look for other irritants that make the eyelids itch. If so, avoid them.
(Q) Dr. Sato. Thank you very much for your prompt reply. (I am very grateful for the place I can post like this even though you live far away from me.)
First of all, we will try anti-allergic eye drops and medication. And I can think of a lot of her mental stress. The change of environment from nursery school to elementary school, the birth of my baby in May, her sister who is 2 years younger than her tends to throw tantrums (and her frustration is directed at me), etc...
I am also doing TSW and my skin rash worsened after childbirth, and I tend to be irritable, and even when I am careful, I tend to take it out on my children, so I think that is also a part of the reason for it. Also, her hair is short and doesn't seem to itch by touching the skin, but she looks hot and humid and sweaty and itchy.
Looking back on it, I feel that the mental aspect is a major cause of her itchiness, so I think I should try to make our interactions with her as stress-free as possible.
Thank you very much for your advice.
Thank you again.
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(Q) Exudates on hands
Hi, Dr. Sato. The symptoms on my hands have been present for about a month and a half now, but recently, from the instep area, exudate has started to appear. If it is not sticking to the gauze, can I just leave it as it is as much as possible? I wear vinyl gloves over cotton gloves for housework and cooking. Since I have to put on and take off the gloves again and again, would it be a cause of aggravation to put a bandage on top of the gauze? Thank you in advance.
(S) If it doesn't stick when gauze is applied, then no gauze is needed. Hence no bandage. The only thing you can do is to keep the plastic gloves on for as short a time as possible.
(Q) Thank you Dr. Sato.
Is the exudate after some time insufficient fluid restriction?
I think I was taking a lot due to the hot weather.
Also, is it not a good idea to keep cotton gloves on during the day and at night?
Last night, when I slept with gloves on, the exudate sticked to the gloves and when I took them off, it felt like they were peeling off.
Thank you in advance.
(S) I am not sure why the exudate appears after a long time in your case. I don't think it is a good idea to wear gloves all day in this hot weather.
(Q) Thank you for your help.
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(Q) Odor after scratching skin
Dr. Sato, It is almost 3 months since I have started TSW and NMT.
It itches when I get into bed, and before going to bed and when I wake up in the middle of the night, it itches furiously and scratches my skin. I'm taking sleeping pills, but they doesn't work. Afterwards, the exudate from the scratched skin may have formed, and my pajamas feel wet and have a strange odor that makes me feel sick. I take a shower immediately, and at night I wipe my body with a squeezed towel because of the itchiness caused by perspiration during hot summer. It has been like this for about a month now. Is this a common condition for TSW and NMT?
Also, is the exudate from the skin due to excessive water intake?
During the day, about 1200 ml of water, maybe a little more in the heat. Exercise is done at home for 20 minutes each in the morning and afternoon. The skin is brownish brown on the body and the legs and face feel like a cloth over the skin.
Will this condition get better with time?
(S) You think you are taking care of your skin by showering, but actually it is preventing your skin from healing. In your case right now, a shower once every 3 days for about 1 minute each time would be good. The temperature should be lukewarm. If you do that, you may get better.
(Q) Thank you for your advice, Dr. Sato.
Is it not good to wipe with a wrung out towel? I get itchy with sweat.
(S) You should probably stop it.
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(Q) Chlorine removal
I am asking for your opinion about chlorine removal in showers. I am purchasing a new shower head with chlorine removal function. Do you think it is better for Staphylococcus aureus if there is chlorine in it? I would like to hear your opinion and the opinions of those who have used chlorinated showers. Thank you in advance.
(S) We do not think it is necessary to remove chlorine. The level of chlorine in tap water will have little or no disinfecting effect.
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(Q) Bacterial infection
Hello. I have a bacterial infection around my face that causes exudate and yellow scabs when it dries. I don't have a dermatologist close to me who recommends TSW, so I am prescribed steroids. Could you please tell me what kind of antibiotic I should prescribe?
(S) Theoretically, you would need to do a culture test to determine the susceptibility of the bacteria. If you don't do that, then I think you can start with oral Keflex or FLOMOX. Topical application should be done carefully due to the problem of moisturizing dependence.
(Q) Thank you for your reply. I am far away and would like to see you if I have a chance, can I get the results of the culture test etc. on the same day and get the medicine?
(S) It takes about a week to get the results of the culture test.
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(Q) Atopy treatment after 8 years of TSW and NMT
I would like to ask for advice regarding my daughter's skin, who is almost 16 years old. When she was 7 years old, she developed atopic dermatitis triggered by a sprue and herpes infection. She had difficulty sleeping and used steroids partially for 3 to 7 days.
However, something was not right, so I went to a clinic in Hiroshima for treatment by TSW and NMT, and over time, her condition improved. Since then to the present, she has not used steroids and moisturizers.
Since last April, eczema the size of a 10 yen coin has appeared on her neck, and from there it has spread from her neck to her collarbone, to her face, armpits, groin area, elbows and knees. She has taken POLARAMINE, showers once a week, goes to bed early at night, eats well, water ristriction at night, and rounds her nails, but she is still struggling with the eczema, (She stopped taking the herbal medicine containing licorice that I asked about before in January of this year.)
The itching and pain in her neck is particularly painful and wakes her up many times during the night. She peels off the scabs in her sleep and many brown skin pieces fall on her bed. The neck becomes oozing and reddish. The exudate dries up by evening, but it hurts to put on her school uniform in the morning and I am looking for something to help.
(1) According to "Chapter 27: Treatment of Atopic Dermatitis" in your book, my daughter has been TSW and NMT for over 8 years, so I considered gauze protection in reference to the treatment for non-steroid-history patients, but the neck and collarbone area peels off after about 5 minutes. It is written that if it peels off, it should be needed, but in that case, is there any other way to alleviate the pain?
(2) The symptoms on my face have calmed down, but the symptoms around my eyes vary from when the color is calm and clean, to when the large white skin suddenly falls off, and when my eyelids are red like pandas. Is it not doing what it should be doing to change so much in a day or two?
I am sorry to bother you, but I would appreciate any advice you could give me. Thank you in advance.
(S) As for the neck, if there are several small festering surfaces, how about applying a small piece to each one? Also, how about sleeping with the head slightly raised? Not using a high pillow, but rather a low pillow, raising the head slightly from the waist. There is no mention of exercise, what about this, does she exercise?
(Q) Thank you for your reply, Dr. Sato.
She was saying that no matter how cool the room is, she gets hot and itchy from the collarbone up, I bought a 6 to 10 degree incline mat and use it when she sleeps. (It is about the size of her head from the waist up.)
She often sleeps on the non-inclined part of the bed, though, because of her sleeping pattern. As for exercise, she plays a couple of hours of club activities in high school (table tennis). If it is not raining, she rides her bicycle to and from school in about 30 minutes, which may not be getting enough aerobic exercise. She said that although she thinks she is sweating, people around her tell "you don't sweat." She also has stiff shoulders, so we will try to find a way to do more aerobic exercise. For fluids during the day, she takes a 1-liter water bottle of barley tea and a 500-ml sports drink, in case of heat stroke. Some days she doesn't drink much, some days she drinks it all, depending on the day. She says she tries to drink a little before she gets thirsty and not to drink a lot at once,
Is she drinking too much? Her weight is about 50 kg. She judged the amount to be moderate based on the color of her urine....
(S) I think that sleeping with head elevated, exercise, and water restriction are all working well. Then, I guess the only thing left to do is to be patient in time will heal.
(Q) I really appreciate your reply again.
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(Q) Allergic Conjunctivitis
I have had allergic conjunctivitis for several years and have been prescribed and treated with ALESION, TALYMUS, then Flumetholon, but now I don't put any drops and have sudden itching around my eyes. When I started going to the ophthalmologist, I told my doctor that I had atopic dermatitis and that I was trying to TSW, but he said there is no side effect , so I reluctantly continued to use Flumetholon.
However, as I continued to use the drug, I felt something abnormal in my body and stopped using it at my own decision. The abnormality was that there was no sweating from the face after strenuous exercise or even after taking a bath (the rest of the face sweated enough to drip), and the eyelid area became dry and itchy during the day. Now, I am itching every day, probably because I stopped using it. Personally, I would like to cure it without using eye drops, but I would appreciate it if you could tell me if there are any oral medications that would be effective. Thank you in advance.
(S) Anti-allergic eye drops that do not contain steroids include. Alesion, Levocabastine, Alegysal, KETAS, Patanol. I think oral antihistamines will also work to some extent.
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(Q) Sweat in summer
It's been 2 months since I've started TSW and I'm scratching all over my body while I sleep. When I have a scratch or a part of healthy skin that stings and itches in summer, if the area is small, I dab the itchy area with a wet handkerchief that I wet with water and wring out lightly to wipe away the sweat. If the area is large, I wipe it with running water. I have always been prone to getting rashes from my own sweat, and even when my atopic dermatitis is not severe, it itches even more if I leave the sweat on. Is this way good?
(S) I think that you should not wipe off the exudate from the wound. Because the exudate is what comes out to make a crust and protect the skin underneath it.
(Q) If wiping off the sweat is not a good idea, how are you all dealing with this? I sometimes have hot flashes from postmenopausal menopause, and sometimes the sweat from it makes my wounds sore and itchy, so I'd like to know more about sweat control.
I also have itching from postmenopausal menopause to whole body. Atopic dermatitis is a narrow area of scars that itch at certain points, but postmenopausal menopause causes a wide area of skin without scars to itch and itch, even in summer (I have been unconsciously scratching my whole body while I sleep since before I started TSW). Is there any good treatment for this itchiness?
(S) You should be able to wipe the non-scratched areas. If it's itchy, taking anti-itch medicine is one way. If menopause is a problem, consult your gynecologist.
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(Q) Calamine lotion
Dear Dr Sato, with many thanks for assisting with this. Is it safe to use Calamine lotion to assist with eczema rashes on the face & neck? It feels very soothing and stops the itch but I don’t know if this is a safe option.
(S) If you are in TSW, I don’t think it is safe.
(Q) Thank you so much for your prompt response. Is there anything else you would recommend just to control the itch at very bad times?
(S) Put a cool pad on your itchy point.
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(Q) Dandruff on scalp
Dear Dr. Sato. I had itchy scalp for 3 months before TSW and NMT, so I have been washing my scalp with hot water.
It has been a little over two months since I started TSW and NMT and I wash my hair two to three times a week, and only once I use solid soap dissolved in a washbowl to make foam. My scalp always feels wet and itchy, and when I brush it, a lot of dandruff falls off. Dandruff can be small. Will this condition get better with time? I don't feel any exudate coming out, but I am concerned about this wet feeling.
(S) I thought you need to go back to washing with only hot water and to avoid using a brush. I mean it is important not to scrub the scalp.
(Q) Understood. I will do as you said. Thank you for all your help. Your reply is alweays very encouraging.
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(Q) Exercise Frequency
I am a man in his 40s who has read and practiced the famous book by you, a bible for atopic patients. It will be just 4 months at the end of this month since I started TSW and NMT. As for my condition, the exudate has stopped, my skin has become dry and flaky, and when I scratch it, white flakes of dandruff come out. The itching has also decreased considerably.
I am very happy to realize that I am gradually getting better, but I am currently exercising 5 times a week, walking briskly for 30 minutes, which I get a little tired. Is would be ok to reduce it to twice a week?
Is there any possibility to get worse and the leachate will leak out again (back to the previous condition)? According to page 37 of your book, it already says "at least three times a week" or "once a week if you are busy," but I asked the question just in case. By the way, the only areas that had exudate were both shoulders and the right upper arm. I would appreciate your answer.
(S) I encourage my inpatients to exercise 5-6 days a week. Once they start working, it becomes difficult to do it 3 times a week. It is important to keep exercising as much as you can. It is also important not to overexert yourself. Even if you exercise once a week, you will be able to increase your physical fitness enough.
(Q) Thank you very much for your reply. I will continue to do so as long as it is not too strenuous.
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(Q) Sleeping pills
It has been almost 2 months since TSW and NMT. I have been taking Myslee and Lendormin daily since 1 or 1 month ago.
I still have some severe pain in the shower, so I'm taking them for another month, but is it not a good idea to continue taking them for 2 months?
2、The condition of my skin is that exudate has been coming out from my cheek for about these 10 days and it has become a scab. Will it gradually get better?
3. Eczema is appearing more and more all over my body and the backs of my hands look like elephant skin. Is it getting worse?
I don't exercise as much as I should, but I try to limit water and eat protein.
(S) 1. Of course, it would be better if you can sleep without sleeping pills, but if you can sleep and recover your strength, I guess you have no choice for a while.
2. It will get better, but to do so, restriction of fluids, especially at night, is essential. Sleeping with the upper body slightly elevated is also a good idea.
3. It is difficult to say with only this description.
(Q) Thank you very much for your reply. I will do as your advice.
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(Q) My thoughts on my blog.
I had severe atopic dermatitis and I've been posting my thoughts and feelings on my blog recently. Hopefully, it will be helpful to someone.
(S) Great.