Dec. 2023
(Q) Thanks again for your help this year.
Good evening. I am a mother of a middle school student who was hospitalized in August. Thank you for your help at that time. Since being discharged from the hospital, there has been no worsening of his condition, he has kept up his fluid intake and continued to exercise moderately, and in the second semester, he was able to attend school 90% of the time and feel normal and happy. Thank you very much.
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Nov. 2023
(Q) About oozing eczema spreading on legs
Hi, nice to meet you. I have been TSW and NMT for a year and 11 months now. The initial withdrawal symptoms were on my face, neck, elbows and hands where I applied the cream frequently, and for some reason only on my knees where I never used it, but, by June of this year, it had settled down to a very clean state. However, in July, I developed an extremely itchy eczema on the back of my thighs, which quickly spread to the rest of my body, probably because I did not take water restriction and exercise seriously. I have been trying to control the water intake and exercise, etc., and now the itchiness and small areas of exudate come and go all over my body, and small debris continues to come off my body. Now I have a very itchy eczema with small blisters clustered together in a rounded shape (1 cm or 3 cm in size) on several areas from my calves to ankles. Whenever I scratch them, they produce exudate, which has recently turned to blood. My local dermatologist told me to go home if I did not want steroid treatment, and I am not sure if this is a symptom of TSW or something else.
Is it correct to take care of this symptom in NMT? I would be very grateful if you could help me. Thank you in advance.
(S) Judging from your description, it seems that the round shaped skin rash is nummular eczema. Both atopic dermatitis and steroid-dependent dermatosis can cause various types of rashes, so it is difficult to distinguish between the two based on the appearance of the rash.
I think it is better to think of it as a mixture of both in various proportions.
As for nummular eczema, first apply gauze protection. If that doesn't help much, try zinc oxide ointment.
(Q) Thank you for your response, Dr. Sato. I try to cut a piece of gauze into small pieces and put it on the places where it is not dry. I was confused and feeling impatient about whether it was withdrawal symptoms or another factor, but now that I hear that it could be either, it makes sense. I would like to follw the way of NMT, and continue taking a shower about once a week. I would also like to try zinc ointment. I feel much better now. Thank you so much,
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(Q) Inspection
Hi, I have been TSW and NMT for 10 years. My body is much better but I am having trouble with eczema on my fingers which used to be only dry. Is it atopic eczema, athlete's foot, or fungus? I'm not sure. I don't want to go to a local dermatologist because there are no steroid-free doctors nearby and I don't want to use steroids anymore.
Is it possible to judge them corrcectly?
Or if it can be judged at a hospital other than a dermatologist, I would like to know which department to see.
Also, in your book, hands are hard to heal until the end, but is it safe to assume that once I get over this point, it will get better?
Thank you in advance.
(S) No one other than a dermatologist would be able to determine this. First of all, do not put water or disinfectant alcohol on your hands. You may consider that TSW will go well if the hand symptoms improve.
(Q) Thank you for your prompt reply, Dr. Sato.
I understood it had to be a dermatologist. When my fingers got bad, I thought of that, my family members have athlete's foot and candidiasis, and I also thought I might have contracted it, so I suspected fungus or mold, but I guess there is also disinfection under the corona. I wish there were more dermatologists like Dr. Sato and your colleagues nearby, and I will keep on trying to do my best.
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(Q) Red light therapy
Hello. Is red light therapy effective during TSW?
(S) I think it is easier to itch due to increased body temperature.
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(Q) About bandages on elbows and knees
I am in the process of NMT. I feel like I have moved from oozing phase to the cracking phase. I have strong rebound symptoms on the inside of my elbow and back of my knee, and since I am in the desquamation phase, I think I am at the stage where I should stay without bandages in terms of NMT. However, the stiffness and cracking causes stiffness and discomfort every time I bend and stretch, itching and pain when clothes touch it (choose skin-friendly materials), and it takes time to do each movement, which also causes muscle stiffness in other parts of the knee, which is very stressful. Should I stop using bandages in these cases as well?
(S) Wrap a piece of gauze around it and put a bandage over it. You can leave the gauze on for a week and change the bandage every day. If the gauze has been on for a week, remove the gauze without peeling the scab off. If there is exudate, wrap the gauze again. If there is no exudate, gauze and bandages are not necessary. In this case, before using the gauze, it should be washed and dried with tap water to remove the antiseptic.
(Q) Thank you for your reply! I appreciate the forum for questions like this.
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(Q) Exudate from nipples
Hi, nice to meet you.
I am asking about my son in his 20's who has been TSW and NMT for 5 years after reading your book. He has had exudate from one nipple for about 2 months. It dries up and almost becomes a pressure sore, but he rubs it or touches it, and it peels off and exudes again, waiting for it to dry, and repeats. He has tried putting gauze on it but it doesn't stick enough. He can't use a medical tape because he gets rashes.
Can he put medicine such as gentacin or dolomycin on it? Can he put medicine such as GENTACIN ointment or Dolmaisin on it?
Should he just do nothing as it is?
I would like to know if you have any suggestions.
(S) GENTACIN or dolomycin may help if there is a bacterial infection. In my book zinc oxide ointment sometimes works.
(Q) Thank you for your prompt reply.
I looked up zinc oxide ointment and found that there is an over-the-counter one. We will give it a try. Thank you very much.
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Sep. 2023
(Q) Hi again, Dr. Sato. I would like to ask for your advice.
Since I consulted with you two months ago, my daughter's symptoms have been worseing. Itching wakes her up many times. so she is still having trouble sleeping. She is able to go to school, but has temporarily stopped getting her bike to school because she doesn't want the pain of the wind blowing on her. Her eczema is all over her body, but the exudation from her neck is so bad (about the size of a palm) that she says it smells bad, so she took a shower to wash it off.
We were determined and prepared to go in Osaka this evening to visit you as an outpatient tomorrow, but I have a fever as my escort and I am unable to go, so I am so frustrated.
(1) I heard that if there is a smell, you need to take an antibiotic, but would it be okay to use the Kefral that she already has?
If so, when should I stop taking it? When the exudate stops? When the odor has stopped?
(2) Also, she usually showers once a week, but should she increase the frequency? Normally she does not want to go in the shower much due to itching and pain.
Thank you in advance.
(S) Smelling itself is not evidence of an infection. If there is an infection, Kefral would be a good idea, but I doubt the dose is sufficient. It is hard to tell here if it is infected or not without actually seeing it. It is also difficult to see when to stop. I can't explain it in simple terms. Showering to remove the odor is probably not a good idea. Showering once every 2-3 days would be fine as long as there is no pain and exudate.
(Q) Thank you for your reply, Dr. Sato.
The exudate is ao much when I wake up in the morning, but is mostly dry by the time I go to bed at night. Some of it has not stopped or has come out again. She will keep the showers to once a week as usual.
(Q-1) I know the pain when the erosive surface is exposed to wind or water is painful. When my child's eczema gets worse and she is in the same situation as your daughter, I try to increase her protein more than usual. I feel that this helps the wound to dry faster and the pressure sores to form more quickly. I hope that your daughter's situation is as mild as possible.
(Q) Thanks for your advice about protein.
I try to be conscious of high protein for her, but there are days when I'm a bit lazy, I am also aware of how difficult it is to make a menu every day. My daughter is doing her best, so I will do my best too. Thank you very much for your kindness.
We visited Dr. Sato today. He told us that there is no infection now and that my daughter is on the way to being cured properly, and advised her not to try to push herself to go to bed early, but to read her study books that she is not interested in, as she will fall asleep, After leaving the consultation room, she was in tears with happiness. We both cheered up and will do our best again from tomorrow. Thank you very much
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(Q) Crack on Fingertip
Hi, I jointed your lecture yesterday on Zoom. I would like to ask about the cracks on my fingertips that were mentioned in the Q&A session. Now, my finger has a crack in some places and exudate is coming out from it. I have some Dolmicine cream on hand and have just recently started applying it, but would it be better to dry them without applying anything or to apply a small amount of Vaseline as mentioned in the lecture?
I always have learned from Dr. Sato's book, this site, and past posts on mixi.
(S) In my book I mention that it would be okay to moisturize the fingers, but I don't recommend it. I think it is safe to just apply Vaseline to the cracks. It would be safe to just apply Vaseline to the cracks. I bet you don't wash your hands a lot. I assume you don't use alcohol disinfection to prevent coronavirus.
(Q) Thank you for your reply, Dr. Sato.
I applied Dolmicine because coming out the "yellow liquid", but I should not apply anything, right?
Is the yellow liquid not a bacterial infection?
There is no hospital that understands TSW here, I am groping in the dark.
(S) If it's a finger, dolomycin can be applied.The expression "yellow liquid" is used for both exudate and pus. The latter is cloudy.
(Q) > The latter is cloudy. That is very clear. Thank you for your repeated replies. I will continue to make it my goal to be able to spend time without applying anything.
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(Q) TSW and NMT for 8 months.
I have read your book. I'm on the fence about whether to be admitted to the hospital because it is so far away. I've been TSW and NMT for 8 months. It is getting better at a very slow pace (no more exudate), but I still have scaling and redness all over my body, and I have been itching every night for the past 6 months or more and can't sleep!
Even though my stomach and back are smooth, they itch and scratch and go right back to being scratchy again. Is there anything I can do to control this itching?
Anti-itch meds are almost ineffective and I can't sleep without sleeping pills. My face is still a little red and dry, but one day I would like to apply lotion and enjoy skin care like I used to. My skin used to be soft and chewy, but now it is dry and wrinkled and I feel like a different person. Will I be able to use moisturizer for a long time?
I recently stopped menstruating. I am hoping to get pregnant again someday in the future. Should I wait for TSW's over and my menstrual cycle to return to normal?
A lot of powdery scabs are all over the floor, I can't face people, and I am sick of my looking like a different person. I am a woman in her 30s and have been on steroids and protopic for about 3 years after childbirth. I had mild eczema as a child.
(S) 1. When patients are hospitalized, they usually can sleep at night within a month or so. In your case, there must be some reason why it doesn't get better.
2. Basically, moisturizing is not good. So makeup is not good either. Some people try it and it doesn't get worse, though
3. Possibly crusty and wrinkled skin can be considered to be on the way to getting better.
4. Menstruation may stop during TSW. If a patient has not had a period for three consecutive cycles, I recommend a gynecological examination.
5. It seems that patients who use Protopic are a little less likely to get well than those who do not use it.
6. Please read my book more carefully about what you want to know.
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(Q) Maou-tou Extract (麻黄湯)
I was infected with COVID-19 and was prescribed Maou-tou extract and Calonal.
Is it okay to take Maou-tou extract?
(S) If possible, avoid it because it contains glycyrrhizin acid.
(Q) Thank you.
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(Q) Aggravation after childbirth
Hi. I would like to ask you about skin rash worsening after childbirth. I apologize for not being able to get to the point, but I would appreciate it if you could answer.
First of all, I will briefly describe my TSW history.
Around the spring of 2022 (age 33) - I started TSW and NMT with Dr. Sato's books.
(I developed severe atopic dermatitis when I was in the third grade of junior high school, spent about three years without steroids thanks to spa therapy, and started using steroids when I entered university. Since then, I used steroids and protopic for about 15 years).
Despite withdrawal symptoms, I became pregnant in the fall of 2022 and managed to get over it while working and recovered enough to lead a daily life by the time of delivery.
The symptoms were severe on the inside of both elbows, neck, décolleté, and scalp. The scalp was especially bad, and the exudate was coming out constantly.
I had a baby in May this year and for a while there was no change of symptoms, but suddenly around the end of June a skin rash started appearing on my breast, neck and elbows, and over time it spread to my face line, décolleté, underarms, face and scalp.
So far only part of my scalp and décolleté have exudates, the rest is rough, reddish-black skin and scratching with bleeding. Sometimes erosions occur. Itching and pain are intense.
Contrary to my expectation that withdrawal symptoms would worsen and heal all at once, I feel that this worsening is gradually going against the healing route, and I am wondering if I can continue to live the way I am now.
I am taking no ointments or moisturizers, bathing only in the shower for a few minutes, controlling the air conditioning, limiting my water intake (since I am breastfeeding, it is difficult to measure, so I do it by feeling), and trying to keep a balanced diet as much as possible.
The challenges for me are as follows
1.Raising three children, including an infant
2.Lack of exercise
3.Feeling depressed easily (scratching myself to look good, not wanting to see anyone)
4.Guilt of having to burden the family with housework and childcare due to physical inactivity.
I feel that it may be withdrawal symptoms and worsening of my original atopic dermatitis, but I cannot be sure. Is it possible that the healing process is delayed due to postpartum hormone imbalance and breastfeeding? By switching from breast milk to formula, will my recovery be quicker?
Although I think that time is the only medicine, I cannot find any of recovering, and I feel depressed and anxious so I posted it here.
I would be very grateful if you could give me some tips on how to heal.
Thank you very much in advance.
(S) Some people get worse after childbirth. The cause of aggravation seems to be overhydration. You may need to change breast milk to formula and adjust fluid intake.
(Q) Thank you very much for your reply!
I had thought that I might not be getting enough water based on the color of her urine, but I wasn't sure at all because I wasn't able to measure it accurately. I will retry the fluid restriction by switching to formula.
I don't know how much worse it can get, so the only thing I can do is just endure. I wonder how everyone is overcoming mentally....
By the way, the other day I went to a dermatologist for my child and asked about treatment without steroids. Then maybe I didn't communicate well enough but he didn't accept it at all and asked me "Which hospital is it doing such TSW?" I told him that I didn't need it, but he forcibly prescribed me steroids. I was disappointed that he couldn't even accept our opinion. It was an event that made me think that even if it was not atopic dermatitis, I would be too reluctant to go to see a doctor....
I am very grateful that I am able to connect with Dr. Sato like this, even if it is such a long way away.
Aug. 2023
(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.
(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.
(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?
(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?
(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.
(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?
(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.
(Q) I am keeping to the fluid restrictions. Should I go to see a doctor and get antibiotics? Or will it heal itself?
(S) If it is an infection, you should take antibiotics, but if it is getting better gradually, why don't you wait a bit?
(Q) I went to Tarao Dermatology the day before yesterday and received antibiotics. Thank you very much.
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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.