Dec. 2021
(Q) Shower while NMT
I've been NMT for about a month now, but when I take a bath and my body warms up, I get very itchy and my skin starts to peel. Is it better to take a shower for one minute about twice a week ? I was advised by someone who has experienced this before.
(S) In general, I think it is best to take a shower twice a week and the time is for about a minute. The water temperature should be around 38-39 degrees and the water pressure should not be too strong.
(Q) Thank you very much, Dr. Sato.
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(Q) Bathing while NMT
It's been about a month now that NMT has started, but I'm still itchy and feel like I'm still rebounding. I have been taking fewer baths and not using soap, but should I use soap during this period? If anyone knows, please let me know.
(Q) I am a person experienced NMT. I've done TSW a long time ago for the first time, so I'm just gonna mention NMT, but my skin was still very dry for about first one month, so I took a shower twice a week for about 2 minutes without soap. Even so, my skin was really itchy after I got out of the shower because of the dryness.
It was about six months after I had been NMT that Dr. Sato told me I could use soap. At that time, my skin had regenerated quite a bit and I had less scabs. I know it depends on people, but I hope this will be helpful for you.
(Q) Thanks for your reply. It seems like a pretty difficult way to skin normalization even only with NMT. It might be better for me not to take a bath too often. I am not able to see a doctor because I am living far away, so your opinion was quite helpful. Thank you for your reply.
(Q) Even if it's just NMT, it will be a rebound like TSW symptom, right? I'm sorry you're having such a hard time right now. I am now in my 10th month. It still gets itchy after baths and when it gets dry, but it's gotten a lot easier now. I believe you will be fine for sure.
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(Q) Nipple skin rash
Dr. Sato, thank you very much for your help with the skin rash on my feet before. I am still applying gauze, but it has improved to the point where I can run. Thank you very much.
Now I have a problem with skin rash on my nipples. When I left the gauze on for a week, thick scabs formed, and when I removed the gauze, the friction with my clothes caused the scabs to come off, exudate came out, and I had to put the gauze back on. I repeated this about 4 times. I've read your saying in your book that nipples can get better with gauze protection and zinc oxide ointment, but when I apply zinc oxide ointment and gauze protection, should I remove the gauze after each bath and apply zinc oxide ointment every time?
I'm going to have a mammogram and an ultrasound for follow-up after breast cancer, and I wanted to keep that my skin rash is as good as possible. I'm sorry to bother you, but I would appreciate your help.
(S) The skin rash on my nipples is difficult to heal.
If you apply zinc oxide ointment, please keep the gauze on for 1 week. After 1 week, remove the gauze, and if it is still oozing after an hour, repeat the same process. If it is dry, zinc oxide ointment and gauze are unnecessary.
(Q) Thank you for your reply, Dr. Sato. I just want to apply only gauze because I'm afraid that if I do without gauze after it dries, the scab will pick off, but I will do as you taught me. You can bring me a great relief. I am very grateful to you. Thank you very much.
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(Q) About asthma attack.
This is my first post. I have been suffering from bronchial asthma for about three days now. The type of attack is probably intermittent, and the last time I had it was about 10 months ago. At that time, my doctor prescribed LELVEA 200 EPRITA 30 for inhalation, which is the standard of care. I am currently in my eighth month of TSW & NMT, and I have not used any inhalants since I started TSW.
Dr. Sato and Dr. Fujisawa also said that it is better to avoid steroid inhalation, so I tried to keep by taking antihistamines only as much as possible, but I had no choice but to inhale steroid inhalant twice because the symptom started to interfere with my daily life. (Having understanding my skin rash to get worse though)
What should I do for this kind of non-steroidal treatment for asthma during TSW? Also, does using steroid inhalations of less than 5 to 10 times tend to cause severe rebound on skin? (I've understood it depends on the person, but..)
I'm going to continue inhalation until the seizures settle down to small ones, then stop inhalation when they become small ones and switch to TSW immediately. After that, I would like to control the disease without using any steroids.
I would appreciate your opinion.
(S) I apologize for the delay in replying. Here is my opinion below.
Dealing with asthma during TSW.
The current asthma treatment recommends the use of leukotriene receptor antagonists and slow release theophylline for patients who cannot use steroids, and the use of short-acting β-agonists during attacks. If asthma symptoms occur, a general physician or respiratory physician should be consulted. In that case, inhaled corticosteroid(ICS) is recommended first. People who are undergoing TSW for atopic dermatitis should be better to say, "I think that if I inhale steroids, my asthma will get better and my skin rash will get better. However, when the asthma gets better and the steroids are stopped, the skin may get much worse. For this reason, I would like to have asthma treatment without steroids as much as possible. I think it is better to express this wish to your doctor. As a doctor with non-steroids treatment, I would like to see more physicians who are willing to fulfill and understand this request.
I'm not an asthma expert, but the basics of asthma treatment are
(1) Suppress airway inflammation with anti-inflammatory drugs
(2) To improve symptoms with bronchodilators.
For (1), steroids are used. For (2), there are a variety of drugs described below.
Bronchodilators are:
1) β2 stimulants, such as Meptin air and Sultanol for short-acting β-agonists, and Serevent, Oxis®, Onbrez for long-acting β-agonists.
2) Anticholinergic agent: Atrovent for short-acting type, Spiriva, Seebri, and Encruse for long-acting type.
3) Xanthine derivatives (aminophylline) include theophylline.
4) Leukotriene receptor antagonists include Onon.
Please note that there are many generic drugs these days, so there are many different names.
When you are in severe asthma condition (like danger of losing your life), the use of steroids would be necessary.
I think the best way to deal with the current situation is as you think.
(Q) Dr. Kenji, sorry for the delay in replying to you.
After that, I went to my family doctor, Dr. Fujisawa, and he prescribed "Meptin air 10μg inhalation", "Theophylline extended-release tablet 100mg", and "Montelukast 10mg", and my symptoms settled down within a week.
Thank you Dr. Kenji for your detailed opinion on how to deal with this.
It was very helpful. I will take it as an important advice for relapses.
Since then (after steroid inhalation), the progress of my eczema is as follows
As expected, my eczema started to recover dramatically on the second day of inhalation, and suddenly worsened about 8 days after I stopped inhaling.
I feel that this is probably a rebound symptom of inhaled steroids.
To be honest, I was surprised that it got worse just like you said.
Now, it's been about two weeks since the worsening, and the eczema symptoms are starting to settle down. So I just have to wait for the eczema to disappear. I've been taking only Theophylline and Montelukast tablets.
Thank you very much for your opinion!
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(Q) I have a question about moisturizing. Even people with normal skin lose oil and moisture as they age, so they need to moisturize in some way. For people doing TSW & NMT, is it better not to moisture in their whole life? Why is there a difference in the effect of moisturizing on the skin of people with normal skin and those who have TSW & NMT?
(S) The difference is whether or not your skin has become dependent on moisturizer. It is safer to assume that the addiction to moisturizer will last a lifetime. I know that some people disappear their dependency along the way. However, if you resume moisturizing, it can get worse.
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(Q) About NMT
I was treated by you at Nagoya City University Hospital and Kinki Central Hospital about 15 years ago.
Since I have started TSW 15 years ago. I've been using moisturizer for a while, but I haven't applied any for about these 4 years. Then, around the beginning of this year, my neck and face started to itch little by little, and at the end of November, It rebounded. After listening to today's lecture, I reconfirmed that it would happen again, but I will definitely not apply moisturizer, and I will refrain from using soap in the bath. I will see you when I return to Osaka. If you have your view, please let me know.
(S) The symptoms of dependence on moisturizer sometimes seem to come back to you a while after you use moisturizing again, and your skin rash may worsen even after you feel it's okay. Be careful.
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(Q) Nasal Drops
My son has been TSW for 4 years now. His nose is very congested, so we went to an ENT, incidentally we told the ENT doctor that he can't use steroids. He was prescribed COR-TYZINE nasal solution. According to the prescription it contains steroids. When I asked the doctor about it, he said it was only a little steroid, and in his opinion, it would be okay. My son's nasal symptoms are also quite severe, and the doctor said that he would use nasal drops that contain steroids to treat the symptoms in general, but despite he cannot use steroids, he gave us this. If he uses this, will he go back to the way he was when he started TSW?
He used to buy non-steroidal, non-vasoconstrictor nasal drops on the Internet, but they were discontinued and no longer in stock. So this is why we decided to go to an otolaryngologist.
What do you think about COR-TYZINE, Dr. Sato? Also, can you tell me if there are any other good nasal drops? (He hasn't used COR-TYZINE yet.)
Thank you very much.
(S) Some people have had nasal drip even more after taking nasal drops of steroids. That's why I think the skin-rash may get worse if you stop using nasal drops of steroids. It seems that nose drops are not very effective. There are Zaditen Ophthalmic Solution and so on. In some cases, it seems that nasal discharge decreases due to water restriction.
Thank you for your reply.
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(Q) Long time no see.
It's been a while since I've seen you all. I've been reviewing the comments in this forum a bit, and I see that many of you are still having problems. Five or six years ago, I was one of the people asking questions here. But now I'm feeling much better and can lead a normal life. I'm a TSW patient who got better and now I'm doing "forestry". I've been working outside for two years now, and I have no problems with my condition. You advised me "office work, it might be boring though, suits for you considering of keeping your condition better." I'm sorry I haven't followed what you told. Now, while I continue to work outside, I'm going to have a reconstruction of my anterior cruciate ligament, which I had cut 15 years ago. I was told that it would take a year of rehabilitation because there were many problems since it was cut a long time ago.
Since I had to quit my job for the rehabilitation, remembering "Well, I had a hard time with the TSW treatment, which is why I post my comment now. Good luck with your treatment. I will do my best too.
(S) Thank you for your comment. I'm glad to hear that you are getting better. Please don't think that you will be unable to exercise, but continue to do upper body exercises as well.
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(Q) My son scratching all the time
Hi. Can I ask you something? I have a 12-year-old son who has been TSW and has not been on any medication or moisturizer for a long time. He doesn't have any exudate, but now his collarbone and stomach are red, itchy, and he scratches constantly on a daily basis. They are very rough. He can't seem to stand scratching, but she has recently cut and polished his nails properly and has no long nails at all. He seems to be making an effort in his own way.
Is it okay to just keep scratching and just keep my eye on him?
(S) If he is not bothered by it, I think that is fine. I think it would be better if he restricts bathing, limited water at night, and continued exercise.
(Q) Thank you for your time and reply. He is no longer old enough to be a child, but he still drinks at night when he is thirsty, and he takes long-time showers because it feels good to do so. He also takes long, lazy showers because they feel good. But he has started to cut her nails on his own and exercise. I'm hoping that little by little, he can do more things on his own.
Thank you for your advice.
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(Q) CORECTIM Ointment
My daughter was prescribed a medicine called CORECTIM Ointment. I would like to know what you think about CORECTIM Ointment. She is 9 years old, and in the winter, her hands and the back of her knees are painful. She doesn't use steroids or Protopic Ointment, and she moisturizes sometime depends on her mood using Nivea, Vaseline, lanolin, Hirudoid, and spring water as she chooses. She usually does not moisturize. Moisturizing doesn't seem to make her feel even better. Nivea seems to be good for her, and she often moisturizes with Nivea in winter.
(S) I couldn’t have a chance to fully examine and haven't reached my conclusion about the Corectim yet. It works by suppressing the inflammatory process, so I think it is similar to Protopic. For now she should protect the affected area with gauze, bandages, and long pants.
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(Q) Exercise during knee-pain
It's been a while since I've seen you. I was hospitalized before.
I have been feeling painful with my knee when I exercise for about a year now. My orthopedic surgeon says that cycling is good for me, but is it enough for exercising? Please let me know if there is any other good exercise therapy. Thank you very much.
(S) You know, as there is a cycling competition in the Olympics, so it is a good exercise. Even when cycling, you need to protect your knees well. How about sitting on a chair and doing some upper body exercises? Please take care of your knee first.
(Q) Thank you very much for your advice. I had an MRI scan yesterday and it showed that there is a small amount of water in my knee. I would like to pedal a bicycle and move upper body with radio gymnastic exercises carefully.
Nov. 2021
(Q) Hi, Dr. Sato.
I have been suffering from hand eczema (itchy and blisters on the palm side of my hands) for about 10 years and have been applying over-the-counter medication only when itchy, several times a month. It got worse this summer and I started TSW and NMT. One month after I quit steroids, the rebound appeared around my neck, the back side of my left hand, and the inside of my right wrist in that order.
The palm of my hand has healed to dry extent. I think the back of my left hand is almost okay.
I have two questions for you.
1) Why is it so late to appear symptoms on my neck one month after I stopped steroids? Does it mean that my recovery will be slow?
2) I've heard that around the neck and collarbone are slow to heal because there are a lot of lymph, is this true?
Thank you for your time.
(S) I can't give you an answer based on the information only you have mentioned. I'm not sure because the studies have not proceeded at all about how the skin rash appears on different parts of the body, I'm afraid.
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(Q) About TSW, NMT
My 10-year-daughter has had atopic dermatitis since she was 2 years old. She has been using steroids for one year and then TSW and NMT for 7 years now. The back of her hands, where she first developed eczema, has completely healed, but she now has eczema elsewhere, her face, neck, and the backs of elbows and knees are affected. Initially, she was also doing NMT, but my husband and I have a difference of opinions about it, so she has to shower once every three days. She was taken care of by Dr. Mitsuko Sato before when she was 4 years old.
(S) As for hospitalization, I need to consider the necessity and effectiveness. I would like to think about hospitalization after examining her.
Oct. 2021
(Q) Steroid Eyedrops
Hi, Dr. Sato. It's been a while. I used to come to you for treatment. Thanks to your help, I am now in my seventh year of TSW, my skin is getting softer, the itching is getting less frequent, and I can sleep better at night. Thank you very much. Now, I have an epiretinal membrane and a cataract in my right eye, and I will have an operation on my right eye next month in November. I currently go to an ophthalmology clinic in my city, but since I need a specialist to operate on my epiretinal membrane, I will be operated on at the clinic by two doctors, the director of the clinic and a specialist from the university hospital. So, I was asked to go to the university hospital and received a diagnosis from the doctor who would be my surgeon. At that time, when I told the doctor at the university hospital about my TSW history for seven years and the eye drops after the surgery, he said, "Okay, then let's go with non-steroids," but the doctor at the eye clinic in my city said, "You can use steroidal eye drops and it won't affect anything on your skin," . But I said "The doctor at the university hospital also said to use non-steroidal drugs," he didn't listen to me. "If something happens to my skin, we'll think about it after that." he said. The surgical procedure document says, "Use eye drops of Flumetholon for one month after surgery. I'm worried about whether it's okay to put steroids in my eyes for a month in my situation I've spent 7 years of TSW and my skin has improved. Is it okay to use steroid eye drops for a month after eye surgery?
(S) Using steroid eye drops may make the eczema a little better. However, when you stop using it, the skin could worsen. It may not get much worse, though. Some people do not get worse. I’m not sure the difference. If you have to use it, it is safer to stop it slowly, not abruptly.
(Q) Thank you for taking the time to reply. Your comment just gives me relief. I’ll keep on doing!
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(Q) It's been a while. I have been hospitalized before, and thank you very much for taking care of me that time. Recently, my skin around the neck has been getting worse. There are some parts that have improved, such as the quick drying of the exudate, but I wonder its bacterial infection if a little sticky exudate comes out. So I'd like to ask you something. Is it possible to find bacterial infection by sight without any tests? Also, can I get antibiotics without taking a test? I don't think you can say anything unless you see it directly, but if there is anything you can tell me about the sign of bacterial infection, please tell me.
(S) We need about 5 days for the results of bacterial culture test. Bacteria are always present on the skin of people with atopic dermatitis, so we need to distinguish between skin bacterial infection as a disease and just the presence of bacteria. This explains in the book. In the case of an infection, you will need to take antibiotics. Please read the book carefully
<New version> Adult-type atopy treatment learned from patients: TSW and NMT therapy for intractable atopic dermatitis, Tsuge Shobo Shinsha, 2015, p41, p109～ by Kenji Sato.
(Q) Thank you for your reply. I’ll do it.
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(Q) Hi, Dr. Sato.
When my son was 6 years old, he started TSW and was admitted to Hannan Central Hospital. He got better smoothly and sometimes up and down, but he slowly got better without any medication or moisturizer. Finally, he is the 6th grade now, and he went on a school trip without any problems. As a mother, I was very touched that he was able to go on a trip away from us, and I would like to thank you, Dr. Sato.
We just go to see you when his condition worsens, but when it gets better, I am always grateful to you. Please take care of yourself.
(S) I’m really happy to hear that he got better and was able to go on a school trip. Hearing such a good story, I feel rewarding with TSW treatment and activities involved. It would be great if you could spread more people about it.
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(Q) Hi, I am a TSW patient from Taiwan.
I used to do TSW therapy in your way (with my doctor), and I really feel better. You saved my life. Thank you very much.
However, I didn't know that tapping the face was not a good idea, so I didn't usually do much, but I did it when sleeping (sometimes unconsciously). Then I was diagnosed with cataracts, which I regret very much even though I'm 22.
Looking for various papers, I found a paper from 2019 that said it was caused by breaking of the blood-aqueous-barrier (BAB) saying it was caused by rubbing or hitting my eyes. That's very disappointing, because it means I broke my eye with my own hands, right?
What I want to ask is, have any cases in your patients developed cataracts even though they were not caused by tapping their face?
(S) Of cause they are.
(Q) Thank you, Dr. Sato.
Knowing there were other factors, my regret will be lighter. It is difficult to find doctors who can support TSW treatment, much less one who would do the right way. My Japanese is not so good, so at first I read Tokuko’s blog in English. I would like to introduce TSW to other patients in Chinese spreading them about the right treatment of TSW. Thank you very much.
(S) Your Japanese is pretty good.
Sep. 2021
(Q) I have eczema only on my face. When I take a half body bath, I sweat many times more than I do exercise. How about taking a half body bath being careful not to put water on your face? Is there any reason why a half body bath is not good without water on the face?
(S) Active sweating by exercise is more meaningful than sweating by passive one like half body bathing. If you just warm your body, the itchiness will only get stronger. Soaking in hot water for a long time results moisturizing.
(Q) Dr. Sato, I was relieved to hear your advice. I appreciate it.
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(Q) Hi, Dr. Sato. I put gauze on the affected area, but since it is firmly attached to the skin, I take a shower briefly. As time passes after bathing, the affected area gets pruney and some parts of the gauze come off, so I slowly peel off the gauze and cut it off with scissors. Is it necessary to remove the gauze? Is it okay to leave it on from a hygienic perspective? Wouldn't peeling it off also take away the protective covering on the skin? I'm not sure if it's a good idea to leave it on. I apologize for my simple question, but I would appreciate it if you could help me.
(S) Keep the gauze on for one week. After one week, remove the gauze only, without water and without removing the crust; if it is moist with weeping exudate on the affected area after an hour, reapply the gauze. See below.
< New edition > Adult-type Atopic Dermatitis Intractable Atopic Dermatitis and Steroid/Demoisturizing Therapy, Tsuge Shobo Shinsha, 2015 Chapter 11. No Wiping of Exudates, p. 122 -123
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(Q) Deterioration for the first time in three and a half years.
My son was examined by you when he was in the second grade. He is now in 6th grade. He has always been fine without applying anything, but this summer it has gotten worse, I think due to sweating. He has a lot of itching, especially behind his knees and from his waist to his hips, and he has rough skin with scabs.
We've been reading your book again. He's gotten a little better at the habit of ripping off the scabs, but when he has uncontrollable itchiness, he scratches badly and it doesn't get better.
Should I apply Vaseline to the affected area and wrap it with gauze to protect it? He is not comfortable with moisturizing because of his experience of TSW and NMT before, so he is not doing anything in particular now but using cold compresses for a change. At his request, he often sleeps with cold compresses wrapped in gauze and placed on the back of his knees and waist, and does it on a daily basis as well. Is this a bad thing in terms of NMT?
(S) I suppose spreading cold compresses all day long would be moisturizing. If there is fissure or exudation, he should put a piece of gauze around it and keep it on for one week. If it comes off by scratching, put on another gauze. If possible, do not use tape to hold it in place. If he is under stress, he may be scratching more often.
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(Q) Goose bumps during TSW
I'm a male in my 30's. I was admitted to Hannan Central Hospital a year and a half ago and you took very good care of me. Thank you very much.
After starting TSW,I have goose-bumps skin in the pore area from my stomach to my back and lower body, and especially my lower body is itchy. I have been cutting my nails short, but when I scratch too much, I end up with exudate, and then I have to do it all over again. How should I deal with the goose-bumps-like skin?
Could you give me advice?
(S) The goose-bumps-like skin means you're almost there to healthy skin. The best thing to do for you is to reduce scratching and avoid scratching directly, such as over the pants.
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(Q) Hi, Dr. Sato. Some people say that the sea is effective for TSW, but what do you think about going to the beach?
(S) There is no data to show that soaking in sea water (salt water) is good for atopic skin. I believe that if you go to the beach, you will have so much fun and you could forget itchy.
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(Q) My thoughts for TSW
I went to see you seven or eight years ago and started TSW. Thank you for your heip at that time. I didn't watch "Sekai Gyoten News" the other day, but I was surprised to see how much "TSW" was being denounced on the Internet news. I had been using steroids for over 30 years, and the rebound was so crazy. I had to quit my job, and bothered my family. Nevertheless, I am glad that I went on TSW. My dry and atopic skin has not healed completely, and I still scratch constantly (lol), but by sleeping enough, living a regular life, and trying not to stress, it will heal naturally. Now, I only apply a thin layer of white vaseline from the drugstore when it gets too dry, and I don't use any other medication, oral or external. I realize that my immune system and natural healing power are amazing.
It was Dr. Sato and other doctors with steroid-free treatment who taught me that. Also, Dr. Sato taught me to think for myself in TSW instead of relying on doctors.
I think that being in the minority is often quite difficult in Japan, especially under the corona pandemic, so not everyone can do it without having a strong conviction to carry on. I was very fortunate to have doctors who were in the minority of not using steroids. I am grateful for that. Thank you so much. I know you are busy, but please take care of yourself.
On a side note, I found that another series of articles about atopic dermatitis in another newspaper. Of course, steroids were recommended (lol). I knew about Dupilumab, but there are also new drugs such as Delgocitinib, Baricitinib and Upadacitinib. I can't understand at all what's going on, (lol). Sorry for my long words.
(S) Thank you for your comments.
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(Q) Desquamation and Folliculitis after TSW
Thanks to you, I've been TSW and NMT and now I'm able to live a comfortable life without moisturizer, ointment or medication.
This is just my hypothesis, but what do you think about the connection between atopy and Staphylococcus aureus?
It seems that there is a correlation between atopic dermatitis and the increase of Staphylococcus aureus, but I found on the internet that they don't know if the bacteria increases with the worsening of atopic dermatitis or if the atopic dermatitis worsens because of the increase of bacteria. However, it seems to be true that the number of bacteria increases when it gets worse. In other countries, there is a treatment for atopic dermatitis called bleach bath therapy, but I think the main purpose of that is to reduce the number of Staphylococcus aureus. I saw an article on an overseas doctor's blog about an elementary school child who went to a dermatologist for the first time and was told to take a bleach bath therapy first instead of being prescribed topical medication. It also said that he went into remission. I've been taking this therapy for a month now, and the lichenification on my elbows and back of my knees is still there, but the desquamation on my shoulders has gone away. I'd like to know if it could be caused by Staphylococcus aureus on the skin for people to have a little bit of skin that keeps falling off for a while even after TSW?
This is one more hypothetical question, but isn't atopy caused by an imbalance of bacteria on the skin, which disrupts the skin's immune system and barrier, leading to eczema?
If so, rather than using steroids, if we can reduce the amount of Staphylococcus aureus, we will be able to cure atopic dermatitis. Actually, It seems that research is being conducted in Japan to reduce Staphylococcus aureus. I would like to know your opinion about Staphylococcus aureus.
(S) The following article was published in the British Journal of Dermatology in 2010.
Antibiotics for Staphylococcus aureus do not improve atopy Br J Dermatol 2010
There was no evidence for the efficacy of antistaphylococcal medication as commonly used in the treatment of non-infectious eczematous lesions.
antistaphylococcal agents should not be administered without solid evidence.
Antibiotics are necessary for eczemas such as impetigo and boils, but not antibiotics or antiseptics to cleanse the skin.
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(Q) About Steroid Ointment
When a dermatologist prescribes a topical steroid, does the more stronger-class of steroid the doctors prescribe, the more income they will earn? For example, is there a difference in dermatologists’ income between prescribing Locoid and Dermovate? I asked this question because I was wondering why strongest level of steroid was being prescribed to me even I was originally mildly atopic symptom. Could you give me a reply?
(S) NHI price is the amount of money a doctor gets when prescribing drugs. That drug is purchased from a pharmaceutical company or a drug wholesaler. The difference between the purchase price and the NHI price is the doctor's profit. (of course, the purchase price is lower than the NHI price) Therefore, the NHI price alone does not determine the profit. With this as a premise, please take a look at the following figures.
・Locoid ointment (Group 4) 12.1 yen / 1g, 121 yen / 10g
・Dermovate ointment (Group 1): 19.9 yen / 1g, 199 yen / 10g
・White Vaseline: 20.2-23.8 yen / 10g
Can you see that there is about a 10-fold price difference between Vaseline and Dermovate?
(Q) Thank you for your reply. That made sense to me.
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(Q) Please share your ideas
I have been TSW for 10 months and NMT for 9 months. Since the summer, the skin rash in my atopic prone area has suddenly spread more and more, and what I'm having trouble with now is the exudate in my armpits. I work part-time job in a customer service job, so my co-workers have found a mixture of exudate and blood on my white shirt. I have been using sweat pads, but the amount of exudate is too much for me to handle. If you have any ideas or items that can catch the exudate in my armpits where I move around a lot without being noticeable, I'd love to hear from you.
(S) If there seems to be a bacterial infection, antibiotic medication would be necessary. I hope you are not drinking too much water.
(Q) Thank you for your prompt reply, Dr. Kenji Sato,. I am doing water restriction but judging by the color of my urine, so I will do some calculations from now on. If it gets any worse, I'll talk to the doctor about possible infection. I use fingertip-less cotton gloves on my hands and cotton arm covers on the inside of my elbows during working, but I've been having trouble finding a good way to cover my armpits. I will try various methods.
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(Q) bacterial infection
The area of the wound is large, and I was diagnosed with bacterial infection the other day. I had taken antibiotics for 5 days. I realized the wound was healing even after scratching, but after a few days, the wound seems to be getting bigger. I refrain from taking a shower for a week. Does this mean that the antibiotics did not work or were not enough? I'm worried that it may get worse. Is it okay to wait and see as it is? In general, when you get bacterial infection, it says you should clean it with soap, so I feel uneasy about not taking a bath.
(S) There is a possibility that the duration taking oral antibiotics was short. It would be difficult to shower or wash with soap when you are infected. Hopefully, you should take shower without washing away the exudate. I think it's better to use gauze as an artificial crust on the weeping area and then dry it.
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(Q) 6 and a half years after TSW
Hi, Dr. Sato. I'd like to ask you a question. I have been TSW after using steroids for about 30 years since I was a child and have been TSW for about 6 and a half years now. Immediately after starting TSW, It was so terrible, but I am much better than I was then. However, it is still very painful in the summer season when I sweat a lot, and it is difficult to lead a normal social life. As you can see, my skin is still really itchy even after six and a half years of TSW, but will it improve if I continue to TSW? Do you have any examples of such other patients? I would appreciate it if you could give me some advice.
(S) Sorry if you feel bad by my using strong words.
You said you are doing on TSW, but don't say to NMT. These two are necessary in order to get better. In this therapy there are things you must do and there are things you must not do. Are you recognizing these things exactly? In some cases, things that you thought to be bad are not so bad from a third person's point of view. When you are mentally depressed, this kind of negative evaluation will come out. Please go back to the basics and consider it again. I'm sure I can help you if you visit me.
(Q) Dr. Sato
Thank you for taking time out of your very busy schedule to reply. As for NMT, I am doing it completely.
I have read all of Dr. Sato's books over and over again, and I am basically working on TSW and NMT based on your ideas.
As for the itching, it is so strong that sometimes I can't do anything else, but it is getting better little by little.
After all, I think you are right saying "you need to see me." I live in the Kanto area, and I feel frustrated that I cannot visit you soon, but I would like to find opportunity to visit someday. Thank you very much for your advice.
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(Q) Red exudate
I've been TSW for over 25 years, but for the past few years I've had eczema on my ankles that wouldn't go away, and 9 months ago I used steroids to wear socks for my breast cancer surgery. After that, I stopped using steroids, but suddenly my eczema got worse and spread to the back of my knees and thighs, and exudate started to come out.
Now that is red like blood and oozes out of the gauze and drips.
Is it okay to just put gauze on it?
(S) In some cases, if something in red color means bleeding, it may indicate that the situation is getting better. Since I cannot accurately evaluate the current situation, I think it would be better for you to see me.
(Q) Dr. Sato, thank you very much for your prompt reply.
I feel that I spend a lot of time in anxiety, so just receiving your reply eases my anxiety. I think it's bleeding, but it doesn't seem to be getting any better, so I'm going to see you, Dr. Sato. Thank you very much.
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(Q) Edema to the shins and feet
I was admitted to the Dermatology Department of Hannan Central Hospital in July 2019. After that, my condition was so-so, but from around early August, the skin eruption on the ankle got worse and the exudate started to came out. Later, edema developed, which now extends to the shins of the legs and allows exudate to drip down the floor. My shins are swollen and I can't even walk indoors. I'd like to see you, but I'm afraid it's too far away (living in Setagaya ward, Tokyo). Is there any way I can get it?
(S) The most likely thing is to drink too much water. If you have a problem with heart, the same symptom will happen though.
(Q) Thank you, Dr. Sato. It seems that the restriction of water intake might been loosen in summer. Before this deterioration, I walked five kilometers every morning. I did muscle exercise and I don't think of any problem with my cardiopulmonary function. I will do my best taking up to 1200 ml water a day. The exudate seems to be shifting from the ankle to the shin. I try to put on a piece of gauze-treatment. Thank you very much.
One thing I'm a little concerned that the exudate has an unpleasant odor and whether it has bacterial infection.
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(Q) About Vaccination for COVID-19
I'd like to ask a question about vaccination for corona virus. I want to get a corona vaccination, but I am worried about it because I have atopic dermatitis. Does it have anything to do with side effects? Please answer when you have time.
(S) After the vaccination, some people get worsen their rash, others may not . I don't know in advance which one it will be.
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(Q) Spots with white, and yellow head
I am a mother of a 6th grade boy, and my son has not applied steroids since he started TSW at his age of 6. In February of this year, he developed rash caused by a mask and his face and neck area became cracked. It took me six months to finally get his skin to look good even with the mask on. One thing that has been bothering him is that I keep getting yellow pimples on his neck, forehead, eyebrow area, and back. I don't know if it's because I'm in puberty or not. Yellow pimples pop up often, but they don't get worse. It seems to come and go.
Is it okay if I just wait and see how it's going? Please let me know.
(S) If it is acne, try to wash face gently. Washing too hard is not good for NMT, so do it carefully. Antibiotic medication may help in some cases.
(Q) Thank you very much for answering my questions. He always makes use of what you taught. Please take care of yourself during the corona pandemic.
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(Q) Sunburn or Sunscreen
Hi, Dr. Sato. My name is Mizuno, and I'm going through TSW and NMT for a year and a half based on your book. I have a question about sunburn.
I went on a 4-day kayaking trip in Romania, where the sun is quite strong. I followed the method of "NMT" and didn't apply any sunscreen, but instead I wore a wide-brimmed hat and long sleeves to protect myself from the sun. But I couldn't even prevent the sun from shining on the surface of the water, and I got quite a sunburn. My face, in particular, was still burning even after four days, and my skin was so dry that it hurt to talk or smile. My lips in particular are peeling off, and the skin is coming off in a scaly pattern all over my face.
So here is a question for you. In a case that you are exposed to the scorching sun that you cannot protect with a hat or a long sleeve, what do you think would be better for my skin during TSW: to keep NMT and endure the after-effects of sunburn, or to apply sunscreen for a short period of time (and remove it thoroughly) to prevent severe sunburn? I'd like your opinion.
I know kayaking is an extreme example, but it's something that I've been genuinely questioning over the past few days while enduring sunburn, so I'd appreciate it if you could give me your opinion. Thank you.
(S) My patients that have been wearing makeup for a day, such as at a wedding, have almost never made it worse. However, there are quite a few people who see a recurrence of eczema if they continue doing for a few days. How many days of application will make it worse probably depends on the person. If you use a mask and sunglasses to block UV rays, it will probably help a lot.
The best thing to do is not to plan for such a thing. The second is to wear a hat, long-sleeved clothes, mask and sunglasses, and the last is sun screen, although it can be dangerous. The action of washing it off can also lead irritation to skin.
Aug. 2021
(Q) TSW & Corona Vaccine
Sorry to bother you. It's been about 7 or 8 years since starting TSW and recently I've been having skin irritation and exudation. I keep trying for recover, but I'm not sure if it's safe to get the corona vaccine in this condition.
My body is not strong by nature and I am worried about my immunity. I'm a 37-year-old man, and I'm wondering what I should do.
(S) If there seems to be a lot of exudate on your skin, I think you can wait until it gets better. Some atopic patients get the vaccine and some don't. Some don't have no problem and others get worse on their eczema after vaccination. It is impossible to know without trying.
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(Q) Swimming for children
I have a question to ask, Dr. Sato. What is your opinion on swimming for children during TSW? Has anyone ever been affected by chlorine, hot water or something?
(S) If your child has a lot of oozing and crusts he or she should not do it. It will be too painful to do. After the condition eased, it would be a kind of good exercise, but in rare cases, some people react to chlorine. I think it's better to go in a little bit longer and see if it gets worse. After swimming and before you change your clothes, you will need to wash away the chloric water with tap water.
(Q) Thank you for your reply, Dr. Sato.
First of all, I will take her to the pool a few times and see how her skin looks. Thank you very much for your detailed reply, it was very easy to understand.
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(Q) About Nummular Eczema
Dr. Sato, I have a question to ask. My son has never been diagnosed with atopic dermatitis , but he seems to have like a nummular eczema on his shins. We're hesitant to visit the dermatology department because I think it's only prescribed steroids. It would be helpful if you could tell me the way to cure it without using steroids.
(S) You can also try zinc oxide ointment. If there is an infection, topical and oral antibiotics may also be helpful. If the diagnosis of nummular eczema is correct, it will take some time to heal.
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(Q) UV Therapy
Hi. I live in Okinawa, Japan. I heard that UV therapy is good for atopic dermatitis. Do you use it? What kind of equipment is it? I am considering going for the treatment.
(S) Currently, I do not offer this treatment at my hospital.
It may be good for itching in some cases, but it would be very difficult to heal.
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(Q) Spread of skin rash in the middle stage of TSW
Dr. Kenji Sato, I'm sorry to bother you. It's been 9 months for TSW and 8 months for NMT. Since 5th months, I have had a reddish skin rash on the inner side of my elbows, under my armpits, behind my ears and the groin which I have not had before. Since the early stage of TSW, I'm trying "scratch and dry" around my eyes, mouth, wrists, back of my hands and 10 fingers, but I cannot see any sign of recovery. Is it common for the rash to spread to the common site after 5th months? Does this mean that the atopy itself is difficult to cure in the future? I would appreciate it if you could tell me from your experience.
(S) There are many reasons why it gets worse on the way of TSW and NMT. Considering of the season, sweating may be one of the key points and you sweat a lot, so you may end up taking too much water. Some people get worse by getting vaccinated. Please try to think about various worsening factors by yourself. And think and find the countermeasures against it.
(Q) Thank you for your reply, Dr. Sato!
The extreme heat in my town, Fukushima city, has continued since the end of July, which is unique to the basin, and the heat rash spreads to the whole body due to sweating, and now it seems that the itchiness is exploding by mixing of prickly heat, eczema and steroid rebound. I check the color of my urine to make sure I am not drinking too much water, but sometimes I can't stand the summer heat and drink up about 150 cc of cold tea at once (I refrain from drinking at night). I wonder if the fact that the redness of the affected area cannot disappear and the exudate oozes out on scratching means that water restriction is not enough. (I stop taking the bath and shower, and do a single gauze treatment.)
(S) You just give it a try.
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(Q) Which is more likely to cause a rebound of TSW, steroid ointment or oral steroids?
(S) It is impossible to simply compare the influence of the two because there are many different ways to apply topical steroids, the length of time they are applied, and the strength of the steroids used, and the amount and duration of oral steroids-use may vary.
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(Q) About meals
As for meals, should I eat anything in well-balanced meals without going too strictly?
On the Internet, there are some people with eczema get cured only by dietary restriction without TSW and NMT.
Is it correct to think that they were cured not because of "intractable" atopy but because the diet method happened to be effective for them?
I hesitate to eat things that are said to cause atopy such as additives, oil, sugar, flour, and dairy products.
(S) From my point of view, atopic dermatitis is not caused by food allergies. These two diseases are different. One of the major causes of confusion in the current atopic treatment is recognition that the cause of atopic dermatitis is food allergy.
I only restrict food to people who really have food allergies (I mean, food allergy means when urticaria and/or anaphylaxis occur after eating. Positive food tests are not included in food allergies.).
These people have already known what food they have reaction, so they're restricting by themselves before they come to see me. Coming to see me means that they still have eczema even though they are restricted. This shows that food is not the cause of atopy for these people.
If nothing happens, you can eat additives in food, oil, sugar, flour and dairy products without worrying. You just keep balanced meals.
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(Q) Bilanoa® tablet
It's been a long time. I left Hannan just 10 years ago. Thank you very much for taking care of me that time.
By the way, since last month, my skin condition has worsened for the first time in seven or eight years. My upper body is covered with eczema, and I get itchy and wake up many times during sleep. If it gets worse, I'm considering if I have to be hospitalized in consideration of my work. I can't tell at all whether it's because of the BCAA I took for exercise when I was in good shape, or because I kept taking Bilanoa I got from the hospital at work. However, now I'm just trying to cure it, and I keep restricting 1,200 ml of water daily.
So I would like to ask you one question. When I visited the hospital at work, I was prescribed Bilanoa because I do not have Epinastine. Because the hospital is located in a special workplace, the types of medication they prescribe are limited. Is there any problem in using this Bilanoa?
(S) Bilanoa has only been on the market for a short time, but the frequency of strong side effects does not seem to be high.
(Q) I will continue to take Bilanoa while keeping an eye on the situation. If it still doesn't improve, I'll visit you again. Thank you very much for your help.
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(Q) Dear Dr Sato,
Is NMT suitable to cure seborrheic dermatitis? Thanks!
(S) I don't think so.
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(Q) My daughter's TSW
Hi there. It's been two weeks since my daughter started TSW and NMT at home.
She has been experiencing dryness and sweating all over her body, and some exudates have started to appear. Due to the dryness of my whole body, she has been itching a lot, scratching a lot, and can't sleep at night. She has a lot of scratches and hasn't showered these two days.
If the scratches hurt in showering, is it okay to apply some cream or something?
Considering of what kind of changes will occur in the future and the infection, I would feel safest if she were to be hospitalized.
Is it available to stay in the hospital now?
(S) Applying cream works moisturizing. It would be better if you do as a gradual reduction method.
Please ask the medical cooperation section of Hannan Central Hospital if she can be hospitalized.
(Q) Dr. Sato, thank you very much for your time and answer.
She has been doing TSW and NMT, and I don't want her to make it worse, so she will continue NMT.
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(Q) 5 weeks in
Hi. I have stopped steroid use for 5 weeks now. I have all the symptoms, red skin (especially on arms, boobs and face), elephant skin and a bone deep itch.
I am in Australia and have been to numerous doctors but none support the journey. They all believe it is eczema and continue to prescribe stronger steroid creams.
My skin has been rotating from red and raw like a burn victim to a dry, hard layer on top each day. Today is my first day of Moisturiser Withdrawal.
I’m anxious as I will need to work while having a flaking face.
My question is, do you see or work with clients in Australia? I can’t find a speacilist who has history in TSW or believe it exists.
(S) Please contact
Renate Cowell
Administrator
Topical Steroid Withdrawal Australia Group
renatesum@hotmail.com
Jul. 2021
(Q) Is it true that steroids cream stay and accumulate inside the body?
If so, do inhaled steroids and eye drops do so as well?
(S) Inactivated steroids can stay in the body, but they do not have the function of steroids, so there is no problem.
However, it seems that the skin cells somehow remember that steroids have been used on your skin externally for a long time. I'm not sure how the mechanism is, but it seems that you need to keep in mind that you have applied steroids before. As for inhaled steroids and eye drops, I don't know exactly.
(Q) Thank you for your reply.
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(Q) Bacterial infection on my skin
Hi, Dr. Sato. It's been a year and a half since I started TSW and NMT relying on your book and this forum because I live in the UK and don't have any doctors nearby to support me.
Last year I consulted with you about the infected eczema on my shoulder. Since then, I've taken antibiotics several times, and before I knew it, a year had passed, but although the eczema has gotten better, it hasn't completely disappeared.
Since May this year, my eczema has become noticeable again, and I've been to the hospital several times, but it hasn't gotten any better, and today I was told that there is no treatment left other than steroids, and I'm at a loss. I am posting this here to get some advice from you.
I've posted a series of photos here, from last year's eczema to this year's new one: https://docs.google.com/document/d/1SDH6iX10x4w8RkpwmsJWUv3Gyx0j7hKEsIeyuRsN-kw/edit?usp= sharing
You can see this year's pictures on page 9.
Since mid-May, I've been getting more and more pimples on my shoulder.
I saw a doctor on May 20 and took Fluclox antibiotic for two weeks, which improved a little, but I finished the antibiotic without being completely cured.
On June 8, I visited the doctor because the blistering eczema became more noticeable. I was given Fusidic Acid cream to avoid additional antibiotics since I had just finished two weeks of antibiotics, and applied it four times daily.
it seemed to have improved.(No photos were taken during this time)
I had a swab test on July 1, and on July 12, I was diagnosed with severe Staphylococcus aureus proliferation, and was given Fluclox for 1 week, which works against Staph Aureus and erythromycin, which I had not tried before.
As of July 19, I have finished antibiotics for 1 week, but the eczema is getting worse. The dry, itchy area spreads to my arms. New red blister-like boils also appeared.
I was in a hurry to see the doctor, but he told me that he had done everything he could do except for steroids and that steroids were the only treatment left, so I refused and went home.
I would appreciate it if you could tell me what is the best treatment for Staph Aureus infection while I am TSW and NMT. Is it not good to keep taking antibiotics for weeks? Thank you very much for your time.
(S) People with atopic dermatitis have a small amount of Staphylococcus aureus on their skin even if they do not have an infection. But there is no need to remove it. If there is an infection, doctors can check the sensitivity of the bacteria to antibiotics and choose the most effective one. It is impossible to judge whether antibiotics are appropriate in your case just by looking at the picture. It seems to be very difficult, but I recommend that you see me.
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(Q) Going to the beach
Dr. Sato, I'm glad that my daughter and I were able to see you last week. Thank you very much. We got a lot of advice and I have a feeling that she will get better. Well, I forgot to ask one question. We are planning to go to the beach in early August. She is trying to be careful with the sun. Last year she got sunburned and it got worse, so I'm scared. We're planning to spend most of time in a tent this year, but I wonder if we'll get sunburned even in the tent.
What about going into the ocean? Is it bad for her skin?
Until last year, my daughters and I used to go to the beach because we thought it was good for atopic skin, but I don't know how it really is. Even taking bath makes her sting now so I wonder if it's too early to go to the beach.
I'd be happy if you answer my question.
(S) If she doesn't get wicked sunburn and feel pain, and she can enjoy swimming moderately, it would be good for her to be a good exercise. It depends on the person though.
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(Q) About rash
I've been doing TSW, TPW, and NMT for about a month. The worst part is my face, and I feel like I'm on the mend with repeated oozing and peeling, but I'm starting to get rashes on my stomach and hands and feet where I never had symptoms. I think it's more of a rash than eczema.
I think they may have appeared because I haven't taken a bath... In this case, should I wash them lightly with soap?
I only take a quick shower once every few days.
(S) You'd better not use soap. If you don't wash off the exudate, a short shower (within a minute) even every other day or every day may be good this time of year. (in some cases)
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(Q) Piel de elefante no acaba
Good morning, thank you in advance for your attention
1. After 25 years of topical and oral corticosteroids (prednisolone, betamethasone, mometasone, tracolimus) I stopped it 3 years ago and started TWS in which I almost never suppurated or had moisture or exudation. So use a lot of natural oils and things like Apis, licorice. But my skin got stuck in a cycle of semi-inflamed skin, peeling thick and very itchy. That's why I started NMT 12 months ago. Very strict, however again the exudation was very little (the first 2 months). After I started a phase of dry, elephantine, and irritated skin, I did not have large scabs either, only thick scaling, but the skin was always irritated. After 8 months my skin has started to improve a lot, it is still somewhat dry with white powder when I scratch. however my arms, hands and knees seem unable to overcome the dryness. My skin is thickened, irritated and white when I scratch, and my hands break without moisture. The heat affects me a lot and gives me eczema. Some say that petroleum jelly on deep wounds would be fine in NMT.
1. Will it be prudent to use it in those parts only where there are wounds or is a zinc-based cream better? I have been drinking normal water for 3 months, should I go back to restriction?
2. Is it normal to take so long and not find natural hydration in these parts of the body?
3. Fifteen days ago, red patches of eczema started to appear again. If I can get past TWS, will the eczema come back? If it comes back, what can I use, since I don't want to go back to corticosteroids?
Thank you for your answer.
(S) 1. You can put ointment only on your fingers and soles. You should restrict water intake.
2. I am sorry that I don't have any information for assessing your TSW-NMT journey.
3. Even if you get past TSW, you may have eczema again by various causes. Basically you should not use topical medication.
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(Q) The use of oral corticosteroid.
I went to see the dermatologist today considering of possibility of an infection and was diagnosed with a severe infection. In fact, my skin is sore, and the exudate is coming out almost all the time. I'm pretty sure it's an infection, because it smells like rotten protein.
My doctor who doesn't believe in TSW, so he prescribed me 8 prednisone 5mg tablets a day (to be reduced gradually over 3 weeks), Minocycline, Betamethasone ointment, and told me to take a bath every day and apply Vaseline. I've only used steroid ointments before, so I have difficulty taking oral steroids, which are said to be very strong! I would appreciate if you give me some opinions.
(S) If it is really an infection, you should take Minocycline orally and see how it goes. However, I don't know if the diagnosis of infection is correct since I haven't seen your skin in person.
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(Q) I started TSW from September in 2020, and although it got better in December, it started to get worse again around March of this year. Now, red erosions are appearing on my face, neck, and chest, and they are getting worse day by day. There is also a lot of exudation, and although it does clot, there is obviously a lot of it coming out. I was prescribed antibiotics, which I took for two weeks, but it hasn't gotten any better. Is there any possibilities I got infections? I haven't been no fever, but the erosions often have heat. I would appreciate if you answer to this question.
(S) If the bacteria is resistant to the antibiotic you were taken, it will not work. I cannot say that there is no possibility to infection just based on information you mentioned. You may need to consider whether you are taking too much water. Is there anything that is aggravated by washing the affected area, etc.? In any case, it is impossible to tell without an actual examination.
(Q) Thank you for your quick answer.
I am in overseas now and there are no dermatologists around who understand TSW. Is it possible for me to have telemedicine with you? Or it would be helpful if you can refer me to a dermatologist doing it.
(S) I do not offer telemedicine.
Ami Skin Clinic in Tengachaya, Osaka
http://ami-skinclinic.com/
Please consult with Dr. Takahiro Yamada.
Jun. 2021
(Q) TSW for 8 years, rebound
Recently, my skin has become rough due to fatigue and stress.
The inside of my joints are rough and oozing over all the time. Even if the exudate dries up, I tend to bend the joint, and it melts with body temperature and doesn't seem to recover at all. What should I do in such a case?
(S) Check yourself for aggravating factors and causes of delay for improvement. Fatigue and stress and so on.. Keeping the joint flexed means moisturizing so keep it straighten over 90 degrees. Gauze protection may also help. I hope you don't take too much water. What about lack of exercise?
(Q) I've started to adjust my water intake, and I only drink 550ml plastic bottle of water and 200ml black canned coffee a day. I have been lacking in exercise for a long time, so I have been trying to walk for an hour recently.
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(Q) I am a mother of a 9-month-old baby.
He has a large eczema on his stomach. When we went to his pediatrician, the doctor prescribed HIDERMART ointment. I'm worried because I've never heard of this. Could you tell me a bit more about this ointment?
(S) HIDERMART cream contains "Glycyrrhetinic acid". It may have a very slight mineralocorticoid effect as a side effect. I don't think it is a drug to be used for the first aid.
Please refer to the following. https://www.qlife.jp/meds/rx13365.html
(Q) Thank you for your prompt reply. I will see how it goes without applying it.
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(Q) COVID-19 Vaccination
I got to know about you through Tokuko's blog and have been TSW and NMT based on your book. I'm 6 months steroids free and 5 months NMT, the spread of the itchy rash to my whole body at the beginning has stopped and it has now only on my upper body. The back of my hands, all fingers, and wrists are the worst, and I have been scratching and drying them repeatedly for 4 months now. The itchiness peaks 2 or 3 times a day, and I scratch uncontrollably, producing exudate and blood, but I try to keep in mind that "the last scratch should be gentle. Thanks to the support of my family and the understanding of my workplace, I've been able to continue my part-time job using a lot of ice packs.
Yesterday, I received an application form from the city for a coronavirus vaccination. I know it is probably more than two months away, but I wanted to ask your opinion on whether it is appropriate to being vaccinated during TSW. I'm very sorry to bother you, but I would appreciate your reply.
(S) Children with atopic dermatitis often show worsening of the skin rash when being vaccinated. I think the same thing can happen in case of the COVID-19 vaccine as well. I think it depends on the individual's perspective as to which is more important, life or worsening eczema. Please think about it on your own.
(Q) Dr. Kenji Sato, thank you very much for your reply about the vaccination! It was very helpful. I will consider it with adjusting my condition. I will continue to TSW and NMT for the better. Thank you very much.
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(Q) About steroid inhalation for asthma
I have had asthma since I got older, and this year I was exposed to cedar pollen for the first time in a long time, and my asthma symptoms worsened and I have to use an inhaler now. (It is a combination of steroids and tracheal dilators.)
I have mixed feelings because I am using steroids while my child has done TSW, but I can't stop my cough without the inhaler. And my child is 2 years old and I still breastfeed her 4-6 times a day.
Will my using inhalers with steroids have any effect on my child?
Also, I know this is a strange question to ask you (a dermatologist), but is it possible to control asthma with anything other than steroids? (I'm also trying to get pregnant with my second child.)
(S) I'm not sure if you can control it until you actually try it. There are various drugs other than steroids as follows.
・LABA：long-acting beta2 agonist
・LTRA：leukotriene receptor antagonist
・SRT：sustained released theophylline
・LAMA：long-acting muscarinic antagonist
・DSCG：disodium cromoglycate
・Antiallergic drugs (except LTRA)
See below to get information.
https://medley.life/diseases/54b52b19517cef641a0041c3/details/knowledge/drugs/
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(Q) Is ultraviolet therapy effective during TSW? I've heard that itchiness will be improved so I'm just curious about the effects. Do I have to continue it like steroid ointment?
(S) It is effective in some cases, but it seems difficult to make it work well. There seems to be no fixed way. It seems that you need to consider and try individually.
(Q) Thank you for your reply. I will try it once and see how it goes.
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(Q) Healing Time
Is it possible to recover within a month of TSW using NMT depending on your age and length of steroid use?
(S) Generally you can't recover within a month. You need various times to recover depending on what you do and what you don't do.
(Q) I have another question, as I'm currently dealing with TSW I have been using BioDrone a Humic and fulvic acid complex supplement. Will that in any way impact my condition for the better.
https://nlstar.com/en/store/biodrone/73327/
(S) I don't think so. You just need to eat balanced food.
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(Q) Dr. Sato.
I always read your book, "Atopy Treatment for Adult Patients, New Edition" I have seen you when I was in good condition. Thank you very much for everything.
I have been TSW for 5 years now but I have not been able to NMT, so I have been applying lotion and Vaseline to my face from time to time.
At the end of March 2021, I went out during a bad pollen season and my condition got worse. Also, when I go for a light jog, a kind of sticky sweat comes out from my neck and back. This is the first time I have experienced this kind of sweating and I would appreciate any advice on how to deal with it.
Thank you very much for your continued support.
(S) Please check whether it is sweat or not. Absorb with white gauze, and if it turns yellow, it is exudate. If it only gets wet, it will be sweat. In the case of sweat, you don't have to do anything.
(Q) Thank you very much for your time in answering my question. I am sure I will be in touch with you again.
May. 2021
(Q) Is it safe to take a bath every day after the desquamation period (fine scabs)?
(S) I think it is better to gradually increase the amount of time spent in the bathtub to make sure it is safe, not to take a long bath. I think it is better to start with a short time in the bathtub. For example, 30 seconds is a good start. You also need to be cautious about using soaps.
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(Q) Dear Dr. Kenji Sato
I went see you this March. I am so grateful to have found this treatment.
It was one week after I had been NMT. You encouraged me and said, "Just keep going like this way." I was able to go through the treatment with peace of mind, even though my lymph fluid and skin were very rough. The skin peeled off quite a bit. It's been 3 months since I started NMT now, and about three days ago, it suddenly got worse, when I scratched my neck in the middle of the night, and the exudate wouldn't stop coming out. It was in one place first, but it had spread widely along the wrinkles of my neck. It also spread to my shoulders. My arms have also gone from flat to bumpy, and as soon as I scratch them, weeping comes out, and the color of the wound is the same as my neck, orange like pine needle. It itches so much. The back of my knees are the same. It's not like the eczema and dryness right after NMT, it's kind of like the eczema I had before NMT. My face and body feel hot. The top and bottom of my eyelids are also cracked and I can't open my eyes in the morning due to lymph fluid. By the second month after NMT, it was quite dry and no more exudate came out when I scratched, but now, just a little scratching brings out lymph fluid. The eczema on my inner thighs also quickly becomes soggy. The lymph fluid on my nipples is also very bad and does not dry up easily.
I'm a little worried because it has suddenly gotten worse.
I've been reading your book over and over to see what could be the cause.
Am I infected on my neck and arms? Would it be better to take antibiotics?
Should I take a shower or bath at least once a day to reduce the bacteria on my skin and prevent infection?
I also drink about 1100cc of water a day, excluding meals.
I do aerobics every day, though not intensely. My temperature is about 37C.
I'm sorry to bother you. I'm not sure if I can go to see you at Hannan Hospital right away, so I'd like to ask the doctor about it. Thank you very much.
(S) In case of sudden deterioration, infection is the most likely cause. Of course, other factors must also be considered. I think you should try antibiotics first, but I think you need to see a doctor. Another thing to keep in mind is the amount of water in the food. Even if the amount of water outside of food is kept constant, if there is too much water in the food, there will be too much water.
(Q) Thank you for your quick reply. It's great to have a doctor who is always there for his patients.
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(Q) I'm sorry to bother you, but I have a question for you.
I’ve done TSW and NMT last year under state of emergency of coronavirus and was completely cured. After that, I wore a mask every day and had no skin irritation at all. However, since March of this year, my skin has started to peel and become red due to the mask. I also noticed it on my chin and other parts of my body where I never had atopic dermatitis. So, I moisturized my face and put on the mask several times and it didn't get dry. However, my eczema is still there and I still feel itchy.
In this case, should I moisturize only when I wear a mask? Or should I leave it alone?
I would like to hear your thoughts on masks.
(S) I do not agree with moisturizing with ointment. I have not been able to find a good solution on mask so far. The only thing you can do is not to wearing it as much as possible (except in crowded areas, confined and enclosed spaces and close-contact settings)
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(Q) The bumps (like goosebumps) that occur toward the end of the stage on TSW are gradually narrowing, but I'm still concerned about it on my upper arms. What should I do to improve it?
(S) You don't need anything special. Keep doing what you've been doing. Almost there.
(Q) Dr. Sato, thank you for taking the time to reply. It's very reassuring of you to say so. I would like to continue doing the same thing as before. Thank you.
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(Q) Can I ask you a question?
Currently, We are required wearing masks due to coronavirus. What kind of masks are appropriate for atopic patients?
I think 100% cotton is good, but the washable type is hotter than the usual disposable type. I feel that moisturizing to the skin is promoted by wearing a mask.
(S) I'm sorry, I can't give you a right answer because the more effective it is, the more moisturizing it becomes.
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(Q) Worsening after removal of both ovaries and hysterectomy
I've asked about hormone replacement therapy the other day. Sorry to bother you again.
On May 14, I had both ovaries and uterus removed, and while I was in the hospital for seven days after the surgery, my skin condition did not worsen, but on the second night after I left the hospital, it worsened explosively.
The worsening area was mainly on my face and neck, but the itching was all over my body. My face and neck are swollen, and exude on my face comes out even when I don't scratch it.
I was admitted to Hannan Chuo Hospital once before, but it was worse than that time and I have fatigue.
I'm not sure exactly what the cause is, but I guess it's the hormone medicine that was prescribed when I left the hospital.
It's a hormone pill called l'Estrogel 0.06%, and I apply it to both arms once a day. I have been applying it for two days since the day I left the hospital.
I would like to explain the situation to the doctor in charge at the hospital where I had the surgery, but I have talked to him about my anxiety about my atopy before the surgery, but it was difficult to get him to understand about my atopy, and I think he will not understand this time.
My questions are below.
Have you ever seen a situation like this or a similar case?
Also, in the past, I have been able to overcome TSW by restricting fluids and increasing exercise when things got worse. Would the same method be effective to improve this time?
I am very worried because the situation is different from the past due to the use of hormones.
I am also thinking of visiting you.
I would appreciate it if you reply to me. Many thanks.
(S)
>Have you ever seen a situation like this or a similar case?
→I haven’t seen similar cases ever. You need to consider the possible deterioration after discharge.
>Would the same method be effective to improve this time?
→You need to do the thing as always. Don't get too tired because your physical strength has decreased during the hospitalization. Pay attention amount of water in food.
>I am very worried because the situation is different from the past due to the use of hormones.
→I don't think you need to think too much about the effects of that hormone.
>I am also thinking of visiting you.
→I think that’s better..
→If the area of topical application has not worsened, the topical application seems to be fine until now. If you raise your upper body slightly from the waist, the exudate from your face will decrease. You're not taking any water at night, right?
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(Q) About cold sore in mucus of mouth and on lips.
Dear Dr. Sato, thanks for always answer me very quick, u re very nice! My washing hair problem is ok now. Seen that I have very oily hair and scalp in 30?c temperature and high humidity in HongKong. I have to use shampoo for oily hair, then I can change to wash my hair every 3-4 days now. But the shampoo made my hands dry, so it is sad that need to apply moisturer on hands.
Now my main problem is I have open wounds, some yellow pus and crusts inside my mouth(mucus area), on lips and lips corner.
I seen 3 times doctors in 1 month, first and second time are given oral antibiotics and antibiotics cream. Then the 3rd time, he gave me oral antivirus and antivirus cream for 5 days. After i eat the food and before I apply the cream, used wet gauzes to pat my wounds , but it was very dry and more eczemas came out. I also can’t brush my teeth: Do u have suggestions? Free to use Japanese because I can google translate it, many thanks again!
Cold sore in mucus of mouth and on lips
(S) 1. You can use Vaseline or other moisturizers only on your fingers.
2. The rash on the oral mucosa and lips looks like herpes simplex. I think you should take an antiviral drug such as VALTREX Tablets.
3. You should stop rubbing the wound with gauze.
4. You should cut your food into small pieces and eat them.
(Q) Dear Dr. Sato, Thanks for answer me! Do u feel it’s ok that after I eat something, use little wet or totally dry cotton to pat my lips? Also, is it ok that rinse and spit out my mouth with water instead of brush the teeth every night? Just afraid the water made my lips more cracked because it is in tsw now. Thanks!
(S) Do u feel it’s ok that after I eat something, use little wet or totally dry cotton to pat my lips?
→Gently with wet cotton.
is it ok that rinse and spit out my mouth with water instead of brush the teeth every night?
→OK
Just afraid the water made my lips more cracked because it is in tsw now.
→Do not forget that when the skin becomes better, the skin develops dry crust and fissure.
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(Q) I'm sorry to bother you.
In the case of cold sore, if it is not too severe in appearance, is it better to just apply an ointment such as Vidarabine ointment, or to take a medicine such as valacyclovir for five days?
Under the corona pandemic, so I'm not sure if I should go to see a doctor because my symptoms are mild.
Could you give me your opinion?
(S) The best thing to do is to do nothing. If your symptoms are mild, that's fine. If you want to apply Vidarabine, it is safe to do so for a very short time. You can also take oral Valacyclovir.
(Q) Thank you, Dr. Sato, for your prompt reply. The scab on my mouth is not spreading and does not seem to be getting worse, so I will do nothing and see what happens. Many thanks.
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(Q) Hi, Dr. Sato. I'm a mother with a 2-year-old daughter.
I finished reading book you wrote, "Adult-Type Atopic Therapy Learned from Patients: TSW and NM Therapy for Refractory Atopic Dermatitis." I'm really glad I came across this book.
Do you know any doctor in Hokkaido with non-steroids treatment like your idea? Please let me know if you know.
As described below, I started to TSW at my own discretion.
I'm not going to rely on medicine anymore, but I'm worried about what I'm doing because I'm not a medical worker. Since 2 months old, she has been applying Locoid and Hirudoid every morning and evening. During infancy, the eczema was mainly on the face and neck, and since around the age of one, the typical atopic area, such as the stomach, elbows, knee joints, buttocks, and ankles, has been spread. She was told that moisturizing is important and stopping inflammation of eczema is important in every hospital, so she followed it.
However, it didn't get better at all, it turned red as soon as she stopped applying the ointment. Someone said that it would get better when children were about 2 years old, but my child was getting worse and worse... so I couldn’t do any more but I was really impressed at the treatment you advocate.
It's been about a week since I stopped applying steroids and Hirudoid for her based on my own judgment. Since the itchiness is strong, she only applied jojoba oil, but I'm thinking of not using oil. Originally, the part where eczema is likely to appear is red and swollen, and eczema spreads widely on the stomach, and the whole body is itchy and scratched.
(S) I'm worried about your baby. I'm sorry to hear that.
By the way, I hope you have already read "No to Steroids: Atopy Treatment for Babies and Children, Kodomo no Miraisha, 2nd Edition 2019, Kenji Sato, Mitsuko Sato.
If you ask doctors (below) to treat your child without steroids, they may do so, but I don't think they will do NMT. If it gets worse, they will also use steroids. You may want to see them after knowing these things. The address of doctors with non-steroids treatment in Hokkaido are below.
・Dr. Kinuko Sasaki, Inoke Dermatology, 6 Minami 9jo Nishi, Chuo-ku, Sapporo, Hokkaido, Japan 011-511-5003
・Dr. Chieko Nishio, Nishio Dermatology Clinic, 3F Shiroishi Medical, 1-1 Kita Nango-do, Shiroishi-ku, Sapporo-shi, Hokkaido 011-865-0671
・Dr. Michio Matsuda, Bun-en Matsuda Dermatology Clinic, 4-2-10 Bun-en, Kushiro, Hokkaido 0154-38-5160
・Dr. Hitoshi Miyazawa, Nishisapporo Dermatology & Allergy, 3F, 7-2-11 Nishimachi Kita, Nishi-ku, Sapporo, Hokkaido 011-667-1199
(Q) Thank you for your reply. I haven't read the book yet, so I immediately ordered it from Amazon. I live in Hakodate, but I would like to have a chance to visit Sapporo to see the doctor. Thank you for sharing this information.
Let me ask again. My concern is that she may be absorbing a significant amount of steroids, I have been applying it for her almost every morning and night for about 2 years as shown below. And, she has only been TSW for about 10 days.
She hasn't had any oozing ever, but is it possible for eczema to heal without exudate?
Will ooze come out from skin just after stopping cream? (She also stopped applying the oil yesterday.) So far, the redness has spread and the itching is bad, but it hasn't gotten too bad. I wondered if it was because she still had steroids in her body.
Ever since she was a little baby, she used to get redness around her mouth, and she used to put Locoid on it. I think there is also an influence that food touched after baby food started. I didn't know any better at the time, but she used to apply it about five times a day. She used to apply a mixture of steroids and moisturizers all over her body because it was troublesome to separate them. When she was about a year and a half old, the area around her mouth started to get red again frequently. Around that time the pediatrician changed and I learned that the face absorbs better, so she was prescribed Prednisone, but it didn't work at all and she ended up putting on Locoid.
Now she has rosacea symptoms around her mouth. Her body also became uncontrollable with the Locoid and she was prescribed Rinderon, which I repeatedly applied for her, but it did not get better.
(S) Some people get worse after about 20 days of TSW.
Some people improve without any exudate.
Steroids are almost gone in a month.
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(Q) I have a daughter who has been TSW for 3 years. The other day, she received a reexamination form at the otolaryngology examination at the elementary school, and when she visited the clinic, she got a 0.1% Rinderon nasal spray nebulizer. I realized it when I saw the medical certificate after we got home, and it’s too late to regret it. Isn't it possible to return to the starting point like the early symptom of TSW with this only one shot? I'm worried.
(S) You'll know the results in a week. If the symptoms appear, there is no choice but to resume TSW. I can’t say exactly but it mustn’t be happening.
(Q) Thank you for your reply, Dr. Sato. I'll see how it goes for a week. I just hope nothing happens.
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(Q) Hello. Sorry for the long text.
I have a question about my 5.5 months old baby's atopy.
From around 3 months old, her face skin became stiff and her ears began to itch. At 4 months old, her face became very dry, and she developed ring-like erythema and red patches on her stomach, chest, and arms. At 5 months old, her redness and wetness increased, and her skin began to ooze and we went to see a pediatrician.
When I refused to take steroids, a doctor gave me Azunol, which I applied it to her for three days, but I didn't feel any effect, so I stopped applying it. After she started oozing, she also stopped moisturizing.
Now, her cheeks and ears are exuding and thicken, and they look harden. The rest of her skin is dry, especially around her eyes and hairline. Her body is less red than before, and the puffy areas are becoming dry.
She is still on porridge only, and she is trying to move on to the next step to a solid food this week.
I know she needs to switch to formula since I breastfed her completely but right now she is having formula only before bedtime. We will try to switch to milk. She is now 5 and a half months old and weighs 8.4 kilograms, and her weight gain has been slow since around 4 months.
I have two questions.
First, I know it's a little late to be asking this, but for a baby who doesn’t use steroids, is it better to go on NMT more slowly?
Her ears are itchy, so she scratches them a lot, but her body only scratches when she's naked. She has a habit of rubbing his eyes hard when he goes to sleep and when he wakes up, and I don't know if it's because she's itchy or if it's just a habit, but she rubs them a lot now, so I feel that the exudate around her eyes will be hard to dry.
I thought about putting gauze on it, but I don't think there was enough exudate to make it stick, and since it was on my face, it was difficult to keep it on.
Is it better to apply Azunol or zinc oxide ointment in some cases?
Secondly, how to take a bath.
She can't put gauze on the area, so fibers and dust inevitably stick to the exudate. I really don't want her to get it wet, but I'm afraid of her getting infected from the dirt, so I pour hot water on it and remove the dirt with my fingers. She takes a quick bath every day, without using soap because I'm afraid she might get painful.
I don't feel any increase in the amount of exudate before and after taking a bath, so I don't think I'm scrubbing too much, but is it okay to take a bath this way?
Is it better to reduce frequency more in this situation?
I myself did TSW before I got pregnant, and I've also read the book "No to Steroids", but I've been giving my child a hard time because I've been making decisions based on my own experience.
I was told that there is currently a two-month waiting list at Sato Pediatrics, so I am hoping to see you at Hannan-hospital soon. I apologize for the long post.
(S) > First, I know it's a little late to be asking this, but for a baby who doesn’t use steroids, is it better to go on NMT more slowly?
There is no need to resume moisturizing now.
> Secondly, how to take a bath.
At this time of the year, she should take a shower once every 2-3 days, and only shower for 20-30 seconds without scrubbing.
> so fibers and dust inevitably stick to the exudate.
Do not remove it. You need to leave it as a crust.
(Q) Thank you very much for your reply, Dr. Sato I will be careful about how she takes a bath. I understand all the things that stick together are working as scabs. I feel like her skin get more exudate on rainy days, so she spends hard time in the beginning of the rainy season. I tend to focus on her skin only, which is not good. She has started baby food smoothly, so we are going to enjoy it!
Thank you very much!!
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(Q) My 5-year-old son was examined for symptoms of TSW before. My son still has rough skin sometimes, but he hasn't used steroids or moisturizers for 2 years. Thank you for the other day.
I have something to ask you about my husband.
A few weeks ago, he put some ethanol for disinfection IP (Ethanol C2H6O 76.9 ~ 81.4 vol%, additive isopropanol) on the cracks at the base of the fingers on the back of his hand and got oozed and reddish with 2cm in diameter. After that, he kept not getting it wet in the bath, etc., and scabs started to form, but It has repeatedly cracked and the scabs peeled off and the exudate came out. he feels that it is getting better little by little. Today, when he was diagnosed at the dermatology department and received a diagnosis of alcohol rash and asked not to use steroids, his doctor told that it would not heal without medication, so he was prescribed zinc oxide (10%) single ointment "Hoei" and heparinoid oil cream (0.3%) "Nipro".
In case of alcohol rash, should he apply these ointments? Or is it all right to dry it like as same as the process of TSW treatment, and when the exudate comes out, use gauze and make scab, and improve it little by little?
The rash is about 2 cm in diameter now and it's being cracked, wept
and dry in half each.
(S) "Let it dry as it is. When the exudate comes out, use gauze. Repair it little by little making a scab cover." would be fine. It is better to reduce washing hands as much as possible.
(Q) Thank you very much for your kind reply.
I will reduce the hand washing and let it dry out and see how it goes.
I am very grateful to have found Dr. Sato's book on TSW and NMT. I'll keep on doing without steroids and without moisturizer.
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(Q) Dr. Sato, please excuse me for taking time out of your busy schedule.
I am a woman in my mid 20s. It's been just for two years since I started TSW and NMT.
Thanks to Dr. Sato's book and this forum, I have managed to overcome the rebound and am able to have a normal life. I thank you from the bottom of my heart.
However, my hands don't still improve at all. I had been using MYSER Ointment for 9 years. In your book, you say, -It is no wonder that steroid-dependent dermatosis appears most strongly in the fingers. Eczema of the hands often worsens after the general skin rash has improved.- So, I understand it will take a long time to cure.
But my hands are very itchy, especially on the backs of my hands and palms, and they are so dry that there is a lot of white crusts and fine scabs falling off every day and they are rash with fissured and scabs constantly. I try not to use a hand-sanitizer or wash my hands with soap.
If I continue NMT, will my body eventually be able to produce its own sebum? Can you please tell me how your patients are progressing and what I should keep in mind?
I would like to visit you for a medical examination, but since I live far away, I would appreciate your comments in reply. I know that you are having a tough time every day under the corona pandemic, but please take good care of yourself.
(S) Wash your hands with tap water only, no body soap or ethanol.
Use gloves for a short time. Your hands inside the gloves will be covered with sweat in 5 minutes.
(Q) Thank you for your prompt reply, Dr. Sato.
I will wash my fingertips with tap water only and wash my hair with shampoo quickly using gloves. My hands have not improved as much as I would like, so I am very grateful for your advice.
I believe that many patients have really been helped by your treatment.
I wish your continued success and good health. Thank you very much.
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(Q) I'm currently doing TSW, but how often should I take a bath?
In my case, once every two days seems to be the best (Taking a bath once a day makes me dry, once every three days makes me itchy).
(S) I can't give you an answer because I don't see the your skin directly. If you find the best frequency for you, please try that first.
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(Q) I have been TSW and NMT for 6 years now.
Even now, it gets much worse in the summer, but I manage to get through it with water restriction and exercise.
I am going to have both ovaries and uterus removed and will need hormone replacement therapy for about 10 years after the surgery.
I am wondering if I can take either the ointment or an adhesive skin patch, both of which are supposed to be moisturizing.
My doctor said : The ointment is applied to the arm once daily and the adhesive skin patch should be applied to the abdomen and changed every two days.
Will both of them be supposed to moisturize?
Also, which one do you think has less bad effect on atopic dermatitis?
I'm sorry to bother you, but I would appreciate your reply.
(S) The oral medication would be fine? Both will moisturize but the area is small.
(Q) Thank you very much for your prompt reply.
After all, it would be moisturizing, wouldn't it?
I heard that there are also oral medications for treatment, but in my case, because of my age, I will have to take hormone replacement therapy for a long period of time.
I was a little relieved because you told me that both of them have a small area.
My doctor said that it is possible to change the treatment during the course of the treatment, so I think I will try one of them and see how it goes.
Apr. 2021
(Q) Bacterial infections during TSW are common but is it possible to get the coronavirus from sore skin?
(S) According to data from the UK, atopic skin doesn't mean getting the coronavirus easily.
(Q) Thank you.
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(Q) I have been on TSW and NMT for almost 4 years now.
The itching was still quite bad and I could hardly sleep at night, but around last September, my skin was moisturized naturally and had recovered with little scratching and desquamation.
As the dry season started, I really felt itching with dryness so I increased exercising and started jogging with a dash every two days. (5km in about 30 minutes)
Even after more than six months, my face, head, neck, armpits, elbows, knees, and groin area were getting worse by keeping scratching (I tried to be patient as much as possible though), because increasing the heat inside the body with a lot of sweat (my clothes were wet) and stimulation of the shower after jogging.
I continued jogging for 7 months, but my condition became like a rebound, I could hardly sleep at night and the constant itching made daily life impossible, so I stopped jogging and took a walk every day again.
The oozing skin all over my body started to dry up and improve in 2 weeks.
I know I need to exercise more, but what should I do in this situation?
Would it be caused by malfunction of sweat glands that I can't sweat normally?
(S) Excessive exercise sometimes can make your condition worse. You should need know about a level of your own physical strength. A sauna might be good if it's just for improving the sweating function.
(Q) Thank you for taking your time to reply, Dr. Sato.
It might have too much exercise for me. Last summer, during the extreme heat, I had sometimes stopped walking for about a few weeks and then my skin had recovered considerably. The same thing happened several times before. I have got tired easily since I was young, and I haven't been able to sleep well for the past few years, so my physical strength may be quite low.
I will consider taking sauna and bedrock bath to stimulate sweat glands.
Thank you.
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(Q) I have had two rebounds on TSW but I got over it and the itching has completely gone since last year. However, since Friday, fine urticaria has spread to both arms, abdomen, and inner thighs, and It has been feeling hotness and itchy. I took anti-itch medicines such as Alesion at home and rested my body. The urticaria has not disappeared, although it has gone down for a while. I am not allergic to any food. Since last year, I have no problem with any diet. There are no particular changes in my daily life, so stress is unlikely to the cause of the deterioration.
Please let me know what I should do in this situation.
Thank you in advance.
(S) If it is urticaria, it will disappear completely in a few hours. And it can be effective considerably with Alesion. Therefore, I guess it is not urticaria. I’m not sure if it is eczema, bacterial infection, or something else. You need to see a doctor to find out what's going on.
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(Q) I went see a respiratory doctor because I kept having a mild dry cough, I’m not sure whether it was because of my new job or the change in lifestyle due to under coronavirus pandemic, and was told that I might have asthma because my eosinophils were also elevated. He recommended me to take an inhaler to prevent asthma attacks, but I avoided it because I am on TSW, and I only take Montelukast 10mg tablets at night before going to bed, but the mild cough has continued for about two months. He said that I should really take an inhaler I am still worried about this.
(S) Eosinophils are increased in asthma, but also in atopy. It is difficult to determine which has a stronger effect. I think that the one with stronger symptoms may have a greater impact.
It is better for the skin not to use steroids if possible. Bronchodilators such as theophylline, leukotriene antagonists such as Montelukast, and antihistamines can work for it considerably. Also, loosening the water restriction to the extent that does not aggravate the eczema will also help a little. Planned exercise load may also be effective. Please consult to your doctor.
The following may also be helpful.
https://mixi.jp/view_bbs.pl?comm_id=1758719&id=36247554
(Q) Dear Dr. Sato. Thank you very much for your reply despite your busy schedule.
It was very helpful, along with the Mixi site. I will keep on doing.
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(Q) Hi. It’s been a while!
It's been seven months now since starting TSW. I started living alone and my condition is getting worse due to changes in the environment. But thanks to a book by you, even if it gets worse, I can spend it without much panic. Thank you very much.
Well, as the title says...
I used to apply Almeta ointment to my eyelids before doing TSW.
(The right eyelid was applied more frequent)
Perhaps because of that, the swelling of the left eyelid was reduced relatively quickly.
The right eyelid is still swollen and sometimes has tic. It’s like the symptoms of eyelid myokimia, which sometimes occur.
Is this related to TSW symptoms?
Have you ever seen your patients who have similar experiences so far?
(S) It's said as follows on this website. "https://eye.tenink.net/miokimia/"
The causes are daily habits of action such as stress.
Physical fatigue, mental fatigue (stress), lack of sleep, irregular life, as part of eye strain caused by using a computer or smartphone for a long time…
This symptomatology may occur even when you drink coffee a lot.
On this website it doesn't say the cause is by topical steroids. When I don't have enough sleep, it sometimes happens to me, too. It may be related to the lack of sleep by worsening of the rash.
(Q) Thank you again for your reply and URL!
As I still have itching on my eyelids and face, especially there is dryness on the right eyebrows and eyelids, when I blink, my right eye feels heavy. The right eye may be overused and get tired...I'll keep it up on TSW in the long run.
The temperature is unstable these days, so please take care of yourself. (I’ll do that, too ^^)
Thank you for answering!
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(Q) My son is 10 years old. He has been eczema from an early but he has spent almost without using steroids, but his knees became lichenified and scraped severely and he could not bend his knees when it was severe so he had applied Antebate that the doctor prescribed for 9 months in total.
Eczema on the inside of the elbow similar to the back of the knee, redness, peeling, and dryness are constantly seen around the neck and around eyes. He used Dexan VG for his elbows and Locoid and Protopic around his neck and around eyes.
Over time, folliculitis (like a large white acne) began to appear frequently on the back of the knees and inside the elbows. At the same time, he started to get fever and sty, so I might be worried too much, but I was scared and stopped steroids.
He has a habit of scratching and touching his skin, and he can't stop scratching even after steroid was applied, so it hasn't improved especially before and after use.
The back of the knee is so red and there are always 10 or 20 folliculitis.
The part with the scab is depressed and exudate is weeping. Having folliculitis and weeping exudate and scab and scratching and folliculitis again and again, which makes us we’re not sure what to do.
He was taken antibiotics twice at the pediatrics department, but the situation does not change even if it subsides a little while I am taking it.
When he gets folliculitis, he washes it off with a lukewarm shower, doesn’t take care of it in order to get it dry at home. When the exudate or appearance is too bad, he goes to school holding down with “ Tubifast ” putting non-stick gauze.
Isn't the way of dealing with it wrong?
How can he get out of the current symptom?
The area around my eyes is red, white and dry, and the fine skin peels and seems to be very itchy. He rubs and scratches while sleeping, which is from before steroid is used. He uses eye drops during the pollen season, but the itching around my eyes doesn't disappear.
Is there no choice but to leave it as it is? I'm worried if it affects his eyes.
(S) It seems that the main symptom is strong lichenification on the back of the elbows and knees and cracks, and sometimes bacterial infection, and erythema on the eyelids, which often scratches the eyes, right? If he has a habit of touching the wound, it may be better to wrap the wound with one piece of gauze and cover it with a bandage. Non-stick gauze is often not good, and it is difficult to adjust the pressure attaching “TubiFast”. If he really has folliculitis, he will need antibiotics. He needs to look for sensitive antibiotics in bacterial cultures. If his eyes are itchy due to hay fever, he may need to take antihistamines or apply eye drops. It is difficult to treat atopy in children around the age of 10. Sometimes the symptom continues even due to mental stress. Finding the cause of mental stress is difficult, but there are quite a few cases which parent-child relationships are a major factor. Please consider it.
(Q) Thank you for your reply.
He scratches his eyes and neck but he almost never scratches his body while sleeping.
From a young age, he behaves calmly outside, but at home it is easy to lose his temper and feels frustration. On the other hand, he is easygoing and does things at his own pace, but he is nervous, such as tiding himself many times and fixing the Velcro closure on his shoes many times.
I think that touching the body and wounds is also caused by mental side.
You mean that mental stress would be related to independence and dependence between parents and children or the sign of beginning to adolescence.
He takes Allelock and Onon all year round because he has allergic rhinitis. He also applies eye drops during the pollen season.
As he feels painful taking the gauze off, I honestly don’t want to… but I understand that non-stick gauze is not good.
I will change to use thin gauze when he goes to school. I guess his dermatologist will use much steroid containing antibacterial agents for him. We’ll ask his doctor’s advice about internal medicines at the pediatrics department.
(Q) Sorry to bother you again. We went to our pediatrics yesterday and told his doctor we didn't want to use steroids anymore and got antibiotics and Acuatim. Last night, after showering (the scab has peeled off), he applied Acuatim and he applied zinc ointment on the area where exudate was still a lot and protected it with gauze.
The pediatrician told us to remove the gauze every day and take a shower and apply an ointment, but we honestly don't want to take the attached gauze off every day and remove the scab.
I can't see the affected area under the gauze, but is it no problem even if he doesn't remove it for about a week?
The gauze may get twisted or dirty because he plays at school.
In this case, is it okay to shower over the gauze and then absorb the water with a towel without removing the gauze?
We'd like to try the treatment with a piece of gauze while preventing bacterial infections.
(S) I think you're doing in a right way. I advise my patients not to remove the gauze for up to a week. After a week, only the gauze will be removed not to come off the scab. Wait for an hour after taking it off, and if the affected area is still wet, you should put the gauze again. You don't need gauze if it's dry. The reason for waiting for an hour is to judge whether the wetness is caused by sweat or exudate. Take a shower gently in order not to peel the gauze.
(Q) Thank you for your reply. Your explanation made that clear to me.
I'll do it the way you told me!
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(Q) Dear Dr Sato,
Would like to know do the Seborrheic dermatitis is the healing part/period of tsw? My face ‘s deep layer is dry tsw skin, but also have thin oily yellow crust and some little white plus pimples on face. Do I need to wash my face with only water every day or every 3 days? Also, do you suggest to apply Hyaluronic Acid on mild eczema skin? Many thanks to you and Tokuko san!?
(S) Seborrheic dermatitis is different disease from Atopic dermatitis or TSW.
Try to wash your face gently every 3 days.
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(Q) It's been 10 years since I started TSW and now I have eczema on my face.
Since last year when I wear a mask on a hot day my cheeks swell and turn red
It becomes hard, dry, and peels repeatedly. I use a cloth mask, but it’s not working.
Exudate came out and skin rash is spreading to the clavicle because it's getting hot recently or something. I think it's because of pollen though.
I’m in a trouble because I have to wear a mask and work.
Is there any way to deal with it other than not wearing a mask?
(S) Many people are getting worse by wearing masks. It is supposed to moisturize a lot. However, wearing a mask is necessary against coronavirus. There is no good idea to deal with it so far, I'm afraid.
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(Q) Why is one of the doctors of “Atopic” prescribing Dupixent and Collectim?
In addition, he recommends excessive sugar restriction while your treatment is no dietary restriction.
Is the policy of “Atopic” just that you don't use steroids?
Patients may be confused about what is right.
(S) There are some differences in the treatment methods of doctors who insist on steroid-free treatment for atopic dermatitis, to be precise. For example, regarding the use of moisturizers, My (Kenji Sato) way of treatment to patients is that it sometimes should be used, but sometimes not, depending on the patient's age, skin lesions, lesion sites, work environment, etc. When a new drug comes out, some doctors take time to evaluate it, and others get information quickly and evaluate it immediately. In addition, the type of drug used may differ depending on the work of the practicing doctor or the hospital doctor. The doctors of “Atopic” explain that topical steroid treatment should be avoided as much as possible for atopic dermatitis, but in reality you may actually be treated with steroids if it is difficult to withdraw from steroids and steroid use is recommended for a limited time. I am very grateful for your support for steroid-free treatment, but the medical field is complicated, and it is not possible to provide all patients with the best treatment for them with only one evaluation standard. I would be very grateful if you could understand its difficulty.
If you have time, I would appreciate it if you could read "What is Atopic" on Atopic's website.
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(Q) I am going through TSW and NMT for 4 months. In the past month, my symptoms have worsened, and I feel dry and itchy to the place where I had no atopic symptoms and had not applied any steroids or moisturizers before. I’ve heard that TSW and NMT are just things that get rid of steroid dependence and moisturizing dependences, not cure atopy itself. In my case, is it okay to leave it as it is, or is it better to moisturize on some parts?
(S) It’s difficult to answer your question because I’m not sure what atopic symptoms (you mentioned) are.
If you have applied steroids before, the steroid works on the part where you have not applied, and if you do TSW, you may have symptoms on your skin.
In any case, I don't think you should moisturize.
Mar. 2021
(Q) I'm starting to have questions about how to use moisturizers, so I’d like to ask you here.
My baby is 6 months old, weight 9.5 kg.
Breast milk + baby food once (no food allergies so far)
Newborn eczema and newborn desquamation were seen 1-2 months after birth, but he improved with a moisturizer after bathing.
From about 4 months after birth, his ears were cut, the area around his ears was red, and he started to have eczema. We consulted our family doctor and were prescribed Hirudoid and Kindabade, but I decided to apply only Hirudoid. The condition now gets ups and downs.
Five months after birth, the affected area extended from around the ears to the neck and there is dryness of the shins on both feet. He seems to scratch a lot as he gets sleepy.
When I told our family doctor that we didn't want to use steroids, I was told to apply Hirudoid more often, and now I apply it about 5 times a day and takes a bath every day. Soap is used only in the genital area.
Should he stop using moisturizers? In the case of stopping moisturizers, should he reduce the number of times he apply it gradually?
Should he take a shower instead of taking a bath?
In addition, I would appreciate it if you could give us some advice. Thank you.
(S) Bathing and showering should be reduced and shortened. Moisturizing should be stopped in a week. If you have any other questions, please read "NO for steroids! Atopy treatment for babies and children" (Kenji Sato, Mitsuko Sato, Miraisha for Children, 2010).
(Q) Thank you for your reply.
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(Q) Thank you for always answering my questions.
I would like to ask you two questions this time.
It's been a year since I started TSW and NMT. Until recently, my skin has been in good condition, but from the time there’s a lot of pollen in the air, my skin began to itch. I can sleep at night.
Is this caused by washing a bed sheet and drying them outside every day?
And regarding ceramides, should I avoid taking supplemental ceramides as they will moisturize?
(S) For people with hay fever, drying a bed sheet outside may cause symptoms.
Oral ceramide does not work as moisturizing and is useless.
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(Q) I have eczema, a reddish face, and thick and rough skin. Would it be a problem if I have a double eyelid surgery? I’m concerned about infection…
(S) I think the thick and stiff skin is due to scratching the face often. You mustn’t be good to scratch after the surgery, right?
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(Q) My son, a fifth grader, had no problem with his skin wearing a mask for a year, but since February, both his cheeks started to be rough and can’t heal for a long time, probably because of the mask and hay fever. The scalp also seems to be itchy.
I can’t do anything, just watching over.
If you use an "inner frame" for the mask attaching inside the mask to prevent it from sticking, will it be useful even in a slightly?
I would appreciate it if I could hear your opinion.
Thank you.
(S) You just have to give it a try.
(Q) Thank you for your reply, Dr. Sato.
Spring break is coming soon, so I'll try many ways while shortening time that he wears a mask.
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(Q) Is it true that NMT will result in “inner dryness”?
Moisturizing makes your skin vulnerable to scratches, but as you continue to moisturize, your skin becomes stronger… How is this possible? I would like to know your opinion from your experiences, Dr. Sato.
(S) I don't know the exact meaning of “inner dry”. Even you restrict water in NMT, the required amount of water is still present in the body.
The idea of NMT was born from the fact that I noticed that the skin is easily damaged when scratched if you continue to moisturize. It's the opposite way, isn’t it.
(Q) Thank you for your reply, Dr. Sato.
I understand clearly. I will continue to NMT as usual.
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(Q) What do you say to the Chinese herbal medicine Taitsukou for TSW?
(S) It is not good when you are doing NMT because it is an ointment . For people who are not steroid-dependent or moisturizing-dependent, it could be used as a moisturizer, but it is not clear to be effective. I'm not actively recommending it. Please do not misunderstand.
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(Q) It's been about half a year since starting NMT. My face is covered with thick skin and there are like a few yellow crystals, and a small amount of exudate come out from the wound. I tend to scratch my entire face when I'm sleeping. Even if I feel relieved after I could stop touching, but the next day I get depressed by scratching. I blame myself because I can’t stop scratching, after touching a little where is not so itchy.
Even so, I feel that I have recovered more than before by going to bed earlier these days. However, I have to go to a foreign country where is 8 hours behind. I leave Japan at noon and arrive there in the mid-afternoon. In Japan time, it will be around midnight. How should I deal with the time difference? I am worried that the time difference will make my recovering skin worse. Also, is the air inside the plane too dry for me while I'm doing NMT?
(S) Your skin could be worse with a time difference of 8 hours. However, some people travel to Europe and improve their rash (I guess you travel to Europe). The air would be very dry inside the plane.
(Q) Dr. Sato, That's right. I try to sleep as much as possible and adjust my body condition by getting sunshine so that I don't get tired anyway, but I'm still worried. I will keep humid inside the plane. Thank you for your response.
(Q) I'm Akina, who asked you about the effect of the time difference the other day.
Thank you for your reply.
It's been about 10 days since I’ve got to by plane. Since I had nothing to do during the flight, I was a dozing off around for an hour. On the day I arrived, I went to bed around 8 p.m. and was able to sleep until around 7 in the next morning. Those days I was able to fall sleep from 10 p.m. to 8 a.m. This might sound a little long-sleep, but I wake up many times because of itching, so it is about eight and a half hours of sleep, actually. I was able to adapt to local time smoothly.
As you said, since I came here in Europe, my skin seems to have gotten a little better (the redness has decreased and the dry, thick, hard skin has become thinner). On the long flight, the dryness was really sever, and it was quite tough in the second half of the flight. I put two wet towels near my seat, but I'm not sure if it worked or not.
As I thought that there might be someone who is worried about the time difference, I posted this comment so that someone could refer to my experience.
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(Q) I got Kaposi varicelliform eruption. I'm on medication for herpes now.
It's been 3 days since I started taking it, but it's still spreading.
Should I take a shower every day? Or twice a week?
(S) Is that really Kaposi varicelliform eruption?
If so, it would be better to take twice a week.
(Q) Thank you for your answer Dr. Sato,
I've gotten anxious because it's been a month since I stopped using steroids, and my skin condition was bad and I had Kaposi.
Thank you.
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(Q) Is the demand for TSW treatments expected to reduce in the future because of Dupixent, Collectim Ointment, and other new drug approvals?
(S) Since the Collectim ointment is used externally, it will not work very well by developing the problem of moisturizing dependence.
Dupixent does not cause the problem of moisturizing dependence, but it seems that there are symptoms that are difficult to heal (such as facial erythema), and patients with severe symptoms cannot be decreased.
Since steroid treatment has already been done by the time Dupixent treatment starts, the number of patients requiring TSW will continue to increase in my opinion.
Feb. 2021
(Q) I heard that TPW appeared to take longer to heal than TSW, why?
(S) I’m not sure why. That is based on my experience to have seen patients. Exudate of Protopic users seem to have more serious and longer to heal in withdrawal symptoms.
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(S) Currently, you can be admitted to Hannan Chuo Hospital without waiting for admission. Both men and women are available. If you are worried about your skin condition, please come to see me. Please read the hospitalization information on the hospital website carefully.
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(Q) I consulted on my genital area on this bulletin board a month ago. From that point on, I feel that the condition of the genital area is improving little by little, going back and forth. I can't say with confidence yet...
On the other hand, the whole body except the genital area has deteriorated in the past month.
I am very anxious because I was aiming for 3 months to TSW. The affected areas are the face, neck, ears, sides, arms, inner elbows, genitals, nipples, inner thighs, and back of the knees now. In the past month, my neck and inner elbows have become so itchy, feverish and exudate that I can't sleep. The inner elbow becomes sticky with the exudate just by holding the bowl during the meal. If I touch my smartphone for 5 minutes, not only the inner elbow but also the scab on the neck, which should have been dry, becomes sticky with the exudate. Also, in the past month, itching and red small rashes have newly appeared on the inner thighs and the back of the knees.
I’m maintaining a well-regulated life except the lack of sleep at night. Since I have a lot of exudate, I eat a lot of protein in a well-balanced manner. Because of the risk of thrombosis by taking low-dose pills, I take 1 to 1.5 liters of water a day, and for this reason I only get hard stools. The amount of exercise has also increased. I have no stress except for pain and itching.
I used weakly acidic hypochlorous acid water (concentration 50ppm) for the first time yesterday. The inflammation of the inner elbow and arm has subsided, and itching is the only area without skin. This is my current skin condition.
When I was surfing the net, I found two graphs of the worsening wave of TSW on another site. According to the graph, there was the first peak of deterioration in the 2nd to 3rd weeks after the start of TSW. Next, there was a second deterioration, which was the third month after the start of TSW. In particular, it was written that it deteriorated sharply in the 2nd to 3rd months. Furthermore, the second peak was more serious than the first one. The period of deterioration of the second peak is from the 2nd to 6th month (or 8th month) of the start of TSW.
Am I in the second peak now, frankly?
Is this graph credible in the first place?
Thank you.
(S) It seems that you will not know unless you actually see a doctor. I recommend that you have a medical examination. You may need to be hospitalized.
(Q) I understand. I’ll consider it. Thank you.
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(Q) Excuse me, Dr. Sato.
My son's face has been getting worse since February.
There is a wound around his nose and the exudate from it solidifies, it is scraped and solidified repeatedly during the night.
As it hardens, I don’t care of it and just wait for natural healing.
He tries not to get wet and keeps water restrictions. Should I just keep watching the situation?
I look forward to your answer.
(S) I can’t answer your question without seeing your son’s skin directly..
There are too many unknowns such as age, judgment of infection, and complication of seborrheic dermatitis.
(Q) Thank you for your reply.
We are having a medical examination soon. I appreciate your answer as always.
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(Q) Good evening, Dr. Sato.
Since last March, I have been carrying out TSW and NMT with the book you wrote.
I am suffering from exudate from my ears and nipples, so I will write about it. The exudate from my ears was quite terrible, but thanks to the strict water restriction (up to 1L), it has become very dry.
However, the exudate from both nipples is still terrible, and if I wear a bra, it sucks so much that the pad gets wet, which will cause eczema on the entire breast, so I always put a piece of gauze on the nipple without wearing a bra. Even so, the clothes around the chest became sticky and wet, not hardening the gauze. When I wake up in the morning, I get exudate enough to make big stains on the bed sheets.
I don’t mind as the sheets and T-shirts can be washed, but is it common that a large amount of exudate still comes out of the nipple almost a year after the start of NMT? If it is best to leave it as it is, I will do so, but if you have any other idea, please let me know.
I think you are busy, but thank you.
(S) It's not rare for it to take a long time to heal, but I haven't heard much about the amount of exudate you have. That might be bacterial infection. In that case, oral antibiotics are needed. If you are not infected, try zinc oxide ointment once.
(Q) Thank you for your prompt reply.
I put on a thick layer of zinc oxide ointment and then covered it with gauze. I think it's dry and the exudate is low. Is it enough to change this once every few days, like the same as one-piece gauze method, after it gets dirty or when it comes off naturally? Excuse me for the question again.
(S) If the gauze sticks, leave it as it is for a week
If it comes off, reattach it.
(Q) Thank you for your reply while you are busy, Dr. Sato.
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(Q) This would be my second question since the end of last year.
It's been 2 years and 7 months after starting TSW.
Maybe because of my age, the hair around the crown becomes thin and I want to use a hair restorer, but most of the hair restorer contains licorice and glycyrrhizin. Isn't it good after all? Isn't it also good to use purple root extract, which has the same ingredients as Shiunkou?
Thank you.
(S) It will be whether choosing hair or eczema, won't it.
Please judge for yourself.
(Q) Thank you for your reply. I’ve experienced hellfire by TSW, so I'll give priority to eczema (laughs). I give up using the hair restorer.
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(Q) Hello. I have been hospitalized before.
In my symptom that tends to get worse, but my body feels like the body is burning.
The face and neck which symptoms are severe become hot and I sweat more and more.
It will subside after a while, but there are several times a day, and at that time I feel so sick..
Often after meals, but not always.
What exactly does this mean?
Also, do you have any solution? Please let me know.
(S) Isn't your blood pressure just rising after eating? If the rash gets better, it will heal. It would not be a menopause.
(Q) It’s related on blood pressure, isn't it?
It was hard for me to eat because of the burning and dullness, but I was a little relieved to know the cause.
After all, if the atopic symptom does not improve, that will not improve either, right?
Thank you for your reply while you are busy.
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(Q) Dr. Sato, I'm sorry to ask you a question.
In the case of symptoms such as crusted impetigo, I think that other hospitals will prescribe antibiotic ointment and oral antibiotic medicine, but do you think that taking oral medicine alone will improve faster?
If you have impetigo, is it better not to take a shower and to dry it all the time, or is it better to take a quick shower? The affected area is dry.
I look forward to your answer.
(S) Of course, if you don't have a moisturizing addiction, taking ointment and oral administration will be quick to improve. It cannot be unequivocally determined if you have a moisturizing addiction.
It depends on the condition of impetigo. If it looks dry, the quick shower will be effective. It is difficult to judge if it is moist or exudate.
(Q) Thank you for your prompt reply while you are busy. It was very helpful.
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(Q) Is my understanding correct to cure seborrheic dermatitis by natural healing just like atopy treatment without doing anything basically?
(S) For people without atopy, first use ketoconazole cream or liquid.
Seborrheic dermatitis occurs when you are not feeling well. Therefore, the outbreak can be suppressed by taking precautions such as not catching a cold, not getting sleepless, taking an appropriate amount of food, and not receiving strong ultraviolet rays.
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(Q) It's been many years to get better and worse since I've started TSW using antibacterial agents but this time I've seen some nummular dermatitis. Also, while I didn’t care of them, I got some more on my body in a few weeks, and they on my arms got bigger and bigger.
After a lot of research, I thought it was nummular dermatitis, but I thought it might be due to ringworm.
How is the difference judged? I am in trouble because I am only prescribed steroids at this dermatologist.
And what is the treatment for ringworm-induced eczema on the body?
I would be grateful if you could reply.
(S) Please see the photo at the URL below to determine if you have ringworm.
I think that ringworm can be cured by topical antifungal agents. Over the counter ones are sufficient.
It may be judged it as eczema as you are prescribed only for steroids. It may be that you are already addicted to steroids and topical steroids are no longer effective.
(Q) Dr. Sato, thank you very much for your prompt reply.
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(Q) I’ve got a job offer from a company that has a two-shift system. I see online information that irregular life worsens atopy. When I talk to a doctor, some say it's better not to work at night, while others say it's fine.
I would like to hear from your thoughts based on your experience in atopic dermatology.
Personally, I think that the job content and occupation do not affect the deterioration of atopy, and I will not know until I actually try it.
(S) There are quite a few people who get worse with night shifts. It's safer to avoid it.
(Q) Dr. Sato. Thank you for your polite answer.
I would like to consider choosing a job that has fewer exacerbations.
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(Q) What do you think about Collectim Ointment?
> Will I have withdrawal symptoms if I quit Collectim Ointment?
(S) You can think of it as basically the same as Protopic. Because it is a drug that has the function of blocking a part of the route of inflammation.
However, since it is still moisturizing, it may be necessary to withdraw from moisturizing even if it is used as a steroid withdrawal.
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(Q) Dr. Sato, I'm sorry to ask you a question.
After starting TSW and NMT, scab-like eczema developed around the clavicle, and itching was strong and scabs were formed repeatedly, and the affected area expanded and this condition has been for 3 years.
Finally, when I felt my limitations and consulted a nearby dermatologist, I was diagnosed with trunk-type impetigo eczema and was prescribed oral antibiotics and topical medicine for 2 weeks, but no improvement was seen and the period of administration was over and it’s starting to get worse again. There are different types of antibiotics, so should I try other antibiotics? We would appreciate your feedback.
(S) I'm sorry, but I can't say anything because I haven't seen your rash. Even if an antibiotic doesn't work, it doesn't mean it wasn't an infection. It may have been an infection caused by bacteria that are resistant to the antibiotic. Or it may have been a non-infectious rash.
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(Q) I think Dr. Sato thinks that atopy and pollen are not related, but why is the number of atopy patients getting worse every year during the pollen season?
(S) On the contrary, I would like to ask you, is pollen the only thing around atopic patients during the pollen season, that is, around March? There are many things that change, such as personal changes, such as clothing and social changes, such as various problems that change from year to year, environmental changes, such as changes in temperature little by little. Since it is the expression of pollen season, you only pay attention to pollen, and in reality, you cannot know the cause of deterioration without considering a surprising number of things.
If you have allergic rhinitis or allergic conjunctivitis and the cause is pollen that flies a lot in the spring, you will see deterioration of the skin in that area when your eyes and nose become itchy and scratch the surrounding area. In my experience so far, this is about it.
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(Q) The details of vaccination against the COVID-19 are being decided little by little, but is it okay to vaccinate if you are TSW and NMT? I’m worried about it. I stopped vaccination against normal influenza after TSW and NMT (although it is still in the process). What about the vaccination ingredients for COVID-19? Is it okay to vaccinate if the skin condition is stable? I am thinking a lot. I think it will be my own decision in the end, but what do you think about it, Dr. Sato? I would appreciate it if you could let me know. Thank you.
(S) There are two types of vaccines. Both seem to be effective, but the safety is unknown. In particular, Pfizer's is a new mRNA method, so I have no idea. If the safety can be ignored, it will be implemented, but if the safety is uncertain, it will not be done. Since the vaccine made in China is an inactivated vaccine, it will be similar to influenza. However, this side effect is unknown.
The effect on atopy is unknown, so there is no way to say it.
(Q) Thank you for your reply, Dr. Sato.
I heard the mRNA method for the first time. I immediately searched on the net, but it was too specialized and too difficult for me...
I am even more worried because people who are in good health without any problems are worried about vaccination. By the time it's my turn to inoculate, improve your skin condition, take proper measures against COVID-19, and look into this a lot. And what to do? After all, it is a difficult problem.
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(Q) It has been for 7 months since I started TSW treatment on my own with the book you wrote.
Current symptoms include (1) forehead, eyelids, lower left eye, redness of nasal lip groove (telangiectasia?), Forehead moss, white dermatographic urticaria, scales on the entire face and hairline, (2) upper chest and armpits. Apparent atopic dermatitis in the anterior-posterior, interscapular, and inguinal regions (3) Wrinkles in the abdomen, white dermatographic urticaria in the abdomen
(1) Balance-conscious nutrition (high protein) (2) Running, muscle training, stretching exercise (3) Sleep (difficult to fall asleep) (4) TSW (Topical Steroid Withdrawal), NMT (No Moisturizing Treatment)
I’m working on these ways above.
If all of these symptoms are relieved, are TSW and NMT supposed to be successful?
Is there a lot of people who have similar symptoms and have been overcome?
I will overcome atopic dermatitis by any means, but I feel like I'm about to break my heart. I would appreciate it if you could answer my questions. Thank you.
(S) >If all of these symptoms are relieved, are TSW and NMT supposed to be successful?
Of cause. However, those who get worse seasonally may get worse at the time. Therefore, I think it is necessary to live a cautious life even if you are in remission. I think it is necessary to have an attitude of improvement over the years.
I think that the efforts from ① to ④ are fine, but it is necessary to carefully consider each specific content. For example, you don't need to eat a lot of high protein unless you have a lot of desquamation and exudate. Even if you run and you get too tired, it will have an adverse effect on your skin.
Considering of the current state after taking about 7 months, I think that something is wrong or something is missing. Although you live far away, I feel that a direct medical examination is necessary.
I'm sorry I can't say something to encourage you.
(Q) Dr. Sato Thank you for your reply. After reading your comments, I felt better and felt the need to reconsider my actions.
Don’t say so, "I'm sorry I can't say something to encourage you." Without Dr. Sato, I would have been instilling steroids now (the inside of my eyes became severely itchy before TSW treatment), and prurigo, which could not heal no matter how much steroids are applied, disappeared immediately after starting TSW treatment. (That was crazy) Thank you.
Finally, let me ask you one more question.
I didn't get any exudate, so I thought I shouldn't be too conscious of water restrictions.
Is water restriction effective for any atopic dermatitis (my symptoms: redness of the face, dry skin, desquamates)?
(S) Moderate water restriction is necessary throughout your life. Even no-exudate skin can easily get exudate if you drink a lot of water.
(Q) Thank you for your reply, Dr. Sato. Thank you again when I take your medical advice.
Jan. 2021
(Q) Some people say that it is better not to apply anything to the baby, but moisturizing the baby is pervasive as common sense, but in your opinion, is that wrong, Dr. Sato?
A doctor in Ageo said to me, if you apply a moisturizer such as petrolatum to your baby, it will cause atopy, so you should never apply it. Do you have the same opinion?
(S) Please read the following.
Atopic's website. Kenji Sato's blog in it. It is included in item 2 of the medical treatise. The title of the sentence is "Should Moisturize High-Risk Newborns with Atopic Dermatitis?" The URL is below
http://atopic.info/satokenji/category/medical-paper/page/2/
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(Q) It’s been 5 months since NMT (No Moisturizing Treatment).
Sometimes the winkle at the edge of the eye is cut so much (it’s like the back of the ear or the edge of the mouth is cut) and it hurts very much. I don't know if it's atopy or something, but I have a symptom of tears coming out of my eyes all the time, so I'm worried that it will get wet and difficult to dry resulting may get a bacterial infection. For the time being, it feels like the red peeling has hardened. Is it all right to just dry (try to) without doing anything in such a state?
Also, every morning, I put my eyes on a small cup of water and crackle to wash them, but was this wrong?
I'm sorry to hear that you are busy, but thank you.
(S) Isn't it allergic conjunctivitis? I think it would be better to use anti-histamine eye drops and oral medicine.
(Q) Thank you for your quick reply. My eye doctor said the surface of my eyes was scratched by scratching my eyelids.
I was prescribed Diquas eye drops and Alesion eye drops.
As they are not steroids, is it okay to use it?
(S) It’s okay to use Diquas ophthalmic solution and Alesion ophthalmic solution.
(Q) Thank you, Dr. Sato!
Now I can use it with no worry.
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(Q) I had been hospitalized under your help several years ago and succeeded in TSW (Topical Steroid Withdrawal) and NMT (No moisturizing Treatment). Thank you at that time. It was a life-changing experience that I couldn't thank you enough.
By the way, thankfully, I have given a child and I am preparing baby products, but they always say that it is a moisturizer. I can guess it's best not to use it, according to your methods, but is it better not to use moisturizers on delicate baby’s skin shortly after birth? What should I do if I am concerned about dryness?
(I don't know if it's atopy yet, but I don't want to make the cause of atopy as much as possible)
If you have any other precautions regarding skin care for newborns, infants, and children, please tell me (books are also acceptable). I know your busy, but thank you for your cooperation.
(S) I think it's best not to apply extra things because it's "delicate skin shortly after birth".
Book title: NO for steroids! Atopy treatment for babies and children
by Kenji Sato Mitsuko Sato
Children's future company
Please read this.
(Q) Thank you for your reply while you are busy.
That book, whether or not you have atopy, is useful for prevention! Actually I had already checked it, but I couldn't find it at the bookstore and was wondering about purchasing it. I would like to order it immediately!
Thank you.
In such a time, you are working for us patients. Please be safe and take care of yourself even more m (__) m
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(Q) Nice to meet you. It's been 2 months since my first TSW (Topical Steroid Withdrawal) and NMT (No moisturizing Treatment).
On the day it started, the forehead, mouth circumference, ears, neck, back neck, inner elbows, arms, and back of the hands became rough, and one and a half months after the start, the back of the knee, collarbone, armpits, nipples, and pubic area (including hair part) started to get rough, too.
The genital area and nipples started to get rush around 14 years old, and the inner elbows and back of the knees started to develop around 8 years old, and I applied locoid for a fixed period each time it became rough.
I’m not sure whether the cause of deterioration was the influence of self-restraint by COVID-19 pandemic and wearing masks in 2020, but the skin on the back neck, scapula and pubic area became rough, and a large amount of Locoid, Hirudoid and Bepotastine were prescribed by a nearby dermatologist. I applied Locoid → healed → soon became rough, and strange blisters appeared between my fingers for about 10 months, and I realized that it was an unnatural and vicious cycle. This is why I started to TSW.
I think that my condition is milder than other patients, as it is said that there is no exudate period since the start of TSW. The inner elbow is covered with scab, but I feel that the recovery of scratches is accelerating little by little. However, my biggest problem right now is the genital area.
I'm scratching before and at bedtime, and I'm crazy about itching when I get up. The condition of the genital area is a mixture of cracks, exudates, and scabs. I make it cool down, which only causes severe pain. So I apply a small amount of saline solution, but I still get severe pain on the verge of goose bumps, sore throat, and incontinence.
However, unlike just cooling, it gradually better with saline. But this pain seems to be quite crazy like the itch just before.
You cannot run, cross your legs, or lie down because the genitals rub against each other. Now, it’s all I can do to walk due to mental problem causing by my genital pain.
Probably because I had been applying steroids in a problematic family environment since I was a child, I was depressed and had no decent menstruation due to irregular bleeding until I was 24 years old. I was finally diagnosed polycystic ovarian function 2 years ago (2019) and have a monthly period with low dose pills. Currently, I don't have a job because of the pandemic, but since I left my parents, I am mentally stable.
I was diagnosed as not having an infectious disease such as Candida albicans by a gynecologist.
The skin is the worst during and one week before menstruation.
Shower is once a day considering of Corona virus. However, only the genital area is once every 3 days.
The moment I put on the comforter (japanese futon), I feel itchy due to the warmth and static electricity that clings to me, so now it's easiest to sleep on a hot carpet with a blanket, and that's the way I'm calm.
I spend as much time as possible in my room with no underwear. I wear elastic waist pants at home because the trousers with a zipper hit the genital area hard and hurt.
I take one tablet of Bepotastine at night for about half a year. Low-dose pills for 2 years and take loxonin, caronal, or the over-the-counter drug EVE a once a day for 10 consecutive days to control severe pain in the genital area.
What should I do to deal with itching and pain in the genital area?
How should I use with sanitary napkins?
Is it okay to take Bepotastine and painkillers?
I think you are busy, but thank you.
(S) 1. You have a long history of applying steroids in the genital area, so I think it will take some time to heal.
2. You also need to consider a rash caused by sanitary napkins. It means that it was just a rash if it is improved by changing other type of products.
3. I think it is necessary to cut the pubic hair with scissors to reduce the irritation caused by the hair and the bacteria that adhere to the hair. If possible, it’s better to apply gauze, but it is not applicable because you need to change it every time you urinate. So applying gauze is not applicable.
4. Continue TSW, but stop NMT and start another TSW method. That is, the moisturizer is continued for a while, although TSW is going on. Once the skin has improved, NMT is carried out step by step. In other words, leave 1 hour after bathing and apply petrolatum. Do this for about a week. Next, 2 hours, then 3 hours. And then you will wait until the next morning. After that, the moisturizer is done with intervals starting every other day and it will be NMT at the end.
My <new edition> Adult-type atopic treatment learned from patients: TSW / NMT for intractable atopic dermatitis, Tsuge Shobo Shinsha, If you have 2015 edition, Chapter 4 NMT, 7 Methods of NMT , (2) Please read about "time and feeling".
(Q) Thank you for your reply, Dr. Kenji Sato. I'll try to do my best.
As you said, it was very refreshing to cut and pull out the pubic hair. I have used cloth sanitary napkins for a long time, so rashes caused by oil are unlikely. It was a place where germs could easily grow, when I felt “so itching!” I took a cold shower and it became easier. I tried applying Aznol or Hirudoid as a temporary moisturizer, but it was sticky and crusted slowly, and I felt itchy, so I immediately returned to NMT. Then, it turned yellow and scabbed safely. After that, the crusted area became cracked day by day, and suffered severe pain that made it impossible to walk or sleep. The yellow scab with the cracks caught on my pants, and the scab turned over and it always hurt.
Since I had just started TSW and NMT and I thought that “scabs” equals “red scabs”, I felt height of anxiety to the condition at that time. So I removed all the yellow scabs.
Then, I could see young skin from below, and seeing beautiful skin for the first time in a long time gave me joy and relief. However, the next day, desquamation started and it was painful. Now I’m in this stage.
I wrote it as the pubic area, but to be exact, it is a mons pubis. It is a place where pubic hair grows densely, which is closer to the navel than the clitoris.
It seems that the exudate is hard to come out, and the gauze does not stick.
Q1 What kind of treatment should I take the next in the condition of the young skin desquamation and cracks at mons pubis where exudate is hard to come out?
The exudate sometimes doesn’t come out unless you pinch it with your fingers and squeeze it out.
Q2 If I lighten exercise, I can get up at night just before scratching and wait for it to be calm. If I increase the amount of exercise, I will become sleepy and I had already scratched it at the time I noticed.
However, if the amount of exercise is heavy, recovery is quick except for the skin that was scratched in the middle of the night. The skin that is scratched is always a mons pubis, so I'm worried about countermeasures.
Q3 There is a crack in the mons pubis, and it is difficult for exudate to come out. Even if the exudate comes out and hardens, it will make cracks at the same place immediately. I wonder that using Ekiban (liquid bandage) on these cracks and rough skin will speed up healing.
When the skin of the mons pubis hurts so much that it makes me cry, I feel painful, sad and anxious. At such times, I am doing my best by reading and holding the teacher's book.
I think you are busy, but thank you for your cooperation.
(S) It's better to cut with scissor your pubic hair, but don’t pull it out.
A-1: It is not good to remove the scab. Even if the crack hurts, you have to endure it. Rhagades occur because the skin begins to heal and becomes dry. The act of squeezing exudate is not good.
A-2: The amount of exercise must be adjusted to the physical strength of each person. It is impossible to judge this without actually seeing it.
A-3: A crack that does not allow exudate to come out is a crack that tends to heal and means that it is moving in the right direction. It is good to fix the exudate with gauze, but you should avoid using bandages as much as possible.
If you put up with the cracks, it will heal. If you can't do this, you won't get better forever.
Keep patient.
(Q) Thank you!
Just hearing your comments of healing tendency made me positive about the treatment. I will continue to do my best.
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(Q) It’s been 7 years since TSW and NMT.
I have been using inhaled steroids for half a year since I have asthma.
Recently, I have gotten erosion-like scratches for the first time in a while.
> Is this the effect of inhaled steroids and makes the skin thinner?
(S) I don't know without seeing it
>Can inhaled steroids exacerbate atopy?
(S) The skin usually improves while using inhaled steroids. It gets worse when you stop it.
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(Q) There seems to be a method called atopy manipulative treatment at the manipulative treatment and osteopathic clinic. It seems that it will heal by improving blood flow, improving internal organs, etc., and they suggest that it should be continued once a week for the first two months and once a month for about a year.
I have been TSW and NMT for about 8 years, but the dryness is so intense that I have been taking a bath for about a year. Shower is only for the lower body. Anyway, I wanted to improve it even a little, and I was interested in atopic manipulative treatment. Is this necessary or effective? Since the prices are as high as 7,000 yen at a time, is exercise by yourself, such as walking, the fastest way to improve?
(S) I haven't worked on it myself, so I can't answer because I don't have the data about it. I think exercise is necessary. There are many other things you can do to TSW and NMT. I think it will be better if you do other things.
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(Q) Nice to meet you!
It's been two months since I started TSW and NMT this winter. At first, the redness and itchiness were terrible for the skin, but now it is calming down. As the original skin gradually becomes visible, there are some parts that are shininess, tautness to skin and smooth like vinyl skin. Is this a healing process? Or is it another skin problem?
(S) I'm sorry, but I can't judge without actually seeing it. I recommend that you have a medical examination.
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(Q) I made an appointment for a medical examination on the 21st, but from this Wednesday, blisters have appeared on my lips and around them. I've been had Kaposi's varicelliform eruption before, so should I apply the Aracena S ointment for herpes leaving at home until the 21st and see what happens? I don't have a fever. I'm from Aichi prefecture. Thank you.
(S) I hope it doesn't spread any further. If it spreads, you may want to take an antiviral drug.
(Q) Thank you for your reply. I'd like to see you at hospital, so I'll wait and see until the 21st. Thank you for taking your time.
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(Q) Dr. Sato recognizes that food and pollen are not related to TSW and NMT, but which of (1) steroid dermatitis and (2) atopic dermatitis does it mean?
> If it is the former, do you think that TSW and NMT require dietary restrictions to prevent the symptoms of atopic dermatitis?
(S) I think that both ① and ② are irrelevant. Food allergies and hay fever are different diseases from atopic dermatitis.
A food allergy is not a food allergy even if it is positive in the RAST allergy test. Food allergies are only in the case you eat some food and actually experience anaphylaxis. If you really have a food allergy, you must avoid it. However, As it’s common to get a little itchy after eating something you don’t need to limit it. This is not a food allergy.
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(Q) I have been reading the book you wrote and have been TSW and NMT since 2020. June (living in Shizuoka, 39 years old, one daughter successfully TSW). My daughter's skin became normal after TSW and NMT. After withdrawal, I became terrible, my skin turned over, and my lower body, arms, hands, and face were recovering. My back was getting better, but from the end of December, the area around my shoulders became itchy like an insect bite, the surface of the eczema was dented, and when I picked it strongly, blood came out, and it was very itchy. Is done. In the case of prurigo, I was watching the progress to observe the situation a little more, but the eczema spread in a band shape to the back and it was very itchy. Once the exudate comes out, the itch has subsided once and it has become a scab, and some of the old ones have healed naturally, but they are spreading to the back. It doesn't seem to be herpes because there are no blisters at all. According the book you wrote, I thought that there was a possibility of bacterial infection instead of prurigo, so I'm thinking of going to a nearby doctor as I couldn't go to Osaka because of the pandemic. I think that prurigo is also accompanied by itching, but is itching even with a bacterial infection? I'm worried if my local doctor will make a correct diagnosis, but is it okay to take antibiotics for bacterial infections and follow-up for prurigo?
(S) I think that "antibiotics for bacterial infections, follow-up for prurigo" is fine.
Even shingles can be itchy, not painful. Be careful.
(Q) Thank you very much for your prompt reply.
I went to a nearby doctor yesterday. Eczema near the waist may be shingles. Itching on the shoulders would be aggravation of atopy. It couldn't be judged if it was prurigo because my skin was dry. I was given a prescription for herpes zoster and maybe a suspicion of a bacterial infection, so I decided to take a look at it for a week. It's the second day of oral administration, but the itchiness around my waist and shoulders is decreasing. It's turning to a scab.
(Q) I have a question for you.
What is the difference in appearance between bacterial infection and prurigo?
In my case, a part of my skin becomes itchy like an insect bite, and a lot of red spots spread and a lot of scabs on my skin are formed. Can a bacterial infection cause this situation? Is prurigo swelling?
Thank you.
(S) Bacterial infections are erosive or pus-filled rashes. Prurigo is a hard, rugged, slightly raised area of about 1 cm. Bacterial infections also occur on prurigo. In this case, it will be exudative on the top of the hardened area.
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(Q) I'm sorry to bother you.
My 11-year-old son has a bumpy eczema on his crotch and around the base of his feet, which is itchy and he always scratches and does not heal for a while.
Even if he takes a short shower every day, he is itchy all the time.
When it hurts by scratching, I try to apply a thin coat of タイツコウ and anti-suppuration medicine to him, but he seems itchy again soon after it gets better.
If the scratched eczema produces a small amount of exudate and dries quickly, is there no worry about getting bacterial infection?
Thank you.
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(Q) Dear Dr Sato/sir/madam,
I am doing no moisturer treatment around 6 months already. I have some question would like to ask you. Thank you so much!
I live in Hongkong. It's very hot and humidity around 80-90. Before nmt, I need to wash my hair everyday to prevent itchy. My scalp don't have eczema now. Now because do the nmt, I wash my hair every 3 day with milk soap bar. But it is very itchy after the shower day and my scalp start to have acnes.
Is it normal? Will my scalp start to less itchy and less having acnes if i still wash my hair every 3 day on the futute? Wash the hair with milk soap bar or only water would be better? Are there some patients in 阪南中央病院 also have this problem?
Thank you so much! Highly appreciate that Dr Sato helped many tsw and ad patients around the world.
Best wishes,
Michelle
(S) Please stop using milk soap bar. Just wash your hair with water every 3 days. Many patients with atopic dermatitis have itch on their scalp.
(Q) Dear Dr Sato, thanks for your quick reply! Would you suggest to wear hand gloves to wash hair? Is it too long to wash the hair around 4 minutes? If i feel super itchy before the next shower day, any suggestions to help? Many thanks!
Would you suggest to wear hand gloves to wash hair? →Yes.
Is it too long to wash the hair around 4 minutes?→Shorter than 30 seconds.
If I feel super itchy before the next shower day, any suggestions to help?→Shower less frequently.
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(Q) I am 40 years old and I’m doing TSW and NMT reading the book you wrote for 2 years and 3 months.
Currently, the face, neck, shoulders, back, precordium, entire arms, and ankles have strong itching and exudate, and the skin is generally rough and easy to tear. I limit drinking water, run about 5km, and raise my head about 20cm at bedtime, but it doesn't improve.
Currently, I'm not taking any medicine and take a shower only.
Question (1) What do you think I should do first in the current situation?
Question (2) Do you think that it will take time to heal for bumpy skin?
Question (3) If I restart steroids, should I start with the weakest ones? And should I see a doctor who recommends other steroids instead of Dr. Sato? (As my child enters elementary school, if the TSW and NMT condition is as bad as it is now, I'm thinking of suspending it around March. Before using steroids again, I'm struggle to find other ways. I would like to hear your opinion.)
(S) Question (1) It seems to be quite serious from your comment. Considering of your current state taking for 2 years and 3 months, the most important thing is to see a doctor. I'm not sure if you are able to do enough from the above description. Possibly you can need hospitalization required.
Question (2) It seems to be serious, so it will take a long time to heal. Hospitalization will be the fastest and better to improve.
Question (3) I don't know if TSW and NMT are sufficient, so I think it's too early to proceed to ③.
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(Q) I'm sorry, I know you must be busy, but..
I myself have done TSW and NMT under Dr. Sato and my condition is gradually recovering.
Today, I would like to talk about one of my relatives.
He or she has hand eczema and I only apply Antebate when it's really sever. In the summer, athlete's foot is likely to form on his or her feet, so he or she used to wear well-ventilated slippers. From around December, he or she changed to thick fleece slippers with warm toes due to the cold weather, but from around the end of the year, locally dry eczema on the soles of my feet began to develop, and the range gradually expanded to the interdigital area. A similar dry eczema has spread to the interdigital area. There is no exudate unless scratched.
I am worried that the eczema area may crack and become infected with bacteria.
It seems that athlete's foot is also present, but when he or she goes to see the dermatologist, it’s likely to be prescribed a steroid ointment mixed with a fungal agent, so I consulted with you.
As a response,
① Suspect athlete's foot, purchase a commercially available antifungal ointment, apply it, and dry it as much as possible.
② Avoid applying ointment and check the progress by NMT.
(If there are signs of infection, take antibiotics)
Which is better, ① or ②?
Also, if you have any other good advice, I would appreciate it if you could let me know.
I'm very sorry while you’re busy, but it seems to be painful to see and I'd like to do something about it, so thank you. I took a picture of the affected area, but I'm sorry I don't know how to post it.
(S) It is ①.
However, I think it's best to go to see a dermatologist and have his or her feet tested for fungi. Normally, steroids are not given when athlete's foot occurs. If prescribed, just don’t use it.
(Q) Thank you very much for your reply while you’re busy, Dr. Sato. I immediately advised my family to go to a dermatologist and have a fungal test. I wish I could improve...
Don't catch a cold on your way to work in cold winter.
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(Q) Due to atopy, the areola and genital area are heavily pigmented and black.
Will the pigmentation fade? Will it remain black for the rest of my life?
(S) Even in healthy people, the genital area is darker than the surrounding skin. Anyone has a black areola. If you had eczema in these two places in the past, it will return to the same blackness as a healthy person after the eczema has subsided.
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(Q) Hello. Dr. Sato
When I went to see a doctor in Saitama, I was told, "If you parent and you are using steroid ointment, all the family members living with you will have steroid dermatitis."
It is true that if I hold a child's hand with a steroid-coated hand, I will indirectly apply steroids to others, but if you don't care so much, isn't TSW and NMT possible?
Please give me your thoughts, Dr. Sato.
(S) The use of steroids in eye drops and nasal drops may reduce skin symptoms, and discontinuation may exacerbate the rash. I think it is safer to be careful not to apply even the slightest amount of steroids.
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(Q) I understand that NMT is essential in Hannan-type TSW.
Will steroid dermatitis moisturized with Hilroid during TSW be cured?
I'm thinking about temporarily giving up TSW, which is a painful decision though due to itching caused by severe dryness that I'm about to get itchy during work.
In TSW therapy, there is another way that you stop only steroids first and continue moisturizing. And then you stop moisturizing when the affected areas are better. If you are in shortly after starting TSW you should take this method stopping moisturizing slowly. However, there is a risk of withdrawal symptoms when you stop moisturizing.
If you have stopped steroids for months and years, moisturizing may not cause withdrawal symptoms, but it may occur. Consider the possibility of withdrawal symptoms of NMT when resuming moisturizing.
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(Q) Happy New Year, Dr. Sato.
Recently, there are some patients who have been treated with TSW and NMT to relieve them by shooting Dupixent. Which do you think is more beneficial to your body, returning to steroids or inject Dupixent with continued TSW and NMT?
(S) The statement of Dupixent says that steroids and moisturizers should be used continuously. So I have no experience at our hospital, so I can't give you my opinion.
However, since Dupixent also inhibits substances that cause inflammation, it may be possible to be similar way to oral administration of Neoral. If so, I think you can have some problems when you withdraw Dupixent.
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(Q) Sorry to interrupt you.
I am a patient with severe asthma who was hospitalized in Hannan.
I was managed to endure asthma, but after I called for ambulance several times, I ended up to rely on steroid inhalation.
After doing TSW, I was first prescribed Flutide and Cuvar, but soon my face turned into like a rock, and then I was given Lervea 200. I'm scared to take it, so I asked a doctor to change to one with a low dose of 100, and now I'm taking this and Meptin. However, as I use it every day, it is difficult to heal the affected area.
When I couldn't keep up and got worse, I was prescribed a new drug, Zolea. It worked magically for asthma, but the neck and the inside of elbows, which had applied Muhi on heat rash before, became red and swelled, and the exudate began to seep out. The doctor didn't recognize it as a side effect of Zolea, but I stopped it with certainty. Asthma soon recovered and it took four months for the skin to recover. Things never work out as you expect.
Currently, I am content with low quality life with low dose Lervea. I wanted to feel better, but I thought it was impossible for me to live with the exudate. This is my choice in my life. FYI