You can read the whole contents in the following site.
In the article, a recent paper of Dr. Simpson is introduced. It revealed that high-risk infants of eczema were prevented from developing illness by frequent application of emollient.
http://www.jacionline.org/article/S0091-6749(14)01118-X/abstract
On the other hand, some patients with eczema, especially TSA/W patients, improve by stopping emollients as I have already written.
http://mototsugufukaya.blogspot.jp/2013/06/is-moisturizing-really-help-to-cure.html
It sounds controversy or very confusing. But it is not so difficult to explain logically. It only means that avoidance of the risk of oncet is different from the way how to treat the illness.
I explain it to be concrete. If I had two babies and one was with eczema while the other not, I would use emollient frequently for the purpose of prevention of eczema to the latter. But I might not use emollient to the baby with eczema because I consider maturartion of the skin is disturbed by it.
Emollient is supposed to prevent immunological sensitization of various antigens in the immature skin of high risk babies. On the other hand, emollient may delay maturation of skin against environmental dryness. In eczema-undeveloped babies, the merit of emollient is greater than demerit while in eczema-developed babies demerit might exceed merit because they have already been sensitized.
I don’t recommend using too much soaps or detergents to both babies. It is because they remove natural emollient which is produced by babies themselves. On the other hand, I recommend adequate disinfectant therapy in patients with eczema.
http://mototsugufukaya.blogspot.jp/2013/06/disinfectant-therapy-to-staphs-on.html
Soaps are different from disinfectants. I am afraid that might be another confusing problem among patients attention should be called to.
Sorry, the comment column is not available now. But the author believes readers can find some hints to overcome their own situations by the previous comments.
Hi Doctor,
返信削除Thank you for taking the time to make this information available to us all. However I need some help.
I am an 18 year old female from Australia and I've been battling eczema and asthma since I was about 7. I've been using topical steroids almost everyday for 10 years. I believe I may be addicted. I have discoid/nummular eczema on my trunk, typical atopic eczema on my face (worst part) and recently I've been developing these red bumps on my arms and legs I believe are prurigo.
Pic: http://i.imgur.com/3oPQLHz.jpg
I am not sure what to do, I'm still on steroids. Ive read that prurigo is extremely difficult to cure so will I be stuck with it my whole life? Will they go away once I go through the topical steroid withdrawal process?
What should I do? Thanks Doctor.
They are not prurigo. Prurigo is harder nodules with more chronic appearance. They are papules. You are not necessarily addicted.
削除Hi Dr. Fukaya, I had read that article. I also had gone to see Dr. Simpson for help and support in getting through tsw a month after I began tsw because I was told he was the top Derm on the west coast. When I told him what I was doing he looked very perplexed, upset, and seemed to not know what to say. Finally he said in a very loud tone "You have chronic eczema and will have to be on steroids for the rest of your life!" I replied "I don't think so". Needless to say, I had to continue my search for a doctor who would support me in my tsw recovery. I would love to heqr your opinion on what he told me. I had childhood eczema which went away in my late teens. I'm 59 years of age now. Used potent tcs heavily on my hands for two years to treat steroid induced eczema. I didn't know at the time it was caused by using the tcs on a small spot on my leg every few days for 20 years.
返信削除There is no mention in that article about what was put on the babies skin prior to the appearance of the so called eczema. I can only imagine how things like baby oils, baby powder, and other lotions, soaps, etc. would cause a babies skin to break out. There was also no mention of what the so called"improved" babies skin was like 1-2 years later. Seems to me most babies are born with bodies that have a natural ability to moisturize themselves and anything applied to their skin could very likely irritate it and make it break out.
Anyway, I am at 15 months tsw and used a tiny amount for 4 days in September, and again a month later. I found that it set me back probably 3 months in my healing so will not be doing that again. My question to you is this, I'm in late stages of healing and was wondering if systemic steroids would get me over the hump. I still have thin skin on my hands where my main problem was/is and would like to get on with life. Do you think systemic steroids would cause the same "cellular memory" relapse I experienced with using tsc recently once I ceased using them? If not, what systemic steroids would be best to use, dosage, and how long? I used prednisone for a week immediately upon ceasing tcs at the beginning of my tsw, but once I tapered down by the end of that week the rebound was horrible. Thanks again for everything.
I recommend you not using oral ones because you seem to be doing rather well at present.
削除Oral steroids are hard to cause cutaneous addiction like topical ones but easy to cause psychological addiction. Some patients try to take only for a few days at first but tend to use continuously for over years. I think you are only tired with repeated flares which will be weakened and disappear as time passes.
Sir what do you think of bleach bath treatment for children? I particularly like your post of the patient that cleared with disinfectant.
返信削除I have no experience but the mechanism may be similar to the disinfectant therapy.
削除Sir there is a Dermatologist in south Africa that applies emmolient, diluted topical steroid and topical antibiotics to his patients and achieves good results. These patients aremostly children. Some have been in tsw for several months and have followed his
返信削除treatment due. Is it reasonable to think that these patients do not have tsw but overgrowth of staph? What is your thought on resistance?
2. If a person successfully went through tsw. Would they be able to apply Ts in future. Say for example if it was given in small application after allergy testing? 3. After tsw what if patient had needed oral steroids for.medical problem like anaphylaxis would that cause rebound?
Such patients with steroid resistance may be included. I can’t say anything more.
削除2 Yes. 3 No.
Thank you Doctor for your valuable time.
返信削除It is difficult to get information on what the limits are after TSW pertaining to how to use and what to use. I thank you immensely.
Thank you Dr. Fukaya;
返信削除Do you know of any doctor's aware of TSA that could assist me during TSW ? I am just afraid of starting it, after 25 years using TS's;
Thanks very much
I am so sorry that I don’t know such overseas doctors.
削除But please remember that TSW can be achieved all alone without any assist of doctors. And I am here to transmit as much information as I have known.
You can find comrades through internet and get support from anticipators. Be smart and strong.
Tks a lot for your support
返信削除Hi Doctor, tks again; have you know the studies about a new drug being tested called DUPILUMAB? Tks
返信削除I know the medication is now during study but I don’t know if it is really useful.
削除Dear Dr. Fukaya! My son is 11 months old and going through TSW. He oozes a lot specially his ears and neck. Is there anything I can do to help him. He was on hydrocortisone 2.5%, desonide and triamcinolone 0.025% on and off for about 6 months. I stopped all his steroids 4 weeks ago and his hands and legs started to heal slowly but his face, neck, head, ears are oozing badly. Please help us!
返信削除Maybe the comments and answeres by June Chan and me will help you.
削除Please find them in the following URL.
http://mototsugufukaya.blogspot.jp/2013/06/hyaluronic-acid-of-around-100-thousand.html
Dear Dr Fukaya! Thank you very much for your fast response. I am just a desperate mom trying to help my son through this. In your experience, how long does the oozing last? His ears and neck are still oozing for the last 3 -4 weeks. His oozing soaks the bedsheets and pillows badly. Is it normal?? He doesn't have fever and still plays and smiles. Night time is completely different because he scratches his ears and neck badly and other areas as well. Have you heard of Burrow's solution (domeboro)? Is it safe to use on an 11 months old to help trying it up? Thank you very much for your time
返信削除It sounds normal to me. I can’t predict when the oozing ends but there is an end. Take it easy and stay strong. It is good news that your child is smiling in the daytime. It is enough.
削除I have never experienced Burrow’s solution but I don’t recommend it because I have never heard that it worked for eczema or TSA also.
Dr Fukaya,
返信削除do you have an opinion on topical sodium cromoglycate? i read it is a mast cell stabilizer and they have made a lotion from it (Altoderm)
i use it for hay fever in nasal spray, if i understand how it works it should not give withdrawal, maybe it is an alternative to steroids, maybe can be used with clofibrate for a double action?
Best regards,
Stephan
There is enough evidence that topical cromoglycate is useful though it is not so strong as topical steroids..
削除http://www.ncbi.nlm.nih.gov/pubmed/405998
http://www.ncbi.nlm.nih.gov/pubmed/2114208
I have once tried to prepare topical cromoglycate also. But the problem was its cost. I could obtain base powder from inhalant capsule for asthma but one 20mg capsule cost 0.4 USD. It means 20g ointment of 10% (net 2g) needs 40 USD only for the powder base. I thought it was too expensive. So I gave up.
I knew Altoderm was investigated in UK at that time. Is it available now? How much per 1 ml (or gram) is it and what is the percentage of cromoglycate? Can you buy Altoderm as OTC drug or is prescription required? Please let me know.
The mechanism is different from topical clofibrate. Clofibrate suppresses non-allergic part of eczema while cromoglycate suppresses allergic part. So I think these two can work as double action. Or there is a possibility that patient with poor efficacy to clofibrate reacts to topical cromoglycate.
Unfortunately i'm from Italy but i did some research to provide you some data.
返信削除Altoderm is 140g ointment 4% sodium cromoglycate and price is £62.5 or about 95 USD.
so approx. 17 USD/gram of cromoglycate. and it is prescription only.
but I think there is a cheaper way to obtain.
here in italy, as NALCROM, 20 oral capsules x 100mg, they have no excipients (i mean the powder inside is pure cromoglycate) and price is 7.6 EUR
so approx. 4.4 USD/gram
from an online OTC pharmacy i found 100 x100mg capsules at £75 which means 11.5 USD/gram (NALCROM generic)
i think sourcing directly from china suppliers would be even cheaper (no comment on quality here)
Thank you very much for the useful information. I recommend you try Ateroderm first. If it is effective, you can look for other reasonable ways.
削除I have no experience of topical cromoglycate but one experience of topical suplatast tosilate.
http://www.ncbi.nlm.nih.gov/pubmed/16792748
It was effective for one patient who was not reactive to the topical clofibrate. So I guess other anti-allergic oral drugs also can be used in the topical form.
Hi Dr Fukaya i have been going through tsw for 8 months and my skin is healing. My eczema started when i was just a baby. It was mainly on my cheeks then as i got older all over my body. My question is i also have asthma and i am given steriod inhalers. I try my best to avoid them but sumtimes my breathing gets bad so i must take them. Will this affect my tsw process.
返信削除Don’t worry. TSA is caused by topical form of corticosteroids. I suggest you use inhalers as usual.
削除Thank you. So basically its all about being patient untill i am fully healed. Also have you heard of cases of people who fully recovered and stayed well
返信削除Of course. For example, my tax accountant is formerly a patient of mine. He has fully recovered and has not relapsed more than ten years.
削除Wow thats motivating.can you explain more about relapsinng. Is their any way i can speack to you on phone
返信削除Sorry, but you can read my articles in which I have explained almost all I know.
削除Good luck and always believe in yourself.
Hi there! My case is a bit different from the 'regular' topical steroid withdrawal. As that I'm myself and withdrawing from protopic which I've used primarely on my face for 3 years. I'm now 13 months in and coming out of a horrible full body flare (my first). Wondering if you have any experience with protopic withdrawal and if this is similar as topical steroid withdrawal? Just wondering how long i will be in I guess.
返信削除Please refer to my article in the following ULR.
削除http://mototsugufukaya.blogspot.jp/2013/06/the-difference-between-steroid-induced.html
The blogger in the following site has experienced protopic withdrawal also.
http://skinofrose.blogspot.co.uk/
Hi Dr Fukaya,
返信削除My daughter (14 month old) has been diagnosed with eczema since she was 1 month. She has used the following steroids:
-Hydrocortisone (Feb 14, Mar 14, Apr 14)
Triamcinolone (Mar 14, Apr 14)
Desowen (Aug 14)
She used these steroids for at most 15 days in total. After stopping steroids in Aug 14, her eczema was confine to the back of her knees and ankles.
In Jan 15, I introduced egg white to her diet and she developed many red dots on her legs a week later. Her pediatrician advised that it could be egg white allergy and recommended me to do a skin prick test 2 weeks later to confirm. We did the skin prick test in early Feb and the test shows she's allergic to egg white and dairy. The pediatrician also recommended doing wet wraps on her to improve her eczema condition, which I did that very day.
However, the day after the skin test, she started to have a full body flare. She had red dots and red patches all over her body (including face and eyelids and hairline), she also had white bumps on her skin. Then her skin would become extremely rough and flakey for a few days before becoming red again. Even until today, her skin has not yet recovered and is still red and dry. I looked at ITSAN and your blog and it seems like she's experiencing steroid withdrawal. So my questions are...
1. Is she having just eczema or steroid withdrawal? She last used steroids in Aug last year, so why is she having withdrawal only now? Did the skin prick test or wet wrapping trigger it?
2. I read your blog and it seems like steroid withdrawal duration are typically 20% of the length of time which steroid was used. She used steroids from Feb – Aug (about 30 weeks) so does it mean that her withdrawal duration should only last about 6 weeks? Because until today, her skin is still red and dry and itchy and it has been about 6 weeks since she flared so terribly.
3. Because of her eczema itch, I dress her in long pants. But each time I undress her to change diapers or bathe, she would go into a scratching frenzy of her legs. Nothing can stop her, not even distracting her with her toys, we have to physically restrain her hands. Why does she itch less when she's dressed? Is it because the air irritates her skin? Or is this a psychological thing that she's facing? Do you have any itch control advice?
I appreciate your advice. Thank you very much.
Maybe it is eczema and is not TSW. Most of patients especially at young age will heal regardless of use of TCS. But it takes years. Take long care of your daughter and yourself.
削除Hello,
返信削除I am very depressed and afraid :(. I have a lesion on my penis on outside of foreskin for 3 weeks. I visited dermatologist, she took a swab and results came back for Klebsiella Oxytoca and Gram Negative rods. She put me on Antibiotics Ciphin for 5 days (2x a day) and Penicilin for 10 days (3x a day) and also prescribed steroid cream Belogent.
It is a potent steroid cream, it contains:
Betamethasoni dipropionas
genthamicinum
I was also using Pityol cream. Belogent was used 2 daily thin or medium layer on 1x1 cm area or less on foreskin and Pityol 1x in the evening before bed.
I stopped using Belogent yesterday after realizing it is either potent or super potent steroid.
I used Hydrocortizone (thin layer) only twice in my lifetime and for 7 days and never had withdrawal or anything, but I am afraid of this one. First time it was in 2011 on my nose, it may have even been 2 weeks, not sure. Second time was half a year ago on some weird bump on my forehead.
Since I stopped using it only yesterday, I do not know if I will have withdrawal symptoms and how severe they will be (I had none with previous uses of steroid). What I have noticed though is that I have UTI symptoms (may be associated with Penicillin which I finished taking today). Regarding skin, steroid has flattened the lesion almost completely (or healed it from inside) except for center/core of lesion. Also there are many tiny red veins visible there (I looked very closely and counted around 10 different). Also skin is slightly uneven (even next to lesion) and not sure if overall affected skin, or just center of lesion is more sensitive to friction/touch.
I have few questions:
1. What are the risks associated with (super) potent steroid used on Penis? Do you think in my case it may have affected nerves as well?
2. Am I very likely to develop red skin syndrome from steroid withdrawal? How long would it probably last in regards to 10 days of usage and location?
3.Have you had any cases of steroid use on penis? Have many (if not all) patients skin returned to normal eventually?
4.Does penis react differently to steroid use in comparison to skin elsewhere? I know it absorbs more steroid, but regarding healing.
5.May have I done permament damage to my penis, or are steroid effects reversible each time, especially in my case?
6. Would perhaps excision (or even circumcision) cure the problem, since only small area on foreskin is affected?
7. Does thinned skin after such a short time return back to normal (thicken) ?
Yesterday I stopped using steroid, therefore this is first day of withdrawal, I read that syndrome may appear after 7-10 days.
Thank you very much. Have a nice day.
The use of TCS for only 3 weeks will not usually cause TSA/W. If caused, the symptom must be very subtle. Don’t worry.
削除Sorry, my bad, I forgot to mention most important thing: I used Belogent (betamethasone) only for 10 days, not 3 weeks.
削除I know that penis absorbs more steroid, am I still not at any risk?
Glad to hear that :). Thank you very much.