Makise Medical Center
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Makise Medical Center
The biggest concern of current Atopic Dermatitis (AD for short) patients is topical steroid use, which, if used over time could cause skin inflammation and atrophy. Steroids causes IL-1, an inflammatory cytokine that causes cornification cell of the skin, which induces dermatitis, while the action of fibroblasts, which produce new skin cells, are suppressed and this starts atrophy of the skin.
As a result, a little stimulation easily breaks the skin, and the resulting serious itch makes patients scratch their skin so hard that they start to bleed. Moreover, topical steroids gradually lose their effectiveness, forcing patients to use stronger steroids in a larger quantity. Therefore, we will tend to avoid using topical steroids for a patient’s treatment.
However, it is also quite foolish not to use topical steroids at all out of fear. The adverse drug reactions to orally taken steroids include a variety of symptoms such as hypertension, moon face, gastric ulcer, diabetes mellitus, psychosis, cataracts, decreased immunity, and osteoporosis. If steroidal ointment is applied to the skin, a patient shouldn’t worry about these side effects. In order to have the same adverse drug reaction induced by oral steroids, patients must use an exorbitant amount of steroidal ointment on the skin. Everyday application of two 10-gram-tubes of the strongest steroidal ointment such as Dermovate or Diflar all over the body for 1 month will only bring about at most the same amount of absorption of the steroid hormone into the body as when 1 tablet of Predonine (prednisolone) is orally administered. This makes it virtually impossible for the application of topical steroidal ointments to bring about the same side effects induced by oral steroids.
You may find some dermatology textbooks that claim the application of steroidal ointments on the surroundings of the eyes brings about cataracts, but at this point this is only a theory and is not a clinical fact. Although AD patients tend to suffer from cataracts, amotio retinae, and corneal ulcer (in which case I strongly recommend patients to undergo periodic ophthalmologic checks) these ophthalmologic problems are not induced by the adverse side effects of topical steroid ointment. Since skin and eyes are developed from the ectoderm at the embryonic stage, they are sensitive to oxygen radicals due to their same biological origin. In addition, patients scratch the surroundings of their eyes to calm to itch on their face, which intensifies skin irritation around the eyes. Moreover, although it is said that topical steroid ointment causes pigmentation, pigmentation is actually caused by inadequate treatment and failure to control the inflammation of the skin, not by topical steroid ointment.
If topical steroidal hormones are used over a long time, the body will strengthen the action of the inflammatory cytokine, IL-1, and induce skin inflammation. When the action of fibroblasts, which produce the new skin cells, is stunted, atrophy of the skin emerges. Many AD patients will bleed all over their body since their skin itches, which makes patients scratch and tear their sensitive skin. However, this will only happen if patients use steroidal hormones for months to years. Short-term topical usage of steroids will not cause these problems, and thus steroid ointment will be used only in short time periods.
You must keep in mind that it is wrong to apply topical steroid ointment on the skin if you do not show AD symptoms. Doctors and hospitals recommend patients to use topical steroid ointment “for relapse prevention” or “perseveringly”. However you must be cautious since the more ointment a patient uses, the more money the doctors and hospitals will get; they may just be greedy.
Instead, for relapse prevention, use steroid-free ointments.
There are some patients who suffered skin atrophy and inflammations after long-term usage of topical steroid ointment. These patients usually try to stop using topical steroid ointment several times, but rebound and use steroids again. This should not discourage anybody; through alimentary therapy, vitamin-mineral supplements, detoxication treatments, and small changes in lifestyle, it is possible to withdraw from steroids. Although it sounds paradoxical, my patients use topical steroid ointment effectively to promptly withdraw from steroids.
Caution: Some doctors give intramuscular injections of Kenacort (chemical name: trimacinolone acetonide) to their patients for withdrawal from topical steroid ointment. This is more dangerous because it is an injection. If such treatment is used, you must fear the adverse drug reaction of steroids since Kenacort consists of steroid hormones.
Neither Kenacort ointment nor the Kenacort lotion has a problem. However, injection is different from ointment and lotion. You must be especially alert if an injection makes the symptoms of AD disappear quickly since the injection might have contained steroids. Please ask the doctor for more information in these cases. Moreover, although the ointment contains steroids, sellers claim that the ointment is steroid free. Please do not be fooled and do not use any ointments from China.
There are many home remedies often named “AD treatment” which include herbal medicine, hot springs, fasting, vegetable soup, acidic water, prunes, and much more. The effects of these are irrefutable, and many people believe that their symptoms are alleviated, even if they are not fully treated. Anecdotes of success in books that cover family medicine are undeniably true, and are filled with individual examples of happily recovered patients. However, to every successful patient there are 5 or 6 patients who did not experience the same triumph. Even at my clinic, there are several patients who use acidic water only to have their skin harden like a rhinoceros (acidic water is effective in some cases of AD, but some people misunderstand that it does not work for everybody and end up with their skin being worse than before). There are also some patients who spent a fortune on hot springs treatment but did not get the results that they expected.
These home remedies are advertised as if they work for all patients, when in reality they only work one out of 5 or 6 times. Another recurring aspect to home remedies is that they are anti-steroids. They immediately stop administering the “terribly damaging” steroids, which naturally causes patients to rebound. Then AD Businesses, companies that sell overpriced supplements and gadgets that have no medical proof for success, urge patients to “be patient since the steroids and bad fluids will eventually disappear from the body system and wait for recovery”. People can normally tolerate this for 1 to 2 months. However, after a while patients will suffer agonizing itching, and since they scratch their skin throughout the night, they will bleed all over. Patients will be covered in sticky yellow percolation liquid from head to toe, and not be able to live normally, while AD businesses will continue to claim that their treatment “will start working soon” even though it is medically unreliable.
The most dangerous things that can happen in these situations is developing a cataract and becoming emotionally unstable. Patients will be in a terrible condition for 3 months, half a year, and even up to a year without knowing whether their AD will be cured. In addition, there are many young AD patients who also have to worry about their education, employment, and social life, even in a situation without a way out. Patients will be like a passenger of a wrecked boat. They will not know when rescue will come and they will reach an island, all while losing food and water every day. The extreme build-up of stress will further exacerbate their condition, making their situation even worse. Eventually, pigmentation will occur due to the prolonged inflammation, and finally the patient’s skin will harden beyond repair.
This is the reality of anti-steroid treatment. Is this dangerous treatment better than using steroids? Is it safe and natural for the mind and body? There needs to be a better way to deal with steroids. At my clinic, patients are treated so that they ultimately do not need to use steroid ointments, but patients are not expected to immediately stop using steroids, since it is safer as mentioned before. You need to keep in mind that steroids are one of the greatest products of modern medicine, and they are not poison. Without steroids, many people will have to spend their life in unbearable pain, or even worse, suffer death. Steroids must be used in alternate ways, such as combining it with natural supplements.
These are the reasons why I avoid using medication and instead focus on treatment using natural supplements and steroidal ointment. I wouldn’t use steroids if I didn’t have to, but there is nothing that is more effective than steroids at this moment.
Another important aspect of my treatment is that the actual withdrawal of steroids is ultimately achieved. I have never seen a patient successfully suddenly withdraw from steroids, and all those who attempt to do so end up failing miserably. By gradually decreasing the input of steroids, using supplements (that I will mention later on), and carefully watching your diet, even though it may take time, patients will ultimately be cured. After a year of my treatment, patients will realize how their steroid use has decreased. This is the true sense of withdrawing from steroids, and patients will not suffer from a rebound of steriod use. In the long run, there will be inevitable cases where patients will be under excess stress and will show AD symptoms again. However, even in those cases if steroid ointment is used for 2 to 3 weeks, these symptoms can be overcome. The body will change to prevent frequent outbreaks of AD, and the patients will not need to worry about AD becoming a serious issue again.
It is particularly important to keep in mind that in times of stress-prone situations, such as exams and job searches, rapid steroid withdrawal will always fail. In fact, these times are when patients should use steroid ointment instead to reduce itches and inflammation and focus on more pressing issues. Once patients resolve their personal life issues, they can start to withdraw from steroids. Otherwise, they may not succeed and become entrapped in stress. This is common sense, and any treatment that tries to deviate from what is appropriate will be unsuccessful.
AD is a type of Dermatitis, and is an inflammation of the skin. There is no point in sprinkling water from a ladle on a raging fire, or even dumping a bucket full. What will work is spraying the water with a hose and making the fire smaller, then you can use the bucket, and finally when the fire becomes mere embers, you can use the ladle.
Similarly, when the symptoms of AD itching and inflammation are especially acute, you must use a strong steroidal ointment to immediately alleviate the symptoms, and then switch to weaker steroidal ointments as a patient’s skin condition improves. This is a short-term battle, and if a patient is afraid of the steroidal ointment’s side effects (which, as mentioned previously, do not happen in short-term use) and uses weak steroidal ointments, there will be no improvement in the patient’s skin condition. The skin will never recover if the patient scratches it due to prolonged treatment with weak ointments that don’t seem to work. Instead, the treatment needs to work quickly so that the patient doesn’t need to constantly claw at his or her skin, and while the skin doesn’t get further damaged, plenty of sleep will repair the skin. Furthermore, a patient can start curative treatment of AD if he or she takes care of the causes of AD.
The rankings for the strength of topical steroids, taken from the Japanese Dermatological Association’s revised edition of the Atopic Dermatitis Treatment Guide 2004, is listed below for you to see how your prescribed steroidal ointment ranks in this list. As seen in the chart, the steroidal ointments are grouped as “strongest”, “very strong”, “strong”, “medium”, and “weak” according to the steroid used.
In addition, in the guideline there is a section about“Choosing an external medicine according to the severity of a rash” which classifies “strongest” as a wart-like eczema with a hard core, “strong” or “medium” as a medium-sized patch of erythema or a couple of papules, and “weak” as redness of the face. More information can be found on the Japanese Dermatological Association’s revised edition of the Atopic Dermatitis Treatment Guide 2004.
Compare the strength of the steroid ointment you use to your symptoms. Are you using the ointment too cautiously? You should be using an ointment that is strong enough to stop the itching and allows you to sleep soundly.
If there are eczemas all over your back and stomach, use 1 to 2 tubes of 5g steroidal ointments. If the index of absorption of steroidal ointment on the inner elbows is 1, then the back would be 1.5 to 2, the neck would be 5 to 6, the face would be 8 to 10, the pubic area would be 40, the palms would be 0.8, and the sole of a foot would be 0.15. Since the absorption changes depending on the body part, patients should be careful of the strength of steroidal ointment and the frequency of application for each area. If the itching does not stop even if you use steroidal ointment, it means that the strength of the ointment or the frequency of application is not enough. In these cases, do not hold back from using antihistamines before you sleep.
Steroid Ointment Strength Ranking (Atopic Dermatitis Treatment Guide 2004.)
First, buy white petrolatum (Vaseline) from drug stores or the Internet. Then, mix it with the steroidal ointment you have, gradually increasing the ratio of Vaseline to steroidal ointment until you use only Vaseline.
For example, if you were using Rinderon-V (the chief steroidal element being betamethasone valerate), you would start by using only Rinderon-V, then increasing the ratio of Vaseline to Rinderon from 3:7, to 5:5, 8:2, and you would finally use only Vaseline. If you recover quickly, you do not need to use it for a week, but instead 4 to 5 days. In the case of a baby or toddler, the mixture can be used for even 3 to 4 days.
However, in certain cases, recovery may be faster or slower than expected, or there may be changes in circumstances such as a cold that will backtrack the patient’s recovery.
In addition, Rinderon-V ranks as “strong” in the rank of strength of topical steroids, and therefore should be used to treat moderate symptoms. If a patient shows severe symptoms, he or she will need to start from Dermovate and the likes (however infants will rarely have to start from a “strongest” ointment). As the patient’s skin condition improves, the ointment can change from “strongest” to “very strong” and then to “strong”, and then the patient can either start to mix the ointment with Vaseline or just change to “medium” and then finally to “weak”. In the end, the patient should be able to stop using even the Vaseline. Even using Vaseline is not good over a long period of time. Still, there may be some people who may doubt my treatment method and say that they’ve already tried the same method many times before to no success.
However, I can attest that my treatment has and will succeed for many patients; I’ve worked with over 40,000 patients, gone to many hospitals in the east and doctors in the west that are noted for their expertise in AD treatment, gone to the south to obtain hundreds of bottles that supposedly cured AD, and gone to the north in search of herbs; I’ve searched around so much that my JAL mileage has accumulated so much that I can fly to Brazil and back home 3 times. Everyday I gather evidence about vitamins, minerals, and supplements from across the globe through the Internet and have patients try them to check their results. If you follow the procedures I will specify below and steadily decrease the amount of steroids you use as mentioned above, you will definitely either recover completely or by 90% or more. If cutting back on steroids did not work before, it is because there is an additional method you must follow.
To make the process of withdrawal from steroids more efficient and safe, my clinic has developed an ointment, MA(0), which consists of Sun White P-1 (highly purified Vaseline), α-lipoic acid, Vitamin B1, B2, and B12. When patients use MA(0) (whose name comes from my last name “Makise”, not “Mad”!) they recover quicker than when they use conventional Vaseline. This ointment is a product of lots of research and various ideas to make the withdrawal from steroids a safe and speedy process. I found out that α-lipoic acid, a precious antioxidant agent that is soluble in both water and oil, and Vitamin B12 produce good results.
For example, when patients substitute MA(0) for ordinary Vaseline, theα-lipoic acid and Vitamin B-12 makes the transition between weaker steroids becomes smoother. I recommend that you use MA(0) instead of normal Vaseline so that you can start out with a Rinderon-V and MA(0) ratio of 7:3, then 5:5, 3:7, and then finally you will only use MA(0).
Sun White P-1 goes through more refining processes than normal Vaseline, and is mild and has a higher purity than standard Vaseline. Therefore MA(0) can be used on chemically sensitive skin, facial skin, a baby’s skin, cosmetics sensitive skin, and even white petrolatum-sensitive skin.
In addition, aside from non-steroidal ointment MA(0), ointments MA(1), MA(2), MA(3), and MA(4) have been made from mixing Rinderon V and MA(0) so that patients do not have to weaken the steroidal ointment on their own. As the number increases, the concentration of Rinderon V decreases.
Many people order the MA series ointments online, but if you got an examination from my clinic, I can send you a set. However, if you have not yet gone to my clinic, I can only send you the steroid-free MA(0). Due to pharmaceutical laws, we are unable to send MA(1) through MA(4) without an examination. For those who don’t live around Osaka and cannot come to my clinic, we will send MA(0) and you will have to mix it with the steroidal ointments on your own. If the symptoms are light, MA(0) can be enough.
This ointment, made of several plant oils and B-complex vitamins mixed in hydrophilic ointment, is well received by patients for not being sticky. Patients who have recovered enough that can use only MA(0) but still face the possibility of AD returning should use this ointment.
Patients who continue to have itchy skin will use this ointment, which consists of Vaseline, flax seed oil (linseed oil), B-complex vitamins, and antihistamine cream.
When skin hardens so much that it resembles the skin of an animal like a rhinoceros, it is said to be lichenified. To treat this condition, a “strongest” ointment (either Dermovate or Diflal) and MA(0) should be mixed together at a ratio of 4:1 and applied to the affected area.
Wood Tar ointment, a mixture of zinc oxide ointment and tar (derived from acorn tree in the Korean Peninsula of which soil contains lot of germanium), will be applied on top of that and the affected area will be wrapped with bandages (which will be changed at least once every day). Even linchenified skin that couldn’t be cured with immunosuppressants like ciclosporin will be cured in 2 to 3 weeks, so please try this treatment. In addition, this treatment is effective in treating circumscribed neurodermatitis (lichen simplex chronicus Vidal) for middle-aged women. These ointments and lotions are steroid-free, so those who worry about steroids can use these without worry. However, these ointments are used to treat symptoms and do not actually treat AD. Please avoid overusing these ointments.
Psoriasis is different from AD and is said to be hard to cure, but with the right treatment, it can be cured easily. Psoriasis ointment contains the same basic ingredients of MA ointments, but also includes mineral powders that radiate far-infrared rays as well as natural medicine. The ointment will contain steroids at first, but as your symptoms get better the amount of steroids will decrease. In the end, you will be using a steroid-free version of this ointment, and if you use proper natural supplements correctly, your skin condition will improve significantly. I write about psoriasis in a different section.
This is information obtained from Dr. Makise’s having cured atopic dermatitis of 40,000 people or more in total and the latest and highest atopic dermatitis treatment. But this is provided for information only. No action should be taken based solely on the contents of this website; instead, readers should consult appropriate health professionals on any matter relating their health. Readers who fail to consult with appropriate health authorities assume the risk of any injuries. Dr. Makise is not responsible for errors or omissions.
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