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Correct Use of Steroids

Therapeutic Prescriptions by Vitaminx & Minerals

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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(Ⅲ) Correct Use of Steroids

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.)

  • Strongest
  • 0.05%  clobetasol propionate (Dermovate™)
  • 0.05% diflorasone diacetate (Diflal™, Diacort™)
  • Very strong
  • 0.1% mometasone furoate(Fulmeta™)
  • 0.05% betamethasone butyrate(Antebate™)
  • 0.05% fluocinonide (Topsym™)
  • 0.064% betametha dipropionate (Rinderon-DP™)
  • 0.05% difluprednate (Myser™)
  • 0.1% amcinonide (Visderm™)
  • 0.1% diflucortolone valerate (Nerisona™, Texmeten™)
  • Strong
  • 0.3% deprodone propionate (Eclar™)
  • 0.1% dexamethasone propionate (Methaderm™)
  • 0.12% dexamethasone valerate (Voalla™, Zalcus™)
  • 0.12% betamethasone valerate (Rinderon-V™, Betnevate™)
  • 0.025% belcometasone dipropionate (Propaderm™)
  • 0.025% fluocinolone acetonide (Flucort™)
  • Medium
  • 0.3% predonisolone valerate acetate (Lidomex™)
  • 0.1% triamcinolone acetonide (Ledercort™, Kenacort A™)
  • 0.1% alclometasone dipropionate (Almeta™)
  • 0.05% clobetsone butyrate (Kindavate™)
  • 0.1% Hydrocortisone butyrate (Locoid™)
  • 0.1% dexamethasone (Decaderm™)
  • Weak
  • 0.5% prednisolone (Predonisolone™)
  • 1% hydrocortisone acetate (Cortes™)

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