Prurigo Nodularis (PN)

This is a skin disease that causes hard, itchy lumps (nodules) to form on the skin. Recently, its incidence is increasing very much. Some of the nodules start with insect bites in limbs, which gradually spread to the trunk, and in the worst case they can reach the whole body. Probably some viruses are involved in it. Prurigo Nodularis (PN) is a completely different skin disease from psoriasis, palmoplantar pustulosis, atopic dermatitis, and scabies. Everyone can get PN, regardless of age, gender, or race.
PN does not develop immediately after being bitten by an insect. In many cases, after three months to a half year later, very itchy lumps are gradually start forming from the limbs.
The patient may not know the reason and remain very confused. However, when asked in detail, they can explain of their trip to a mountain half a year ago, and there are reasons such as having been bitten by a black fly. If you suffer from PN, try to remember camping trip in mountains. Or bitten by mosquitoes in your back yard. Or even by a cat at home. There are, of course, cases where the cause is unknown at all. Some patients with serious atopic dermatitis can suffer from PN concomitantly without any bites. And PN patients sometimes have a history of other diseases such as lymphoma, HIV infection, and so on.

Usually the treatment is done with ultraviolet radiation therapy with narrow band UVB, or cryotherapy with liquid nitrogen, or local injection of steroids. However, the condition is troublesome when the symptoms do not go away with those applications. Among skin diseases, following mycosis fungoides and scabies, PN causes most serious itch. More itchy than atopic dermatitis. Therefore, patients often cannot do without even oral administration of steroid pills such as prednisolone. Just recently, I examined a patient with PN who well understood the side effects of steroid pill but couldn’t help taking the pill continuously. She had a moon face due to the side effect of the pill. She knew well it. But she cannot stop the pill.

But you should not give up the improvement. 80 – 90 % of itchy lumps will be eradicated in 3 to 4 months by our unique treatment. Without steroid pills or immunesuppressants or very expensive Dupilumab (Dupixent), you can be free from the serious itching, and can sleep well. You will not worry about the appearance of the nodules. Sure!!

1 ) Ointment: MAS(1)

Please put the ointment on the lesion and seal it with the special oil paper.
The ingredients of MAS (1) are : Difluprednate and Clobetasol Propionate, Macadamia Nut Oil, Vitamin B1, B2, B12, α-Lipoic Acid, Fermented Extract of Leaves of Shell Ginger (Alpina zerumbet), Very fine powder of 5 kinds of mineral ores.
Thanks to the infrared rays emitted from the fine powder of 5 stones in the ointment your skin is healed quickly. Other than our ointments you cannot find any ointments that emit infrared rays. Having treated more than 40,000 patients with various kinds of skin diseases, we created the formula of our ointments. It took us 15 years to complete them. Our ointments can cure many kinds of difficult skin problems due to psoriasis, PPP (pustulosis palmaris et plantaris), atopic dermatitis, nodular prurigo, etc. If our ointments cannot cure the lesion, it is due to fungus, or scabies, or serious malignancy such as mycosis fungoides (cutaneous T-cell lymphoma).

Oil Paper: We use traditional Japanese paper that is coated by flaxseed oil. The paper has good air permeability. If it is not available in your country,we can send it from Japan. Especially when you sleep, please cover the lesions by this paper after you put the ointment on the skin.

Please put MAS(1) ointment on the itchy lumps twice a day — morning and night. Especially at night, seal the lumps by oil paper for all night. This technique is very, very, important. In the morning, after you wash out the ointment, please put the ointment again on the lesions. If you don’t like to seal the lesions during daytime, you don’t need to seal the lesions. Just the ointment is enough. But at night, please be sure to seal by oil paper.

However, this method is only for symptomatic treatment. After a few months, itchy lumps may recur. For the true cure, you need to take Erythromycin and Cepharanthine along with probiotics and supplements.

2 ) Erythromycin (Erythrocin® 200 mg) and Cepharanthine ( Cepharanthin® 1 mg)

Erythromycin (Erythrocin® 200 mg)
Erythromycin is an antibiotic useful for the treatment of a number of bacterial infections. I tried many kinds of antibiotics. But Erythromycin is really good medicine.
Theoretically antibiotics is effective against bacteria, but not against virus. Against virus, only anti-viral medicine such as Oseltamivir (Tamiflu) against influenza should be effective. But Erythromycin seems to be effective against virus, too, actually. Theory is not reality. Many drugs are effective in theory, but ineffective in reality. Erythromycin is not effective against virus in theory, but it is effective in reality. When I travel oversea on long international flight, I always take Erythromycin since 2 days prior to the flight to prevent bacterial and viral infections. And it does work.

How to take : 4 tablets/day — Morning 2 tablets, Evening 2 tablets, after meals. But the way of taking is not usual. Please take them as follows.

For 4 days take 4 tablets everyday. And the following 3 days, don’t take any tablets. And the next 4 days take 4 tablets everyday, and don’t take any tablets for the 3 days. For example : If you begin 4 tablets on Sunday, then on Monday, Tuesday, Wednesday, you should take 4 tablets everyday.

And on Thursday, Friday, Saturday, you should not take any tablets. Then, the next Sunday to Wednesday, take 4 tablets everyday. And on Thursday, Friday, Saturday, you should not take any tablets. — repeat this cycle at least for 12 weeks (almost 3 months). *If you are allergic to macrolides, please don’t take this antibiotic.

Contraindications : Ergotamine tartrate, anhydrous caffeine, isopropylantipyrine <Clamine>, dihydroergotamine mesylate <Dihidelgot>, Pimozide <Aurapp>, Asunaprevir <Sunbepura>
If you are on these medicines, please don’t take Erythromycin.

Attention
If you are on one of the following medicines, please consult your doctor, and ask if Erythromycin can be taken together with the medicine.
Antiarrhythmic drug/Warfarin potassium/Theophylline/Aminophylline hydrate/Cyclosporine/Crolimus hydrate/Digoxin (Lanoxin)/Felodipine(Plendil,Renedil)/Valproate (VPA)/Midazolam/Carbamazepine(Tegretol)/Colchicine/Simvastatin/Atorvastatin(Lipitor)/Pitavastatin/Blonanserin/Ebastine/Edoxaban/Zafirlukast/Cimetidine(Tagamet)/Ritonavir/ any anti-cancer drugs.

Caution If you are on CCB (Calcium Channel Blocker) such as Amlodipine to lower your blood pressure, it is safer to refrain from taking Erythromycin, because the combination of Amlodipine and Erythromycin may cause unnecessary hypotension.
But Azithromycin which is also a macrolide antibiotic is safe with Amlodipine, and macrolide antibiotics are very important to treat PN. Therefore, if you are currently taking CCB, Azithromycin is recommended, though its efficacy is slightly less than that of Erythromycin.
The way you take Azithromycin is different from the way you take Erythrocin.
For 3 days take 2 tablets everyday. And the following 4 days, don’t take any tablets. And the next 3 days take 2 tablets everyday, and don’t take any tablets for the following 4 days. For example : If you begin 2 tablets on Sunday, then on Monday, Tuesday, you should take 2 tablets everyday. And on Wednesday, Thursday, Friday, Saturday, you should not take any tablets. — repeat this cycle at least for 12 weeks.

Patients often ask, “If for three months I have been taking Erythrocin that is antibiotic, are the side effects dangerous?”. The answer is “It’s generally not dangerous unless you have a serious illness”. Erythrocin is given continuously even for one year, for example, in cases like COPD (Chronic Obstructive Pulmonary Disease). Compared with the side effects of steroid pill/Dupixent/immunosuppressant such as MTX (Methotrexate), the side effects of erythromycin is really minimal. But, of course, when you feel something bad with Erythrocin (or Azithromycin), immediately stop it, and consult your doctor.

Cepharanthine ( Cepharanthin® 1 mg)
Cepharanthine is an alkaloid extracted from the plant “Stephania cepharantha Hayata”. Cepharanthin is a rather “obscure” medicine in Japan. It is used only for alopecia areata and leukopenia due to radiation therapy for cancers.
Because it is cheap, doctors are not so interested in prescribing it. (Doctors prefer expensive drugs for business!!). And Cepharanthin is going to be forgotten. But we find it effective for various kinds of diseases. Not only for PN but also, for example, psoriasis, atopic dermatitis, multiple sclerosis, ulcerative colitis, hypothyroidism, tuberculosis, etc., though we don’t know its precise mechanism. Nowadays only one Japanese company produces Cepharanthin. I do hope the company keeps producing it.

How to take : 4 tablets/day — Morning 2 tablets, Evening 2 tablets, after meals, every day at least for 6 months. Preferably, 12 months.

No contraindications have been observed with Cepharanthine.

I understand well that the patients prefer natural treatments such as herbs to steroidal ointments and antibiotics. But PN is a so itchy skin disease that it would be almost impossible to cure PN only by natural therapy without using steroidal ointment and medicines. I do not mean to say that it is absolutely impossible, but so serious itching (patients often say “Hell-like itching”) seriously destroys their quality of life.

3) Probiotics

Please read : https://en.drmakise.com/psoriasis/

Numerous probiotics are on the market, and it might be difficult for you to choose the best one. If not possible for you to choose, I recommend Bio-Three®.
http://www.bio-three.com/ . I don’t know if Bio-Three is the best or not for your case, because human gut flora is very different from person to person.
But it seems to be effective for most people because it contains three types of intestinal bacteria (lactic acid bacteria, butyric acid bacteria, amylolytic bacteria)and the combination of these bacteria provides optimal synergistic effects.
At this time, Bio-Three is not available outside of Japan. Therefore, we send it together with Erythromycin and Cepharanthine.
If you eat meat often, you need more probiotics.

* Also, try to eat one apple a day. Apple pectin is a good dietary fiber for conditioning the intestine.

* Ayurvedic medicine recommends cleaning our tongue. Please clean your tongue by a tongue cleaner twice a day. It may improve your gut flora. You can find a tongue cleaner in the Internet.

4) Cost for the Treatment

MAS(1) 50 g: ¥4200
Erythrocin (64 tablets for a month): ¥3520
Cepharanthin (120 tablets for a month): ¥3960
Oil Paper (100 sheets): ¥1600
Bio-Three (60 packs): ¥1380
Minimum Shipping Cost: ¥1400 (to Asia), ¥2000 (North America, Australia, New Zealand), ¥2200 (Europe), ¥2400 (South America, Africa)
Consultation: Free, if on the Internet.

One US dollar ($) is 105 ～115 Japanese yens(¥). It depends on the exchange rate of the day. Therefore, for exmaple, MAS(1) costs $36.5 ～$40.

5) How long do I have to use the oitments? Do these pills and supplements have to be taken forever?

Ointment : For example, if you apply the ointment for 4 weeks and the lesion got improved very much, please apply the ointment for another 4 weeks. In other words, apply more for the number of days required to get the lesion improved. Because even if the surface has got improved,
inflammation remains in the deep part of the skin, so if you stop applying the ointment just because the surface is clean, it will soon aggravate.

Pills : You don’t need to take them forever!!
Erythromycin → Please take for 12 weeks (about 3 months) .
Cepharanthine →For 6 months. Preferably, for 12 months.
But if recurrence occurs, for example, after one year, you would be recommended to take them again for 3 months.

Probiotics : 6 months.

Supplements

They are listed here in important order. Most of them are available in any coutries.

1) Biotin (15,000 mcg – 20,000 mcg/day)
For the skin, nail, and nerve, biotin is a very important vitamin. Large amount of biotin is recommended. Please read the explanation in my webpage ;
http://en.drmakise.com/ppp/

2) Copper (4 mg/day)
Copper can kill virus. Onset of PN is often triggered by insect bites that infects humans with virus. Copper is cheap supplement and you can get it at any vitamin shops or by the Internet. You should not take copper continuously for a long time. Take for 3 months, but the fourth month you stop it. Then from the fifth month take it for 3 months, and stop it for a month, and take 3 months, — like this cycle.
Although the exact cause of PN is unknown, it is thought that the virus must be involved in its onset and development. This sounds strange to many dermatlogists. But I know some cases that were much improved by Oseltamivir (Tamiflu) which is anti-viral medicine. However, although rare, Tamiflu has serious side effects for some patients, therefore, I don’t use it for PN.

3) Glutathione (500 mg – 1,000 mg/day)
Glutathione (GSH) is an important unique antioxidant. It is composed of 3 amino acids — glycine, glutamic acid, and cysteine that contains sulfur.
Due to sulfur GSH is nucleophilic and it attacks a toxic conjugated receptor. Therefore, it detoxifies many noxious substances.

4)Selenium (200 mcg/day)
This mineral is indispensable to glutathione peroxidase enzyme which is very important polymer antioxidant alongside SOD. Selenium is required to make this enzyme. Therefore, when selenium is deficient, naturally, defense against active oxygen and free radicals becomes insufficient.
Selenium also activates thyroid hormone. There are two kinds of thyroid hormones — triiodothyronine (T3) and tetraiodothyronine (T4). T3 is an active form and can be converted from T4 to T3. For the conversion three enzymes are involved. One of them, type I iodothyroninedeiodinase, contains selenocysteine. Selenium is essential for the enzyme to work well. Lack of active thyroid hormone T3 adversely affects PN.

5) Shell Ginger (JIPANG Ginger®)
This is an essential supplement to cure PN. The treatment of PN is completed with JIPANG Ginger®. Yes, you can be free from the agonizing itching forever. But please begin taking Shell Ginger (JIPANG Ginger®) about one year after starting treatment. In the case of PN, if you start taking it within a year, itching may come out due to the detoxification effect of Shell Ginger. Its effect is much stronger than glutathione (GSH) and selenium. For the detailed explanation : https://en.drmakise.com/shell-ginger-jipang/ 

Additional Notes

  • Unlike psoriasis and atopic dermatitis, dietary restriction is not so necessary. But please try to avoid eating meat. Allergy test is also almost pointless. Since the cause must be some viruses, it is the same reason as allergy test is unnecessary to treat herpes.
    Going to dentistry and removing mercury amalgam can seldom cure PN because this disease is not due to allergic reactions to some substances.
    TCM (Traditional Chinese Medicine) or homeopathy can cure PN if you are lucky. But it often takes a considerable amount of time to achieve good results. Usually, the itching is too serious for the patients to tolerate, and the mental stress caused by itching exacerbates more the symptoms.

  • In general, overdose of iron adversely affects the skin. Therefore, patients with PN should not take iron supplements if they are not diagnosed with iron deficiency anemia by doctor. Avoid foods rich in iron such as prune and spinach. Dizziness or pale skin doesn’t always mean anemia. Please go to a physician and get a blood test done.
    And please don’t take too much vitamin C supplement that accelerates the absorption of iron in the intestine. Mega dose vitamin C therapy is very dangerous in the treatment of PN. Don’t undergo it. A large dose of vitamin C injection can alleviate PN for a temporary period — for two or three months. But severe worsening will attack the patients later. And the patients undergo the injection again, then improve. But it soon gets worsened. Again, injection of a larger dose of vitamin C, then improve, then worsen, —- fall into a vicious cycle — finally never cured.

  • Drink plenty of water. At least 1 liter/day, if possible 2 liters. Preferably, in the morning. Water detoxifies many noxious substances that may worsen PN. But if you have a problem in the kidney, please consult your doctor about whether drinking plenty of water is OK or not.

  • Go to bed early
    Please go to bed till 11 pm at latest. The best is till 9 or 10 pm. If you go to bed later than 12 am (midnight), your PN would never be cured.

    Because growth hormone is secreted from the pituitary gland between 11 pm to 3 am or 3 hours after you fall asleep, and growth hormone cures skin problems, and it does other many beneficial jobs for the human body.
    If you sleep after midnight, growth hormone is not fully secreted, and your skin remains damaged. Growth hormone is secreted even if you are 80 years old or more.
     
    To become a monk of Zen Buddhism and other Buddhist sects, young people need very hard training and ascetic practice. Time of sleep is sometimes only 4 hours. But they go to bed at 11 pm and get up at 3 am. They sleep during the most important time for keeping healthy. Traditionally they know the crucial time for the physiology of the human body.
     
    And don’t go to bed soon after you finish your dinner or supper. 2 hours or more after the meals is recommended. Because if blood glucose level is high, the pituitary gland doesn’t secrete growth hormone sufficiently.
     

    You know well human growth hormone is touted very much as an anti-aging supplement. Some anti-aging clinics offer injections of growth hormone. But you don’t need the supplement or injection. Just go to bed earlier. If you have a lot of work to do, you can do it in the early morning. You can get up at 4 am or 5 am in the morning and do the work.

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