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man suffering from steroid withdrawal

Dr. Makise on Steroid Addiction

I’m fortunate. I have a healthy little boy with beautiful skin. It wasn’t always the case though. My son suffered through 5 1/2 years of severe pain, itching and discomfort with the debilitating skin condition known as eczema. As a parent, I felt completely helpless and wondered if I would ever be able to help my son? I stumbled on Dr. Aron while Googling for answers one day and since that first week of starting treatment, my son did a 180 and got his life back – for good. He’ll be 7 years old this summer and he’s never again suffered with eczema. 

My son had severely red skin from topical steroid use. It always worsened right after using them. Dr. Aron assured me that his treatment would address this known issue. He was right. Regardless of what is sometimes written in personal blogs online or purported by websites advocating against the use of steroids, RSS is very easy to solve for almost everyone experiencing it. Dr. Aron has figured it out – and he’s helped thousands overcome this problem. He’s doing it right now. There are hundreds of children (and several adults) in the Dr. Aron Facebook group experiencing the relief from red skin syndrome. RSS, as it is most commonly “sold” today, is a severe “addiction” that must be overcome by withdrawing from steroids. In truth, it is simply the body’s exaggerated response to abruptly stopping a topical steroid.

Interestingly enough, that red skin is not caused by a steroid addiction, is also the view of my personal doctor and my son’s pediatrician, locally where I live. It is in fact, the consensus among the majority of all doctors in the U.S. Even the National Eczema Association states that true steroid addiction is unlikely and rare. This isn’t to say that there’s not a problem with the way steroids are often prescribed and/or administered. The standard for treatment simply needs to be looked at and updated. I personally believe this will happen one day. Dr. Aron’s approach to eczema reminds me much of the challenges Barry Marshall endured while getting the medical world to acknowledge his treatment for stomach ulcers. There’s every chance we may be looking at a future Nobel Prize winner in Dr. Aron. His eczema treatment is second to none and the word keeps spreading. 

I’ve often considered how absurd it was that I had to turn to a doctor living on the other side of the world (South Africa) so that my son could find permanent relief and healing from eczema.  On one night in particular, this had me wondering what the dominant approach to treating eczema was in other countries? Was it more successful? Did other world doctors view steroid addiction and withdrawal in the same way as US doctors? Did they prescribe steroids in a different manner? 

Tadahiro MakisaI was back to the Google machine. I came across Tadahiro Makise, MD, a Japanese doctor who was slated as “cutting edge” for the treatment of eczema and indeed, his specialty for the last two decades has been atopic eczema. Several internet profiles made him out to be a naturalist so I half expected him to be approving of TSW but if he could prove that TSW could affect eczema in any way, shape or form, I would gladly listen.  

What follows is the exchange we had during several emails. I got the feeling that Dr. Makise could have wrote for days, telling of his experiences with treating atopic eczema. He was generous with his words and it became obvious that he was passionate about his work. 

Q. How do you feel about itsan and their advocacy to never use topical steroids? Will abstaining from all steroids (TSW) ultimately work in to help with eczema in the end? 
—- It is a painful ordeal and it is very dangerous, too. I’m against such treatment.
Q. What are the mechanisms by which abstaining from any steroids might ultimately clear the skin?
—- I don’t think abstaining from any steroids might ultimately clear the skin. I recommend my patients to apply steroidal ointments without hesitation. Later I’ll explain to you why — probably the next week — as I don’t have time now. Please wait for a while.

Six days later, the conversation continued. 

Atopic dermatitis (AD) is caused by various reasons. Examples of causes are:— allergy to specific substances, junk foods, unbalanced nutrition, variation of filaggrin gene, mental stress, etc. But in any case, AD is caused from the inside of our body. It is not a skin disease. For example, Candida albicans (athlete’s foot) and Herpes is a skin disease; but AD is the symptom of an internal problem. Most dermatologists only see the skin and they don’t treat AD as an internal disease. I’m not a dermatologist but a general physician practicing in a busy Japanese town of Osaka and I see AD as an internal disease.

For the past 20 years, I have treated more than 50,000 AD patients at my clinic and I see the number of AD patients increase yearly. The majority of my AD patients have previously visited dermatologists and they understand steroidal ointments cannot solve their problem but are forced to continuously use steroidal ointments. Over time their steroid dosage was getting stronger and stronger and the patients realized the effects of continual steroid treatment to their body is bad. Radical “anti-steroid” therapies have emerged from patients who abstain from steroid treatment. I understand this social phenomenon very well but I recommend my patients to use steroidal ointments without hesitation.

You write ;

[How do you feel about itsan and their advocacy to never use topical steroids? Will abstaining from all steroids (TSW) ultimately work in to help with eczema in the end?]

—- ITSAN is right in the following two points.

1) Steroidal ointments stimulate the production of stratum corneum chymotryptic enzyme (SCCE) that breaks the barrier of the skin, therefore, abstaining from steroids can contribute to the cure of AD.

2) Some patients have allergy to some steroids.

Yes, they are right about these two points to some degree. But they don’t understand the below.

1) Any medicines has a two-edged blade. Steroidal ointment does have merit and demerit. But the benefit of steroidal ointments ( = anti-inflammation effect) surpasses its drawback. AD is ” dermatitis”. “— titis” is inflammation. If the skin barrier is broken, there are many methods to moisturize the skin. But how to suppress inflammation? Besides steroidal ointments, I don’t know a substance that suppresses inflammation as effectively as steroidal ointments.

2) I had a few patients who are allergic to steroidal ointments.

For example; One has allergy to prednisolone valerate (it is contained, for example, in Lidomex Ointment), — Patient A – and the other is allergic to diflucortolone valerate (Texmeten Ointment) — Patient B

If Patient A uses Texmeten Ointment, their skin improved very much. If Patient B uses Lidomex Ointment, their skin improved very much. So, it is not possible to generalize that all steroidal ointments cause allergy. The majority of patients are free from allergy caused by any steroidal ointments. Some researchers claim that around 20 % of AD patients are allergic to steroidal ointments but this figure is exaggerated. From my experience after treating more than 50,000 AD patients, it would be at most 2 to 3 %.

I’m against especially quitting “Cold Turkey”. Why? The reason is as follows:

One of the most dangerous sudden withdrawal effects of steroidal ointments is “cataract”. Patients develop cataract during the period of sudden withdrawal of steroid. Not often, but some, even very young patients, develop it. Doctors don’t know yet why sudden withdrawal of steroid hormone causes cataract.

The origin of the skin is ectoderm and the origin of the lens is also ectoderm. The sudden flare up of inflammation of the skin might have some connections with lens of the eyes, because their origin is the same. Therefore, I guess the sudden flare up of the inflammation of the skin should cause some neurological problems, too, because the origin of neurons is ectoderm, too. Depression is one of the typical symptoms of sudden withdrawal effects of steroidal ointments.

As well if you suddenly stop steroidal ointments, a really painful rebound of itching and scratching will take place. Individuals will not be able to sleep, work, study, or go about their daily life. The worst part is you will not know when this painful ordeal will end which creates heavy mental stress. 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. This stress worsens AD symptoms much more. 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.

Almost 95% of the patients who attempt to withdraw from steroidal ointments give up and begin to use steroidal ointments again. During this painful rebound period, their skin condition got worse, and it takes much longer time for them to recover normal skin.

And what is the crucial point is, I would like to emphasize again, ” AD is not a skin disease, but caused from internal problem”. AD is an “Inside Out Disease”. Dermatologists don’t try to cure inside of the patients. When patients’ internal body improves, they can withdraw steroidal ointment naturally . As the internal problem improves, they will need less steroidal ointments and less, and less, and finally null —> finally reaching a complete withdrawal of steroidal ointment.

But on the contrary, complete withdrawal of steroidal ointments doesn’t cure the internal problem at all. As you write, “I don’t understand the mechanism of the curing effect of complete withdrawal of steroidal ointments”. You are perfectly right in this point. That’s why to improve the inside of the patients, I prescribe various combination of supplements, such as vitamins, minerals, and herbs, and healthy foods. But some dermatologists who advocate TSW don’t mention even one word to cure inside.

Then, one question arises. Why can some patients who do TSW be free from AD without taking any action to heal inside? There seem to be some reasons as follow;

1) They might change their eating habit —> more vegetables, less meats, more fish, less sweets. Consequently they cure inside.
2) Some of them really had allergy to a specific steroidal ointment. And avoiding any steroidal ointments leads to cure.
3) The eczema was due to fungus infection. For fungi infection, steroidal ointment are useless. Rather steroid worsens the infection.
4) The eczema and red skin were due to Seborrheic Dermatitis (SD). The cause of some SD is attributed to fungi infection, too.
5) Thanks to a specific mechanism which is similar to Short-Term Prednisolone Therapy (So-Called Steroid Rebound Therapy) in the treatment of Hepatitis B, they are cured.

OK, I’ll refute these reasons here.

1) Patients can change their eating habit at once without experiencing this painful ordeal. TSW is not necessary at all to change the meal habit.

2) If the patient seems to have allergy to a steroidal ointment, change it to another one. Not so difficult to find a steroidal ointment which suits the patient. It is not necessary for the patient to give up all steroidal ointments.

3) If fungi infection, use antifungal medication. This has nothing to do with TSW. It depends upon the careful observation of the doctors.

4) The same as fungi infection. What is important is the careful observation of the dermatologists. That’s all.

5) This is worth discussing. “Steroid Rebound Therapy” for hepatitis B requires very careful control and observation by doctors. Without them, it’s very dangerous therapy. The same is true of the treatment of AD by TSW, even if the same theory can be applied to TSW. And if the patients undergo TSW, they should be hospitalized. Otherwise TSW would be very dangerous.

At this moment, I don’t know if the mechanism of “Steroid Rebound Therapy” for hepatitis B can be applied to the treatment for AD by TSW or not. It would take a lot of time to verify it but I’ve never heard that those who advocate TSW argue this theme. Probably they are too much specialists of the skin to get to know the treatment for hepatitis B. (Recently “Steroid Rebound Therapy” for hepatitis B is getting obsolete because better treatment by interferon is going to be established). Personally I’m interested in this theme. But even if verified, actually who can stay in hospital for a half year for eczema?? Very few!! If they were dying of cancer, they would be staying in hospital even for a year. But just by $5 steroidal ointment the eczema is alleviated.

Recently medical science has become too much specialized to diverse fields. The contact between dermatologists and physicians are getting less and less and almost nothing. This is never good for general health. I treat not only skin diseases but also menopausal women, hypothyroidism, depression, prostate cancer, lumbago, ADHD (attention deficit hyperactivity disorder), to rheumatoid arthritis, etc, etc, at the same time at my extremely busy clinic. I don’t distinguish diseases by the category to which the diseases belong.

To prevent Ebola, scientists of virology don’t care about a very simple fact, because they specialize only in virus. They seem to be occupied in producing an effective vaccine. But the simple fact is that Ebola virus is transmitted through the skin. Why don’t they try to strengthen the texture of the human skin to prevent Ebola and why don’t they try to improve our immune system against the virus? There should be effective methods to stop its infectious power. Later I will discuss about it. If you have any further questions, please feel free to ask me.

I wrote one more email with questions, as I hadn’t yet asked Dr. Makise what he thought about red skin syndrome?

“Dr. Makise,
Would you comment on what is commonly known as Red Skin Syndrome? Almost all proponents of TSW say that severely red skin is a sure sign of steroid addiction.

When you see a patient with severely red skin, after taking steroids, what are your thoughts? I assume from your previous emails that you don’t believe this is steroid addiction or that TSW is necessary to restore the skin to health? “

First of all, “Red Skin Syndrome” is not an accurate medical term for diseases. We don’t find it in orthodox textbooks of dermatology — at least in the Japanese text books. I have one English textbook of dermatology, but I don’t find it in the book, either. Red Skin Syndrome is the word for symptoms — like stomach pain. Not a word for a disease. And for the word for the symptom of “Red Skin”, ” Erythroderma ” is appropriate. And several kinds of skin diseases cause Erythroderma

So, from the beginning, arguments between conventional doctors and TSW doctors seem to be confusing. “Steroid Addiction” is also not an accurate word. Two ambiguous words, ” Red Skin Syndrome” and ” Steroid Addiction” are being used among them. So, more confusing. This is my general impression.

The crucial point of this argument between conventional doctors and TSW doctors is “whether steroidal ointments cause dermatitis or they don’t cause dermatitis”. My opinion is that steroidal ointments don’t cause dermatitis. As I wrote, even if they cause dermatitis, very few. And it is not difficult to improve the dermatitis by changing the steroidal ointment to another steroidal ointment.

Whenever the patients withdraw any steroidal ointment abruptly after long use, of course, it causes rebound, and the skin gets red. This is not dermatitis caused by steroidal ointments themselves. This is due to quitting “Cold Turkey”. Any drugs, for example, cholesterol lowering drugs such as, what is called, statin dungs, cause “rebound”, too, if the patients stop taking the drug abruptly. I’m strongly against statin drug and I let my patients stop taking it, but not abruptly. They should stop it very gradually. Dermatologists should know any drugs can cause dangerous withdrawal phenomena, if abruptly stopped. Not only steroid, but any drugs.

[When you see a patient with severely red skin, after taking steroids, what are your thoughts?]

— I would like to know the true cause of the red skin. — Is the patient suffering from drug allergy, or atopic dermatitis (AD), or seborrheic dermatitis, or psoriasis, or malignant skin cancer (mainly lymphoma or leukemia), or etiology unknown (idiopathic)? And if they suffer from AD or psoriasis and they withdrew the steroidal ointments abruptly, I let them try a different steroidal ointment — usually the unique steroidal ointments that we produce at our clinic. I never recommend TSW. If they suffer from serous itch (often the itch is really abnormally serious), it might be onset of skin cancer such as Sézary syndrome or Mycosis fungoides and I let them go to university hospital to check thoroughly. If drug allergy, careful listening what drugs they have been taking solves their skin problem very easily — don’t take the drug!! If seborrheic dermatitis, change the steroidal ointments to anti fungus ointment. If contact dermatitis, try to find the substance that causes dermatitis, though not so easy to find it actually, I know well. Therefore, apply steroidal ointment to reduce the inflammation.

For AD patients and psoriasis patients, I recommend them to take the combination of several vitamins, minerals, and herbs to cure their inside while reducing inflammation on the outside. Although steroidal ointments are very necessary, they are mere symptomatic treatment. Steroidal ointments cannot cure the problems of their inside. Just like TSW cannot cure the problems of their inside.

I have some AD patients who never want to undergo steroidal ointment. They choose TSW. But they well know that only TSW cannot cure them. And they want to try a unique combination of vitamins and minerals and herbs. It takes long time for them to cure AD by only vitamins, minerals and healthy foods without steroidal ointments. Most will show improvement but most will not be cured 100%. Even in such a case, it is not the TSW that is curing them but the lifestyle changes made during this time.

I also prescribe ointments that contain very fine powder of several kinds of stones. When wild animals get injured, for example, when the foot of a bear is injured, the bear puts the foot into the earth. Because he or she knows the natural healing power of the earth — soil and stones. Deer lick rocks to supplement trace minerals. Monkeys bathe in hot spring to heal injured body (at least in Japan!). They understand the water from the earth is effective. Let’s discover the natural healing power!!

Best regards,

Tadahiro

I thought our exchange was finished until I received another email from Dr. Makise just a few days later. This was information on a specific patient who had gone through TSW and how his life had diminished before seeking treatment.

Dear Mr. Kastner

Male. 21 years old. University student. He was diagnosed as atopic dermatitis (AD) at the age of 3 years old. Without AD, his general health is excellent. I have attached pictures

He underwent TSW in September 2012.

He came to us April 2013. So, he was undergoing TSW for 7 months. His IgE went up to 70,000 IU/ml (seventy thousands) !!!
(Normal IgE should be under 170 IU/ml).

He was diagnosed even with “Hyperimmunoglobulin E Syndrome” by a physician, because the physician didn’t know that he was undergoing TSW. Of course, he didn’t suffer from “Hyper IgE Syndrome” but just because of radical TSW.

While he was undergoing TSW, he took Chinese herbal medicine to cure the problems of his inside but it didn’t work ( Personally I don’t trust the application of Chinese herbal medicine for AD. Not effective. I saw a lot of unsuccessful cases ). During the treatment of TSW, he could not go to school at all, not possible to sleep, too itchy like hell. Now all are OK. But still sometimes eczema will appear and he needs steroidal ointment, because his inside has not been cured perfectly but the amount of the steroidal ointments are getting less and less with vitamins and minerals. He can go to school, and he passed the employment examination to one of the prestigious insurance companies in Japan and he will work there the next year.

If he had continued TSW, there was really no future for him socially, too.

But we must know that he had had conventional treatment ( I mean “applying steroidal ointment for eczema and rash”) before he underwent TSW. But he got to know conventional steroid treatment would not cure his dermatitis. Then he was trapped by TSW. But his symptoms got much worse by TSW and he gave up it. So, the crucial point is that the conventional steroidal ointment treatment does have defects, too, for some cases.

AD is probably more difficult to cure than psoriasis. Not so easy disease because so many complicated factors are involved. Not so simple disease as cured only by TSW.

Best regards,

Tadahiro

PS: I previously wrote that I have treated more than 50,000 patients over a span of 20 years. To clarify; of the 50,000 patients a lot are repeat patients and I meant to say that I have treated AD patients over 50,000 times which equates to around 10,000 different patients over 20 years. Surely my experience is small compared with old experienced dermatologists. But I can treat AD patients from the internal medicine view.

This ended the question/answer relationship between Dr. Makise and I. We exchanged a few more emails about stone powder, my son’s asthma and some off-eczema topics. I really enjoyed his conversation and appreciated his willingness to respond to any questions I had. I’m always amazed by the number of English speaking people in other countries.

As far as eczema, RSS and steroid addiction, I can’t say there were many surprises. Dr. Makise seems to share the same beliefs as most doctors in the US (albeit, he encourages natural healing a great deal more as I think all doctors should) in that TSW simply isn’t accomplishing very much, there are more dangers than benefits and there are better ways to deal with red skin. Don’t trap yourself in the prison that is TSW for the sake of suffering naturally. It’s simply unnecessary and it will not affect the underlying eczema in the slightest – and the eczema is the problem everyone should be focused on.