Treatment of Atopic Dermatitis without Corticosteroids

Director: Mihoko Tarao

Certified member of Japanese Dermatological Association

Assistant editor : Eizo Furuta

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I started my skin clinic in 1980. Patients of atopic dermatitis have increased in number in the past 20 years and severe manifestations have appeared. Atopic dermatitis is a chronic skin disorder, characterized by severe itching. It is very common skin disease in infants, children , and also adults in Japan.

The cause of atopic dermatitis is unknown. Constitutional susceptibility of the skin and a family history of allergy, such as allergic rhinitis and asthma, may have an important significance.

I believe that steroids have a very important role to play in the treatment of atopic dermatitis. However, although steroids are very effective when dermatitis flares up, they have many serious side effects. The most important problem of steroids is dependence. Rebound exacerbation occurs when topical or oral steroid administration is stopped. The other problem of steroids is that they can induce viral infections such as herpes simplex and bacterial infection with staphylococcus aureus. It is possible to treat atopic dermatitis without the use of steroids. I will introduce a way to treat atopic dermatitis without the use of corticosteroids.

1) Keep your skin clean and hydrate the skin
In summer, as soon as you return home, take a shower. Soak the affected area in a bath for a few minutes using moderately warm water twice a day. Since your skin is dry and delicate, don't rub your skin with a rough towel. Wash your body with your hands using soap and shampoo, which are suitable for your skin.

2) Choose soft non-irritating clothing that will contact the skin
Wool, acrylic fiber, jeans, denim and hemp cloths are irritable for delicate skin with atopic dermatitis. Jeans are particularly irritating on the thickened itchy skin of the back of the knees. It is preferable to wear cotton underwear in all seasons.

3) Apply a suitable ointment to your skin
A variety of moisturizing creams and ointments will provide relief from pain or itching. These emollients should be applied when the skin is dry, even if it is not itchy or red. I recommend most frequently applying white petrolatum after a bath or a shower. There are very few emollients covered by health insurance in Japan. When rebound exacerbation occurs, white petrolatum is not very effective, especially in summer, when covering the skin with this gel is uncomfortable. Look for an emollient suitable for your skin.

BOCHI is often useful, if your dermatitis is oozing and crusting. This ointment is also applied to the thickened itchy skin of the back of the knees. GLYTEER often used when the dermatitis is weeping. If you have ever applied steroids to your lesion, especially on the face, the above-mentioned ointments are very likely to induce contact dermatitis. Instead, if you have never used steroids, these ointments may be useful.

Topical antibiotic, for example, erythromycin is sometimes useful when the lesion is red.

4) Take a medicine for itching
For children, an antihistamine may be useful at bedtime when itching is at its worst. There are many kinds of antihistamines and you should choose one that agrees with your skin.
Patients with atopic dermatitis often show symptomatic improvement when treated with an oral antibiotic even without any overt sign of infection.

5) Take foods, which are nutritionally well balanced
I recommend the traditional dietary habits of the Japanese.
Foods that should be avoided: alcohol, coffee, cocoa, cola, spices, salty food, instant food, chocolate, cake, confectionery, pastry, candy, ice cream, meat, hamburger, steak, deep-fried food, tempura, fried noodles, Chinese noodles, spaghetti, butter, cheese, pizza, margarine, mayonnaise, eel, herring, rice cake, bamboo, bracken, eggplant, brown rice etc.

Foods that are recommended: green and yellow vegetables, for example, carrot, leaves of Japanese white radish, Chinese cabbage, lettuce, beefsteak plant, broccoli, green pepper, paprika, asparagus, celery, parsley, Japanese pumpkin. sesame, liver, shellfish, small fish, whitefish, natto, konnyaku, shiitake, mushroom, powdered green tea, oolong tea, etc.

Foods that can be consumed routinely: rice, noodles, tea, green tea, milk, plain yogurt, tofu, bean, egg, fish, squid, octopus, crab, lobster, edible brown algae, laver, wakame, potato, sweet potato, spinach, tomato, fruit, olive oil, etc.

6) Exterminate mites
House cleaning and a change of air are most important for reducing house dust mites and mold.

7) Improve your clothes washing method
After dissolving the detergent for 3-5 minutes, add the clothes to the washing machine. Rinse for enough time to remove the detergent completely.

8) Eliminate stress
Frequently, fatigue, frustration, anger and anxiety can trigger a flare up of atopic dermatitis.

9) Do not pay too much attention to mass media reports
There is too much information about this disease. Skin sensitivity among individuals is various. Nothing is useful for all people: everyone must look for their own individual treatment for oneself.

10) Reduce exposure to allergens
Allergic reactions can occur in response to materials touched, inhaled, and ingested. Detection of the allergen by a scratch test, patch test, IgE-RIST and IgE-RAST may serve as a reference. If an allergen test is positive, avoiding the allergen may improve your skin disorder. Quite frequently, however, an allergen test is not useful for the treatment of atopic dermatitis.

11) Pay attention to complications
The most common complication is secondary infection with staphylococcal bacteria. Bacterial infection usually causes a flare-up of your dermatitis. If your dermatitis is oozing, crusting, or if it has small pustules, a systemic antibiotic is often necessary to decrease the bacteria. An antibiotic of Cefem, for example, Cefcapene pivoxil (FLOMOX), minocycline, clarithromycin and erythromycin are often useful. A bacterial cleanser, such as povidone-iodine is readily available, but occasionally is irritative. Sometimes topical antibiotics, such as erythromycin and sodium fusidate, are effective.

Herpes simplex is the most important complication among the viral infections. It may cause local or widespread infection. Herpes simplex is usually treated with systemic acyclovir, and external medication is supplementary.

Cataracts, glaucoma, detachment of the retina are important complications of the eyes in patients of atopic dermatitis.

12) Maintain the balance of the autonomic nervous system
The autonomic nervous system is complicated. People with atopic dermatitis are sensitive to many things. Try to avoid emotional stresses, fatigue, and overeating. Keep early hours and regular hours, and sleep well to keep up the balance of autonomic nervous system