Some tips from Dr. Kenji Sato's book

Dr. Kenji Sato is one of the very few Japanese dermatologists who acknowledge topical steroid addiction(TSA) and perform non-steroidal treatment for eczema. He published the book "Atopic Dermatitis in Adulthood Learned from Patients" in 2008, where he describes how to understand and start topical steroid withdrawal(TSW). Unfortunately, this book is only released in Japanese.

Here I pick up some useful tips from the book. I am not a medical expert so I may not be translating technical terminology properly, but hopefully you get an idea.

Tip 1 - Do not wipe off clear fluid from ooze

Dr. Sato warns not to wipe clear fluid from weeping skin. The fluid contains necessary protein for skin to recover. Therefore, wiping off the fluid means that you are delaying skin recovery. He recommends to just leave the fluid as it is, or apply a gauze patch and fix it with tapes so that it absorbs the fluid. When you want to change a gauze patch, do not strip it off as it may open up wounds. Instead, wet the gauze in a bath so that it will come off naturally. Dr. Sato also tells not to use tissue papers to wipe off the fluid as those papers have a lot of chemicals and may irritate skin.

Oozing skin is surely uncomfortable, but from my experience it WILL stop. I recently had non-stop oozing from my arm joint. I left it as it is and flush out with warm water once or twice a day and it did stop after several months. My ears and neck are still oozing, but I'm not particularly doing anything. They seem slowly recovering.

Tip 2 - Do not strip scaly skin

Scaly skin causes itches and discomfort and certainly not aesthetically pleasing. However, Dr. Sato says that you must leave it and wait until it comes off naturally. If they are taken off prematurely, it will become flaky again and won't heal.

He also describes "For your skin to recover from topical steroid withdrawal(TSW), your skin needs a number of desquamation. This is not completed with a single scaling, because it takes time for epidermal cells to get back to normal."

Scaly skin has been my biggest problem so far. It looks depressing and doesn't seem healing.
But one sign of improvement I found is that as it takes scaling process again and again, redness on my skin reduced. Earlier this year, I had red eye bags, but now they are gone. Instead, I have scaly patches all over my face and neck. And, from my past 4 years experience, it's been always like this.

Scaling is always the last process of TSW. Although it lasts for ages, it very slowly gets back to normal.

Dr.Kenji Sato's blog (Only in Japanese) -


  1. Thanks for this Tommy. I am really interested in this book, but don't speak Japanese! Please keep us updated with more extracts from the book. x

    1. Hi Louise, sure I will post other tips again. x

  2. I wish I had read this earlier today! I did both of the "do not do"! Oh, well, at least I know for tomorrow. Thanks for sharing!

    1. Hello Brista, my pleasure:)I saw your blog and honestly your skin still looks better than other RSS cases I've seen. Usually the first flare you get after withdrawal is the worst but will get less and less.x

  3. Hello Tommy!

    Wow, we have done several of the do not do's too! That is really interesting about the protein in the ooze, maybe that is why is smells so funny? I dont reckon boy will leave the scaling alone more's the pity, he itches to buggery all the time!

    1. Hello Kelou, thanks for your comment! My fluid smells funny too. I thought the smell came from the infection or something but it doesn't look like it so far. We still have to be careful of sepsis etc though. I saw your blog, great work!:)

  4. Thanks Tommy, its so good to have more and more blogs popping up, it is such a horrendous thing to go through.

  5. Your tips are really helpful. I had no idea what I was supposed to do with the ooze or the flakes. I guess it like any kind of wound, just leave it alone, the body knows what it needs to do to heal itself. Thanks for sharing!

  6. Hello HT,

    Thanks for your comment. I'm happy that you found my post helpful. I hope you will heal soon!

  7. Hi. I just came across your post via Google. I have the worst weeping eczema last night ever in my life. It just wouldn't stop! I didn't sleep at all for 8 hours. I even missed work today! :( I'm glad your share this post because I didn't know I'm suppose to leave the ooze alone. I've been patting my face dry all night because the weeping wouldn't stop. Right now my face is still weeping but I think I'll take your advice and don't touch it! And also with the peeling of skin, I would always pick at it. I think I'll also take the Dr.'s advice and stop picking for God's sake (but there are sooo many!). :( I hope I heal soon.

  8. Hi Tommy,
    Thanks for your blog and keeping it updated. I'm in my 24th month of tsw, and the face and neck are very dry and scaly. (and some redness) I really hoped by now it would have been gone but guess it may need a bit more time to complete the healing process...
    I'm currently doing MW, but i'm contemplating either bleach bath, as a means against infection... I take light shower but after 5 weeks of flair, im willing to try.. Do you know what Dr Sato or Dr Fukaya's stance on bleach bath?

    I was also about to order Dr Fukaya's lotion, but noticed he has new product (200 range - pink bottle). Have you had a chance to use it? :-)

    1. Hi H! Thank you for your kind words, and sorry you're still going through the scaly period - which really is the last part of tsw so you're on a right track :)

      I've heard of bleach bath many times but never really looked into it. What is it exactly? Is it some a kind of bathing method to prevent infection?

      Regarding the 200-range lotion, yes! I've been using it and I really like it. I don't know if you ever used the blue one, but the pink one is much thicker texture and great when skin is sore and feels like skin is missing a top layer (you know what I mean..) xx

  9. Thanks for your prompt reply, Tommy! It is a nice feeling to have that someone on the other side of the globe shares and understands what i'm going through... Ups and down, but there are days that are harder and i think we all have been down that road.. It can be a lonely path at times, especially when it seems like one step forward followed by 2 steps backward.. but i think in the end, we will all get there.. sooner or later. So thank you, Tommy, for keeping up this blog, and letting others know that they are not alone.

    Thanks for the info - i will order the 200 Lotion. I totally get what you mean by "when skin feels like it's missing a top layer..".. :-)

    As for bleach bath, it's just a bath with lukewarm water and diluted bleach (like swimming pool). In NZ, AUS & a few other western countries, it is actively recommended as a means to keep infection at bay for eczema patients.. I'm assuming that you're based in UK, from your articles on experiences at NHS hospitals.
    I read Dr Fukaya's blog on disinfectant therapy for staph infection.
    I can't access both of these therapies he recommends, so i was wondering about his advice on bleach bath, since it aims to disinfect the skin. His english website isn't clear on this, and i was wondering if you came across any advice in japanese, either from dr Fukaya or Dr Sato?

    As i'm doing MW, I am particularly interested in Dr Sato's advice on how to keeping infection at bay and his stance on baths with any disinfectant liquid, eg bleach or apple cider vinegar.

    Sorry I got carried away and it got long.. Lots of hugs to you, and wish you lots of sunshine to brighten up your day.


    1. Hey H! Thank you for the explanation of bleach bath. It's interesting as I've never tried it myself. I've been through a number of rebounds, and luckily apart from herpes infection, I never had staph infection or MRSA. (I mean, as far as I'm aware *touch wood).

      I just scanned through Dr. Sato's website. In 2016, he writes that when MRSA is found, he evaluates it to determine whether medical treatment is necessary. And only when the treatment is necessary, he prescribes oral medications.

      As Dr. Sato is strict on MW, he doesn't recommend having bath or using soap often (he tells, if you must, to put a soap foam on skin literally for 1 second and then shower) - so I wouldn't think that he'd recommend bleach bath. What he strongly recommends is doing exercises (sweat is the natural disinfectant).

      I read the article of Dr. Fukaya in the link you gave. He recommends povidone-iodine 10% solution and electrolyzed strong acid aqueous solution as disinfectants, but in his original article in Japanese, he discusses this in terms of why TS can stop working - and one of his theories is because of MRSA. That is to say, he isn't talking about these disinfectants as a way to prevent infections during TSW in his article.

      Hope this helps! x

    2. Hi Tommy,
      Thanks again for your kind and detailed reply! Its very helpful to know Dr Sato's advice for exercise, and sweat..! Reading what you wrote, "sweat - the natural disinfectant", i went "ah ha!!"...!!!!!

      Since sweat stings, i stopped sweat inducing exercises. And of course, this gave me a bonus of gaining a few kilos... (thanks for that too, TS...!!) So all the more reasons for hitting the gym, being more active and live more (which i kinda neglected a little bit, since tsw..)

      How are your days blooming? Hope its full of sunshine and happy colours. Xx

    3. You're welcome! I'm in the same boat with you for gaining weight and having neglected life a bit. It's tough! Hope sweating helps us recover soon. xx

  10. Hello Tommy,

    1 ) after I exercise, how do I remove sweat from my face as I have heard that if sweat is not removed, it can be harmful for the skin. And
    2 ) will i face facial-inflammation if i let my facial skin dry which will happen if i don't apply moisturizer ( I am looking for MW )
    3 ) is there a way to clean face without using water ?

    1. Hi Monty. I just use a towel to remove sweat, and when it's itchy, I wet the towel a bit before using it. This works pretty well for me. I think after starting MW, skin usually gets tight and uncomfortable, before starting to heal better. I don't know if inflammation definitely happens or not, I think it depends on person and even then it's hard to tell if the inflammation happened because of TSW or MW. I have been using Avene water spray instead of using tap water to wash face. Hope this helps.


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