Here is the very basics of topical steroids addiction and withdrawal. Dr. Satoko Minaguchi showed this during the TSW conference and explained where TSA and TSW stand in the arena of atopic dermatitis treatment. She is a TSW dermatologist working in Saitama area in Japan.
This is the photo of the chart she showed during her powerpoint presentation.
Here is the translated version for you.
TSA shouldn't be discussed as an opposing idea to the orthodox TS based treatment.
Dr. Minaguchi's message was that TSA shouldn't be discussed as an opposing idea to the orthodox TS based treatment, because TSW is a method of a treatment to remove side effects. The opposite therapy to the TS based treatment should be a non-steroidal treatment, in other words 'natural healing'.It's clear that the most of the TSW patients, including myself, went down on the Y route on the chart. We are now back on the route to simple atopic dermatitis or other skin condition we originally had. What I found concerning is those who are in Y'. People in this category thought their eczema was completely cured, and one day, Bam! - they found themselves with TSA. People in X' are lucky ones. Dr. Minagchi told the audience that a factor of 'no rebounds' is currently unknown. (She indicated that it seemed to be just a matter of luck).
Some people do not experience the side effects of TS at all.
Another interesting point this chart shows is that some people do not experience the side effects of TS at all. I know people who used TS and Protopic(PT) and had no adverse effects after they quit. For them, "Topical steroids (or Protopic) worked well." I'm happy for them, not cynically but genuinely. When you begin the TSW/PW, it's easy to see TS/PT as an invention of evil. But I think that refusing TS/PT all together, which is steroids/tacrolimus phobia, can make your already-hard journey harder. There's such a big difference between experiencing the side effects and steroids/tacrolimus phobia. I acknowledge that TS/PT work wonderfully for some people, just not me, sadly.Once we are done with TSW and get rid of the side effects, some people may face a question - "what should we do with simple atopic dermatitis?" Most of TSW doctors, including Dr. Kenji Sato and Dr. Mototsugu Fukaya, believe that atopic dermatitis would often go away naturally.
(it's interesting to visually compare simple atopic dermatitis pictures and steroids induced atopic dermatitis on Dr. Tarao's website)
Wishing you all a good recovery and a beginning of the lovely new season x
Thanks for this post Tommy, Is your skin still doing well and mostly healed?
ReplyDeleteThank you for your comment! My skin got a bit worse over the winter but it is now starting to heal, I think :)
DeleteThank you Tommy! I always look forward to your posts sharing the latest research about TSA/W in Japan. Thank you for your efforts in translating this information! Hope you are healing steadily and well xxx
ReplyDeleteAww thank you ahfaye, how is your skin doing these days? xxx
DeleteThanks Tommy. This is so helpful.
ReplyDeleteHello DiAnn Ellis, thank you for your comment. Glad you found it helpful :)
DeleteThanks Tommy, very interesting ! By any chance do you have the link to the Japanese dermatologists account of her own withdrawal? It seemed to be kicking around somewhere for a while but just can't find it now.... keep on healing x
ReplyDeleteHi Wendy, thank you for your comment :) What do you mean by the Japanese dermatologists account of her own withdrawal? What sort of information are you looking for? x
Deletehello tommy! i'm juliana :D thanks for sharing such informative posts from the japanese doctors!
ReplyDeletei am curious if dr minaguchi specified the number of times of steroid usage in this chart. is it a once off steroidal treatment that would lead to the three different paths X', Y', and Y?
personally, i feel that i (and most others) belong to the Y' group, considering i used steroids for 8 years. every time my rashes heal, i thought that i'm in the clear, and it isn't until a while later that the rashes start to creep back slowly (but it doesn't look like eruptive as the withdrawal symptoms, i just thought it's worsening eczema and never thought that it's a sign of steroid addiction). so it's many repetitions of going on and off steroids before hitting a turning point where steroids stop working for me.
Hello Juliana. Thank you for your comment :) I don't think Dr. Minaguchi mentioned the number of steroid usage in relation to the chart in her presentation. It seems to be a common view among TSW doctors that everyone has a different level of TS tolerance, and just a one-off use of TS wouldn't trigger TSA.
DeleteYou are actually right - the chart does look like a single use of TS can cause TSA which is the Y group. As I understood (probably because I listened to her presentation while this chart was shown), what Dr. Minaguchi meant was that the difference between Y and Y' was down to your present state. The fact you got TSA would place you under the Y group, but imagine there was a person who used the same amount of TS for the exact same period as you - but doesn't have TSA, the parson can be Y' or lucky X'. And what I thought she wanted to tell to the audience was that, even if you've been TSA-free in your whole life, if you had used TS for a long period of time, you could be Y'.
Hope this answers to your question. But again, you are right that this chart can look a little confusing.
Also, I just want to say that I love your blog and admire your bravery of putting yourself out there :)
Thank you tommy , I will try to find that contact in Tokyo ! Hope my skin will improve soon , can't see the end , love your blog thank you
DeleteHello tommy , thank you sharing everything about . I am a TSW and would like to know if you have any contact for a good doctor as Dr sato in Tokyo ...
ReplyDeleteHi Lenka, I'm afraid I don't have any contact in Tokyo. I heard of Dr. Fujisawa in Nerima district but I never visited him..
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