Meeting with Dr. Kenji Sato

I know that I haven't blogged about my skin condition for ages.  To be honest it's because I wasn't sure what was going on with my skin.

20 January, 2014

Since November last year, my skin gradually became more and more aggravated.  I was confused because the way my skin worsened was somehow different from any of the other times I'd experienced before.

I felt that I needed to see someone who could give me advice on this.  I've been fighting TSW since 2008 and I decided that it was the time to ask for help.

The New World

So I booked a flight to Japan, then hopped onto a coach. 21 long hours later, I was in 'The New World'.

Well, this chaotic place is actually called 'The New World(新世界)' in Osaka, Japan.  Yes - I was there to see Dr. Kenji Sato.

I was very nervous. I wasn't originally too keen on meeting him as a patient. I had seen so many dermatologists and every single time I had ended up disappointed.  EVERY SINGLE TIME!  What if this ended up just like all the other experiences? What if he says my skin won't heal or improve for some reason?  Feeling like I was facing that kind of verdict really gave me butterflies in my stomach.

Hannan Chuo Hospital in Osaka, Japan

At Hannan Chuo Hospital

Hannan Chuo Hospital is a relatively big hospital.  Their dermatology department was located on the ground floor.  I was escorted from the reception to the waiting room by a friendly nurse.  I handed in 4 pages of my skin history beforehand.  I was called in Dr. Sato's office at 10:00 sharp.

There he was - Dr. Kenji Sato greeting me briefly.  There was then a moment of silence.  He was flipping through the papers of my skin history marking certain lines in red ink.

The first thing he said to me was that I was the first case he ever saw who got withdrawal symptoms from Protopic alone.  He said that he'd seen many people used Topical Steroids and Protopic together and then got withdrawal reactions.  He thought that Protopic alone would cause as severe withdrawal reactions as topical steroids, and I happened to prove that his presumption was correct.

Dr. Sato then asked about my life style in detail - how often I exercise, what I eat and how long I work etc.  My answers to these questions seemed mostly fine - except I work too long hours (normally 14 hours/day. Dr. Sato told me to cut it to 10 hours/day).  Also, he diagnosed me with seborrhoeic dermatitis by looking at my face.  And, this was the reason why my skin was looking strange.  He recommended me to put soap foam on my face for literally a second (I hadn't used a soap on my face for ages) to deal with infections.  He didn't prescribe Nizoral, let alone topical steroids for it unlike other dermatologists.

I took out my small notebook and quickly jotted down every bit of advice he gave me.  Also, Dr. Sato kindly and patiently answered every single question I asked (it wasn't few).

The Q&A

Here is the list of the Q&A. (Q.s are my questions and A.s are Dr. Sato's answers)

Q. Have you seen any cases that patients healed from Protopic Withdawal?
A. Yes, but Protopic Withdrawal appeared to take longer to heal than Topical Steroids Withdrawal. But it will heal.

Q. I feel that my immune system became low after withdrawing from topical steroids and protopic. Would my immune system eventually return to normal?
A. Yes, it will.

Q. I know you recommend Moisturiser Withdrawals. But what happens if you have dry skin? Does 'dry skin' actually exist?

A. Some people, especially some babies, have dry skin where you can see very small flaky skin. In such cases, applying moisturiers can improve their skin condition.  However, using moisturisers for people who used topical steroids for a long period usually delay healing, so it is not recommended.

Q. My general skin condition became so much worse since withdrawal. Does that heal too?
A. Yes, it will heal.

Q. I feel that my skin gets worse during in cold weather. Would it affect healing?

A. From what I've seen, it looks like cold weather can slow healing a little.

Q. I've been having a lot of eye mucus since several years ago. Does this heal?

A. I just had a patient with the same symptom. The patient got better by the time he left the hospital. So yes, it should go away. (He then prescribed anti-bacterial eye drops.)

Q. After patients are healed after withdrawal, it is okay to wear make-up?
A. Try not to - as make-ups can moisturise skin and some people have another rebound because of that. But, I tend to say that it is fine to wear lipsticks and eye liner as they are only small parts of your face.

Q. Is it okay to apply sun screen?

A. No, it is not recommendable as sun screens can work as moisturisers. If you want to block sunlight, please use long brimmed hats and sunglasses.

From what I saw, Dr. Sato's style was to discover what is hindering healing by looking into your life style and medical history.  He doesn't apply one-to-fits-all solution (because there isn't one), instead he listened to each patient and provides specific medical advice. When he thinks that medical help isn't necessary, he would just leave it as it is.  For example, he said that my anemia and low blood pressure shouldn't need treatment and suggested I stop  taking iron supplements as they sometimes affect stomach and skin badly ("Of course there are cases where you do need those supplements and treatment", he added.)

Topical Steroids for Acne?

During our conversation, Dr. Sato asked if I had acne before.  The question was somewhat unexpected.  I said yes - in fact, I had terrible acne when I was a teenager.  "Did you use topical steroids for the treatment?" asked Dr. Sato. I silently blinked several times - I remember having to use so many tubes of "some ointment" to treat my acne (and how utterly useless they were), but I couldn't remember the name of it.  It was more than 15 years ago anyway.  "I thought you wouldn't usually prescribe topical steroids to treat acne."  "Actually, some dermatologists do prescribe topical steroids for acne. I personally thought it was a problem, so asked a council to stop that. They banned topical steroids to treat acne, but then they took the decision back the next year."  The possibility is that you were prescribed topical steroids for acne without knowing what it was.  I thought that that could've explained why I've been still suffering from TSW after 6 years of my first withdrawal - but I'm still not sure.

After Meeting with Dr. Sato

Eye Drops (Levofloxacin)

When leaving his office, although all I was given by Dr. Sato was a prescription for anti-bacterial eye drops, I felt that I was given exactly what I needed - the confirmation that a hope is still there and that I'm on the right path and I can heal.

I visited Dr. Kenji Sato in March. And it's been 2 months when I'm writing this post. I would like to share how I'm doing now in another post hopefully sometime soon.

Please sign the petition!

Atopic (Dr. Sato's patients group) are gathering petition signatures online to change the atopic dermatitis treatment guideline by Japanese Dermatological Association. 

Atopic has been asking for people to sign the petition on the street as well as online. 

I would really appreciate it if you sign the petition.

http://www.change.org/en-GB/petitions/%E6%97%A5%E6%9C%AC%E7%9A%AE%E8%86%9A%E7%A7%91%E5%AD%A6%E4%BC%9A%E4%BD%9C%E6%88%90-%E3%82%A2%E3%83%88%E3%83%94%E3%83%BC%E6%80%A7%E7%9A%AE%E8%86%9A%E7%82%8E%E8%A8%BA%E7%99%82%E3%82%AC%E3%82%A4%E3%83%89%E3%83%A9%E3%82%A4%E3%83%B3-%E3%81%AE%E5%86%85%E5%AE%B9%E3%82%92%E6%94%B9%E8%A8%82%E3%81%99%E3%82%8B%E4%BA%8B%E3%82%92%E8%A6%81%E6%B1%82%E3%81%97%E3%81%BE%E3%81%99?lang=en-GB

Some people said to me that Japan is advanced when it comes to TSW - the reality is that many doctors prescribe topical steroids too carelessly here (perhaps in your countries as well).  Even a beauty magazine, which I picked quite randomly, recommends medium class topical steroids for rough skin.

Atopic and Dr. Sato are trying to change the guideline, so that non-TS treatments for atopic dermatitis will be officially accepted by Japanese Dermatological Association when TS-based treatment isn't working for patients.

Your signature on the petition will be a great help.

Thank you for reading my post.

I wish you steady healing and peace in your life.

xxx