In Japan, most of steroids-aversive patients of Atopic Dermatitis (AD) and their physicians dislike the authorized therapeuthic guideline of AD established by Japan Dermatological Association (JDA), which do not admit AD therapies without topical corticosteroids.
Because the guideline was made in the 1990s against steroid-aversion, for JDA took it as a "confusion" of AD therapeutic scene and thought that the topical steroids should be clarified to be the only justified essense of modern AD treatments.
Once an AD treatment process avoiding steroids is brought into court, the guideline would be the negative proof.
Even before lawsuits, steroids-aversive patients and doctors always put into uncomfortable moods of outlaw by it.
Such long roads of AD management often convert patients suspicious, which is so stressful for their physicians.
After the guideline of AD, JDA added lots of guidelines of dermaological diseases (urticaria, acne, alopecia, malignant skin tumors and do on).
And in this year, JDA performed a questionnaire to their members concerning how they feel about the guidelines.
I wonder why they planed such questionnaire.
Are they truely willing to hear voices of the members and improve the guidelines, or....?
Anyway, as a member of JDA, I got sent the added up result of the questionnaire.
Just as I had thought, some members answered straightly,
"There are too many guidelines unnecessary," or
"We professional dermatologists need not depend on guidelines, because we know enough."
But others estimated the guidelines are useful and there were mainly three reasons,
1)"a guideline can be a good reference in diseases I seldom treat."
(This must not be for AD because every dermatologist is familiar to AD.)
2)"I can confirm my treatments to be right by the guidelines."
3)"Guidelines are useful to persuade patients, paramedicals and doctors who are not professional in dermatology."
And in the questionnaire a vote to highly regarded guidelines revealed the definite No.1 was the guideline of AD, which got 54% votes.
(The second one was of urticaria:45％, the third was of acne:32％.)
One dermatologist praised AD guideline saying (printed in noticeable red bold letters!),
"..the AD guideline did present a firm position of JDA against the boom of steroids-aversion in AD and got a result of certain resolution of the confusion in AD management. I think it should be valued highly as a contribution to the society."
So more than half of Japanese dermatologists said the AD guideline was good,
because it gave them confidence that their treatments were surely proper, it helped to persuade their patients who were not willing to use steroids, it could warn physicians who had strayed from standard steroids treatments,...
and most of all, it settled down the troublesome confusion due to steroids-aversion of AD patients.
With much anxiety and tiny hope, I read through the result of the questionnaire.
It was disappointed as I had anticipated.
Moreover, I found an ultimately shocking comment in it.
It said as below;
"..how about adding harmful evidences like AD therapies without steroids (into the AD therapeutic guideline) ?"
The word "harmful" should be used to something obviously negative.
It decided non-steroidal AD management were harmful.
I agree if quack therapies guaranteeing impossible cure (Dr. K. Takehara in JDA named it "atopy business") are decided to be wrong.
Such ones will overly advertise promising result, forbid patients to have no treatments other than from themselves, in conclusion cause the patients physical, emotional and financial loss.
However, here this opinion pointed out all non-steroidal thereapies to be harmful.
Is that mean when an AD patient wants to stop topical corticosteroids, his/her choise is wrong?
Is steroid-aversion itself guilty?
But I know though steroids have outstanding effects with plenty of evidences, they have their own limits.
And so as tacrolimus.
Both can improve symptoms of AD just for a while, nevertheless never, ever could cure AD.
Even building up a better constitution cannot be gotten by them.
(Recent topic says a proactive use of tacrolimus 2-3 times a week after skin symptoms are gone can avoid a relapse.
But this is not a reform of constitution, too, just suppressing symptoms to emerge.)
Any famous able dermatologist can not heal his/her child's AD.
I could not heal my AD by my dermatologic ability, either.
Isn't there a possibility avoiding steroids lead AD patients to the direction of natural cure?
There have been no large-scale study.
However, if dermatologists forbid AD patients to quit steroids and reject treating them even if they were in predicaments of secondary skin infections or general hardness due to AD, any verification trials will not be realized.
I don't think just stopping steroids can cure AD.
I think the best countermeasure against AD skin symptoms for now is corticosteroids, too, but I dare to claim we also foresee future scenes when some alternative deprive the position of steroids.
We always should consider another possibilities.
Otherwise, innovation will not come.
There already is a fact that there are not many, but some AD patients who have recovered after throwing out topical steroids under the supervision of physicians who accepted such patients.
I don't know the reason why they could get the recovery; some other effective therapy, taking good care of themselves or only natural course...anyway, they survive now healthier than when they depended upon steroids to control their skin condition.
Yeah, surely, I am one of them!
So I think dermatologists have no authority to deny Steroid-aversion completely.
But things actually happening is...
A JDA member judge it to be harmful.
And there are JDA editors who chose the opinion up to print in red bold letters.
Now I cannot help realizing their intension.
Under any circumstance, the JDA won't admit any non-sterodal management of AD. Never.
My hope was someday AD patients can chose treatments they have according to their own beliefs and dermatologists manage them along their choice.
Is it an impossible dream?
I remember my expirience when I was struggling in my consuming AD.
Even when I needed antibiotics against skin infection, or when I wanted to evaluate my condition by checking serum IgE level and so on, I was precluded to go to see an dermatologist.
Because I knew they would force me to use topical corticosteroids to improve my skin symptoms!
I got my laboratory data by begging neighboring physicians who had nothing to do with dermatology.
Unless dermatologists have a generosity to accept some AD patients' serious urge for non-steriodal treatment course, these patients will lose their way.
Sometimes JDA complains that AD patients often go to physicians other than dermatologic spacialist who do suspicious treatments, but I wonder it is JDA themselves who drive AD patients to them.
If AD patients reach a conviction that steroids therapy is the best for themselves, they'll be back to dermatologists automatically.
Rigorous strain would be counterproductive, wouldn't it?
How JDA make a big show of regulating it's members and campaigning to the society for the doctrine of steroids for steroids' sake, there are flaws in it.
As far as dermatologists cannot totally cure AD, patients never stop longing for true cure and worrying about adverse effects of the non-curative medicine, i.e., corticosteroids.
As AD patients dream freedom from AD, doctors who are willing to help them even if they have little power will continuously emerge.
Will I have to go on a way which would never join the way of my colleagues JDA?
It's really disappointing.