[life instructions for courses without steroids]

. Although Japanese dermatological authorities do not admit except standard therapies centered on topical steroids and taclolimus for atopic dermatitis(AD), not a small numbers of Japanese AD patients intend to avoid strong immunosuppressive agents like steroids or tacrolimus*.
(*Other calcineurins like pimecrolimus have not approved in Japan.)

They and their supportive physicians call the intentions as "datu-suteroido(in Japanese)", meaning "escape from steroids", which in fact mostly indicates "escape from tacrolimus" at the same time.
They are still by any means a minority among Japanese dermatological world.

How could we manage to keep up with the intentions under this difficult situation as minority?
I feel like I find the a clue in a remark once I saw in Adashino-nenbutu temple in Kyoto. I visit there with my friends when I was in a medical university.

The remark is as below:

  Don't be hasty,
  Don't be angry,
  Don't be boastful,
  Don't be dejected,
  And don't be lazy.

I thought we sould live as above mentioned then, and now I think we should continue "escape from steroids" as above, too.
Now I discribe further.


1) Don't be hasty,

We ought to know "escape from steroids" needs quite a long time.
The speed a spontaneous healing progress is incrediblly slow.
But that's the intrinsic, natural course.

The slowly reached balance will be originally steady;
compared to the easily losed one serial steroids' application establishes.

If you anticipate a much shorter period to recover like
"Within one month my skin will change to be better, and I will forget AD in good health in 6 month!",
then you'll suffer a big disappointment.

You would rather be in a neutral mind like
"Of course wonderful if I could be free from AD, but it'll be alright if I could not, as well. Moreover, I could accept if my skin may get worse. Still I would be able to manage myself."
Then you'll be able to find lots of happiness within your daily life.

This disease AD is, i.e., your destiny.
Even if you hate and try to hide it, it will stay in front of you just as is.
Let's just face it composedly.

2) Don't be angry,

I think misfortunes tend to make people store rage in them to vent their gloomy emotions.
They often strongly resent possible causes which brought out today's aggravations.

If you'll be able to going to change the rage into some concrete plans for the improvement, or to certain energy for fighting against AD, then, there might be meanings they had them.
However, the emotion of rage itself is rather bad for your body and soul.

Now you may want to shout like
"The bad emvironment harmed me!", "My company spoied me!", " The society did me bad!", "The doctor malprescribed me!", "My family destroyed me!", and so on.
But hardly anyone will here you, because such evil emotions of hate will be unpleasant for anyone.

Do you want to be a person who spread rages around you and would be given a wide berth to?
Of course not, do you?

In fact, to solve ploblems, needed tools are not angers, but cool analyses of situations.

First, consider if the object you hate is completely bad or not.
It may be good for you in some degree if you see it from other point of view.
You may amplify the good aspect if you change your attitude.

Next, if the object is by no means good for you, try to avoid it.
You won't need to exterminate it if you can avoid to be harmed by that.

At last, if you still judge the object should be blamed, then fight against it straight.
Be ashamed for speaking ill of it behind.

Certain people looks like expanding their anger within or around themselves.
I worry such dark feelings might makes them unhappy.

3) Don't be boastful,

Although it's natural everybody want to think his desicion is not wrong, and it's natural everybody want to think he is precious,
don't misunderstand only you are just and proper.

Didn't you have such an experience that an recoverd AD paient self-righteously insist you to obey the same remedy he/she succeeded?
Or didn't you meet such a physician who believes his/her therapy is the best and the only?
Yes,probably you did.And you must have felt aversions to him/her then.

I can't understand why they need to make others wrong to make themselves right.
I don't think "escape from steroids" is superior to "standard AD therapy", nor the former is inferior to the latter.

A patient who believe only he/she did proper to get cured is boastful, as well as a physician who believe only he/she treats patients properly.
They are like pierrots.

Even if you get what a wonderful cure by "escape from steroids",it would be better you won't become such a bothering pierrot.

Just silently go ahead through the way you believe.
You can recommend some remedies you believe to be good for other patients on their behalf, but never compel them to do it.

When you did good, just straightly be glad and be proud of yourself in your mind.

Please don't misunderstand that you are specially superior.
There are ever so many admirable persons who are working hard as well.

4) Don't be dejected,

There is no need to be depressed or apathic even you are in bad result.

Since "escape from steroids" means exactly giving up convenient and quite effective agents, it's natural the course will be hard.

Stopping the strong, possibly harmful drugs does not mean an instant cure of your AD.
After you conquer the adverse effects of steroids(and tacrolimus), you will confront the original big problem how you can manage the AD.
That is the agenda people all over the world have struggled for a long time and still does not have any sufficient prescription.

So, you don't need to be discouraged.
No good result is always usual.
That never means you are especially unskillful.

The hope is left with you.
In your power of spontaneous healing, in time working to help it work, and in your persistent effort to respect your own body.
At least, you try to minimize outer harm into your important body.
You can be proud of it.

At present you are suffering, but someday, they all will become your good memories.
Don't be too distressed.
Just survive from one day to another, and surely you'll find the future.

5) And don't be lazy.

The phrase "escape from steroids" itself means just stopping medicines.
You are doing nothing then.
Things important are what you are going to do instead of applying those strongly effective drugs to better your AD.

Improving your daily life style, improving your environment, improving your foods, improving your mental condition, ... et cetera.
Anything will do.
Since maybe a single improvement is not sufficient, you will challenge several likely effective ones.

Most of them won't work at once.
But don't throw them away soon, keep up your work.

The total of all things you do everyday will make up yourself in the future.
Shape up a better yourself.


I think lives throughout hard "Escape from steroids" days in AD should be as above.
Please don't be too strained, don't be defeated.
I hope your happy days even if in your disease.


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