It looks to me Japanese AD patients tend to use more dose of topical corticosteroids compared with other countries as far as I know. Why? I describe several reasons I consider below.
First, Japanese worry about uniformity. People often have to make efforts to look normal, and to live ordinarily. So AD patients need to cover their symptoms to keep their faces clean, and to commute their workplace or school every day as healthy people.
Second, Japanese have obedient tradition to authority like doctors. They often does not ask necessary questions to doctors and blindly apply prescribed medicines.
Third, short consultation time prevents doctor's detailed explanation about method and adverse effects of the drug.
Fourth, health insurance system which covers all nation in Japan and current predominant economy of Japan make patients possible to purchase enough medicines.
Fifth, worse environment in Japan like lots of chemicals, airtight houses, dirty airs, humid climate and lacking of exercises make their AD severer and thus demands increase of dosage.
Too much or long use of corticosteroid causes more adverse effects. Corticosteroids change natural course of AD. It effects too strong to human bodies to use constantly for AD treatment.
So unpreferable effects of longtime steroids use like dependency or possible worsening of AD sometimes happen among Japanese AD patients recently.
They become to notice evil effects of the drugs. They have more independency so that they can think about good remedies to AD by themselves.
So not a small number of Japanese AD patients want to give up corticosteroid now.
Dermatologic authority are eager to recover the reliance of corticosteroids since it is the highest card they have.
They emphasize proper use of corticosteroids by professional physicians: i.e. delmatologists does not make problems. They push the responsibility off onto quacks who intend to make money by folk remedies' sales and the mass media who want scandalous subjects.
Some dermatologists notice the limit of steroids therapy and try to apply other remedies including alternative ones, but they are still minority.
Another strong immunosuppressant: taclorimus came out in recent years.
It is already prevalent as second choice. Some use it to give up steroid.
But longer used cases of taclorimus are increasing. Adverse effects of long time use of taclorimus are possible to come next.
AD come to be a disease of very long time span now.
Mild therapies are more preferable to use long or repeatedly.
Japanese AD therapy has been reliable to strong effect of corticosteroids and expectation of possible early spontaneous healing.
But it doesn't seem working by this time.
We are at a turning point.