[A Lawsuit about AD Treatment 1]

-Corticosteroids are Good or Evil?-

A Japanese dermatologist has been sued and defeated in June, 2004 at Tokyo district court.
He had recommended a AD girl to get out from under heavy topical corticosteroids therapy.
As it is fairly uncommon that a doctor lose a suitcase against a patient in Japan so far, it somewhat smells there's some hidden political intension.
The details are as below.

The case is a four-year-old girl.

She was diagnosed as infantile eczema when she was two (April, 1998), and prescribed 1/3-1/4 concentration of betamethasone valerate(a corticosteroid which is 3rd of 5 effect levels) ointments.
She kept light eczematous lesions and steroids prescription was repeated 4 times till next summer.

Next, her parents took her to Tosa-Shimizu hospital which is famous with AD cure in Japan.
She was diagnosed as AD and prescribed a few kind of its special ointments containing corticosteroids, tar(dry distillation tar of defatting soybean), and secret homemade materials working as SOD.
(Lots of AD patients had gotten clear skin with short stay of the hospital, which got the hospital known to nationwide AD patients.
The method is total body application of the special ointments packed with bandage all over. The doctor initially had said it had been the effect of tar and SOD, but as the marverous effect was generally said to be doubtful, he disclosed that the ointment contained corticosteroids. He says he uses 1st to 3rd effect level of corticosteroid and rapidly reduce the level and concentration of them with extinction of symptoms. Still, the precise kind or concentration of corticosteroids and other materials contained in the special ointments of the hospital are not disclosed.)
She continued the ointments more than 6 months.

Then she and her parents came to see the defendant doctor on April, 2000.
He is a practicing dermatologist who is one of the small numbers of Japanese dermatologists who has been saying openly the worriment of adverse effects of long-time corticosteroids use to AD skin (like dependency(addiction), skin properties change to weakened irritative ones, and possibility to make more serious condition).
He recommended her to treat without corticosteroid ointments.
According to the direction of him, She started to leave steroids. He applied pine tar and disinfectant instead.
In spite of his optimistic forecast that she'll be fine before summer, her symptoms became and remained severe. Most of her skin got red and scaled, 2/3 of her hair on the head were lost, and high fever, lack of sleep leaded her to appetite loss, weakness and depressive state. She complained of pain when applying.
After 3 months, her mother decided to change doctor.

By another doctor, her family were introduced to a dermatologist who highly recommend corticosteroids application on AD.
He is a professor of a medical school and the director of AD question committee of Japan Dermatological Association. He is also one of the members who made "the guideline for therapy for AD"(Jpn J Dermatol 110:1099-1104, 2000 /Jpn J Dermatol 113:119-125, 2003) which says the proper use of topical corticosteroids is essential for AD patients. (Thaclolimus is the second choice. Only very light cases can be managed with just emollients.)
He has been surveying health and financial damages by special or quackish therapies for AD.(Jpn J Dermatol 110:1095-1098:2000) In that, he decided any therapies which avoid corticosteroids to be worsening inadequate ones even they were attempted by professional dermatologists.
In short, he approves nothing but corticosteroids (and thaclolimus) as effective main treatment for AD.
The girl entered his hospital and had topical corticosteroids therapy. Her condition quichly recovered.

The girl's parents sued the defendant doctor to be responsible for her aggravation.

The professor in charge of her final hospitalization presented a statement of medical expert opinion to the court which said topical corticosteroids did not induce withdrawal aggravation of skin lesions or systemic immunologic problem including serious influence to the function of adrenal cortex.
The defendant doctor asserted the aggravation was a withdrawal dermatitis caused by previous long-time corticosteroids use and a necessary process to spontaneous healing.

On June, 2004, the judge of the Tokyo district court sentenced the judgement.
It adopted the former's opinion of the two dermatologists. The girl's severe aggravation was decided to be caused by stimulation of the applications the defendant prescribed.

The defendant appealed.

Against recent increase of nature-oriented patients, Japan Dermatological Association and its AD question committee insists topical corticosteroids to be the only priority choice.
(I think it would be necessary for them who does not have other effective options to keep up their positions as proper therapists of AD .)
According to the policy, dermatologists who grope for more natural therapy of AD has been labeled as doing inadequate treatment.

Based on such situation, doctors and AD patients who prefer AD therapies without corticosteroids in Japan are unanimously feeling threatend with this lawsuit.
This might be the start of sanctions against dermatologists who does not obey the policy. They might intend to annihilate such stray doctors. Patients might lose doctors who will support them when they want to treat their AD without corticosteroids help....
This may be the iniciation of real battle.
I hope this fears will prove groundless.



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