-Does it truly necessary?-

One of important points in treating Atopic Dermatitis(AD) is considered to be moisturizing.
I understand the reason as below.

AD patients' skins have troubles in keeping themselves moist enough.
Such a skin cannot play a sufficient role as an barrier to prevent outer forein bodies coming into the inner space, the invaded bodies may act allergenic consequently.

Moisturizing is expected to improve the ill condition.
Supplying emollients from outside means to supply the shortage of original natural moisturizers in the skin.

The supplied emollients will improve the texture, apperarance and maybe function of the skin as well.
If sufficient barrier is reconstructed, allergens will be blocked off, inner allergic reaction will be reduced and atopic eczema will be improved.

That is the expected favorable outcome.

However, in these days as I see AD patients as a dermatologist, I sometimes feel odd "excess" moisturizing is prevalent.

Some patints keep applying emollients still, although their skins already look recovered and moist enough.
Some mothers keep applying emollients every day, though their children's skins do not look dry at all.
I often see such patients in dermatological office.
I can't regard these phenomenons as to be normal.

Originally, doctors started to make patients applying emollients.
Then they came to think just applying is not OK, saying like "Patients must apply them as soon as they finished their bathing, while their skins are wet still.", or, "Plenty of moisturizer will be good."
Everytime I heard such type of suggestions, I wondered whether this would be realy beneficial for patients or not.

Today's doctors are getting to be more aggressive.
In Japanese dermatological meetings, they say moisturizing can prevent worsening of AD after patients get remission by steroids or other immunosuppressives.
In Japanese pediatric meetings, adding to food restrictions to induce immunologic tolerance to allergenic foods, now they are eager to apply abundunt emollients and/or topical steroids to AD kids, too.

I heard one physician orderd a mother to apply emollient to her AD child at least 7 times a day !
Why don't they think what a bother (and waste) this is?
In fact, we are not living to apply emollients.
I think they are losing their true purpose.

Since patients are to follow doctor's instructions, doctors naturally have quite responsibilities.
If the instructions are wrong, patints go the wrong way and struggle in vain.
So doctors should be much more deliberate than patients.

My opinion is "Supplement is no more then supplement."
Don't you think so?

Of course the ideal condition is no moisturizing; as the skin to be natural.
That is the original healthy human skin to be.
But, for some reason or other, in case a natural moisturizing goes in malfunction and last, and if it's too hard to just bear the situation until it recover, then we supply emollients from outside because there is no help for it.

Then the purpose of moisturizing should be to supplement for the time being.
The wrong direction may start with an idea that moisturizing can cure AD itself.

It's possible that moisturizing may gain time for spontanous healing.
Though we can expect such type of natural cure, I think it's arrogant to intend artificial cure by moisturizing.

If the purpose is just to supplement, plenty of dose should not be needed .
Some proper dose will do enough to get tolerable appearance and funciton of the skin for the present.
As your skin gradually recover, you will lessen the applying dose and times, and then finally you'll seldom or never do it.
Shouldn't it be the natural course to be?

Too much supplement may be harmful.
If a skin always recieve excess emollient from outside, there will be less need of natural moisturizing function to work.
That may prevent the original recovering from dry skin.
If the AD patint is a baby or a child, the influence might be more serious.
When a growth of natural moisturizing function was interfered, the child's skin cannot have proper moistness throughout the lifetime.

Moreover, this supplement is not natural, but artifitial.
We add artifitial emollients to skins from outside artificially by our hands.
The work never be the same as the original inner natural moisturizing system.

Any moisturizers, which resemble inner moisturizing components in shape or function are products artilficially made by fuman. They necessarily differ from original inner structures.
And the way we administer them to skins is applying from outside, which also differ from inner secretion or exudation.

Therefore, outer moisturizers never be able to play the role completely same as inner ones.
Any ingredients of the emollient may do somewhat harm to anywhere of the skin system or other places of the body, where we today's human cannot analyze or elucidate yet.

Even if our best performance was done, outer moisturizers are no more alien substances for our skins and bodies after all.
I think we should never rely on them too much.
We use them only while we can't get control without them, and then,
let's say good-bye to them.

It is apparent topical steroids or tacrolimus(pimecrolimus) are much more risky to apply continually.
To compare with them, I often explain AD patients about emollient agents to be "safe" or "free from serious adverse effects" as a clinical delmatologist.

However, to be precise, emollients also have risks of adverse effects including irritable or allergic contact dermatitis.
Every dermatologists know and watch out it all the time.

Then why such doctors start to encourage excess application of emollients?
I, who have deep concern about this situation, consider why it happened.

The first reason I supporse will be the difficulty of AD cure.
More AD patients cannot gain certain relief despite medical cares in recent days.
Doctors are demanded to indicate some brand-new method for them.

Even doctors may be wiser than ordinary people, they are just human, not almighty.
Nevertheless there's no outstanding new solve or therapeutic discovery, they cannot invent reliable new remedies one ofter another.

Then what will they do?
They tamper with already existing therapeutic materials, seeking for some better use of them.
High dose of, or preventive application of emollients would be one of such trials.

But I don't sympathize with such trend.
Doctors should rather tell clearly to AD patients as professional authorities, I think, "We have no more good method by now".

There's always a limit medicine can do.
Yet, doctors don't prefer to admit it.

It's natural physicians like to remind patients with good course, but not bad course among patints they treated.
Recovered patients make them feel good, but on the other hand, they tend to be forgetable about worsening patients or interpret them as to be made sicker by some other factors but their treatments.
That might be a pitfall they would fall into that they have false superior image about their therapeutic achievements.

Such doctors will say like, "All AD patients I treated recovered! (So I'm reliable)."
However, there must be definite patients who did not recovered or get worse and left them in silence.

They will push patients into delusions of excess anticipation to their treatments.
And more, they will be so persistent with their own treatment methods that they won't allow their patients to consider any other remedies.

Denser moisturizing may be able to improve the dryness of a skin.
May also keep the skin in good conditon longer than before.
May avoid invasion of allergens, and reduce allergic symptoms.

But on the other hand, too much moisurizing may aid destroying natural function of the skin.
Moreover such efforts AD patients must put never be guaranteed to be sufficient or lasting, because the skin systems themselves are not changed by moisturizing.

Another problem is lots of costs for a large dose of medical emollients.
If they are not necessary in actuarity, they end in great wastes for patients and the society, just beneficial for pharmaceutical companies.

After all, I think this present situation doctors direct AD patients abundunt artificial moisturizing without explaining any inconvenient points is quite wrong.
At least informing benefits/loss expected and chice of the patient should be needed.

Doctors go wrong way, patients go the same.
In this hard days of difficult disease AD, I think doctors are rather demanded to be more steady, not to fantasize patiets.

Compared with the first reason in doctors' side, the second reason will be in patients' mentality.
Patients hold continuous anxiety and fear against AD which they hear to be very difficult, uncurable and miserable disease.
Such negative feelings can encourage them to do excess treatments.

As they hate so much to be in the severe conditions, they are willing to do anything to avoid them previously.

So the worry force them applying emollients to their already sufficiently moist skins.
Every time mothers find their AD childrens look itchy or scratch, they feel the behaviors to be signs of the worsening of AD and cover their skins by emollients at once to shut the disease in .

The information emollients are effective is twisting patients and families up.
Influenced poor parents desperately gaze only at skins of their childrens, not childrens themselves.
Unhappy situation for patients and families, indeed.

I think the point to avoid AD is simply to live healthy; like to keep regular hours, eat balanced natural foods, do moderate exercise, and so on.
Moisturizing will be needed when skin is severely dry.
You need to worry only after a big wave of the disease chose you to come.
Don't be ruled over by anxiety about AD, not to lose your important lives including your surrounding persons.

And finally the third reason should be commercialism.

Pharmaceutical companies sell medical emollients.
Cosmetic companies sell emollient cosmetics as well.
And there are several moisturizing service business.

They all target on AD patients who require artificial moisturizing.
Inebitably they recommend the use, because
the more patients buy their merchandise, the more profits they make.

Maybe in Japan, the generations born in these 30 years grew up surrounded by plenty of artificial chemicals.
As they have been enjoying to look around, choose, buy and use such cheap cosmetics since they were young,
I worry they may be more defenseless to them.

One day in delmatological clinic, I came across a mother who have massaged her healthy-skined baby with abundunt oil as daily care.
Shocking serous situation, isn't it?

Please notice, such artifitial goods were not exist before recent days.
We humans have been living well without them for over 2000 years.
Now we are in mad surroundings.

Consider before you buy a new commodity
whether your/your child's skin truly need the emollient
and whether it may be harmful to you/your child or not?

Instead of simply believing advertising, you consumers must surely think by yourself all the time.
You can also study from an experience that you buy something failingly.

I know today's AD patients are in torment.
Doctors, surrounding people, sellers, all tell you various things egoistically.
Nevertheless they are not aware why your AD is not cured, they reproach you continuouly for being present AD patient who cannot get cure.

Then what is the truth in AD?
What can cure me and my AD?
Each AD patient has to search and choose it by him/herself through try and error.

I say my opinion.
"Blind moisturizing is not right."

2009.6.(translated 09.7.)@@

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