2014年3月4日火曜日

Topical clofibrate (0.25%w/w) is available through Dr. Fukaya’s web shop.



 Topical clofibrate is a non-steroidal ointment but can suppress mild eczema without rebound phenomenon. The anti-inflammatory effect is weaker than topical steroids.  It can be used individually or simultaneously with the Dr Fukaya’s skin repair lotion (hyaluronan lotion of 100,000 dalton ). As the hyaluronan lotion only prevents skin atropy due to steroids or helps to recover from it and doesn’t work as an anti-inflammatory agent, combination therapy of the lotion and topical clofibrate is recommended for better results to eczema-sufferers.

 Topical clofibrate is an ointment easy to be prepared by any physician or pharmacist. The materials needed are clofibrate capsules which is widely available, cheap and old medication for hyperlipidemia and white petrolatum as a base ointment. The base ointment is not limited to white petrolatum. You can mix clofibrate to anything you prefer or whatever your skin can tolerate. Even water can be used as a base (oil in water emulsion).

 The above photo shows aspiration of clofibrate by a medical syringe and needles from the capsule. Clofibrate is oily transparent liquid and the specific gravity is 1.14. One capsule contains 250mg (0.21ml).



 By aspiration from about 7 capsules, one can collect about 1.1ml of clofibrate. It weighs 1.25grams and is just the amount for 0.25%w/w in 500 gram base.

 White petrolatum is a solid material at the room temperature.

  The melting point of white petrolatum is about 38-60℃. So it becomes liquid completely at the temperature of 70℃. One can add the clofibrate to the white petrolatum liquid and mix them to make uniform.

  After cooling, it returns to solid ointment again and the clofibrate ointment (0.25%w/w) is prepared.

 What is the mechanism of clofibrate as an anti-inflammatory agent? How does it work? It is a little complicated. Clofibrate is one of PPAR alpha ligands. PPAR alpha activates NFkappaB which stimulates to produce TSLP in keratinocytes. The below figure shows the vicious cycle in atopic dermatitis which was elucidated by Matsuoka et al in 2012 (J Clin Invest. 2012 Jul 2;122(7):2590-600). The PPAR alpha ligand such as clofibrate works at the point of red arrow and terminates the vicious cycle.
  There is an interesting report about topical PPAR ligands. Hatano et al reported that a kind of topical PPAR alpha ligand, which had been revealed to suppress mild eczema but have not enough power to suppress severe eczema, can suppress experimental rebound phenomenon after continuous topical steroid use in mice. In the experiment, mice were treated to express eczema by some allergen artificially on the skin, followed by topical steroids application and then continued to be applied topical steroids in one group and replaced to topical PPAR alpha ligands in the other group. The former group developed rebound while the latter didn’t (J Invest Dermatol. 2011 Sep;131(9):1845-52).  


The figure is referred from Hatano’s article above mentioned.

 So if topical steroids therapy is changed to topical PPAR alpha ligand therapy on the way the eczema subsides, sufferers are estimated to have less risk to develop rebound phenomenon. Moreover, as topical PPAR alpha ligands themselves have weak anti-inflammatory effect, eczema sufferers may try to use them as the first choice before using steroids.

 The most recommended usage of my hyaluronan lotion and topical clofibrate for prevention of rebound by topical steroids is summarized as the followings.

1 When you apply topical steroids, add my hyaluronan lotion to the area for the purpose of prevention of epidermal atrophy.

2 After the eczema subsided from severe into mild by topical steroids, change them to topical clofibrate.

3 If the eczema is enough mild, topical clofibrate can suppress the eczema without using any topical steroids.

4 For aged eczema sufferers especially over 60 years old at age, the combination therapy of my hyaluronan lotion and topical clofibrate is highly recommended because the aged atrophy of epidermis contributes to the eczema itself more or less.

 I was very much interested in Hatano’s paper and made up my mind to confirm the utility of topical clofibrate by myself two years ago. So I announced my idea through internet in Japanese and collected 20 patients who would participate in my study. They were divided into two groups double-blindly and the effects were compared between the topical clofibrate applied group and placebo group. The efficacy of objective and subjective symptoms was confirmed significantly and TARC in the clofibrate group also decreased significantly while placebo group not. The whole results of the study was made up to an article and published in the Journal of Drugs in Dermatology. 2014 Mar;13(3).


From my experience of 20 patients, I should add some impression about topical clofibrate. They are as follows:

1 There exist topical clofibrate responder and non-responder. It doesn’t correlate with whether the patient is addicted to topical steroids or not.

2 Even in topical clofibrate responders, abrupt aggravation due to exposure to some factor (allergen etc.) can occur. Patients who chose non- steroidal way and expected much in topical clofibrate are liable to be disappointed in case of such aggravation. Patients with steroid-phobia might even misunderstand the aggravation as the rebound to topical clofibrate.

 So I suggest to topical clofibrate users (especially steroid-phobic patients) as the followings:

1 Try topical clofibrate anyway for about two weeks to one month.

2 If you feel effective, continue to apply it instead of your moisturizer. It seems to have no addicted tendency judging from my observation of several topical clofibrate responders for about one year.

3 If the eczema becomes worsened abruptly, don’t be too much depressed. Remember any abrupt aggravation means a hint for you to find out the aggravating factor in your own case. You may use steroids temporarily or may just endure the severe period until recovery. Even if you use topical steroids, you can change them to topical clofibrate after the eczema subsides and avoid topical steroids addiction.

 As I have already mentioned, manufacturing of topical clofibrate is very easy for physicians or pharmacists. However, if you can’t find such cooperative medical professionals, you can purchase it through Dr. Fukaya’s web shop from me. The price is JPN 3,000 at the amount of 500 grams.

Sorry, the comment column is not available now. But the author believes readers can find some hints to overcome their own situations by the previous comments.
 

92 件のコメント:

  1. Hi Dr Fukuya, I am currently going through TSW. My symptoms are improved but still problematic. There is a clinical trial for an antagonist called OC000459 in the UK which seems to block inflammation. I am just wondering if it is worth trying it or will it most likely worsen the withdrawal?

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    1. There seems to be no report about OC000459 and atopic dermatitis by search in Pubmed using the two key words. Efficacy to asthma is http://www.ncbi.nlm.nih.gov/pubmed/21762224 and eosinophilic esophagitis is http://www.ncbi.nlm.nih.gov/pubmed/23379537.
      I can’t predict the efficacy to atopic dermatitis but what I can say is the cost of the medication must be very expensive like Xolair (http://mototsugufukaya.blogspot.jp/2013/07/a-report-about-biological-product-for.html).

      I think the clofibrate ointment will not be manufactured by any pharmaceutical company even after the evidence is confirmed. It is because there is no patent in this old medication and the cost-benefit balance must be poor. Pharmaceutical companies always seek for completely new and patent-protected medication because it will produce much more benefit due to higher price.

      I am not blaming such companies. I only suggest the fact that pharmaceutical companies exist for stock folders and not for patients though nobody dares to say such a boring thing. Patients must be also smart as for information from such companies.

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  2. is topical clofibrate safe? oral clofibrate seems to have somewhat dangerous side effects.

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    1. The usual dosage of oral clofibrate for hyperlipidemia is 750-1500mg per day while the ointment contains 1250mg in 500g base. How many grams of ointment do you use every day? We dermatologists usually recommend 0.5g to 2 palms of areas (2% of the whole body surface). So if you use the ointment to the whole body, the ointment needed is 25 grams which contains 62.5mg of clofibrate. The real safety of the ointment is yet unknown. However, from the above calculation I think side effects as in oral clofibrate will not occur in topical use of 0.25% ointment.

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  3. Hello Mr. Fukaya,
    How many times a day am I supposed to use this ointment on the affcted parts of my body?
    Best regards and thank your for all your work.
    Stephan

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    1. I adopted twice a day in the article in JDD.
      However it is not determinate. Try and find your own appropriate manner.

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  4. Dear Dr Fukaya,

    I have been using steroid (mometasone) to suppress a major outbreak on face (started treatment about a month from now, before I come to Japan on a study trip); now it is constantly in a 'mild' condition but refused to go away totally (for more than 3 weeks now much longer than the steroid should be used), so I would like to try this clofibrate to hope to help stop the steroid.

    I am wondering if I can order it in Japan (I am now in Kyoto and will stay about three months), but I found this is not available in the Japanese language site, while the international site cannot select Japan as an address.

    I have also started to use the hyaluronan lotion for a few weeks, is it still OK to apply it on areas that hasn't fully healed? (reddish and raised but not seeping) on what level should I stop the lotion temporarily?

    Finally, I just saw in a drugstore here that cosmetic brand ShisXXdo is marketing a drug that it said is a non-steroid anti-inflammatory cream, the active ingredient is "Ufenamate". I was wondering what it is an would it work...

    Thank you so much for everything. Million thanks. (words cannot describe how frustrated I am with steriod-only and blame-the patient-for-rebound doctors...)

    Dead Cat

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    1. Here is an article how to obtain clofibrate ointment in Japan (It is written in Japanese).
      http://blog.m3.com/steroidwithdrawal/20140303/1
      About hyaluronan, you can use it at any part of the body regardless the severity of eczema. About Ufenamate ointment, I don’t recommend it because the ointment is an old product and sometimes works as a stimulant to the skin just after TSW.

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  5. Dear Dr Fukaya,
    What do I apply first--the Skin Repair lotion or the Topical Clofibrate?
    Thank you, Rosemary

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    1. Skin repair lotion is recommended as the first.

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  6. Thanks Dr Fukaya.
    I've been going through TSW for 1 year so far after 6 years of super potent clobetasol propionate. The hyaluronic acid has so far proven effective in preventing atrophy on my face. I'm hoping to have some relief with the clofibrate as I'm in a second major flare with everywhere that the first flare missed, now experiencing the symptoms of withdrawal.
    I received it today and I'm anxious to try it.
    Can it temper the symptoms of TSW flares?

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  7. Hi Dr Fukaya
    It's been 1 year of stopping steroids and I'm in my 2nd major flare where every place that was not previously affected is going thru the debilitating symptoms of withdrawal.
    Clobetasol Propionate was my drug of choice for 7 years.
    Just ordered the Clofibrate and I'm hoping I get some relief. Did you say there was some possibility of alleviating the symptoms of TSW?
    I've been using the hyaluronic lotion for 6 months - no atrophy on my face as a result of usage or in combination w less scratching.

    Thanks for your help and response,
    K

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    1. The second flare often depresses TCA sufferers.
      Topical clofibrate is really temper mild dermatitis but can’t suppress the severe flare.
      Anyway, you are on the right route of withdrawal. Keep your mind strong.

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  8. Hi Dr Fukaya,
    After 1 day of usage on my hand, it is calm after constant aggravation for a month and a half and spreading of the redness.
    I am scared of the term suppress.
    I am scared that this is too good to be true.
    Any comments on clofibrate ointment and TSW that can be helpful?

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    1. Do you mean clofibrate ointment worked in your case?
      If so, your flare is not as severe as you worried and you are lucky because you are a responder.

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  9. It worked and is working. It's wondrous. My flare is stepping down and I can actually sleep at night. My neck is healing.
    Thanks Dr Fukaya. I can't believe this is not celebrated and distributed instead of cortisone.

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  10. Hello Dr. Fukaya,
    Clofibrate is working for me too but i find the oinment very thick, it's starting the hot climate here and sometimes makes me itch like the petrolatum alone do.
    this summer will be very hard using it.

    is it possible to have a clofibrate cream instead of ointment?
    If not, clofibrate alone to make my own cream?

    I asked around and i find it very difficult to find clofibrate here.

    Thank you.

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    1. Clofibrate can be mixed with any liquid (for example: water, olive oil) or any cream you feel tolerable on your skin. In fact, some patients prefer water as a base. As the clofibrate is never soluble in water, you must shake them like a cocktail to make an emulsion every time just before you apply it.
      I suppose you can obtain oral clofibrate capsules from overseas mail-order sites. Please search it.
      If you could never obtain it, I could send the capsules. Send e-mail by using inquiry form of https://drfukaya.ocnk.net/contact

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  11. hello dr fukuya! i used betamethasone 0.05% on n off nly on my face for 22months..is 2yrs enough for healing? plz suggest me ..i never had eczema or oral steroids.. n now into my 5th month of withdrawal have it only on face ..pimply flaky face..can it take more than 2years to heal? though my usage it only 22months

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    1. Please refer to my below article.
      http://mototsugufukaya.blogspot.jp/2013/06/how-long-does-rebound-period-continue.html

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  12. thanks doctor! well i would like to emphasise that i m non eczematic n the problem is only due to topical steroid addiction..whats ur opinion if i use ur skin repair lotion? unfortunately i stay in india how can i get it...

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    1. If your trouble is really caused by TSA. the rebound ends in half a year or one year. My lotion will not help in the early stage of flare. But there are various type of patients. So I cannot say anything definitly.

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  13. ok i will wait n see to the improvements..ya m 100% sure that its only TSA ..i really appreciate ur response sir u r soo helping ..

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  14. i'm currently using triamcinolone plus the skin repair lotion, but everytime i try to switch to the clofibrate, i start to flare. am i just a non-responder or is there a better way to do it? thanks!

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    1. Maybe you are doing well. You can’t suppress the early flare even though you are a responder to clofibrate. Please refer to the following articles for less damage by flare.
      http://mototsugufukaya.blogspot.jp/2013/06/paradoxical-idea-of-systemic-steroids.html
      http://mototsugufukaya.blogspot.jp/2013/06/about-strong-neo-minophagen-c-snmc.html

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  15. Dear Dr. Fukaya,

    I am in later stage of TSW and my problematic area remains of my arms, hands, calves and neck. This is my 11th month and I used to apply TS on my hands for about 4 months. This is my 2nd time going thru TSW. The first time I went thru TSW was 5 years ago without knowing it and then in between I didn't use any TS at all.
    Anyway, I purchased the clofibrate ointment and it's my 2nd day using it. I applied it twice a day on my problematic area with the skin repair lotion underneath. Since yesterday I experienced high fever (104F) and muscle pain on my right neck. I also noticed I have darker urine (almost like brown color). I wonder what's going on and if it's coincidence. On the other hand, I also noticed very good results only after 2 days of using the ointment. I used to have lots of ugly pumps on my skin, and then now they subsided after 2 days. This makes me a bit nervous now with such a fast and miraculous result, as well as the fever and muscle pain.
    Today is the 3rd day and my GP subscribed me with antibiotics, panadol and pain killers. My fever is now gone now a bit (101F) after the medicine but I still have muscle pain on my neck. I suspect it's the muscle pain that leads to fever.
    Could you please advise? I have stopped using the ointment today already.
    Much thanks in advance!

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    1. Don’t worry. Your symptoms of fever and pain must be from another origin. Please refer to my above comment of 2014/3/6. The clofibrate contained in the ointment is little and the absorbed amount to the body is far less. It is a good news that the ointment was effective to you. Please try to use it again when your general condition has recovered. I suppose you will not run a fever or have any pain next time when you use topical clofibrate.

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  16. Dear Dr. Fukuya,

    Thanks for your prompt reply. My fever is gone now and I have started using the clofibrate again. I just want to double check with you: -
    1. So the clofibrate helps to reduce inflammation but it does nothing to speed up TSW recovery?
    2. I have lots of wrinkles and pumps on my arms and legs, would the clofibrate help to clear those out?
    3. As much as I have confidence in you, I am still a bit scared to put anything topical on my skin after what happened. So is there any "addiction" to clofibrate? What's the recommended timeframe I should use it? eg. Use it for 1 week and stop for 2 weeks and reapply again to avoid addiction?
    4. I have this little tingly feeling on my skin after I applied clofibrate, is it normal? Sometimes it feels even itchier than before though overall my skin condition clams down.

    Thanks again!

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    1. 1. Maybe yes. (From the above Hatano’s experiment)
      2. Maybe yes.
      3. I consider topical clifibrate doesn’t induce addiction. It is because there is no other addictive topical agent than topical steroids. Topical steroids are exceptional and rare.
      4. It might be caused by white petrolatum which is used as a base. It is usual and does no harm except it is uncomfortable. There are some patients in whom TSW seem to be accelerated by no use of topical agent at all. But as topical clofibrate is working in your case, I recommend using it.

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  17. Hello Dr Fukaya,

    First of all, thank you for your efforts and your attempts to eliminating this unforgivable skin condition.

    I'm from Sydney, Australia and I have been using TS for almost 6 years, on and off. I have started my TSW last month and was also on 30mg prednisone per day for two weeks (a month ago) due to severe flare-ups all over my body. Last week, I was rushed to emergency due to another episode of severe flare-up and excruciating pain on my face (pins and needles) It could have been due to some kind of allergic reaction because I felt fine before I had good old schnitzel and beer.

    Anyway, the doctor gave me a strong anti-histamine (which did not really work) and 50mg prednisone which I relentlessly took. It eliminated pins and needles on my face and the itch on my body were lessened in about 3 hours, but the severe flare was still there. She also prescribed me another episode of 50mg prednisone to take for another day, but I did not take it (saving it for another day)

    Since then, I have been applying your skin repair lotion and clofibrate all over the body to no avail. I know I shouldn't be expecting an immediate result but I would like to know a few things.

    So my questions are;

    1. Should I be expecting any result from using combo Skin Repair Lotion and Clofibrate at this stage?

    2. I have read that your Skin Repair Lotion suppresses the rebound. So does that mean I could use topical steroid to get rid of the flares first and then apply your Lotion and Clofibrate to prevent the rebound (i.e. flare-ups and intense itchiness)

    3. Does oral steroid (prednisone) affect much on rebounds? Should I consider it as part of TSW? The reason I ask this is because I'm afraid of another allergic attack which I don't think I can take without the oral steroid.

    I guess I don't mind experimenting because I'm still on early stages of TSW

    Please let me know and thank you for your time.

    Kind regards,
    Sonni

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    1. 1 I am sorry to answer “no”. Maybe your flare seems to be severe to be controlled by clofibrate.
      2 I don’t recommend resume of topical steroids even if you apply my lotion at the same time. My lotion can prevent addiction but it will be of less use if the sufferer is already addicted.
      3 Oral or injection steroids are useful in TSW in cases like you. Please refer to the following article.
      http://mototsugufukaya.blogspot.jp/2013/06/paradoxical-idea-of-systemic-steroids.html
      I feel your doctor is wise because she didn’t prescribe topical steroids but oral ones though she might not have admitted the existence of TSA.

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    2. thank you for your prompt reply Dr Fukuya

      I wish there were other ways, although I do believe I'm a lucky one compared to other patients.

      She was a hospital doctor so I'm assuming she does not believe in TSA. But I think my new GP does as he told me to stop using both topical and oral steroids and have recommended me for a doctor specialised in atopic dermatitis which I'm still waiting on her long waiting list.

      my final question is if I could continue using your lotion and clofibrate at the same time to reduce the severity of rebound.

      p.s. Is there any chance I could consult you in person as I may be in Japan during Sep-Oct period.

      Thank you so much,
      Sonni

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    3. I hear Australia is one of very hard countries for patients with TSA because dermatologists are conservative. Sometimes general practitioners do wiser selection than dermatologists because they don’t cling to topical agents. Maybe your doctor was one of such doctors.
      There are many alternatives to escape from TSA. If you don’t use any steroids, that is surely the shortest route.
      I am not sure if my ointment or lotion is of any help in your case. But I recommend tying them every several months. At a certain period or stage, they might help you.
      I am sorry I am now closing my practice as a dermatologist. But I will reply here as far as possible.

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    4. You're exactly right Dr Fukaya, most of the dermatologists I've been to only have prescribed me stronger steroids. Anthroquoril and Diprosone to be exact.

      I will continue to use the lotion and ointment as long as I can and report back here for any improvement (for other TSA sufferers out there). I have yet to come across any doctors who has logically researched and put as much effort as you have on TS so I do believe it will help if I continue to use them.

      And again, your effort is greatly appreciated.

      Thanks,
      Sonni

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  18. hello Dr,
    i m just curious to know why the people who dont have eczema wen use topical steroids (for other reason like moisturising unknowingly as i have done) gets addicted n show the symptoms of itch n flaring on withdrawal?
    in my case i m nt expriencing oozing rather i have blisters like red bumps n pustuels on my cheeks ..i never ever had this thing before the withdrwal ..

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    1. That is something called addiction. Rebound means the situation that is severer and more myriad in symptoms than before starting to apply TS. If the symptoms only return to the situation before application of TS, it is not an addiction.

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  19. ok so this addiction goes away ??? bcoz i didnt have any eczema symptoms b4 application ..nothing at all but now i m flaky n dry getting hives ..does dis mean that the rebound in non eczema people ends earlier than the ones who used it for eczema??

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  20. would you say that clofibrate is weaker than 1% hydrocortisone?

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    1. I am not sure. It is not corticosteroids and can’t be compared with them.
      Topical clofibrate only works to the epidermis and not to immune system. So if the eczema is from the trouble of epidermis, it works nicely. On the other hand, the eczema is purely allergic reaction and the epidermis is intact, it is useless.
      So the difference lies in the mechanism and not in strength.

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  21. Hi, dr.Fukaya. is it possible for TSW not to have any rash at all but still very extreme itch? And could this clofibrat help with it? Thank you

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    1. 1)I suppose you are not addicted in that case. 2)There is a possibility. Please try it.

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  22. I have been given topical steroids with increasing potency each time the steroid stopped working for the last 4 years. The dermatologist diagnosed me with atopic dermatitis on the groin. The last kind given was clobetasol and lately it has failed to overcome the itch. I have stopped everything for the last 5 days. But it is painful and itchy on the groin and scrotum but no rashes and redness. I try applying talcum powder today, it relieves for a few hours. What is this? And which of the clofibrat and the hyaluronic acid will work on it? Thank you.

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    1. I suggest you should not apply potent steroids on the groin area for so long a time. I am not sure if clofibrate or hyaluronan works in your case. What is obvious is that you should stand the situation for a significant period until your skin of the groin goes back to the original situation without influence of TS.

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  23. Do you mind if i ask for your email address dr.Fukaya? For further questions for i am so desperate with this situation while i have a lot of work to do during my final year of residency. Thank you very much.

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    1. Sorry, I only answer here about the contents of my blog.
      From your name, are you an Indonesian? There are so many sufferers in the world. You can communicate each other through ITSAN’s forum.
      http://forum.itsan.org/index.php?action=forum
      You will be able to obtain overseas friends by this severe experience. In Japanese proverb, a wise person never gets up without profit even if he happened to fall to the ground. Be smart and strong.

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  24. Yes, i am an indonesian. I am very grateful for your kind words. I will check with the forum to find out more about my condition. Thank you very much, dr.Fukaya.

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  25. Dear Dr Fuyaka, my 3 years old son had been going through 3 months of tsw. However, due to a medical emergency, it's very unfortunate that we have to restart hydrocortisone cream, and oral prednisolone (2 weeks, with dosage tapering down ). May I know if we can let him use your skin repair lotion and when his condition is more stable, slowly replace hydrocortisone with your clofibrate ointment?

    Can these products be used in a 3 years old child? How should I use them? We really do not wish to let our boy go through another round of tsw, all over again.

    Thank you very much.

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    1. I have few experience of using hyaluronic lotion or clofibrate ointment in patients under 3 years old. However I think they both are safe because there is no theoretical risk.
      If I were you, I will definitely use hyaluronic acid and replace to clifibrate ointment to my son. That’s all.

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    2. Thank you so much, Dr Fuyaka. I'll order these 2 right away!

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  26. Hi Dr. Fuyaka,
    My main problem is tiny blisters on my hands and fingers, would it be okay if I applied the clofibrate ointment and then seal it with bandages for better absorption?

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    1. It’s OK but I suppose your problem is not of atopic dermatitis or TSA.
      If you are not addicted, TS is more effective than my ointment.

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    2. I am going through TSW right now, currently in month 3. The back of my hand has a thick layer of dry skin that continues to weep and my fingers have blisters that are also weeping. I am hoping the Clofibrate can help with this.

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    3. In that case, your problem may be TSA/TSW. As written in the above article, there are patients effective and ineffective. Please try it anyway.

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  27. Dr. Fukuya,

    Is this effective for extremely dry, flaky skin caused by TSW?
    Can you also clarify a bit more on the patients who had success with the Clofibrate; Any idea on their histories compared to the patients that didn't have any success? What is a good overall percentage estimate for the likelihood of success?

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    1. Sorry, all I can say about the ointment is clarified in the above article.
      I suggest you try to use it anyway. I believe it is not so expensive. If it worked on your skin, you can utilize it while if not, you should look for another way.

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  28. Hello Dr Fukaya,

    I used mometasone for about 3 years or so and then I went through really bad TSW. My doctor gave me protopic and used that for 2 years before I decided to get off of that as well this past February 2014.I feel like I am also dealing with withdrawal from protopic as well. I read in your blog that protopic also has rebounding affects as well. So right now I am just trying to use moisturizers. I going through some bad flares on my legs(thighs, knees, and calves) and my arms well. Also, I am on day 1 of using your clofibrate ointment . I will be starting your skin lotion very soon when in comes in the mail as well.

    So in summary I stopped using TS about more than a year ago but I just got off of protopic about 5-6 months ago.

    Here are my questions:

    1. Am I going through the withdrawal from TS and/or Protopic?

    2. Do you think clofibrate and the skin repair lotion will help with my symptoms?

    3. Should I never go back to using protopic? It worked really well but when I heard it also had rebounding affects as well I stopped using it.

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    1. 1 There are both possibilities.
      2 It depends on individuals. Please try it anyway.
      3 It depends on the situation surrounding you. It you can, I suggest you continue to withdraw. But if topical steroid or protopic withdrawal makes it very hard to keep your life, you can select alternative way. It is a strategic retrieve. You may think it is difficult to decide whether you should retrieve or not unless you know you are really addicted. But it is difficult, sorry to say. What is important or realistic is you try to lessen or withdraw from steroids or protopic as much as you can. It is a good news that protopic worked in your case. You have one tool for retrieval at least.

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  29. Hello Dottor Fukaya.
    Please, can you tell me the exact name of tablets containing clofibrate??
    I would buy them for preparing the product but I would not go wrong...

    Thanks very much Dottor!!

    Enri

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    1. I use Clofibrate Tsuruhara.
      http://www.igenericdrugs.com/?s=Clofibrate%20Tsuruhara
      If you need the original capsules for preparing topical agent by yourself, please ask the shop thorough inquiry form.

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  30. Hello Dr. Fukaya,

    I am interested in buying your skin repair lotion but I am not sure if I am going through TSA or not. Around 3-4 years ago, I consumed steroid pills unknowingly for 30days (one pill per day), during that 30days, I have beautiful skin but then 3days after I stopped taking the pills, my whole face was covered with small red bumps that are itchy. So I went to local dermatologist and they prescribed me with oral steroid as well as topical steroid, but as soon as I stopped the treatment, the itchy bumps came back, it has been like that for about 2-3months then I decided to stop this treatment and take low dosage of roaccutane (10mg per day) for 3months. It helped my skin a lot and cleared all the bumps, however 3months after I stop taking the roaccutane the bumps slowly came back, then I went to do laser treatment and appy trans retinoic acid treatment skincare by dr. Goh Seng Heng and then my condition improved a lot, but then again, because I didnt continue the laser treatment as recommended, the bumps slowly came back again. SO by this time, I was free from any steroid for about 2 years then about 6months ago, I started to use it again to control the bumps on my face, I use very sparingly the low dosage of topical steroid, probably 5days per month. But for some reason last month, I keep on using it for the total of about 2 weeks in one month, then I started to realize maybe I need to stop because I am pregnant right now so I dont really want to use dangerous stuff on my body. and just 4 days ago, I found out that both my back leg/calf is red but not swollen, not itchy. Can you help me diagnose if I am really going through TSW? can I use your skin repair lotion on my face to clear up the itchy bumps? Is your product safe for pregnant woman? Sorry for the very long message, and thank you very much in advance.

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    1. Maybe you are not suffering from TSA/TSW. I guess the bumps are a kind of acne. You can use my lotion safely and my lotion is not harmful during pregnancy though it might not suppress the bumps.

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    2. Hello Dr. Fukaya,

      Thank you very much for your prompt reply. I have the feeling that it is not acne since they are clustered and make my skin red and rough to touch. I will buy your skin repair lotion and try to combine it with my moisturizer. Will the skin repair lotion help to strengthen the skin barrier and make my skin less sensitive? I also have similar product that I bought from Avene called the deep moist lotion but I am not sure if it contains the same hyaluronic acid as your product. Could you please help me check? Thanks in advance.

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    3. Avene Eluage is the product of a similar concept to mine.
      Please refer to the following article.
      http://mototsugufukaya.blogspot.jp/2013/06/hyaluronic-acid-of-around-100-thousand.html
      Mine is very simple hyaluronan lotion made of only one ingradient. It is because there are many patients who can’t tolerate other ingradients.

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  31. Hello Dr Fukaya,

    I would like to ask if fenofibrates have the same effect clofibrate when applied topically? And if so, would the recommended concentration be the same as that of clofibrate if prepared with petrolatum?

    Thanks!

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    1. It is possible because it is a medication of the same category. But I have not examined that fibrate. So I can’t say anything.

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  32. Hi Dr. Fukaya,
    I am almost 1 year topical steroid free, and have not been using any moisturizers, I feel my skin is getting stronger. But my face still itch almost every night and I think the itching is preventing the skin on the face from completely healing.
    Would you recommend using the Clofibrate ointment for the itching, or recommend to continue avoiding any moisturizers and wait for the itching to go away.

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    1. It depends on individuals. But if the problem of your face is only itching, I recommend trying my hyaluronan lotion. It strengthens the epidermis.

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  33. Dear Dr. Fukaya,
    Thank you for all your information. It is very nice that you have given your time in doing this despite you leaving general dermatology.

    I have a question regarding absorption in children. Because they are smaller in size does it mean that the medication taken during the topical steroid use take longer to expel from the body. My daughter is three. She has been on TS for 20 months. Her usage is as follows because all usage is cumulative.
    Triamcinolone 0.1% 600grams for nearly 18 months consistently on body not to face and genitals.
    Triamcinolone 0.025% applied for 1 month to areas except face and applied during wet wraps. Used last month
    Dermasmoothe topical oil to scalp 30 grams. used last month.
    Mometasome 0.1% to ankle area 6 fingertip application. Used last month
    Hydrocortisone cream 2.5% 15 grams some application to face ( about 8 times).
    Hydrocortisone cream 1% about 60 grams to body not to face or genitals

    If you are saying it takes 10%-30% is this accurate for children also due their size and areas of exposure?
    Thank you for your time.

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    1. Are you asking about the duration of rebound because I wrote it is about 20% of the period of application of TCS?
      http://mototsugufukaya.blogspot.jp/2013/06/how-long-does-rebound-period-continue.html
      If so, the impression is the same in children as in adults. But it differs among patients as already written.

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  34. Yes sir. Rebound time meaning withdrawal. So 20% time used not dependent on strength.
    Ok thank your that response. I had to change the name due to technical problems. Sorry.

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  35. Hi Dr Fukaya,
    Is it safe for nursing mother to use this ointment? I'm just worried it will be passed down to my baby boy who is still breastfeeding. Thanks.

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    1. I believe it is also safe for nursing mother or babies because the content is very small as written above. There has been no claim or report about the matter.

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  36. Dr. Fukaya

    I just want to ask an out of topic question. Do you think glutathione has a good effect tsw eczema? How about human placenta injectables. Is it safe while nursing?

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    1. I have no experience that glutathione was effective.
      Human placenta does good effect but it is very little. The safety is not guaranteed perfectly because it is derived from human tissue and contamination of new pathogen can occur.

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  37. Dear Dr Fukaya, may I know if i can use the lotion and Ointment during wet wrap therapy on a 5yo? Do we need to restrict the application of the lotion and Ointment to twice daily? Thank you!

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    1. I have no experience of such a use during wet rapping treatment but it is possible and does no harm theoretically.
      Please leave a comment here if you tried it.

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  38. Hello Dr. Fukaya I would ask her questions.

    I tried the topical clofibrate, for now I have not seen big risultatati.
    Can I use it for how long ?? 2 times a day is fine ?? It does not cause addiction or dependence right ??

    My eczema is dry and red (very inflamed) in some places while in others only the skin is dry ..
    In such cases it is better to use the topical clofibrate and when it is advisable to use the dr Fukaya skin repair lotion ??

    Thank You !!

    enri

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    1. Topical clifibtrate is a weak anti-inflammatory agent which works in the epidermis. There is no action on immune system in the epidermis or internal organs. No addiction or dependence was seen from my observation for one year.
      About half of patients don’t respond to topical clofibrate. In such patients, allergy to something might be the main problem and eliminating antigens or aggravating factors might be necessary.
      Or in some patients, withdrawal rebound is so strong that topical clofibrate can’ suppress it.
      I can’t say whether my hyaluronan lotion works in your case or not. But I suggest you to try it anyway if it is affordable for you.

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  39. Hi Dr. Fukaya. First off, I would like to thank you for all the time and research you have put into TSW/TSA and for all the assistance you have provided everyone with. I am speaking on behalf of my girlfriend who i believe is currently going through a second major flare since her cold turkey withdrawal.

    I will provide a little background story into her topical steroid usage. She was prescribed and used two different types of class 2 steroids for around 5 years. She is currently 28 months into the withdrawal process and going through her second major flare after having an entire year of clear skin. A couple of months ago, she began to have what looked like eczema spots on her hands and legs and multiplied to big patches of raised skin with blisters and a lot of oozing.

    At one point, the ooze started to turn yellow and we went to see a dermatologist and confirmed she had a staph infection. She was prescribed oral antibiotics and just completed 1 week out of the 2 week treatment. The yellow ooze has substantially subsided since taking the antibiotics. It seems as though her hands and legs are slightly getting better, some parts of the skin are slightly less raised and less red but majority is still raised and slightly red with some blisters.

    We just received your hyaluronic acid lotion and topical clofibrate. Is it okay to apply both to her skin at this stage? She tested the topical clofibrate on some parts of her leg where the skin is raised but has no open blisters last night. This morning when she woke up, all the blisters where she applied the topical clofibrate are open again and are bright red with some oozing. Is that a normal occurrence? Would the antibiotics have any interaction with the topical clofibrate or hyaluronic acid lotion? How do you think we should proceed from here?

    Thank you for all your efforts,
    Jeff

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    1. There are several possibilities about her situations.
      1 The rebound is so severe that clofibrate ointment can’t suppress it. Clofibrate is rather a weak anti-inflamatory agent.
      2 The flare is caused by allergy reaction against some factor(s). Clofibrate suppresses epidermal inflammation but don’t suppress immune reaction.
      From her history and your description, I suppose 1 rather than 2. Can you upload her photos at any site?
      About topical agents, I suggest not using any topical agent now. It is empirically the hard but shortest way to exit. But if she can’t stand it, I recommend zinc oxide ointment or mixed ointment of zinc oxide and white petrolatum 1:1.
      She can select the alternative way using systemic corticosteroids.
      http://mototsugufukaya.blogspot.jp/2013/06/paradoxical-idea-of-systemic-steroids.html
      But if she is enough strong and the situations surrounding her are favorable, she can select continuing to stay cold turkey of course. Time will heal her flare. Usually the second flare is not so severe as the first one but mentally it is harder than the first one to bear. If her flare relapses so many times, she should look for aggravating factors for her but it is not the time yet.
      Please keep my lotion and clofibrate ointment for the later time. They will help when the severity of rebound becomes weaker in the future.

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    2. Thank you for replying back Dr. Fukaya. As you have requested, here is a link to recent photos of her skin.

      https://onedrive.live.com/redir?resid=31E2BA71592B90!122&authkey=!ALZvZVuWKeCvDRs&ithint=album%2c

      From the pictures, you can see good progress on her hands. They are slightly pink and are oozing a very small amount. Her hands used to be very red and yellow honey crusted before taking the oral antibiotics. Only her legs continue to be a problem. She has been using domeboro solution to calm the oozing on her legs and vaseline in the morning and at night. I do agree with you that it is likely that her condition is from 1 rather than 2. We will keep your lotion and ointment for a later time.

      Thank you for your time,
      Jeff

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    3. It is the geographically diffusing pattern (Type3).
      http://topicalsteroidaddiction.weebly.com/chapter-1212288classification-of-eruption-during-withdrawal-process.html
      Maybe disinfectant therapy will work. Please try it.
      http://mototsugufukaya.blogspot.jp/2013/06/disinfectant-therapy-to-staphs-on.html

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    4. Thank you for replying. Would this povidone iodine work? I believe it is 10% solution.

      http://www.amazon.com/Dynarex-Povidone-Iodine-Solution-Bottle/dp/B005R8580M/ref=sr_1_1?ie=UTF8&qid=1425989597&sr=8-1&keywords=povidone+iodine

      How often should the povidone iodine be applied?

      Thank you,
      Jeff

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    5. Would it be a good idea to finish her final week of oral antibiotics first before trying the povidone?

      Thank you,
      Jeff

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    6. The demerit of antibiotics is induction of MRSA (antibiotics resistant staphs). Disinfectants never cause resistant staphs.
      So I recommend changing antibiotics to some disinfectant after taking antibiotics for several days or two weeks at the longest.
      On the other hand, iodine can’t be used if the patient has iodine allergy. If her eczema worsened, iodine allergy is suspected. Iodine should be refrained also if she has thyroid disease. In those cases, I recommend changing disinfectant.

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    7. Dr. Fukaya,

      Would this electrolyzed aqua system work as a disinfectant solution? The system is able to go down to ph 2.0. Does the ph have to be 2.7 in order to be an effective disinfectant?

      http://www.bawellwaterionizers.com/platinum.html

      Thank you,
      Jeff

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  40. Great! Thank you Dr. Fukaya. We will give that a try next week if necessary after she finishes her full course of antibiotics.

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    1. Maybe yes. But I suggest you first try iodine solution first. The machine seems to be expensive.

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    2. Dr. Fukaya,

      We will be visiting Tokyo in about 4 weeks. Is there a way for us to purchase your hyaluronic acid lotion when we are there? How far away are you from Ginza, Tokyo? Is it possible to pick it up from your store or is it possible to ship it to our hotel?

      Thanks,
      Jeff

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    3. My shop is only on the net. My clinic is located in Nagoya which is far from Tokyo. You can purchase my lotion by delivery service from my clinic to your hotel. Please call to +81-52-264-0213 (Language is only Japanese. Ask for help to the hotel stuff). You can save import tax of your country.

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