Is moisturizing really a help to cure?

Please refer to the following article also for avoiding misunderstanding.

There is a kind of faith that moisturizing is absolutely good for the skin. Do you think it is right?

There is an article about the relation between the environmental humidity and the mice skin.

Abrupt Decreases in Environmental Humidity Induce Abnormalities in Permeability Barrier Homeostasis. J Sato et al. J Invest Dermatol. 2002 Oct;119(4):900-4

 In the study, mice were divided to two groups. One was kept under a humid environment (relative humidity (RH) >80%) and the other under normal environment (40%<RH<70%) for the first two weeks. Then both were moved to a dry environment (RH<10%) for the subsequent one week. TEWL (trans-epidermal water loss: the indication of epidermal barrier vulnerability) was measured every day after moving to the dry environment.

The skin barrier function was better in the normal to dry group than in the humid to dry group. Especially for the early three days TEWL of the latter increased extraordinary.

The above graph shows DNA synthesis of epidermis which means keratinocyte proliferation in the early three days of both groups. The humid to dry group was delayed for one day in DNA synthesis compared with the normal to dry group.

Moisturizing increases the micro-environmental humidity very near to the skin surface. It means the protection by moisturizer works to delay the barrier function recovery.

There is another study. It is about premature baby and incubator humidity. Nurture in the humid environment (RH75) delayed the maturation of infantile skin compared with the normal environment (RH50).

Ambient humidity influences the rate of skin barrier maturation in extremely preterm infants. J Ågren et al, The Journal of Pediatrics,Volume 148, Issue 5 , Pages 613-617, May 2006

So excessive moisturizing do harm to skin recovery by delaying keratinocyte proliferation. I reccomend you should use no or less moisturizer if you want to advance recovery of the skin barrier.

If fact in Japan some of my friendly dermatologists adopt this strategy for patients with TSA. They recommend not use any moisturizer though they know the method is really a hard-landing.
They even advise not to drink too much water because exudation from the eczema itself makes the skin surface humid and it can be decreased by restricting drinking water. The method is not easily recommended because there is a risk of dehydration. But as far as from the viewpoint of accelerating recovery of the skin barrier, the method is right.

On the other hand, some patients with TSA prefer soaking in the bath for a long time. They spend several hours a day in the bath-tub. It is because they feel comfortable only in the hot water (=RH 100% environment). They even sleep in the bath-tub because they can’t sleep at all in the bed because of severe itching.
Such patients are not absolutely wrong. Their way might delay the skin barrier to recover. But they only selected less severer method which they can stand on the way to withdrawal.

So if utilizing any moisturizer is comfortable for your skin, it is not necesarily wrong to apply it. However, it is not a right idea if you think moisturizing is absolutely useful or necessary for the damaged skin. 

Note: It is exceptional about 100 thousand Da hyaluronic acid.

You will understand by using it. It never is a moisturizer but a  kind of nutrient for keratinocytes. Viscosity is lower than usual hyaluronic acid lotion. Efficacy as a moisturizer is low.

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.

17 件のコメント:

  1. Hi my gp said that when the skin is dry, there may be a dermatitis that will develop which relates to dry skinl. Is this true ?

    1. Dry skin is related to dermatitis but emollients don’t always help to improve the dry skin. That is what I wanted to inform by the above article.
      By the way, do you know the following joke? I remembered it by your comment.
      1 If dry, wet the lesion.
      2 If wet, dry it.
      3 If both don’t work, use steroids.
      4 If the lesion doesn’t improve by steroids, try biopsy.
      Now you are a dermatologist.

    2. Hi, I just started my TSW journey. There's a question i would like to ask. So for TSW i just need to stop applying TS only and not doing anything else like moisturizing, and just wait till my skin heals? Is there anything else i can do or take? thank you.

    3. I recommend to TSW beginners to read the whole articles I have written. I believe information is the best remedy for TSW. This is not a joke.

  2. Hi Dr Fukaya,

    Thanks for your insight and research into this area. I've reviewed this post in my blog.

    My personal experience with withdrawing moisturizers have been nothing but great. Wounds heal alot faster, my skin becomes tougher, dry and leathery. They feel stronger. Thank you again!

  3. Dr. Fukaya,

    I used TS for 40+ years am now almost 42 months into TSW with 90 per cent of my body healed and I use no moisture anywhere except for an occasional dab of white palm oil on my hands after doing the dishes.

    In early 2011 when my hands were cracked and sores everywhere from TSW, I went months with no moisture on them and could not bend or use them to do anything. After months of no moisture and letting them stay dry and cracked, I finally put a thin layer of white palm oil on them with soft vinyl gloves that I changed twice a day and they completely healed up with soft baby skin as long as I kept the gloves on. I only took the gloves off for bathing and then changed to a clean pair which was twice a day. I did this until the early 2013 which was about two years total and never had problems with them as long as I kept the gloves on but if I tried to go without for even an hour, they cracked and got sores again. Once they were healed enough from the tsw I took off the gloves and they were fine with no moisture.

    I've been in the ITSAN forums for two and half years daily and have seen several members heal up nicely while using moisture or not using moisture, either way they heal but we also say we know of nothing at this point to speed up healing.

    Dr. Rapaport also has seen thousands heal while using moisture so I'm not sure how it the Japanese doctors come to the conclusion that no ones heals totally while using moisture of that is what they are saying? Please clarify on this and thanks! I was healed pretty much by my 27th month and really think time was the only factor in my healing.

    There are a few new TSW sufferers that condemn the ones who use moisture and say it will hinder healing and use you and the Japanese doctors to back this up but I personally have not seen it hinder healing in my case nor many others who used moisture and healed up nicely.

    I personally don't care one way or the other what a sufferer uses on their skin if not harmful and as long as they can keep their wits about them and get through TSW as there are some suffers who threaten suicide from the stress and length of it all as you well know from your years of expertise in this field. We also remember you saying to use a little moisture for movement and comfort.

    My concern right now is that the ones who are less than a year into TSW advise others and especially new ones to TSW that no moisture is the only way to help the skin, speed TSW up and prevent flares etc. but I'm also seeing long-term users who no longer moisture and still get a nasty later flare of a week to months with redness, oozing and rashes after months of nice skin.

    Maybe you clarify more on this topic for those who panic over the moisture topic? Thanks. :)

    1. It is not a so complicated problem. Some patients become addicted by topical steroids while others not. It is the same thing that there are some patients whose recovery can be accelerated by disuse of moisturizers. I admit that it is a fruitless effort for the others to refrain from moisturizers. Disuse of moisturizers is not suitable for all patients but worth to try if recovery from TSA is extraordinary delayed or the patient intends to withdraw from TSA as rapid as possible regardless of hardness. (It is my opinion. Dr .Sato recommends disuse of moisturizers more strongly than me from his own experience. Most dermatologists will think that disuse of moisturizers is crazy. I am between the two. )

  4. Hi Dr Fukaya, I hope you are well. I had a horrible rebound after starting TSW eight months ago but after two months of moisturizing I did MW and was finally able to heal over multiple skin breaks and get tremendous relief from all of my symptoms. I experienced a hard landing for 7-10 days. For many months after that my symptoms were far less severe due to not moisturizing. Many people I know experienced the same results as I did when doing MW. The "main" controversy in The US is over whether doing MW makes the TSW journey a more comfortable journey than doing TSW via using moisturizers. I understand it is up to the individual, but what are your observations about the comfort factor for your patients that did not moisturize during TSW compared to the ones that did? Did the ones that did TSW without the use of moisturizers have an easier recovery like I and others are seeing by not moisturizing?

    Also, when you say "hard landing" do you mean for the whole duration of TSW, or just the initial transition from moisturizing to MW like I experienced? Thank you.

  5. Thank you for taking time to answer Dr. Fukaya, I wanted to help ease the stress of some who feel they will not heal soon enough or find more comfort using moisture. :)

    A few more questions for you.

    Do people actually get "addicted" to moisturizer or just used to it?

    Is four weeks the amount of time to adjust to no moisture and then after that it is comfortable?

    Have you seen more or less patients go without moisturizer and what time frame difference do you think it was to heal for those who did not use it compared to those who did?

    Did the ones not using moisturizer say they had a more comfortable recovery compared to those who used moisture?

    Did some go back to moisture no matter how long they tried not using any?

    Did any of your patients heal within one year by doing this method?

    Most important, I appreciate that you are not pushy or dogmatic with people and understand their emotional state during this hard withdrawal. I only like to share and not advise as much as possible since each one suffering has to live with whatever decision they make. The questions are compiled from many in the forums and your answers are greatly appreciated. Thanks again. :)

  6. Dan and Joey.
    When I saw patients with TSA , I used to recommend the use of moisturizers (white petrolatum or zinc oxide ointment). So all photos of the procedures for example in
    http://www.xtosis.com/chapter12.htm are of moisturizer use. Some patients did not seem to successfully withdraw from TSA (For example in http://mototsugufukaya.blogspot.jp/2013/06/how-long-does-rebound-period-continue.html). I admit some of such patients might be suffering from so called “moisturizer addiction”. In fact, I have an experience that one of my patients, who was hard to improve after TSW, visited Dr. Sato, was advised withdrawal from any moisturizer and successfully improved.
    On the other hand, some patients dropped out from Dr. Sato’s way from its initial hardness. Such patients visited me and successfully withdraw from TS with the use of moisturizer. It is also a truth.
    There are many obstacles which make natural healing of atopic dermatitis hard. Long term use of topical steroids and dependence to moisturizers are both difficult to be noticed. Such obstacles are different in patients.

  7. Hi Dr Fukaya,

    Thanks for the information. I'm have gone thru MW and it has been nothing but wonderful so far.

    Is it possible to link me to Dr.Sato email in private? I've tried to search for his email thru various university's site but they are difficult to navigate due to Japanese.

    My email is cyzleslie@gmail.com...

    appreciate it!

    1. Dr. Sato is a poor correspondent. It is partially because he is really very busy in seeing patients and partially because he is not so quick to write even in Japanese. The following site is a bulletin board among his patients and he sometimes writes there to patients. You also can write something in English (Of coarse Dr. Sato can understand English). http://8617.teacup.com/atopy/bbs
      I believe Dr. Sato will be pleased to know foreign patients also succeeded in moisturizer withdrawal.

  8. Thank you Dr Fukaya for your response, highly appreciate that!

    I wish you well for the new year ahead!

  9. Thank you again for your answers Dr. Fukaya. :)

  10. Hi Dr. Fukaya, many people here in the US are now doing moisturizer withdrawal and nearly all are very happy with the results. The number one question seems to be "when will my skin start to produce it's own oils"? I don't know the answer to this question and am wondering if you had any insight into this? Respectively, Dan

    1. Sorry, I can’t answer to the question because it is not clear for me too. Aside from oil production, many sufferers experience sweating too much or urticaria(hives) at the last stage of TSW. I think they are signs of skin recovery.
      About oil production, there are people who need moisturizers even in healthy population. So I think there are patients who need moisturizers after TSW also.

    2. Dr. Fukaya, thank you so much for your reply. And thank you for being so generous with your time, research and knowledge. It's highly appreciated! I can't say that enough! Thank you for everything!


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