Original title :
Steroid Addiction 2010 - I'd like to request the Japanese Dermatological Association to remedy its guideline for management of atopic dermatitis.
This site is a translation of the book published in Japan.
The Guideline for management of Atopic Dermatitis developed by the Japanese Dermatological Association (JDA) does not refer to steroid addiction or rebound as a side effect of topical corticosteroids.
Earlier in the past, Dr. Kligman, with a sharp clinical observation, has already alerted atopic dermatitis patients' likeliness of getting addicted when treated with topical corticosteroids (TCS). In Japan, Dr. Enomoto reported in 1991 that rebound flare after discontinuation of TCS is similar to the steroid withdrawal syndrome.
In 2006, Dr. Cork, a pediatrician in England, announced the epidermal barrier disruption mechanism, by which he clarified the long-term application of topical corticosteroids, which are highly effective anti-inflammation drugs, will lead to steroid addiction or rebound, a harmful event peculiar to the skin.
Following these studies, researchers have studied non-steroidal new medicines, traditional antihistamines, and classic tar drugs under the notion that long-term application of TCS leads to addiction and rebound, and efforts have been made to find and develop medicines that are free from or alleviate addiction and rebound.
However, no reference is made to addiction and rebound peculiar to TCS application in the atopic dermatitis management guideline prepared by JDA. Under such circumstances, JDA member dermatologists will continue to prescribe TCS, without noticing the adverse effects, and more and more patients will suffer from addiction and rebound, which might be avoided by switching to new or traditional drugs.
Being a JDA member dermatologist and worried about the current situation, I've decided to publish this book believing this is the best I could do. This book, also intended for general readers, describes the past several-year progression in the applicable field in plain words citing studies conducted mainly overseas.
This book consists of 35 chapters. Each chapter is based on the reference material indicated at the top, and I added supplemental explanations.
I hope dermatologists, non-dermatologist physicians, patients with atopic dermatitis and other people will deepen their understanding of this issue by reading this book.
January 1, 2010
Mototsugu Fukaya MD, JDA certified dermatologist