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<title>間違いだらけのアトピー性皮膚炎診療 | 株式会社文光堂</title>


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<meta name="description" content="数多くのアトピー治療の実績を持つ著者が，なぜ日本に難治性が多いのか，日本独自の不適切な治療が行われている理由とその問題点を鋭く指摘しつつ，劇的に改善する世界標準の外用療法を紹介．根強く残るステロイドへの偏見を払拭し，全国各地で行われている保湿剤を使用した「減ステロイド療法」をやめて，「医学的根拠に基づいた適切なステロイド外用療法」を提示することにより，アトピーに悩まされている患者さんとその家族を救">

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		<h1 class="catchCopy">アトピー性皮膚炎は世界標準の外用療法で簡単に良くなる！</h1>
		

		<h1 class="title">間違いだらけのアトピー性皮膚炎診療<span class="version"></span></h1>
		<h2 class="subTitle">なぜ日本の患者は治らないのか，どうすれば治るのか</h2>

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					著：渡辺晋一（帝京大学名誉教授／三河皮膚科(名誉顧問)／ルビーテッククリニックランドマークコヨハマ(顧問)）
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				<ul class="property"><li class="disc">A5判・172頁</li><li class="disc">ISBN&nbsp;978-4-8306-3477-2</li><li class="disc">2022年1月27日発行</li></ul>

				
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		<div class="headers"><h3 class="current content">内容</h3><h3 class="preface">序文</h3><h3 class="indexes">主要目次</h3></div><section class="current content">数多くのアトピー治療の実績を持つ著者が，なぜ日本に難治性が多いのか，日本独自の不適切な治療が行われている理由とその問題点を鋭く指摘しつつ，劇的に改善する世界標準の外用療法を紹介．根強く残るステロイドへの偏見を払拭し，全国各地で行われている保湿剤を使用した「減ステロイド療法」をやめて，「医学的根拠に基づいた適切なステロイド外用療法」を提示することにより，アトピーに悩まされている患者さんとその家族を救うための一冊．</section><section class="preface">序　文<br><br>　私は日本で初めてのレーザー外来を帝京大学病院皮膚科に開設し，また皮膚真菌症（真菌（カビ）による皮膚感染症）治療の研究を行っていたので，一般の皮膚病患者さんばかりでなく，皮膚真菌症やレーザー治療を求めて来院する患者さんを多く診てきました．しかしここ10年以上前から，このような患者さんばかりでなく，インターネットを頼りに都内はもちろん，地方からも私の治療を求めて来院する患者さんが多くなりました．診察するとその半数近くが重症のアトピー性皮膚炎患者さんでした．<br>　これらの患者さんは色素沈着を伴う紅斑（地色の中に存在する赤い皮膚）と落屑（らくせつ：フケのような皮が剥がれ落ちたもの）のため，特に女性では顔の皮疹（皮膚にできた発疹）を化粧で隠すことができず，外出しなくなった患者さんもいます．さらに見た目の問題だけでなく，痒みのために夜も寝られず，精神的にも追い込まれている患者さんも多く，中には会社を休んだり，仕事をやめた患者さんもいます．しかもこれらの患者さんは，長年大学病院や複数の皮膚科で治療を受けていた患者さんばかりでした．そしてこれらの患者さんが受けていた治療をみると，いずれも共通した特徴がありました．それは保湿剤を全身に外用した後にステロイドを患部だけに外用したり，ステロイド外用薬を保湿剤と混合して使用するなど，今までの皮膚科教科書には記載がなく，しかも世界標準のステロイド外用療法とは異なるものでした．このようにステロイド外用薬を保湿剤で置き換える「減ステロイド療法」は，かつての「脱ステロイド療法」に近いものですが，このような外用療法が全国各地で行われていたのです．そこで不思議に思って調べてみると，これらの治療法はいずれも日本皮膚科学会などの講演で繰り返し述べられた治療法でした．<br>　このような治療を受けていたアトピー性皮膚炎の患者さんを，最も強力なステロイド外用薬で治療すると，2～3週間程度で良くなり，痒みも劇的に消失し，再発もほとんどなくその後のコントロールも簡単です．さらに患者さんからは非常に感謝され，「早く先生に出会えればよかった」と言われることが多いのです．このことから，世界標準である炎症を抑えることができる強さのステロイドの外用療法を行えば，アトピー性皮膚炎は簡単に良くなることがわかりました．海外でもアトピー性皮膚炎の患者さんは多いのですが，重症アトピー性皮膚炎患者さんはほとんどいません．つまり，日本の学会等で宣伝されている治療の多くは，患者さんのためではなく，製薬会社の利益のための治療法のようです．<br>　そこで難治性アトピー性皮膚炎で悩んでいる患者さんを救うべく，わが国の皮膚科治療の問題点を指摘しようとしましたが，抵抗勢力のためになかなか講演する機会が得られませんでした．自社製品の宣伝のために行う製薬会社の講演会は全国各地で数多く行われていますが，私のように皮膚科治療の問題点を指摘する講演にはスポンサーがつきません．それでもまれに地方の医師会からアトピー性皮膚炎治療の講演を依頼されることがあります．しかし私の講演時間はたった1時間で，すべてを話すことはできません．また私の講演後に，聴講者からぜひ講演内容を本にしていただきたいとの強い要望があったため，2019年に日本医事新報社から「学会では教えてくれないアトピー性皮膚炎の正しい治療法―利益相反に基づいた治療から証拠に基づいた治療へ」という本を出しました．ただし「学会では教えてくれない」という枕言葉は日本医事新報社の方が提案したもので，私が望んだものではありません．いずれにせよこの本を出版することによって，世界標準の治療が日本でも行われるようになれば，日本のアトピー性皮膚炎の患者さんは救われると思いましたが，今でも日本独特の不適切治療が行われています．<br>　最初その理由はわかりませんでしたが，最近私の本を買った美容皮膚科の先生から，ある学会で私にお礼をしたいと話しかけられたことがあります．その先生が言うには，私の本の通りにアトピー性皮膚炎治療をしたら，患者さんから「こんなに良くなったのは初めてだ」と大変感謝されたというのです．そしてその直後に「今までの治療は一体何だったのでしょうね」と言われたそうです．<br>　つまり私の「学会では教えてくれないアトピー性皮膚炎の正しい治療法」の本は，すでに開業している皮膚科医にとっては非常に迷惑な本のようです．なぜならば患者さんを良くすれば，今まで不適切な治療をしてきたことを責められる可能性があるからです．そのため私の教え子（高浜市・三河皮膚科院長）から皮膚科医向けの本ではなく，患者さん向けに本を書いたほうが，アトピー性皮膚炎患者さんが救われるのではないかと提案されました．<br>　そこでいくつかの医学出版社に声をかけたのですが，一般向けの本を出していないからと断られてしまいました．私は今まで多くの医学出版社に頼まれ，多数の原稿（1,000編以上）を書いてきたので，どこかの出版社はOKしてくれると思っていましたが，あてが外れてしまいました．その理由はわかりませんが，製薬会社からの広告料が得られないとの思惑があったのかもしれません．今回，私が帝京大学の皮膚科に勤めていた時に一緒に仕事をしていた皮膚科医である浅井先生が，文光堂の社長になっていたので，浅井先生にそのお話をしたところ，一般向けの本を出すことを快諾してくださいました．そこで一般向けのアトピー性皮膚炎治療の本を執筆することにしました．なお本書は一般向けの本であるため，医学的な文献はすべて省略してあります．ただアトピー性皮膚炎治療に興味がある方は，私の著書である「学会では教えてくれないアトピー性皮膚炎の正しい治療法」（日本医事新報社）という本に，海外の文献も記載されていますので，それを参考にしていただければありがたいです．<br><br>2021年12月<br>渡辺晋一</section><section class="indexes">巻頭カラー<br><br>1章　湿疹・皮膚炎群とは<br>　1　湿疹・皮膚炎群の分類<br>　2　湿疹の症状<br><br>2章　アトピー性皮膚炎とは<br>　1　アトピー性皮膚炎の定義<br>　2　アトピー性皮膚炎になりやすい人<br>　3　頻度<br>　4　病因<br>　5　おもな症状<br>　6　アトピー性皮膚炎に血液検査は必要か？<br><br>3章　日本のアトピー性皮膚炎治療の変遷<br>　1　筆者が皮膚科に入局した頃―東京大学時代―<br>　2　脱ステロイド療法<br>　3　減ステロイド療法<br><br>4章　帝京大学で行った世界標準治療の結果<br>　1　対象<br>　2　治療法<br>　3　個々の患者さんの治療結果<br>　4　治療結果のまとめ<br><br>5章　当科受診までに受けていた治療の検証―世界標準治療とどこが違うのか―<br>　1　内服療法<br>　2　外用療法<br><br>6章　治療薬の選択<br>　1　どの外用薬を選択するか<br>　2　ステロイド外用療法<br>　3　皮膚科専門医でも根拠なくステロイドの外用を忌避する（嫌って避ける）人は多い<br>　4　ステロイドバッシングの具体例<br>　5　脱ステロイド療法，減ステロイド療法の根本的な原因はどこにあるのか<br>　6　顔の皮疹にはステロイド外用薬を使用してはいけないのか<br><br>7章　ステロイド外用薬の正しい外用方法<br>　1　外用薬は直接皮膚につける<br>　2　外用回数<br>　3　投与量<br>　4　外用期間<br><br>8章　ステロイド外用薬をつけても，良くならない原因は？<br>　1　不適切なステロイド外用療法<br>　2　診断の間違い<br>　3　何か原因がある<br>　4　擦る，洗うなどの生活習慣が原因<br>　5　患者さん自身が掻くなどの機械的刺激をやめることができない<br>　6　患者さんが指示通り外用薬を使用しない<br>　7　ステロイドの副作用を湿疹と区別できない<br><br>9章　プロアクティブ療法<br>　1　プロアクティブ療法とは<br>　2　プロアクティブ療法にはステロイド外用薬かカルシニューリン阻害剤の外用か<br>　3　日本のプロアクティブ療法の問題点<br>　4　プロアクティブ療法の意味するもの<br>　5　結論<br><br>10章　アトピー性皮膚炎を含む湿疹・皮膚炎の治療原理<br>　1　掻くことによって湿疹はひどくなる<br>　2　湿疹を良くするための治療原則<br>　3　正しい外用方法<br><br>11章　アトピー性皮膚炎に対する新しい治療<br>　1　新しいアトピー性皮膚炎治療薬<br>　2　まとめ<br>　3　注意すべきこと<br><br>12章　日本の皮膚科治療の問題点<br>　1　治療を受けても良くならない原因はどこにあるのか―医師側か患者側か<br>　2　治療に反応しない原因は医師側にあることが多い<br>　3　医師を選ぶ際の目安<br>　4　よい医師に出会うための方法<br>　5　不適切な治療を行っている皮膚科専門医が必ずしも悪いわけではない<br>　6　日本の皮膚科教授の問題点<br>　7　日本皮膚科学会の問題点<br>　8　日本の皆保険制度では必ずしも医師を責められない<br>　9　日本の皮膚科治療は東南アジア諸国より劣っている<br><br>索　引</section></article>
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