“Chiwako’s Story”

The story of the recovery from Palmoplantar Pustulosis
(a variant form of Psoriasis Vulgaris )

By:Chiwako Mogamiya
Authorized Instructor for Health and Exercise

My challenge to overcome Palmoplantar Pustulosis

In the autumn of 1995, I was rehearsing with my students in preparation for our annual dance exhibition. While dancing, I happened to notice some unusual pus-filled rashes on the right palm of my hand. When I consulted with my family doctor, he simply gave me some ointment without any comment. So, I tried the ointment and as time went by, the eruptions did not improve. The eruptions also developed on my left palm and soles of my feet. However, I did not worry too much about them, because my doctor said that the eruptions were probably due to physical and mental stress caused by my hectic dance exhibition schedule. So, I thought everything would be back to normal when I completed the exhibition. However, that was not the case! The eruptions became worse, so I decided to consult with various other doctors. Some of the doctors suggested that my condition was due to inflamed tonsils or possibly metal allergies to a crown I had.

Meanwhile, as time progressed, I suddenly was attacked with severe pains in my neck, anterior chest and back, and then I could not move at all without some assistance. Then the doctors told me that the cause of the disease was unclear and that there was no treatment for it and therefore I was obliged to decide to draw the curtain of the rest of my life!

Additionally, I consulted with many dermatologists with no conclusive results. They all told me the same thing -“the cause of the disease remained unknown and there was no current treatment available.” I continuously suffered from painful, pustular eruptions on the palms and soles. Additionally the eruptions developed extrapalmoplantarily on my arms, elbows, legs and knees.

I began to feel embarrassed when I went shopping and accepted change since my hands looked so awful. I could not wear sandals, because the nails on my toes were crumbled and looked terrible. As the disease progressed, I was disturbed sleep, because I could not turn over in bed due to the severe chest pain and backache.

Thus, I decided that I could not continue to teach dance. I prepared to tell my pupils that I would have to give up teaching. However, when I explained my condition to my pupils, several of them later brought in a newspaper article to show me. The article talked about the treatment of the disease by Dr. Masaru Maebashi, a physician and researcher authorized by the Japanese Society of Internal Medicine.

I did further research on Dr. Maebashi and found that he practiced at National Akita Hospital near my home. So, I anxiously scheduled an appointment to see him.

Dr. Maebashi examined details of the disease for more than one hour and then allowed me additional time to ask him questions. Dr. Maebashi diagnosed my disease as sternocostoclavicular hypereosotosis characterized by pustular eruptions on the palms and the soles of the feet and severe pain of the chest and back due to bone damages. He gently told me not to worry about the disease, because it was completely curable! The moment I heard his explanation, I was so happy that I cried and cried for joy.

After treatment by Dr. Maebashi the eruptions on the palms and soles were completely gone after seven months! The chest pain and backache have also completely disappeared. So I could sleep comfortably every night!

My disease was cured so rapidly by the treatment and encouragement of Dr. Maebashi. I recovered my splendid life and could dance again with pleasure. Later, two friends of mine who also suffered from Palmoplantar Pustulosis are now enjoying their life again after treatment by Dr. Maebashi!

Background of Dr. Masaru Maebashi

Dr. Maebashi is an excellent physician licensed by the Japanese Society of Internal Medicine. He is also a famous researcher who has studied the pathogenesis and treatment of various diseases, such as hypertension, atherosclerosis, metabolic abnormalities and immune dysfunctions.

All of his studies have academic origins and are applied to the treatment of patients.

In 1998, the Japanese Society of Internal Medicine highly praised his study on Palmoplantar Pustulosis and its related diseases as one of the most excellent investigations in Japan. The Society also recommended his study on dementia as very comprehensive.

While studying Palmoplantar Pustulosis at the Medical School of Tohoku University, Dr. Maebashi established treatment regimen for it.

Treatment of Palmoplantar Pustulosis

The treatment consists of a combination of oral administration of biotin and supplementary therapy with corticosteroid ointment. Once the concentration of the steroid applied to the skin lesions is diluted and as symptoms improve the treatment will no longer be necessary. This particular treatment of Palmoplantar Pustulosis is now authorized and approved by the Japanese Society of Internal Medicine.

Dr. Maebashi has treated more than 5000 patients with Palmoplantar Pustulosis and Sternocostoclavicular Hyperostosis successfully up through June 5, 2007 when I last checked statistics on the disease.

The treatment also achieved a favorable therapeutic effect on diseases caused by immune dysfunctions, such as psoriasis vulgaris, atopic dermatitis, rheumatoid arthritis, erythematodes, scleroderma, Sjoegren’s disease, IgA nephropathy and Crohn’s disease.

Interesting Facts about Palmoplantar Pustulosis (It is a systemic disease, and not a skin disease)

Palmoplantar Pustulosis is not merely a skin disease but a systemic disorder with frequent complications of bone lesions, diabetes mellitus, IgA nephropathy, Crohn’s disease, or chronic thyroiditis. Especially, bone lesions are complicated in most patients. Therefore, the pustular eruptions on the skin may be regarded as one of the characteristic symptoms.

In the United States, Palmoplantar Pustulosis has been considered a disease entity and has been categorized as a subtype or a variant form of psoriasis vulgaris or rheumatoid arthritis. The cause of the disease remained unknown, although local infection such as inflammation of the tonsils, genetic abnormality, metabolic disturbance or immune dysfunction had been proposed. The disease tended to aggravate despite various treatments.

Immune dysfunction and biotin deficiency

Palmoplantar Pustulosis is a disease caused by deposition of immunglobulin A(IgA) on the palms and the soles of the feet. If IgA deposits on the periostiums, the disease accompanies bone lesions as sternocostoculavicular hyperostosis.

Biotin is a kind of vitamin B group and plays an essential role in the metabolic reactions of glucose, fatty acids, amino acids and nucleic acids and in the subsequent regulation of immune system. Biotin deficiency, therefore, causes metabolic abnormalities with a subsequent reduction of T lymphocyte-mediated suppressor activity. As a result, there occur excessive amounts of IgA deposits on the skin tissues and the periostiums, inducing the disease. The treatment with biotin corrected all of these metabolic abnormalities and subsequent immune dysfunction, resulting in complete improvement of the disease.

Thus, it is possible to say that biotin deficiency may be responsible for these abnormalities and subsequent occurrence of the disease.

Biotin and intestinal microflora

There are 100 trillions in number and 500 different microbial species existed in the intestine. These bacteria in the intestine are named as intestinal microflora. They proliferate by taking nutrient from food and intestinal juice secreted from the intestine, and then excreted with feces.

Intestinal microflora is transmitted to a baby from its mother at birth, so the spectrum of the microflora of the baby is at first similar to that of the mother. The spectrum, however, is easily affected by the contents of meals. Intestinal microflora produces many kinds of vitamins including biotin, which are absorbed from the intestine into the circulation, where they are utilized metabolically and physiologically. Thus, the deficiency of vitamins, in general, does not occur except vitamin C, because vitamin C cannot be produced in humans.

At this stage, there is something that we have to know about biotin. Biotin is contained in various foods, but the vitamin in foods is bound to protein. So it cannot be absorbed from the intestine.

Since biotin produced by intestinal microflora is free-typed and not bound-typed, it can be absorbed easily from the intestine and be used. If there are some disturbances in the production or absorption of free-typed biotin, biotin deficiency will occur.

Biotin deficiency may occur as follows.

Palmoplantar Pustulosis and ‘harmful’ intestinal microflora

The patients with Palmoplantar Pustulosis have frequent episodes of severe constipation or persistent diarrhea before the occurrence of the disease with susceptibility to the presence of ‘harmful’ intestinal microflora. Thus, biotin deficiency would occur when the ingestion or degradation of the vitamin by proliferated ‘harmful’ microflora in the intestine impairs absorption of biotin from the intestine. It is, therefore, suggested that biotin-limited conditions produced by ‘harmful’ intestinal microflora in patients with Palmoplantar Pustulosis plays a causal role in the occurrence of the disease.

According to the study on the intestinal microflora by Dr. Maebashi, Lactobacilli including L. bifidus are one of the bacteria to ingest much biotin in order to proliferate. Dr. Maebashi also shows that these bacilli are considered to cause biotin deficiency, because a large amount of these bacilli are found in the stool of patients with Palmoplantar Pustulosis.

Lactobacilli had been considered to be ‘useful’ microflora, which produce lactic acid to suppress the proliferation of ‘harmful’ ones. Hence, it is also used as one of medicines for intestinal disorders, but they induce biotin deficiency by ingesting the vitamin. In the treatment of Palmoplantar Pustulosis devised by Dr. Maebashi, he uses activated Clostridium butyricum ,a kind of probiotic agents, as an effective remedy for intestinal disorders, because this agent does not degrade nor ingest biotin to suppress ‘harmful’ microflora including Lactobacilli.

Yogurt and lactic acid drinks had been thought to be healthful foods to proliferate ‘useful’ microflora in the intestine. But they are almost of no use, because bacteria in food and drinks are destroyed by the strong hydrochloric acid in the gastric juice, when they pass through the stomach. Even if, some bacteria could reach the intestine, they would be excreted rapidly with feces. However, it must be emphasized that, as these foods contain much protein and calcium to produce skeletal tissues, they are useful to prevent osteoporosis.

Are tonsils implicated in the occurrence of Palmoplantar Pustulosis?

It had been thought that the tonsils were implicated in the occurrence of Palmoplantar Pustulosis. In fact, there were some reports in which the pustular eruptions were temporarily relieved after operative removal of the tonsils. But there was no critical information to verify the causal role of the tonsils to be associated with the initiation and the severity of the disease.

It seems likely that postoperative administration of antibiotics prevents the proliferation of ‘harmful’ intestinal microflora to degrade or to ingest biotin which is produced by ‘useful’ bacteria in the intestine.

The pustular eruptions in the postoperative patients relapsed in a short time and the disease became more exacerbated and exaggerated with subsequent development of bone lesions, because of the proliferation of antibiotics-resistant bacteria among the intestinal microflora.

Does Specific Dental Treatment help Palmoplantar Pustulosis?

Dental treatments such as extractions of various teeth or crown restorations have also been tried for relief of Palmoplantar Pustulosis, but failed to improve. All of these treatments cannot provide benefit on metabolic abnormalities and immune dysfunction occurring in the patients.

Smoking and Palmoplantar Pustulosis

Smoking including passive smoking seems to play the incidence susceptibility of Palmoplantar Pustulosis. While smoking, serum biotin levels in patients with Palmoplantar Pustulosis were significantly low as compared with those in healthy subjects. Smoking decreased the biotin levels in the patients and made the disease worse, because one cigarette reduced the biotin levels compared to half of non-smoking conditions and exerted harmful influences upon some factor or cluster of factors to be related to the immune system and metabolism.

Stopping smoking habits are crucial to the therapeutic effect of biotin and the occurrence as well as the prognosis of Palmoplantar Pustulosis

Attempts to Inform Others about the “Cure”

I have made numerous attempts to contact “Health” channel networks about the cure for Palmoplantar Pustulosis. However, I was not able to make appropriate contact. It is my hope that many people who have the disease will see my website and seek Dr. Maebashi’s help.

If anyone knows how to get the message across the TV network, please let me know! Since we need to spread the good news about the cure, others may get help as I did!