About house dust mites in the housing environments

Here I will present a case which I saw many years ago.
He suffered from eczema mainly on the lower extremities while there were a few typical lesions of atopic dermatitis also in other parts.
His family moved when he was 12 years old. He developed the above described manifestation after that. Their family thought he might have developed TSA because he had used TS so long. So TS was discontinued. But his eczema didn’t subside and worsened every summer. After three years he visited me on Sep 16 1997 (right upper photo).
The rebound due to TSA was excluded from my diagnosis because his skin manifestation differed from it and the seasonal worsening tendency was obvious.

The regular seasonal worsening means he reacted to some environmental factor. So I went to his house for research.

Remember that nobody can correctly identify any environmental aggravating factor without a real field research and any medical doctor including me is not a specialist of such kind of research. So I went to the patient’s house with some specialists. They were architects, pest controllers, chemistry scientists and so on. They were all my friends and I asked them to accompany . I used to repeat such field works more than one hundred times for my patients.

His family lived in a rental apartment. We found the floor was all covered with carpets and our architect judged the house was poor in airflow. Our pest controller collected the dust on the carpets and examined by microscope. The result revealed there were 179.8 house dust mites per square meter and the ratio of male-adult mite, female-adult mite, young mite was 15:5:10. It means the carpets were the place where mites lived and produced descendants.

His family moved to the other apartment for the purpose of change of air. We went for the field research again and found the floors were all made of wood and the airflow was enough. The house dust mites on the floor were counted as only one per square meter.

The patient improved rapidly after moving as the top photo in 97.11.20.  I followed him for one subsequent year and confirmed that his eczema never worsened (photo 98.10.23).

I will present another case. She had suffered from the whole body eczema. Her parents stopped TS because they suspected TSA and visited me.

I couldn’t judge her dermatitis was purely of rebound or amplified by the other factor. As her blood examination showed she had high IgE to house dust mites, I went to her house for the research with my comrades.

When we went to her house, she was just sleeping in the sofa. She liked the sofa and slept there every night like the photo. The sofa was made of cloth and we found the density of house dust mites on the sofa was more than 200 per square meter. The sofa must have been absolutely one cause of her eczema.

Remember that we dermatologist can’t know how the environment surrounding an individual patient is like. All people including doctors have a tendency to think their own life-styles as a standard. But in fact all human beings live in the different life styles, that is different environments.

The former dermatologist advised to use allergen-free bed clothing and her parents purchased it. But the parents never suspected the sofa was a nest of house dust mites.
The patient recovered gradually after the sofa was discarded. The photo is after one year.
I can’t judge how many ratio of the initial eczema was due to TSA and how many ratio was due to the allergy to the house dust mites. However she recovered anyway.

What I’d like to insist is that you could never identify where and how many the house dust mites exist. Look at the below photo for example.

This is a bed of another patient. Can you judge how many mites are on the bed clothing only by seeing it?

On the floor carpet we counted 100/m2, the coverlet 3/m2 and the electric blanket between the coverlet and the bed 650/m2. It is warm and comfortable to use an electric blanket but it is also comfortable for mites.
There are other environmental aggravation factors than house dust mites. Most of them are invisible. Only the specialists can identify correctly by the real field research. And such specialists are very rare.

But remember if the factor was identified correctly and removed from your environment, it surely is the most reasonable rescue.

I repeated such works with my comrades who were complete volunteers sympathized for my idea and accompanied with me free of charge. They were all persons of good will.
I am ashamed of myself to my comrades I  couldn't continue the above volunteer work from my personal reason even though I myself was a proposer.

However,there were not so many cases which we could identify the obvious aggravating factors. The rate was less than 10% by my memory. For most patients the housing environment seemed to have no relation with their eczema. But the fact that there was no aggravating factor was of course useful for the patient.

Other aggravating factors in the environment which we could find include mold, formaldehyde in the newly built house and cats. A cat was sometimes identified as an obvious worsening factor visible but difficult to be removed. Most patients didn’t discard their lovely pets and continued to live with cats. I remember one patient. He didn’t use any steroids for many years and his eczema improved soon after admission to our hospital but worsened just after discharge. I went to his house and researched. There was no possible aggravating factor except one cat. But his family couldn’t discard their cat and continued to keep until the death of the cat. After the death of the cat in two years, his eczema completely improved.

What should you do if you suspected the existence of environmental aggravation factor? The most reasonable and scientific way is what I did formerly, that is a real surveillance of your housing environment by specialists. However, you could not find such specialists usually. So I recommend trying a short journey or travel. Especially if you are enough young, you should travel all over the world and look for the environments in which you can live. If I were you, I will definitely do so.

It never means you had better live in the country rich in nature. In fact, allergens are richer in the country than in the city. It is because allergic reaction exists as an offencive reaction against other living things. For a patient with allergy to mold, the safest living space is an apartment on more than the 10th floor in the city. The largest origin producing mold is the soil of the ground.

Your skin itself is an indicator of worsening factors. Utilize it effectively.

I also remember another patient. He suffered from eczema for a long time and I advised him to travel Okinawa, the most southern prefecture in Japan. He became emotional and angry. He appealed that he might die if he traveled at the present skin conditions. I answered “ It would be really nice if one died in such a beautiful place.” So he decided to travel in Okinawa. Just after he got off the airplane he felt comfortable and his skin improved in a few days. He must be living still in Okinawa now.

It is such a thing about the environmental aggravation factors. You, patients with atopic eczema resemble like the sweetfish which live in the clear stream. Try to travel or move drastically and find your place. It might be the best and simple answer.

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