(Photo of Louise King in Topical Steroid Withdrawal: follow her on Instagram.)
Heard of No Moisture Treatment, aka NMT? It’s a radical process that those who’ve tried it swear helped them recover from topical steroid withdrawal faster and more efficiently than standard steroid cold turkey. But what is it, and how do you do it?! We’ve collected tips, advice and strategies into one handy NMT guide.
What is NMT?
No Moisture Treatment (aka NMT) is the counterintuitive - and pretty controversial! - method of re-educating your skin and your body to function normally again, when the natural inflammatory response to an eczema flare has been dampened by the use of topical corticosteroids.
The short version is that it’s a way of training the skin and the adrenal glands to work efficiently by rationing the amount of water you put on or in your body.
The long version is pretty long, but worth getting a handle on if you’re in the thick of topical steroid withdrawal!
NMT was first pioneered by Dr. Kenji Sato in Hannan Chuo Hospital in Osaka, Japan. Dr Sato who discovered that severely restricting moisture intake (both moisturisers on your skin and the water you drink) allowed skin damaged by topical corticosteroids to heal quicker than just avoiding the steroids. He still sees patients at the hospital, and admits some for in-patient hospital stays, so he can monitor their progress and care for them during the healing process.
How do you do NMT?
The following guidelines have been gleaned from Dr Sato’s work, from TSW support groups and the website of his assistant Tokuko Kemada. It is not medical advice. Dr Sato treats his patients on a one-to-one basis, and gives his patients individual treatment regimes, so this is not intended as a substitute for that kind of personalized care; it’s just information about how the NMT regimes works, so you can make an informed choice about your own health.
We’d always recommend that you consult a doctor when undergoing such a radical programme. There is a distinct shortage of doctors across the world who accept how widespread a problem TSW is, or even that it exists at all, so this isn't necessarily an easy task. But since some of the NMT regime goes against conventional medical advice, you’d be well-advised to find a doctor who can make sure you’re not getting infections, and who can check your blood pressure, pulse and other vital signs. A doctor doesn’t necessarily need to agree with everything you’re doing, but you do need to keep yourself safe. There's a significant difference between being directly under a doctor's care while undergoing NMT and doing it all by yourself.
If you get poorly: stop NMT and make sure you’re getting enough fluids to recover!
If you need personal support from Dr Sato, then contact him directly.
Do what works for you!
It’s worth noting that many people start NMT and find it too slow, too gruelling or too painful to continue with; everyone takes a different length of time to heal from TSW and there is no shame in changing tactics. Plenty of people go through TSW without cutting out moisturisers or limiting their water intake. You need to do what works for you. If that means using balm on your lips and eyes so you can function in the world, then so be it. Not everyone going through TSW is able to spend 30-90 days as an in-patient in Dr Sato’s personal care, and your mental and physical well-being is definitely more important than sticking to a regime for the sake of it!
All that said, if you do want to go ahead with NMT, what does it entail?
Following a NMT regime
- Limit your daily fluid intake to about 1-2l a day depending on your weight and your symptoms; this includes fluid in your food, so fruit, for example, count towards the amount.*
- Only drink 200ml of water with your early dinner (around 7pm) and have none overnight
- Limit showers and baths to one or two a week
- Make them short (2 mins) and warm not hot; remember that you’re only washing because you need to keep skin clean and free from infection
- Use soap-free, unperfumed body wash if you need to, otherwise just water (Balmonds Natural Shampoo & Body Wash would work perfectly)
- Use a soft setting on the shower, not high pressure, so as not to damage fragile skin or wash away crusts
- Wear thin, light, cotton clothes, not heavy synthetic ones.
- You need airflow and to keep skin cool; one loose, light top, plus a pair of loose, light shorts would be ideal.
- Keep your room cool; Dr Sato finds that cooler air works better at healing the skin than warm atmospheres
- Keep your environment moderately humid: not too dry and not too moist
- Exercise for around 30-60 mins a day to optimise healing; it should be exercise that raises your heart rate, not gentle strolls.
- Any water you drink afterwards is only meant to replace sweat lost during exercise; that means sips not glugs!
- Take an antihistamine 30mins before exercising if you find yourself itching afterwards
- Eat well: your body is losing protein as it oozes, so eat plenty of non-salty, protein-rich food, and make sure you are consuming plenty of essential fats as well. Avoid alcohol, processed, sugary or additive-heavy food.
- Sleep well: make sure you’re asleep between 10pm-2am to maximise the body’s regenerative state and growth hormones, and use the lightest bed coverings you can get away with.
- Reduce your stress levels as much as you possibly can.
- Try to scratch gently through clothes or gauze rather than directly onto skin to reduce damage
- Don’t pick scabs or crusts on purpose
- Don’t put anything at all on skin, not foundation, eye shadow or blusher, in fact not even sunblock - wear hats, long sleeved/legged clothes, parasols or stay completely out of the sun instead.
- Don’t wipe away the ooze and definitely don’t use tissue paper: cover with a single piece of thin cotton gauze. Replace gauze bandages or squares within the week and check for signs of infection.
*Tokuko Kemada recommends the following daily amounts of moisture:
- 1,000ml – 1,500ml if you weigh between 50-60kg
- 1,300ml – 1,800ml if you weigh between 80-90kg
For more information about TSW, its symptoms, effects and strategies that can help, see our TSW Info Hub.
We've spoken to many brave people who are undergoing TSW, and they've told us that in their experience a few strategic products have helped them cope with the gruelling process of NMT. These are their personal suggestions, not official, Dr Sato-endorsed products, because true NMT involves no using moisturisers at all.Balmonds Natural Shampoo & Body Wash works as a soap-free, scent-free and irritant-free shampoo/body wash.
If you require medical advice we recommend you always contact your healthcare professional.
If you or someone you are caring for seems very unwell, is getting worse or you think there's something seriously wrong, call for emergency services straight away. For general medical advice, please contact your healthcare professional, this article does not contain or replace medical advice.
Do not delay getting help if you're worried. Trust your instincts.