No Moisturizing Treatment (NMT)

By Linette Roungchun

4 min read

So by now, you’ve probably heard of topical steroid withdrawal (TSW) and its torturous symptoms. You don't want your body addicted to steroids any longer, so you're ready to stop using all oral and topical steroids. You've heard the stories, seen the pictures, and you've silently observed in all of the TSW Groups on Facebook and TSW accounts on Instagram. You're now horrified of what is in store for your body and what to do now.

This or That

Which dry skin symptom is more frustrating?

Speeding up TSW

As of right now, there is no cure for TSW other than time itself. But is there something that can make this process go by a bit faster? Why yes, yes there is. It is called "No Moisturizing Treatment." How do I know about this treatment? Because like you, I am going through TSW and have searched for months for anything that would help. After all that research, stress, and itchiness, I was led to NMT.

What is no moisturizing treatment (NMT)?

Dr. Kenji Sato founded No Moisturizing Treatment after closely monitoring his TSW inpatients 24/7 at Hannan Chuo Hospital in Japan. Dr. Sato is known as 'the leader against topical steroids.' NMT was translated into English by Tokuko Kameda, one of Dr. Sato's former patients who completely healed her TSW with NMT. She hoped that translating this to English would help TSW sufferers around the world. This treatment was specifically designed for those of us who were diagnosed with eczema, treated with topical steroids, developed a topical steroid addiction, and who have stopped all steroid usage and are now going through TSW.

What does NMT do?

Topical steroids mimic cortisol, a naturally produced hormone in the adrenal glands. Because we have damaged our skin by applying this synthetic stress hormone to our skin, we now have to train our skin to remember how to produce cortisol on its own. This is where NMT comes in. By following NMT, we give our adrenal glands the chance to produce cortisol once again.

What if you get sick during the treatment?

Before starting any new treatment, you would need to find a doctor who supports you, especially in your NMT journey. They don't have to agree with you - they just have to check your vitals and make sure that you are not experiencing any infections or any other health issues while doing NMT. What if you get sick during NMT? If you get sick, NMT instructs you to stop NMT completely and allow your body to have as many fluids as it needs to recover. Take your time recovering, and come back to NMT once you're all better.

Can you do NMT if you're pregnant or if you're a child?

If you are pregnant or considering this treatment for a child, please consult your child's doctor and the resources below. More information on how to treat a child will hopefully come out soon. Dr. Mitsuko Satou (pediatrics) and Dr. Kenji Sato have just released a book about kids and topical steroids. Here's to hoping that an English translation comes out soon.

How to do no moisturizing treatment

So how do you follow NMT at home? NMT is a lifestyle change.

Depending on your weight and the severity of your symptoms, you would need to restrict your water intake to 1-1.5 liters a day. It includes the amount of water in your food.
You will also need to exercise to get your heart rate up to 120bpm, for an hour a day.
Sleep between the hours of 9pm-2am because they are the golden hours for your skin to repair.
Cleanse only to prevent infection and do not apply anything to the skin, since the skin repairs itself when it is dry, not wet - no moisturizer, makeup, wraps, etc. Wearing tight clothing and covering up at night in sheets is also considered moisturizing.
Do not pick at your skin, nor wipe away the ooze.

There are a few more guidelines to follow, but these are the main ones! The rest can be found in the resources below. I realize how drastic this treatment sounds - but remember that TSW is a pretty drastic disease.

Importance of exercise

I emphasize the exercise because I know all too well the temptation NOT to exercise, especially when your own sweat makes you itch like crazy, you can't regulate your temperature, and your skin is so dry and taut that it tears at even the smallest movement. I get it. I've been there. Some parts of my body are still there, actually. But remember, your lymphatic system relies on you to move so your body can heal.

We're all human

If you need to be covered with something when you sleep, just choose a very light sheet rather than a comforter. If you get really thirsty, then go ahead and drink that water! We are all human. But just try to be self-aware and try harder to do better each day. After all, you're the one benefitting from this treatment. Like I mentioned earlier, do what you can. Your mental health is a huge part of this process, too, so always remember to forgive yourself and to always do your best.

Trying NMT

I have healed so much with NMT. However, this doesn't mean that NMT will work for you. My advice is to try it if it sits well with you and stick with it for a bit since, as with any treatment, things can get worse before they get better. Most importantly, make sure a doctor is monitoring you because they will be able to spot any irregularities in your health.

Resources

Have any more questions or concerns? The following links should provide you with the answers you are looking for. Also, feel free to reach out to me here on AtopicDermatitis.net at @linetteroungchun or @linettero on Instagram, as I post updates on my NMT journey. Happy healing!

You can read Tokuko’s blog here.
You can also find support in these other groups on Facebook:

NMT Education Group (Dr. Kenji Sato and Dr. Mitsuko Satou have approved this group as the official site for NMT. They both monitor this site as much as possible. Do not comment on this page; it is used strictly for learning.)
Support Group for NMT - TSW (comment and ask questions/support/discussion)
The NMT Healed Club (journeys and photos of those who have healed to encourage you)

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The AtopicDermatitis.net team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

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Jimidy Member
Hi, I'm completely new to this site. But thought I'd comment. Quick background: I spent most of my childhood in hospital with eczema and have gone through almost all treatment types. Even being admitted to Great Ormand Street has having one of the worst cases of Atopic Eczema documented. I am now 39 and completely Eczema free! Other than the odd flair up that I can easily manage. No Steroids, no creams, no cyclosplorine or tablets based on arsenic (yes I tried those too). There are a number of things I changed in my life that helped me to achieve this. One of which was NMT (although I never knew it was called that). I just simply stopped using creams, oils and moisturisers as most me itch and hot, so I wanted to itch more... It was torture. Other key changes were: clothing and bedding material (only cotton). And use simple over the counter antihistamine to suppress my immune system if I have a flair up (let's say for example I go to someone's house who had a malting cat). Oh and I now live in a damp/mould free house! I eat and drink anything I want including dairy products and egg white, (many experts told me this was the issue). Anyway. That about sums me up. I'd be happy to give advice, or help anyone struggling with this. I did for 30 years, and my kids did for about 5 years. But now we are all free of it. Get in touch if you need help or guidance.
1. Nina Ajdin Moderator & Contributor
 <inline-mention username="Jimidy" user-id="4786521"/> welcome to the site! Glad to have you here and part of our community. Thanks so much for sharing what has worked for you and your family. I'm so glad you were able to find what works for you. We are all so different and it is so wild how different things work (or don't) for different folks! Glad to have you here and I'm so happy you were able to heal! -Nina (AtopicDermatitis.net Team Member)
diana Member
Thank you for this article. I had TSW after cold turkey stopping my 10 years of continual steriod cream use (on my eyelids). That was 20 years ago, but ive never really fully recovered and still rely heavily on moisturizers, coconut oil, aquaphor, vaseline etc. in order to avoid intense itch and dryness. Do you think NMT would be helpful for me even though it has been years since my steroid use?
1. Linette Roungchun Moderator & Contributor
 Though of course I cannot diagnose since I am not a medical professional, I can say that your case sounds similar to what I have experienced (being reliant on moisturizers) and that yes and no, NMT might help you! I say MIGHT because you might just benefit from MW which is Moisture Withdrawal. NMT is more of a lifestyle change and in my experience really helps with controlling the oozing. If you’re not experiencing any oozing, I definitely suggest MW since I don’t think the liquid restriction would help you much, and in fact might do more harm than good if your vitals are not being monitored by a doctor. I have not moisturized (except for a handful of panicked moments where the moisturizer ended up much more harm than good) in over 2 years, and even before knowing about MW, I stopped moisturizing my back, bottom, and my legs. Those areas of skin that I have left alone are sooo much stronger than when I was reliant on moisturizers! I highly recommend that you don’t just take my word for it, but rather go into Instagram and look for the profiles that say TSW/NMT/MW. You’ll see for yourself that our bodies were truly meant to take care of themselves! The Eczema Podcast has a great episode on this where she interviews a man who used to work for Blistex, and he also delves into the history of the beauty industry and how women in particular have been sold this idea of “Beauty in a jar” when in fact we are just moisturizing dead skin cells and do not need these moisturizers. I’m wishing you so much healing and luck! I know how scary it is to begin the MW journey, so don’t be hard on yourself! Maybe start with one arm or leg or whatnot and see how it goes. Yes, it might not feel crazy dewy or anything, but you’ll feel your skin getting stronger. Good luck!
karen Member
Can you start NMT with a child? We have her off tropic steroids but still on moisturiser. We had an operation and she could not use cream for a day and we saw an improvement. Thinking we may try to do NMT to help her.
1. Linette Roungchun Moderator & Contributor
 Yes! Please head over to the resources listed at the end of this article to find info for kids! I have seen many many cases of children doing NMT and even helped a mom and now her child’s skin is strong and clear 😀 I highly recommend the NMT Support group on FB. Use the Search feature on there to type in any keywords for your searches. Every conversation that was ever had in that group with those key words will come up. Also feel free to post and ask questions in the SUPPORT group for NMT 😀 Good luck! -Linette Roungchun (Moderator for <a href='https://atopicdermatitis.net' target='_blank'>atopicdermatitis.net</a>)