What is NMT?

- No Moisturizing Treatment (NMT) is a protocol advocated by Dr. Kenji Sato in order to more quickly recover from topical steroid withdrawal (TSW).

- Dr. Sato uses this protocol in his inpatient clinic in Japan to help patients recover from TSW.

- Practically all of the information about NMT is translated from Japanese and shared by Tokuko Kameda, a former patient of Dr. Sato's inpatient clinic.

Tokuko's main post about NMT (background, protocol, tips, personal history): http://tokuko.chu.jp/tokukonoheya/2017/11/25/how-to-get-over-topical-steroid-withdrawal-asap/

Tokuko's post about how moisture impacts healing and what can be considered a moisturizer: http://tokuko.chu.jp/tokukonoheya/2018/06/15/what-can-be-moisturizers-for-fellows-launching-no-moisturizing-treatment/

Tokuko's post that touches on the history of Dr. Sato's NMT and Tokuko's journey in spreading awareness. Also the post talks about babies and children doing NMT: http://tokuko.chu.jp/tokukonoheya/2019/11/29/nmt-caregivers-reports-for-children-and-babies/

- Drying out the skin promotes and encourages more healing.

- Allow the body to produce more natural cortisol hormone.

- Don't use any products on your skin. No soap, no hand sanitizer, no shampoo, no lotions/moisturizers,etc.

- Wear loose clothing and only use light blankets

- Shower for only a few minutes every 3-4 days.

- Exercise for 1 hour everyday striving to get heart rate up to 120bpm.

- Limited to 1 liter of water per day (this includes water content in food and drinking liquid).

- Lowering stress levels as much as possible.

- Sleeping from 10pm-2am. Preferably 9pm-7am.

- Protect skin from sun (wear hats or use umbrellas).

- Scratch if you need to. It's better to scratch and be relaxed than to mentally stress out about not scratching.

- My understanding of what happens with overuse of topical steroids: the body gets used to having synthetic cortisol provided from an outside source (topical steroids/oral steroids/corticosteroids) so the body lowers the production of natural cortisol hormone. Why make so much when it's already provided?

- So when you take away the steroids, your body goes through withdrawal because now it can't keep up with the demand for cortisol since it already stopped making its own. Without adequate cortisol, you get all these TSW symptoms.

- The goal of NMT is to 1) not add other irritants to the skin and 2) encourage the body to produce more natural cortisol hormone.

- When products are used on already compromised skin, they have the potential of slowing down healing and possibly making the skin more compromised. Not using products makes it so the skin doesn't have to worry about dealing with additional outside detriments and it can instead focus on healing the already compromised skin.

- Washing without soap allows the natural bacteria on skin (hands/body) to take care of itself. For example, using antibacterial soap strips away bacteria (good and bad) so it leaves hands more vulnerable and you'll have to keep using antibacterial soap.

- This is a similar case with soap in general (antibacterial or not). Soap is good for usage if you really need help scrubbing stuff off like raw meat or poop, but otherwise, it seems okay to not use soap.

- Not using shampoo is a whole movement in itself: "The No Poo Movement"

- Not using shampoo will cause hair to get more oily/greasy. Shampoo strips away natural oils and that's why the scalp produces way more oil to compensate. Eventually, scalp oil production should balance out and hair won't be as oily/greasy looking.

- If TSW affects your scalp, then shampoo may irritate the scalp skin more.

- If you don't want to stop using shampoo, then it's advised to wear gloves and use bar shampoo instead of liquid shampoo.

- Even though the skin looks dry, this is good for TSW and NMT because the goal is to keep it dry (for more optimal healing).

- Moisturizers work by creating a barrier on the outside of the skin trapping in moisture. The goal is to let the skin dry out, so creating a moisture barrier is counterintuitive.

- Like the way moisturizing creams work by creating a barrier on the skin to trap moisture from leaving the skin, fabrics can also act as a moisturizer (something that moisturizes) because it's function is literally to be an extra layer above your skin to keep in heat and moisture.

- Wearing loose clothing will allow airflow to the skin and keep the skin dry.

- Using light blankets will allow for more airflow and also keep you from sweating (which also acts as a moisturizer cuz the sweat can sit on the skin and rehydrate it).

- Keeping the skin dry is one of the biggest goals of NMT because keeping the skin in a dry environment gets the body into healing mode. This means drying from the inside (water consumption limitation) and outside (showering).

- Short showers = less time the skin is touched by water = less moisture

- Exercising encourages the body to produce natural cortisol hormones

- If sweating occurs, wipe sweat because it will moisturize the skin.

- Slow down a bit to not sweat so much. It's a balancing act.

- While the protocol says to limit water, the goal is NOT to be dehydrated. Dehydration is bad. Dehydration is not conducive to healing.

- The goal is to limit water enough to dry out the skin which will promote more cortisol production.

- Limiting water also removes water from exudate (also called ooze (noun) ). This will allow the exudate to be more viscous and stick to the skin more and possibly create a protein rich crust. If the there is too much liquid, the exudate will ooze (verb) and run down the skin in drips. Oozing ooze just becomes wasted proteins that get wiped away. It's better to create a crust (like a scab) so the skin underneath can use the resources (proteins from ooze and protection from crust) and heal.

Many people are concerned about the water limitation aspect of NMT so here are a few articles to read before I create my own write-up about water: Link 1, Link 2, Link 3, Link 4

- This is good for healing from any condition.

- Specifically with TSW, our bodies are lower on cortisol, the stress hormone. The body needs to get back into regular production of cortisol. Being constantly stressed out by outside factors (work, school, relationships, responsibilities) will cause the stress hormones to be allocated to deal with those stresses instead of being used to deal with the stress of the TSW skin.

- Examples of lowering stress: taking a break from work/school, unloading responsibilities, resting more, participating in relaxing activities.

- Natural cortisol levels rise in the morning and dip low as the day goes one until it's at it's lowest around bedtime. The golden hours of 10pm-2am are when growth hormone production kicks in. Growth hormone is used to help regenerate cells aka heal the body.

- I've questioned the actual time period of 10pm-2am because wouldn't it just be based on someone's sleep schedule as opposed to global time? Don't night shift workers also get a boost of growth hormone when they eventually go to sleep after work? Eventually, I decided to not worry too much about nitpicking and just followed the protocol and went to sleep at 9pm hoping to line up my circadian system with the sun.

- Imagine having sunburn and continuing to stay in the sun. If the skin is already compromised, it's better to keep it away from the sun until it heals enough to handle the sun again.

- Some people may thrive in the sun while others may burn. There isn't enough distinction as to why that happens (except on a case by case basis) so the protocol lists a blanket reccommendation that everyone should protect their skin from the sun.

- A common sentiment in the NMT community is to allow yourself to scratch if you feel the itch. It's better to be accepting and supportive of your condition rather than fighting with yourself.

- Getting some relief from the itch will help with the mental aspect of dealing with TSW. Sure, it will set back the skin a little, but it's better than being in a negative mood and scratching later anyway.

- All the information here is a summary of my research and own thoughts.

- Please do way more research than just reading my website.

- For a list of my tips and suggestions on how to ease into all this go to the Helpful Tips page.

For more information about NMT, check out the links in the Resources page.

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