No Moisture Treatment Guide For TSW
The No Moisture Treatment (NMT) protocol was developed by Dr. Kenji Sato, who is a medical doctor in Japan. He has been treating patients with topical steroid withdrawal (TSW) since 1994. This guide will go through the EXACT guidelines that Dr. Sato uses with his patients. After reading this post you will be able to decide for yourself if No Moisture Treatment is worth trying.
SEE BOTTOM OF BLOG POST FOR QUICK SUMMARY OF NMT
Left: Brendan at the start of NMT, Right: Brendan 4 months into NMT
Why No Moisture Treatment?
The idea behind NMT is that it gets you through the inflammation and oozing stages of TSW as quickly as possible so that you can get to the flaking and remodelling stages of TSW, where healthy skin will start to grow and appear. It is similar to the idea of getting a cut and allowing that cut to scab up naturally. The skin underneath the scab is newly formed healthy skin. If you have whole-body TSW, your entire body is like one giant scab. NMT speeds up this “scabbing” process".
1. Avoiding bathing and showering as much as possible
One of the main guidelines in this protocol is to avoid showering and bathing as much as possible. This allows the skin to completely dry out and naturally scab/flake off to allow new healthy skin underneath to come out. People suffering from TSW have very sensitive skin and so something as simple as water can be irritating to the skin, leading to discomfort and slower healing. Furthermore, the temperature difference between TSW skin and the water can trigger sensitive nerves in your skin and cause irritation.
Frequent washing also gets rid of a lot of the “good” bacteria on the skin. These natural bacteria play a major role in regulating our immune systems. It is possible that people suffering from TSW have more “bad” bacteria than “good” bacteria on their skin. Therefore, it is important to try to maintain the “good” bacteria for as long as possible. Avoiding frequent bathing and showering will help to accomplish this goal.
NMT does not mean absolutely NO water on the skin. You can use a cotton cloth or towel with some water to wipe off certain areas of the body that need cleaning, such as your armpits or groin area.
Depending on the stage of your TSW or your exercise levels, you may be allowed to do very brief showers, for example, maybe 30 seconds to a minute per shower. Dr. Sato allows his patients to do quick showers once every 3-4 but only after their skin reaches a certain stage. This is usually after about a month of strict NMT. If you must shower, remember to pat your skin dry afterwards and never rub!
Lastly, this protocol suggests avoiding soaps and shampoos. However, they mention that if you must use soaps, use a bar soap over liquid soap. This is because liquid soaps may contain added ingredients that will cause irritation to the skin. They suggest that you can use a bar soap instead of a shampoo as well if needed. However, it is best to avoid these products if possible.
2. AVOID ALL topicals
Another major part of this protocol is to avoid topicals. Steroid creams are definitely not allowed. Other medications such as immunosuppressants (ex. Protopic or Elidel) are also not allowed. Other topicals to avoid include creams, lotions, serums, sunscreen, make-up, and lip balm.
When the skin is going through TSW, it is very sensitive. We want to avoid any irritation to the skin and allow it to naturally dry out and heal as fast as possible. This is the reason for avoiding all topicals.
3. Limit Fluid Intake
This guideline is probably one of the hardest to follow but is one of the most important. Limiting fluid intake allows the skin to dry out faster. This is especially important when you are going through the first two stages of eczema, the inflammation and oozing stages. However, we do not want to limit fluid intake to the point of dehydration
If you are 50-60kg, aim for 1 to 1.5L of fluid per day.
If you are 60-80kg, aim for about 1.2 to 1.6L of fluid per day.
If you are 80-90kg, aim for about 1.3 to 1.8L of fluid per day.
You are allowed a 20% increase to your daily amount if you sweat a lot due to exercise or your work.
If you get sick, for example you catch a cold or you have a fever, you should stop this water restriction.
Fluid from the foods that you consume also count towards this daily limit. Let’s go over how to calculate the fluid in foods. First you must weight the amount of food you are eating. Let’s say you are eating 100g of rice. Now you need to search on the internet to determine how much percentage of rice is water. Rice is about 65% water. Now you do 100g x 0.65 (65% water) to get 65g. Grams can be converted to mL in a 1:1 ratio so 65g becomes 65mL. Therefore, 100g of rice contains 65mL of water that will count towards your daily fluid intake. This may be a lot of work for you to calculate the amount of water in the foods you eat every day but it is necessary to ensure you are not going over your daily fluid intake.
Your dinner should NOT exceed 200mL of fluid intake in that single meal.
Furthermore, you can use the colour of your pee to help you determine if you are drinking enough water.
Transparent pee: too much water
Light yellow pee: too much water
Dark yellow/orange pee: PERFECT
Dark brown/red pee: too little water
3. DIET RECOMMENDATIONS
The main diet point in the NMT protocol is to eat a healthy well-balanced diet with an adequate amount of protein. I recommend eating 1.2g of protein per kilogram of your bodyweight.
Avoid foods high in sodium/salt as these foods will just make you thirsty. Fast food and packaged foods often contain high amounts of salt. Sauces and canned foods also might have high amounts of salt. Be sure to check the nutrition label!
One specific recommendation that the protocol makes is to avoid licorice because it contains glycyrrhizin, which is a compound that potentially has corticosteroid-like effects in the body. You want to stay away from things like licorice candy or licorice tea.
Lastly, try to have dinner at least 3 hours before bedtime. This will allow enough time for your body to digest the food so that your digestion does not interfere with your sleep.
4. Exercise Recommendations
The NMT protocol suggests 1 hour of exercise every single day. Any type of exercise works but you want to have an intensity that is enough to break a sweat but not enough to irritate the skin. Fast walking is a common exercise for TSW sufferers but you can also do strength training, jump rope, sports, or whatever you enjoy. Exercise not only filters your lymphatic system to regulate your immune system, but it will also improve your mood, which is very important when it comes to TSW.
Even if you sweat during your daily exercise sessions, you still want to avoid showering and bathing if possible. Instead you can consider wiping off sweat with a dry cotton towel and allowing your skin to air dry.
5. Clothing recommendations
Avoid tight clothing as it can act as a moisturizer by trapping in moisture between your skin and your clothes. Wear loose clothing. Even something as simple as tucking your shirt in can keep moisture on your skin and cause irritation. Avoid wearing too many layers. Similarly, avoid covering up with blankets.
Stay away from using gauze and bandages if possible. However, if you are bleeding heavily from an injury such as a cut, disregard this guideline and use bandages as you normally would. If you are in the early oozing stage, avoid wrapping or covering the ooze. Allow the ooze to naturally air dry instead.
6. SLEEP Recommendations
Aim to go to bed around 9 to 9:30pm so that you can be asleep between the hours of 10pm and 2am. The NMT protocol suggests that growth hormone is released in large amounts between the hours of 10pm and 2am. Although this statement is not entirely true, sleep is definitely very important for the release of growth hormone, which is a major hormone involved in the rebuilding of skin. Ideally you want to maintain a consistent sleep schedule (wake up and go to bed at the same time everyday!).
7. Stay out of direct sunlight
Since we cannot apply sunscreen on this protocol, you want to stay out of direct sunlight. Wear a hat or use an umbrella when you go outside. Going outside is still recommended because it is important to get vitamin D. Sunlight also improves mood. Just make sure you stay in the shade as much as possible since the direct sunlight can cause irritation or damage to your unprotected and sensitive skin.
8. It is okay to scratch
You will feel itchy during this protocol. It is okay to scratch every once in a while. Remember, the goal is to focus on longterm healing. A little bit of scratching here and there will not have a major effect on your skin at the end of the day. So don’t waste time worrying about a little bit of scratching!
SUMMARY OF NMT
Avoid bathing and showering
The goal is to dry out the skin so that healthy skin underneath can come out
TSW skin is so sensitive that water will irritate the skin
Frequent washing removes good bacteria from the skin
You can use a cotton cloth or tower with water to clean areas of your body as needed
30-seconds to 1-minute showers may be allowed after about a month of strict NMT
Avoid soaps and shampoos if possible. Bar soaps may be used if needed
Avoid topicals
Avoid steroid creams and other medications such as immunosuppressant creams
Avoid all other topicals including moisturizers, creams, lotions, serums, sunscreen, make-up, and lip-balm
Limit fluid intake
If you are 50-60kg, aim for 1 to 1.5L of fluid per day
If you are 60-80kg, aim for about 1.2 to 1.6L of fluid per day
If you are 80-90kg, aim for about 1.3 to 1.8L of fluid per day
You are allowed a 20% increase to your daily amount if you sweat a lot due to exercise or your work
Stop water restriction if you are sick
Fluid from foods also count towards your daily fluid intake
Dinner should NOT exceed 200mL of fluid intake in that single meal
Diet Recommendations
Eat a balanced diet with adequate protein (aim for 1.2g of protein per kg of bodyweight per day)
Avoid foods high in salt
Avoid licorice
Eat dinner at least 3 hours before bed
Exercise Recommendations
Aim for 1 hour of exercise per day
Intensity should be enough to make you sweat but not enough to irritate your skin
Choose physical activities that you enjoy
After exercising, wipe sweat off with a cotton cloth or towel and allow skin to air dry
Clothing recommendations
Wear loose clothing because tight clothing acts as a moisturizer
Avoid wearing layers
Avoid covering yourself in blankets
Avoid gauze or bandages unless you are bleeding from an injury
Do not wrap or cover ooze. Allow it to air dry naturally
Sleep recommendations
Go to bed at 9 to 9:30pm so that you can be asleep between the hours of 10pm and 2am
Quality sleep produces growth hormone, which plays a major role in skin repair
Maintain a consistent sleep schedule everyday (wake up and sleep at the same time everyday!)
Stay out of direct sunlight
Go outside everyday but stay out of direct sunlight
Wear a har or use an umbrella if needed
Stay in shaded areas when outside
It is okay to scratch
Do not stress over a little bit of scratching
Left: Beryl before NMT, Right: Beryl after 3 months of NMT
