I recommend Dr. Kenji Sato‘s ‘No Moisturizing Treatment‘ (NMT) in my blog for Topical Steroid Withdrawal (TSW) sufferers due to my long experience of Atopic Dermatitis and healing from VERY severe TSW with it.
***NMT is the method for TSW but not for the perfect healing of Atopic Dermatitis (AD). Human beings still can’t find out the etiology of AD except filaggrin gene.
Every time I update my Japanese blog in English, I receive hundreds of messages/comments/inquiries a day via comment columns of my blog and SNSs from all over the world. That means so many TSW sufferers have been lost in their journey looking for good remedy.
A lot of people have already tried MW (Moisture Withdrawal) but NMT is different from it and very drastic method to avoid letting your skin moisturize. It was developed by Dr. Sato based on his many experiences with TSW patients for a long time. Some doctors might announce desk theory to let younger doctors see patients but Dr. Sato has been seeing TSW patients in everyday clinical practice and that is why his theory works for patients.
He is the leader against Topical Steroids in Japan.
It is noteworthy that he had noticed danger of Topical Steroids, Protopic and Neoral early on in his career. This fact must make you realize his diagnostic ability. If you were seen by him, you’d feel safe with his skilled accurate diagnosis and observations, however, since it is difficult to come to Japan to be seen by him for people in foreign countries, and his books haven’t been translated to other languages yet, I’ll keep sharing detailed information of his method for such sufferers and patients who can’t meet experienced dermatologists for TSW.
Well, in the hospital, Inpatients are discharged from hospital 45 to 90 days later usually. Before leaving, they often visit other inpatients’ rooms to encourage so I had seen their conditions were VERY good then, in fact, it was hard to find out affected parts on them. I realized that healing tended to happen at the very end of the process but it was much faster than I expected.
Especially, the fact that no one applies ointments or cream or oil or any other moisturizers to be healed like that was amazing for me.
Today, I’ll try to explain about moisturizers subjected above to accomplish NMT but this is only for people who set themselves seriously to ‘No Moisturizing Treatment (NMT)’.
It is VERY tough for the time being because you have to dry your dry skin and it looks like as if the symptom got worse from the first stage to the very end of one in NMT. Dry skin covered with a lot of crusts looks like horrible aggravation sometimes for us, meaning for non-professionals, but the symptom is the process of healing.
Skin needs to dry before healing.
Remember when you got injured. The part develops a scab first and under the scab, new skin is produced preventing invasion by bacteria/germs at the same time. Then after the affected part dried to finish making healthy skin, the scab comes off naturally.
Imagine this. If you moisturize the injured part over and over with moisturizers, the skin can’t dry and it inhibits generating a scab to be healed. If you peeled off the scab before drying in the middle of healing, it takes longer time because your body has to make a scab again. Besides, if you moisturize the injured fresh part, it is as if you keep the part wetting. I guess process of healing of NMT is the same thing with this. Again, skin needs to dry before healing.
Before you read explanations of moisturizers, please check out one of my posts below to know NMT.
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Well, let me explain what can be moisturizers to accomplish ‘No Moisturizing Treatment‘(NMT).
In the public mind, since dry skin induces itch, medical professions tend to advise you to moisturize skin. Also, increasingly fevered Moisturizing boom due to commercial strategies reflects attitudes and values prevailing in society.
However, you don’t apply any ointment or cream or oil or any other moisturizers in NMT, I mean, you apply nothing on your skin during the process of NMT.
If you are a sufferer of Atopic Dermatitis (AD) or TSW, it must be easy to imagine how tough it is. I also was scared before I tried to do it and it was a fight against pain for a while after I started it. Most of AD/TSW sufferers have dry skin so if you leave affected parts dry, you will get many cracks here and there….I know you also are the same.
However, eventually, this is going to function beautifully. You’ll dry your dry skin without applying anything anyway and it is the major protocol of this treatment.
Besides, this method is not only drying your skin but avoiding to take a bath and a shower as much as possible.
Taking a bath and a shower let shed your moisturizing ingredients into the water and can be moisturizers at the same time.
So as long as you take this treatment, you need to try to diminish numbers of times. When you do it, you have to finish in a VERY short time.
I guess, you imagined like, “5 mins or 10?”……Uh-oh…….Nope!
Dr. Sato sometimes says, “You are authorized 2 sec.”…………lol He likes joking but it is serious in a sense. This means, we have to finish it SO quickly.
While we are in the hospital, we take a shower once 3 days or 4 days and try to finish it in several tens of seconds.
Also, no one washes their faces even in the morning. We have to dry our skin and needs to generate moisturizing ingredients by ourselves at the same time.
If your symptom is severe, of course you shouldn’t take a bath/a shower definitely because you will run protein from the surface of the skin into the water. Crusts (flakes) and ooze are made of protein and that is important nutrition to produce new skin. You shouldn’t lose it.
Per Dr. Sato, the main reason to take a shower is to avoid infectious diseases diminishing bacteria on your skin. At the same time, if you take a bath/a shower very often, it washes away generated antibacterial substances but not only being lost moisture through the skin.
Also, when you take a shower, please don’t forget that the water pressure should be very low.
Before I know this method, while I was taking bed rest at home with VERY severe symptoms, was taking a bath everyday without knowing that it was very dangerous action. The water turned to be white in a short time because flakes (crusts) covering all over my body peeled off in the bath tub or ooze ran into the water.
When I entered the hospital to be seen by Dr. Sato, I knew that I had severe hypoalbuminemia. Maybe it had been happening every time my TSW turned to be severe in the past because my fatigue was horrible at that time but I didn’t realize it and doctors who I was seen also hadn’t noticed it.
It turned to be the primary (major) sickness after all though my TSW was VERY severe when I entered the hospital. This is one of the reasons that I keep advising you to be seen by a doctor sometimes as checkups even if you have to take home remedy. There are medical profession’s portions when you get over sicknesses all the time including diagnosis of infection too.
I understand your feeling that it will be a relief to wash away crusts or ooze that smells bad in the bath tub, however, avoiding frequent bath/shower is very important for prompt healing. If you do it often, it can be dangerous too.
Hot springs also can be moisuturizers.
Each country has different customs instead of hot springs (i.e. Sauna, Jjimjilbang, etc….) but we have a custom to enjoy hot springs in Japan. Dr. Sato doesn’t recommend them. Although there are doctors who recommend ‘hot spring treatment’ even among anti TS doctors, as an experiencer, I agree with the theory that hot springs can be moisturizers. It might look as if you get well after taking it due to components in hot springs but until the day you feel healing happened, I also don’t recommend such activities. Count them as moisturizers.
As for other customs in your country, I don’t know them very well but either way, if you get warm in the bath tub or anything, you usually feel itchy so until you get better, the restriction will be a sound choice. Or don’t stay in it for a long time to avoid itch.
If possible, please try not to use Soap.
When you have to use it, take soap bars but not liquid soap. Also, don’t take soap bars that say they are good for your sensitive skin, or good for atopic dermatitis, or additive free, or moist feeling, or moisture-rich, etc…because such soap tends to have moisturizing effects.
When they make liquid soap, surface-activating agent (surfactant) is used definitely. Do you know what it is made from? It is a petrochemical product.
Also, liquid soap remains ‘in’ your skin even if you believe you washed it away.
Using Shampoo also is not recommended.
It can be a moisturizer.
Wash your hair with good temperature shower water only. We call it ‘Yu-Sham’ that means hot water shampoo, not using shampoo actually.
When you really want to use shampoo, use soap bars making a lather with it instead of shampoo.
After you got well, shampoo also might be ok but don’t use ones that include surface-activating agent (surfactant) or rinse or conditioner or treatment.
We have been manipulated by commercial strategy of companies and everybody shampoos or takes a shower everyday lately, however, human beings haven’t done it so often originaly, I mean, we didn’t do it very often long time ago. It is the custom companies made on purpose to sell products.
However, once you imagine about the restriction of taking a bath/a shower, you would worry about the smell from oozing skin. Since it includes very important nutrition, meaning, protein, it smells so bad. Unfortunatelly, there’s no way around.
However, protein works to produce your new skin and it is necessary for your healing definitely.
Please do not rinse ooze and just try to dry the affected parts.
After ooze dried, I know youk feel intense itch so you will scratch the parts definitely but still, you should dry the parts again not to wipe it off. It will happen over and over in the process.
Repeating the process, your skin is getting stronger eventually. The process is so hard and I know that you will completely disappoint yourself every time you scratch all crusts off but nevertheless skin needs to be dried before healing. If you added moisturizer, it will obstruct the healing. Dr. Sato fully knows it is sickness to feel itchy so it is ok to scratch.
And remember this. To wipe off ooze can be a moisturizer. It makes it more difficult to dry your skin.
After excercise, what should you do?
Dr. Sato recommends to work out every day to boost metabolism. It helps producing new skin.
In case you get sweaty, do you think you can take a shower every time?
…..Nope. Still, take a shower/bath once 3 or 4 days. Just dry your skin naturally.
For drenching sweat, wipe it just like touching your skin gently to absorb it with a dry cotton towel. Please do not scrab with it.
In the hospital, inpatients work out every day so eveybody gets sweat very often. Even in summer, they dry sweat naturally or absorb dropping sweats with a dry cotton towel. (Again, do not scrab. Just touch it with a towel gently).
I explain this saying ‘they’…..because I wasn’t able to walk first in the hospital due to severe symptom and after a while, was able to walk slowly. So I couldn’t work out very well, but still, even such a person got it over within 90 days with NMT.
Everytime I explain about sweat and frequency of a shower/bath, some people send me questions like ‘I feel itchy after I got sweat so I can’t do this. What should I do?’
….Ahem….I understand it. Evrybody is the same with you. Yep. I agree……but…..
I don’t need reposrts what you CAN’T do from all over the world….LOL! You should do only things you can do so you don’t need to show me reasons that you can’t do it…..
I’m telling you. If you do Dr. Sato’s NMT thoroughly following the direction in other post above, TSW sufferers will see significant improvements within 45 to 90 days. All of his patients who used to be in the hospital can be testimonies of prompt recovery. In other words, since we followed his protocol strictly, we could get it over within that time frame.
If you can’t make it, healing takes longer than that. No more and no less. You have the freedom to choose treatments. I just can explain the best method and can say if you follow the method strictly, you can get it over the fastest. Everybody has situation so please don’t worry too much not to be able to do it.
Anyway, in case you feel itchy due to sweat, you can take a shower….but only 5 sec or so, I recommend. I’m not joking. We take such a strict way in the hospital and that’s why we get it over so fast.
This also must be a surprise for you but to apply gauzes thick
or putting lots of bandages on can be moisturizers.
You understand the feeling that your skin contains moisture and humidity inside them, don’t you? If you wrapped a part up in a bandage, you can’t evaporate humidity through the skin.
NMT’s protocol is dry the affected parts and encourage producing new skin, so you don’t apply anything including gauzes and bandages basically.
It is ok to put a piece of gauze on the afffected part only cutting it the same size with the part in case your skin can’t make a scab easily due to a lot of ooze. It is applied instead of scabs so one piece only in any situation.
After it started to peel, cut off the dried part only and leave the rest of it as is.
You can take a shower with the gauze as is and it is ok to leave it on the skin up to one week.
**Gauze should be washed with water in advance to avoid the stimulation of gauze itself and antiseptic.
Even if your skin looks so bad, you don’t apply anything or don’t put bandages on. Just dry it.
I had never tried such a treatment in my long experience of Atopic Dermatitis. I used to apply Topical Steroids or something always when it got worse in the past and put on bandages for raw skin. It was a common sense of treatment for skin problems for me.
However, this method defied conventional wisdom. It was a big surprise for me because skin was generated the fastest than any other treatments.
During TSW, you sometimes feel shivering cold.
However, to stay in blankets or thick top covers or
comforters can be moisturizers.
When you sleep, it is unavoidable not to catch a cold but adjust the room temperature and try not to stay in bed all day long. It definitely is a moisturizer.
Even if you are staying out of comforters, if you wear wind breakers or thick clothes, or etc….the outfit can be a moisturizer.
Are you sick and tired of hearing these strict restrictions already?….lol I understand your feeling very much because I also have chattered my teeth due to feeling of shivery cold but if you accomplish them radically, healing happens faster. I promise.
The Air Flow in the clothes also is important.
The moisture-containing air due to your body temperature can be a moisturizer.
In Hannan Chuo Hospital, I used to wear a thin cotton big T-shirt and a pair of big thin cotton short pants. Inpatients are not recommended thick clothes. Thin clothes that allow air to pass through easily are ideal.
If you put your shirt into pants, that also can be a moisturizer. You know what I mean?
Think about the air flow even inside clothes all the time and dry your skin. See? This treatment is such drastic.
Because of ooze, you might be wearing towels around your neck but it can be a moisturizer.
Before I knew NMT, I used to put a thick gauze towel around my neck because ooze was dropping, however, if it is running, just absorb only drops with the gauze gentlly and dry the part wearing an open necked cotton shirt.
Again, ooze is necessary for healing. Don’t wipe it off.
High-necked collar shirt and Turtleneck shirt also can be moisturizers.
Face guards and masks also are moisturizers.
TSW sufferers prefer to peel crusts off…..lol We tend to do it but to keep a skin pliable can be a moisturizer to be exact. Healing takes longer if you do it.
Water restriction makes big difference for healing.
If you take too much water, excess fluid remains in subcutaneous tissue. It can be the cause of edema/swollenness and can be a moisturizer.
Especially, don’t drink much water at night or before you go to bed.
I checked with Dr. Sato regarding water restriction before I post this because I receive so many inquiries about it. Below is the translation of his explanation. The quantity of water includes fruits, yogurt, jelly, pudding, etc…Not only water.
The water restriction for TSW is approximately from 1,000 to 1,500 ml per a day for people weighing 50 – 60 kg. Might be ok from 1,300 to 1,800 ml per a day for people weighing 80 – 90 kg.
However, if you have erythrodermia/exfoliative dermatitis showing wide range of redness on the entire body, 20 % more water will be allowed.
If you got sweat a lot after exercise, you could drink additional water checking the change of your weight. If you disregard the sweat absorbed in your clothes, you can take additional 500 ml water in case you lost 500 g. However, if you got sweat a lot and it was absorbed in the clothes, you need to consider it too.
In case you have a cold or something and have a fever more than 38 ℃, you should stop water restriction and drink water as you would like.
(Thanks Dr. Sato! This is the perfefct explanation for us!)
I really want to help many TSW fellow sufferers because I fully know how tough it is. That’s why I share the information taking time though English is not my first language and if I could help as many people as possible, it would be my pleasure. However, during the process, since you need to bear hardship going through this treatment for a while and it can be as if it is getting worse during the drying process, I have a concern.
The thing is……If you don’t take exact way or if you added your original method though NMT should be done precisely, healing takes longer. Or if you can’t be patient due to pain or your compelling situation and quit it in the middle of the procedure that looks like aggravation, you won’t learn how great it is. And then, if you announced ‘This was not good…..It didn’t work for me!’, with the approaches above, so many TSW patients would miss this great method.
Please understand that you have responsibility for that. So if you have strong intention to accomplish it, I definitely recommend you take it reading my explanation carefully. It is the fastest way to get over TSW and you also can be a testimony.
In addition, as I always mention, this should be done with proper monitoring by physicians as checkups. if your symptom is diagnosed as ‘Not dangerous.’, just be patient and wait until healing happens. Just wait. You might repeat to scratch and dry, scratch and dry, scratch and dry…..but your skin is getting stronger little by little and then, healing happens to you.
Dr. Sato fully knows that it is itchy sickness and itches are uncontrolable. You can’t help it. He says, ‘It is ok to scratch because this sickness has a certain symptom with itches. It’s such sickness. Scratch and dry, scratch and dry, scratch and dry…but last scratch should be done gentlly at least. Your skin will be stronger gradually.’
You can scratch in NMT. Again, everyone, you should know that you MAY scratch because no one can control it. Don’t be disappointed after you scratched.
Please don’t concentrate on seeing affected parts only. See the parts that got well. Do not expect 100% in any situation. No need to do the comparison with others.
Such mind also can help your healing.
Do you notice that there are grateful things here and there all the time? Even in your current situation, there should be many. Remember this. You are experiencing this journey to find them out in spite of suffering.
The day will be soon. Trust your natural healing ability.
Hang in there!! Good luck!
**Please don’t misunderstand this. There’s no data in the world about frequency of TSW and no one can proove if it won’t happen any more for good. It is the scary point of side-effect of medications. You just can be healed from your current TSW shortly with this method. Also, this doesn’t mean it can change your original body composition or your original sickness though most of us feel it gets much better than before.
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