It seems like a crazy idea - refusing to use moisturisers on skin that is agonisingly dry - but for those who follow the no moisture protocol (aka no moisture treatment/therapy or NMT), the practice seems to work.
The theory is that skin which is readjusting to life after steroid use needs to relearn normal cycles of regeneration and repair, rather than relying on either topical steroid creams or moisturisers to make it work.
When someone stops using topical steroids after prolonged use, it’s as if their body has suddenly had a crutch taken away; it has to learn to walk again, unaided. The theory behind NMT is that this process is speeded up by forcing the body to work to repair itself without the aid of emollients, and by reducing the amount of water in the body.
It’s a radically challenging process, and it’s meant to be! It is a shock to the system in order to trigger healing.
NMT was pioneered by Dr Keji Sato in Japan. He admits patients to his hospital and monitors them closely, being extremely careful with the amount of fluid they drink or put on their body. His protocol comes with a whole host of other measures, as well as moisture restriction: rest, exercise, nutrition and environment all play their part. This means that an in-patient stay with Dr Sato is a very different NMT experience to going through it yourself, in your own home, possibly while still trying to work. So while, even in the best circumstances, NMT is never a walk in the park, some people are going to find the process easier and speedier than others.
So do what feels right and possible for you! Stress is never great for the skin, and you need all the comfort and support you can get if you're going through topical steroid withdrawal. Prepare yourself in advance seek the support and wisdom of the TSW community!
For more information about what NMT involves, see our article NMT: No Moisture Treatment Guide For Topical Steroid Withdrawal. And 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 Skin Salvation for when lips and eyes are cracked and extremely sore
Balmonds Natural Shampoo & Body Wash works as a soap-free, scent-free and irritant-free shampoo/body wash.
Balmonds offer information and support, whether you’re going through topical steroid withdrawal, looking for safe long-term management strategies or wondering whether your symptoms match the condition. For more information about TSW, its symptoms and how to manage them, go to the ITSAN website. Other hashtags to follow for peer-to-peer support: #thisisnoteczema #tsw #TSWFab5
Photo at the top of the page courtesy of Laurie Wills. Follow Laurie's topical steroid withdrawal on her instagram: @laurieskinstory
Current medical advice is not to use daily topical steroids continuously for more than two to four weeks; then the frequency should be tapered to twice weekly use.
Balmonds Skin Salvation makes a great emollient for dry skin during topical steroid withdrawal: it's soft, gentle, natural and feeds dry, fragile skin with essential nutrients for healing.
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.