No Moisturising Treatment (NMT) is a therapeutic protocol that emerged from Japan through the work of Dr. Kenji Sato in Hannan Chuo Hospital in Osaka.
NMT targets people experiencing topical steroid withdrawal (TSW)—a condition caused by the discontinuation of corticosteroids after prolonged use. NMT advocates for the complete avoidance of moisturisers and reduced water exposure, theorizing that it encourages the skin to restore its natural barrier functions and cortisol production, which might be disrupted by long-term steroid use.
NMT has gained significant traction among TSW communities with a plethora of shared success stories through social media. Despite this, it remains largely anecdotal in practice, with little clinical evidence in Western Medicine supporting its effectiveness. As a result, its benefits, challenges, and outcomes vary widely among users. Here, we explore the protocol, potential risks, and community insights.
Core Components of NMT
- Moisturiser Avoidance
NMT’s defining element is the strict elimination of creams, lotions, and other skin moisturisers. Proponents suggest that this allows the body to regain control of skin hydration and cortisol balance without relying on external substances. - Water Restriction
Water consumption is often limited during NMT, as proponents believe excessive water intake could hinder the body’s ability to regulate inflammation during TSW. Similarly, bathing is reduced to once every few days, typically without the use of soap or shampoo. - Lifestyle Adjustments
Regular exercise, restful sleep, and a nutrient-rich diet, particularly one high in lipids and proteins, are encouraged to support recovery. This holistic approach reflects the idea that skin health extends beyond topical applications.
A Controversial Protocol with Mixed Results
While NMT aims to restore the skin’s natural barrier function, experiences within the TSW community are divided. Some report improvements, such as reduced flares or exudation (weeping skin), within weeks, while others struggle with severe dryness, infections, and discomfort.
In Japan, Dr. Sato implements NMT in clinical settings, offering medical oversight for patients experiencing the harsh withdrawal symptoms. However, as it has spread to other parts of the world, many individuals attempt NMT independently—often modifying it to suit their personal circumstances.
In these cases, hybrid versions of NMT emerge. For example, some users apply moisturiser only to their face while adhering to NMT on other parts of the body. Others, due to their professional obligations, bathe more frequently than the recommended protocol allows. These variations, however, raise questions about the consistency and effectiveness of the approach when deviated from its original design.
Adoption Within Online Communities
NMT has gained particular traction among people in the TSW community who opt for the “cold turkey” approach—abruptly discontinuing steroid use rather than tapering off gradually. For these individuals, the no-moisturising protocol aligns with the philosophy of total withdrawal, following that eliminating all external interventions, including moisturisers, allows the body to recalibrate its natural barrier function and cortisol regulation more effectively.
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This approach reflects a desire for immediate detoxification, with many reporting that the strict avoidance of creams prevents dependence on external relief during the withdrawal process. However, given the intensity of symptoms that often accompany cold-turkey cessation—such as extreme dryness, itching, and flares—many in this subset of the TSW community find NMT to be both physically and emotionally challenging. These difficulties have prompted some to modify the protocol, using moisturisers selectively while attempting to follow the broader principles of NMT, highlighting the individualized nature of withdrawal journeys
Medical Supervision is Recommended
Given the absence of standardised treatments for TSW and limited clinical studies, health professionals emphasise the importance of medical supervision for those attempting NMT. The rigid nature of the protocol can present significant challenges, including heightened discomfort, bacterial or fungal infections, and emotional distress. Many in the community report exacerbated symptoms, such as anxiety, depression, and insomnia, which further complicate recovery.
Western dermatology has yet to adopt NMT widely, partly due to the lack of peer-reviewed research validating its efficacy. Without this it is difficult to establish NMT as a reliable method for TSW management, leaving patients to rely on anecdotal evidence from online support groups. This do not invalidate the lived experience and discredit the shared experiences of sufferers and their carers.
This does not diminish the value of lived experiences or discredit the shared journeys of healing and improvement from sufferers and their carers.
Community Feedback and Calls for Research
NMT’s popularity within the TSW community highlights a broader need for research and better medical guidance. Many individuals turn to community forums and Facebook groups to share their experiences, offer peer support, and explore new treatments. While these platforms provide valuable insights, they also underscore the risks of self-directed healthcare—especially for a complex condition like TSW.
The variability of individual responses to NMT reflects the challenge of treating TSW. No universal timeline or outcome exists; some patients experience significant progress, while others struggle to cope with prolonged symptoms. Until clinical trials or comprehensive studies emerge, NMT will likely remain a controversial and experimental approach when self-administered. Ultimately, shared data, processes, and insights between Japanese hospital protocols and Western healthcare will need to be explored.
Balanced Perspectives
Within the TSW Assist insights, NMT has emerged as an anecdotal solution trending in effectiveness for managing TSW. Ultimately, the conversation surrounding NMT reflects a broader challenge in TSW care—namely, the lack of evidence-based treatments and the reliance on anecdotal solutions. For now, those considering NMT are encouraged to seek medical advice and proceed cautiously, recognizing that every recovery journey is unique.
Further studies and scientific inquiry are essential to determine whether NMT can play a role in mainstream TSW management or if it remains a niche approach with limited applicability. As the TSW community continues to explore novel strategies, the hope is for the emergence of safer, evidence-based treatments that offer more consistent outcomes for all sufferers.
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