NMT Protocol

No Moisture Treatment by Dr. Kenji Sato

The text below is copied form Tokuko Kameda's translation of Dr. Kenji Sato's NMT Protocol used at Hannan Chuo Hospital in Osaka, Japan, with light edits for typos, clarity and updates.

----------------------------------------------------------------------------------------------------

First of all, a big thank you to Dr. Kenji Sato, for his dedication and his involvement in the treatment of RSS and TSW. And also to Ms Tokuko Kameda, who was a former patient of Dr. Kenji Sato, who achieved spectacular healing in 3 months at the hospital where Dr. Kenji Sato practises.

I will describe in the following paragraphs my learning from Tokuko with regards to Dr Sato’s method which does not require purchases of any products. To note, the method must be followed strictly and be under close monitoring by healthcare provider as it is rather unique.

This method is called NMT: No Moisturizing Treatment, i.e. "treatment without cream".

Often patients with TSW used cortisone, incrementally, and they also increase the dosages (protopic is also a part of them) after initial prescribed dosages no longer work and the skin got worse and worse. Fast forward 10, 20 or 30 years later, a heavy user TS patient will have this “RED SKIN SYNDROME”, it is like burnt skin, which oozes when scratched, and even oozes when without scratching, sometimes you feel cold... and your life just becomes a nightmare. The fastest method to be cured of this is the NMT - NO MOISTURE TREATMENT.

To follow the NMT, method you will have to be mentally strong, and believe in it, do NOT try to add other methods at the same time or modify it. Especially if you add creams or other moisturising products or processes, it will no longer be an NMT. You must understand that thoroughly. You have to be strong and follow through diligently.

Of course it is harder to do it alone at home without daily medical supervision than to have it at the hospital, so if healing takes a little longer than hospital inpatients - this is normal but the result will be rather similar.

On average, patients with TSW are cured within 3 months when they are monitored closely at the hospital. If it takes a lot more time for you, you may have missed something or a step, so try to read and learn NMT carefully again.

Kindly take note that NMT is used to overcome the addiction to corticosteroids but it will not cure you perfectly of your atopic dermatitis.

You have to learn the method by yourself, as long as you ask questions that have already been explained somewhere, that means you have not read the method well. We strongly recommend that you create a notebook and keep track closely.

Wishing you the fastest healing. Take back the control of your life! 💕💗

TOKUKO KAMEDA.

 

  •  long-term and / or strong use of steroids

  •  use of tacrolimus (protopic)

  •  use of moisturizers after stopping topical steroids

  •  taking bath and / or shower frequently and in long durations

  •  drinking large amounts of liquid, drink liquid at night!

  •  washing exudates (ooze) and / or scratch crust

  •  insufficient protein and fat intake

  •  being inactive/sedentary and taking bed rest during the day (bad)

  •  insufficient amount of exercise (bad)

  •  being told not to scratch

  •  poor management of psychological stress

  •  focusing on the wrong things signs: itching, pain, etc. instead of focusing on erosion symptoms, red, brown, white , exudate, crust, etc.

II

IiI

IV

  • APPLY NOTHING ON YOUR SKIN

  • Do not put on cortisone, do not take oral corticosteroid

  • Do not apply cream or oils.

  • Do not apply makeup.

  • Do not put  sun screen UV cream or other.

  • Do not stay in bed all day

  • Do not wrap affected parts with bandages or micropore tapes

  • Do not remove small pieces of dead skin

  • Do not wipe exudate/ooze, (it should be allowed to air dry)

  • Do not consume too much water.

  • Do not put sea salt or other in your bath (if you add anything to your bath, it is no longer NMT)

  • If you have chapped/dry lips it would be better to avoid putting balm or other moisturizing product on your lips

  • Do not go to the sauna etc ...

  • Don’t sleep during the day.

II

IiI

IV

Do not expose yourself to sunlight, (do not use anti-UV cream/ sun block or sun screen), wear a cap/hat, or use an umbrella to block sunlight especially when your skin is red, "burnt" etc.

 

It is absolutely necessary to do every step described here. You have to sleep between 10pm and 2am  they are called the “golden hours” or "happy hours" of the regeneration of the skin. This is not necessarily obvious but do as regularly as possible, especially in the beginning you will see the difference. If you have trouble falling asleep try to go to bed at 9pm or 9.30pm and get up early in the morning. You are allowed to take pills to help you sleep.

 

You have to do at least 1h of sports or workout per day, until you sweat. And of course you must avoid showering afterwards. You can split the work out into 2 or even 3 sessions, if you are afraid of sweating too much. Your heartbeat need to be at 120 bpm when you play sports, it's a great booster for your metabolism.

II

IiI

IV

  • THIS PART IS VERY IMPORTANT. There is a strict water/fluid restriction to be followed. This is the most difficult part of the NMT. During the first month you should NOT exceed 1L per day (in general per adult body weight) It's not just about the water you drink, it's about the water in your food:  fruits and vegetables. This part is crucial.  In the following month, you can increase fluid intake to 1.2L. The water/fluid limit depends on your weight - if you are between 50 and 60 kilograms you are allowed between 1L and 1.5L of water/fluid per day (if you sweat a lot because of sport and if you have erythrodermia/exfoliative dermatitis showing wide range of redness on the entire body, 20 % more water will be allowed. And between 1.3 and 1.8L of water for people who weigh between 80 and 90 kilograms.

    • UPDATE, per Dr. Sato:  "People need water, however the amount of water needed varies from person to person.  Some people need only about 1000 ml/day of water, which is a rare case, some other people need about 3000 ml/day, which is also a rare case.  Common people need about 2000-2500 ml/day.  So, a suitable amount of daily water intake is present for each person under certain condition [sic]"

  • As a rule of thumb:

    • If your urine is transparent / too bright it means that you took in too much water.

    • If your urine is dark yellow, dark orange, it means that you followed the right amount of water intake.

    • If your urine is reddish,, it means that you did not drink enough water/fluid.

    • If you suffer from erythroderma / exfoliative dermatitis with large parts of your body that are red, you can drink 20% more water.

    • If you sweat a lot while exercising, you can drink a little more. If you lose 500g weight after exercise, you will be able to drink additional 500ml of water to make up for the loss.

    • If you have a cold, flu or other disease with more than 38C degree of fever, stop the restriction of water, it would be dangerous to continue this, and drink as much as you need.

    • If you ooze too much it is certainly because  you took in too much water.

    • When you eat an apple, you have to weigh it, search on the internet the percentage of water contained in an apple and do the calculation yourself. It's the same for a  cup of yoghurt ... or any other food.

    • The water limitation is the key to success!

  • You have to COUNT the water contained in every food that you eat :

    • There is 50% of water in cooked chicken

    • There is 50% of water in rice

    • There 35% of water in bread

    • There is 80% of water in potatoes

  • The 1 liter liquid restriction is also about the liquid contained in your food. If you eat an orange, you should weigh it, and search on internet the percentage of water in an orange. If it’s 100g and the percentage of water is 80% it means that there is 80ml of liquid in your orange. You have to add those 80ml in your 1L daily limit. There is also water in rice, in chicken… every drop of water/fluid counts! it is not only about the water that you drink.

  • Dinner should be 3 hours  BEFORE going to bed, and during dinner the liquid intake should not exceed 200 ml. Example of dinner : 50 ml of fluid from chicken, 50 ml of  fluid from rice, 80ml of water” and 20 ml of fkuid from a fruit” (50ml of chicken will be around 90grams of chicken depending of how it is cooked)

  • You should avoid soy sauce, salty food, because it will leave you feeling more thirsty.

II

IiI

IV

  • During NMT, try to decrease the frequency of baths / showers but avoid wiping the body. The bath / shower is designed to prevent infections, so take them carefully, but finish them VERY quickly, ideally, 30 seconds, 1 minute, 3 minutes, etc. if possible with low pressured water. Do NOT rub your skin with a towel. Dab gently with a towel and then dry in the open air.* Hospital patients at Hannan Chuo Hospital usually take a shower every 3-4 days and no showers allowed when symptoms are severe for 1 month.The showers are there only to avoid infections. To limit infections, cut your nails very often and do not get your hands dirty to avoid washing them too often.Avoid water that is too hot because it will remove all your bacterial flora that is good for you.If you can shower without putting soap, this is better. Avoid liquid soaps because they are made with harmful manufacturing ingredient which is detrimental to your skin. If you need to use soap, use a hard soap.

  • Eat a healthy and varied diet, especially protein, lipids... (chicken, meat, etc.) your skin needs protein to regenerate. Do not forget to count the water/fluid included in rice, vegetables, meat etc. Water/fluid should not be drunk before sleeping, so it is advisable to have dinner around 5:30 pm or 6:00 pm to avoid eating and drinking just before bedtime

  • Do not wear gloves that will make your hands hot and sweaty. Gloves must be suitable for the outside temperature.

II

IiI

IV

  • DO NOT tear the ends of dead skin or pick on them. Let nature do it for you. This part is very important, if you don’t respect this, you will ooze again.

  • It is better not to scratch, but because it's a very itchy disease, nobody  can not tell you NOT to scratch, it's impossible unfortunately. So, when it is itchy, scratch it, and you just air dry it.  But there is this “reflex” scratch that you cannot avoid, sometime when you remove your pants you have this habits to scratch, but you don’t really feel itchy. This one you can avoid

  • If You feel lousy, miserable, weak, and other depressive mental state, remind yourselves this bad phase will pass. Some people started NMT in their 80s and they too healed. The months will past before you know it. If you need support and to vent, come to the group to talk about it and we could even meet up. Be strong -  we will win, we will overcome all that, we must try to stay positive even if it is not easy on a daily basis.

  • It is not recommended to use tools to scratch. It is better to scratch with your fingers, avoid scratching with your feet. And it is better to scratch over your clothes, it will be better for your skin.

II

IiI

IV

  • Do not feel bad after scratching, even a super hero with a cape and a red underwear could not resist the urge to scratch. You will see improvement little by little, do not worry too much. Follow the steps, and everything will be better.

  • The oozing/exudate (yellow liquid) has a distinctly awful smell. It is normal because it is protein, and will help you regenerate healthy skin, so do not wipe it, it must be allowed to air dry

  • If NMT does not work , you have unfortunately missed a step described in this manual, do not hesitate to ask questions in case of doubt.

II

IiI

IV

  • Do NOT use Cyclosporin, it will not help your immune defense system.

  • Do not be too much of a perfectionist, if you have cured 80% - this is is already great. Don’t forget how far you have improved in this journey.

  • NMT and MW (moisture withdrawal) are two different treatment methods - do NOT confuse the two.

  • If you have dry skin, do not worry it's even a good sign! Keep up the momentum going.

  • Do you think the situation is getting worse? Some days are better than others.  Do not worry -  it's all part of the process. If you scratch, let it dry and if you scratch again and let it dry again ... do not worry, it's normal.

II

IiI

IV

  • This is a typical daily routine for illustration:

    • wake up at the latest  by 7:30 am

    • sweep/ vacuum dead skins

    • change bedsheets - general house keeping

    • breakfast at 8am

    • morning jogging/sports

    • lunch at 12pm

    • afternoon jogging/sports

  • You should wear loose cotton clothes, for e.g. t- shirts and shorts if temperature is around 27C

 

  • Do not take/eat/apply liquorice (licorice), glycyrrhizin/glycyrrhizae radix. The names are different but they are the same ingredients that are normally contained in food, chinese medicines, cosmetics, even alcohol!. Once you have taken/used it, your brain and adrenals will be confused as though have begun to to use steroids again!

  • Be careful if you have asthma, it can get complicated with inhalers that contain corticosteroids. Discuss with your doctor. Make a test of Allergy PUCE ISAAC which is a very complete test, have it prescribed by your allergist.

II

IiI

IV

II

IiI

IV

The ORIGINAL TEXT as copied form Tokuko Kameda's translation of Dr. Kenji Sato's NMT Protocol used at Hannan Chuo Hospital in Osaka, Japan, with light edits for typos and clarity.

----------------------------------------------------------------------------------------------------

First of all, a big thank you to Dr. Kenji Sato, for his dedication and his involvement in the treatment of RSS and TSW. And also to Ms Tokuko Kameda, who was a former patient of Dr. Kenji Sato, who achieved spectacular healing in 3 months at the hospital where Dr. Kenji Sato practises.

I will describe in the following paragraphs my learning from Tokuko with regards to Dr Sato’s method which does not require purchases of any products. To note, the method must be followed strictly and be under close monitoring by healthcare provider as it is rather unique.

This method is called NMT: NO Moisturizing TREATMENT, i.e. "treatment without cream".

Often patients with TSW used cortisone, incrementally, and they also increase the dosages (protopic is also a part of them) after initial prescribed dosages no longer work and the skin got worse and worse. Fast forward 10, 20 or 30 years later, a heavy user TS patient will have this “RED SKIN SYNDROME”, it is like burnt skin, you ooze when you scratch, you ooze even when you don’t scratch, sometimes you feel cold... and your life just becomes a nightmare. The fastest method to be cured of this is the NMT - NO MOISTURE TREATMENT.

To follow the NMT, method you will have to be mentally strong, and believe in it, do NOT try to add other methods at the same time or modify it.Especially if you add creams or other moisturising products or processes, it will no longer be an NMT. You must understand thoroughly. You have to be strong and follow through diligently.

Of course it is harder to do it alone at home without daily medical supervision than to have it at the hospital, so if healing takes a little longer than hospital inpatients - this is normal but the result will be rather similar.

On average, patients with TSW are cured within 3 months when they are monitored closely at the hospital. If it takes a lot more time for you, you may have missed something or a step, so try to read and learn NMT carefully again.

Kindly take note that NMT is used to overcome the addiction to corticosteroids but it will not cure you perfectly of your atopic dermatitis.

You have to learn the method by yourself, as long as you ask questions that have already been explained somewhere, that means you have not read the method well. We strongly recommend that you create a notebook and keep track closely.

Wishing you the fastest healing. Take back the control of your life! 💕💗

TOKUKO KAMEDA.

According to Dr. Kenji Sato, here are the factors that aggravate, lead to TSW and prolong the healing process of TSW:
1. long-term and / or strong use of steroids
2. use of tacrolimus (protopic)
3. use of moisturizers after stopping topical steroids
4. taking bath and / or shower frequently and in long durations
5. drinking large amounts of liquid, drink liquid at night!
6. washing exudates (ooze) and / or scratch crust
7. insufficient protein and fat intake
8. being inactive/sedentary and taking bed rest during the day (bad)
9. insufficient amount of exercise (bad)
10. being told not to scratch
11. poor management of psychological stress
12.focusing on the wrong things signs: itching, pain, etc. instead of focusing of erosion symptoms, red, brown, white , exudate, crust, etc.

HERE are the rules of NMT :

APPLY NOTHING ON YOUR SKIN
Do not put on cortisone, do not take oral corticosteroid
Do not apply cream or oils.
Do not apply makeup.
Do not put  sun screen UV cream or other.
Do not stay in bed all day
Do not wrap affected parts with bandages or micropore tapes
Do not remove small pieces of dead skin
Do not wipe exudate/ooze, (it should be allowed to air dry)
Do not consume too much water.
The cure will be longer if you do not follow these steps
Do not put sea salt or other in your bath
If you have chapped/dry lips it would be better to avoid putting balm or other moisturizing product on your lips
Do not go to the sauna etc ...
If you add anything to your bath, it is no longer NMT
Don’t sleep during the day.


II. Do not expose yourself to sunlight, (do not use anti-UV cream/ sun block or sun screen), wear a cap/hat, or use an umbrella to block sunlight especially when your skin is red, "burnt" etc.

III. It is absolutely necessary to do every step described here. You have to sleep between 10pm and 2am  they are called the “golden hours” or "happy hours" of the regeneration of the skin. This is not necessarily obvious but do as regularly as possible, especially in the beginning you will see the difference. If you have trouble falling asleep try to go to bed at 9pm or 9.30pm and get up early in the morning. You are allowed to take pills to help you sleep.
IV. You have to do at least 1h of sports or workout per day, until you sweat. And of course you must avoid showering afterwards. You can split the work out into 2 or even 3 sessions, if you are afraid of sweating too much. Your heartbeat need to be at 120bpm when you play sports, it's a great booster for your metabolism.

V. THIS PART IS VERY IMPORTANT. There is a strict water/fluid restriction to be followed. This is the most difficult part of the NMT. During the first month you should not exceed 1L per day (in general per adult body weight) It's not just about the water you drink, it's about the water in your food:  fruits and vegetables. This part is crucial.  In the following month, you can increase fluid intake to 1.2L. The water/fluid limit depends on your weight - if you are between 50 and 60 kilograms you are allowed between 1L and 1.5L of water/fluid per day (if you sweat a lot because of sport and if you have erythrodermia/exfoliative dermatitis showing wide range of redness on the entire body, 20 % more water will be allowed. And between 1.3 and 1.8L of water for people who weigh between 80 and 90 kilograms.
 
 
As a rule of thumb:
If your urine is transparent / too bright it means that you took in too much water.
If your urine is dark yellow, dark orange, it means that you followed the right amount of water intake.
If your urine is reddish,, it means that you did not drink enough water/fluid.
If you suffer from erythroderma / exfoliative dermatitis with large parts of your body that are red, you can drink 20% more water.
If you sweat a lot while exercising, you can drink a little more. If you lose 500g weight after exercise, you will be able to drink additional 500ml of water to make up for the loss.
If you have a cold, flu or other disease with more than 38C degree of fever, stop the restriction of water, it would be dangerous to continue this, and drink as much as you need.
If you ooze too much it is certainly because  you took in too much water.
When you eat an apple, you have to weigh it, search on the internet the percentage of water contained in an apple and do the calculation yourself. It's the same for a  cup of yoghurt ... or any other food. The water limitation is the key to success.

You have to COUNT the water contained in  every single food that you eat :
There is 50% of water in cooked chicken
There is 50% of water in rice
There 35% of water in bread
There is 80% of water in potatoes

The 1 liter liquid restriction is also about the liquid contained in your food. If you eat an orange, you should weigh it, and search on internet the percentage of water in an orange. If it’s 100g and the percentage of water is 80% it means that there is 80ml of liquid in your orange. You have to add those 80ml in your 1L daily limit. There is also water in rice, in chicken… every drop of water/fluid counts! it is not only about the water that you drink.

Dinner should be 3 hours  BEFORE going to bed, and during dinner the liquid intake should not exceed 200 ml. Example of dinner : 50 ml of fluid from chicken, 50 ml of  fluid from rice, 80ml of water” and 20 ml of fkuid from a fruit” (50ml of chicken will be around 90grams of chicken depending of how it is cooked)

You should avoid soy sauce, salty food, because it will leave you feeling more thirsty.

VI. During NMT, try to decrease the frequency of baths / showers but avoid wiping the body. The bath / shower is designed to prevent infections, so take them carefully, but finish them VERY quickly, ideally, 30 seconds, 1 minute, 3 minutes, etc. if possible with low pressured water. Do NOT rub your skin with a towel. Dab gently with a towel and then dry in the open air.
* Hospital patients at Hannan Chuo Hospital usually take a shower every 3-4 days and no showers allowed when symptoms are severe for 1 month.
The showers are there only to avoid infections. To limit infections, cut your nails very often and do not get your hands dirty to avoid washing them too often.
Avoid water that is too hot because it will remove all your bacterial flora that is good for you.
If you can shower without putting soap, this is better. Avoid liquid soaps because they are made with harmful manufacturing ingredient which is detrimental to your skin. If you need to use soap, use a hard soap.

VII. Eat a healthy and varied diet, especially protein, lipids... (chicken, meat, etc. ..) your skin needs protein to regenerate. Do not forget to count the water/fluid included in rice, vegetables, meat etc. Water/fluid should not be drunk before sleeping, so it is advisable to have dinner around 5:30 pm or 6:00 pm to avoid eating and drinking just before bedtime

VIII Do not wear gloves that will make your hands hot and sweaty. Gloves must be suitable for the outside temperature.

IX DO NOT tear the ends of dead skin or pick on them. Let nature do it for you. This part is very important, if you don’t respect this, you will ooze again.

X. It is better not to scratch, but because it's a very itchy disease, nobody  can not tell you NOT to scratch, it's impossible unfortunately. So, when it is itchy, scratch it, and you just air dry it.  But there is this “reflex” scratch that you cannot avoid, sometime when you remove your pants you have this habits to scratch, but you don’t really feel itchy. This one you can avoid

XI. if You feel lousy, miserable, weak, and other depressive mental state, remind yourselves this bad phase will pass. Some people started NMT in their 80s and they too healed. The months will past before you know it. If you need support and to vent, come to the group to talk about it and we could even meet up. Be strong -  we will win, we will overcome all that, we must try to stay positive even if it is not easy on a daily basis.

XII. it is not recommended to use tools to scratch. It is better to scratch with your fingers, avoid scratching with your feet. And it is better to scratch over your clothes, it will be better for your skin.

XIII. Do not feel bad after scratching, even a super hero with a cape and a red underwear could not resist the urge to scratch. You will see improvement little by little, do not worry too much. Follow the steps, and everything will be better.

XIV The oozing/exudate (yellow liquid) has a distinctly awful smell. It is normal because it is protein, and will help you regenerate healthy skin, so do not wipe it, it must be allowed to air dry

XV If NMT does not work , you have unfortunately missed a step described in this manual, do not hesitate to ask questions in case of doubt.

XVI Do NOT use Cyclosporin, it will not help your immune defense system.

XVII Do not be too much of a perfectionist, if you have cured 80% - this is is already great. Don’t forget how far you have improved in this journey.

XVIII NMT and MW (moisture withdrawal) are two different treatment methods - do NOT confuse the two.

IIXX. If you have dry skin, do not worry it's even a good sign! Keep up the momentum going.

IXX Do you think the situation is getting worse? Some days are better than others.  Do not worry -  it's all part of the process. If you scratch, let it dry and if you scratch again and let it dry again ... do not worry, it's normal.

XX: This is a typical daily routine for illustration:
wake up at the latest  by 7:30 am
sweep/ vacuum dead skins, change bedsheets - general house keeping
breakfast at 8am
morning jogging/sports
lunch at 12pm
ffternoon jogging/sports

XXI: you should wear loose cotton clothes, for e.g. t- shirts and shorts if temperature is around 27C

Do not take/eat/apply liquorice (licorice), glycyrrhizin/glycyrrhizae radix. The names are different but they are the same ingredients that are normally contained in food, chinese medicines, cosmetics, even alcohol!. Once you have taken/used it, your brain and adrenals will be confused as though have begun to to use steroids again!

Be careful if you have asthma, it can get complicated with inhalers that contain corticosteroids. Discuss with your doctor. Make a test of Allergy PUCE ISAAC which is a very complete test, have it prescribed by your allergist.
 
Source of reference:

http://tokuko.chu.jp/tokukonoheya/2017/11/25/how-to-get-over -topical-steroid-withdrawal-asap /? fbclid = IwAR0Ykq5iHr9rSanzezYugi783MGVWc_W1sbvpapjG0wvKPIbcj7L3UymIw4
http://tokuko.chu.jp/tokukonoheya/2018/06/15/what-can-be-moisturizers-for-fellows-launching-no-moisturizing-treatment /? fbclid = IwAR1KHgJSNktli0Ge-JVpO0HBJBbD6X99aGbDraXADP9eC2YKIJVweCsAvmQ


And the facebook group NMT:

And the facebook group of supports French (not NMT): https://www.facebook.com/groups/551554324983978/

http://www.itsan.org