by Lindsay Mailloux, PharmD Candidate
We have all experienced it before. Whether it be a bug bite, a case of poison ivy, or the annoying t-shirt tag rubbing against your neck, you know what it feels like to have an itch. These cases usually have an easy solution—scratch your arm, cut off that tag, or maybe even apply some hydrocortisone cream. However, if you or your child is one of the many individuals who suffer from atopic dermatitis, more commonly known as eczema, you know the solution is not so simple.
Atopic dermatitis is the most common skin disease among children, affecting 20% of children in the United States and other developed countries.1 This skin condition usually starts affecting individuals during infancy and lasts into adulthood.2 Because atopic dermatitis acts like an allergic reaction, it cannot be cured—only managed. For less severe cases, the symptoms of itchy, dry, and irritated skin are usually treated with regular use of hypoallergenic moisturizers and maybe the occasional use of hydrocortisone cream for the bad flare-ups.2 Other non-medical practices can be used, such as applying lotion immediately after taking short baths to trap the moisture on the skin. Another handy tip is to keep nails clean and short to avoid damage to the skin from scratching.2 However, these measures are not always sufficient for the more severe cases of eczema, and individuals may have to resort to more intensive drug measures like taking prescription oral corticosteroids.1 Because these drugs have more serious side effects, especially for children, researchers are looking for better alternatives.
One study published this year suggests a new type of treatment called “wet-wrap” therapy. In this technique, a child with eczema takes a 10 to 20 minute warm bath and then rubs a moisturizer and medicated cream into his or her skin. The child is then wrapped in wet clothing to “trap” the medication and dressed in additional dry clothing over top. After a minimum of two hours, the wet clothing is removed.1 The goal of this therapy is to reduce irritation and help restore overall health and hydration of the skin. In this prospective cohort study, seventy-two children with moderate-to-severe cases of eczema were treated with wet wraps to test if the therapy improved their condition. However this study was limited by the fact that it did not have a control group for comparison, and its results cannot be generalized to adults.1
The study showed two major benefits of wet wrap therapy not seen with typical treatment. The first is that wet wraps were found to increase the effectiveness of a weaker medication, thus avoiding the need for a stronger drug with more worrisome side effects. Secondly, this technique was actually shown to help heal the skin and provide relief for a month after treatment.1
Since wet wrap therapy was first introduced about twenty years ago, various studies have shown its significant potential in treating eczema. One study showed that wet wrap therapy improved children’s eczema by an average of 74% when compared to their original condition. 3 In addition, a review of multiple studies determined that using wet wrap dressings with a medicated cream was both a safe and effective treatment.4
However, it is important to recognize that this treatment is currently only used for more severe cases of atopic dermatitis under the direct supervision of health care providers. One opinion from medical experts explains that wet wraps are currently used as a “safe crisis intervention.”5 This means that the technique should only be used in severe cases of eczema when the patient is too young to safely use prescription oral drugs. Another important point this expert makes is that use of wet wraps can result in side effects including lowering the activity of your adrenal glands or increased risk of bacterial infection. 5,6
One reason that this new practice is not used outside of the instruction and supervision of a health care provider is because of the complication of the process and the various methods of accomplishing it. One article pointed out that an official wet wrap method has never been established. For instance, various types of medicated creams and bandages have been used as well as different lengths of time for keeping the wraps on the skin. This lack of standardization makes it difficult even for health care providers to recommend wet wrap therapy.6
Current evidence strongly suggests that wet wrap therapy has definite potential as a safe and effective treatment for eczema. However, the major downside of this therapy is how complicated it is to use. At this point, it is not a good idea to try it out without supervision of a health care provider. But keep an eye out for guidelines on wet wrap therapy— this may be a huge area of treatment just around the corner. Also, consider asking your doctor about wet wraps if you or your child is losing the fight against that itch!
What are your thoughts? Do you think the benefits outweigh the risks? What other similar techniques would you recommend in the fight against the eczema itch?
- Nicol NH, Boguniewicz M, Strand M, Klinnert MD. Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program. The Journal of Allergy and Clinical Immunology: In Practice. 2014;2(4):400-406.
- Krinsky DL, Berardi RR, Ferreri SP, et al. Handbook of nonprescription drugs: An interactive approach to self-care. 17th ed. Washington, D.C.: American Pharmacists Association; 2012.
- Wolkerstorfer A, Visser RL, De Waard FB, Van DS, Mulder PGH, Oranje AP. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: Influence of corticosteroid dilution. Br J Dermatol. 2000;143(5):999-1004.
- Devillers A, Oranje A. Efficacy and safety of ‘wet‐wrap’ dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: A critical review of the literature. Br J Dermatol. 2006;154(4):579-585.
- Oranje AP. Evidence – based pharmacological treatment of atopic dermatitis: An expert opinion and new expectations. Indian J Dermatol. 2014;59(2):140-142.
- Devillers ACA, Oranje AP. Wet-wrap treatment in children with atopic dermatitis: A practical guideline. Pediatr Dermatol. 2012;29(1):24-27.