Skin Care World

Atopic eczema (also known as atopic dermatitis) is a common condition, especially in children, ranging from mild flexural involvement to severe and chronic inflammatory disease that can persist for years. Most children will outgrow their eczema but for some it can persist into adulthood.

Wet wrapping is a technique used in the treatment of atopic eczema when the condition has not responded to the first-line management of emollients and topical corticosteroids. It consists of a layer of warm, wet Tubifast 2-Way Stretch bandage or Garment covered by a corresponding layer of dry Tubifast 2-Way Stretch bandage or Garment. Emollients, with or without topical corticosteroids, are applied before the bandaging is put in place. The wet wrap technique is aimed at rehydrating and cooling the skin and reducing inflammation through increased absorption of topical corticosteroids which in turn reduces the itch-scratch cycle (1).

Clinical research reported on the successful use of emollient-antiseptic preparations with wet wrap dressings on six subjects (three children and three adults) with acute exacerbated atopic eczema. The most pronounced changes reported were for itch and sleep loss. The improvement in the condition of the skin lasted beyond the actual treatment period. A reduction in Staphylococcus aureus colonisation was also noted (2).

In a study that treated 12 children (mean 8.5 years; range 3-12 years) with severe atopic eczema who had failed to respond to conventional topical corticosteroid and emollient therapy with a 2-week course of once-daily diluted 0.1% mometasone furoate wet-wraps. A significant improvement, as shown by a marked reduction in clinical severity scores, (measuring the severity of clinical lesions) and self-assessment scores (measuring the severity of the symptoms as reported by the patients/parents) was seen in 11 patients and overall mean scores were significantly improved (p < 0.005). The adverse effects were described by the authors as mild, tolerable and self-limiting, and post-treatment early morning plasma cortisol levels were not depressed (3).

Authors investigated the effectiveness and hypothalamic-pituitary-adrenal (HPA) axis suppression of various corticosteroid dilutions in children with severe atopic dermatitis using wet wrap dressings. Eighteen subjects were treated with a 50% dilution of fluticasone propionate 0.05% cream for 2 weeks. In another five subjects, a side-to-side comparison was carried out with 10%, 25% and 50% dilutions of fluticasone propionate cream under wet wrap dressings. A further eight subjects were treated with 0% (emollient only), 5%, 10% or 25% dilutions of fluticasone propionate cream applied to the whole body under wet wrap dressings. After one week, a major improvement averaging 74% was noted in regard to SCORAD rating (severity scoring of atopic dermatitis). No apparent differences between 5%, 10% or 25% dilutions of the corticosteroid were observed. Of the three groups of subjects included in the study, HPA axis suppression was noted in only 3 of 23 subjects, in the first and second groups.(4).

The use of wet wrap dressings in the management of atopic eczema in both children and adults is reviewed in numerous published articles: these are listed below.