Wet wrap (aka wet dressing) is an underused and intensive topical treatment which is highly effective for severe atopic dermatitis (eczema). It could easily be done at home simply with cotton bandage or just an old towel !
Wet dressings placed over topical steroids work well to reestablish control in patients with widespread eczema.
A recent retrospective analysis reviewed the cases of 218 patients with atopic dermatitis (age, <18 years) hospitalized at Mayo Clinic (Rochester, Minnesota) over a 30-year period. Closed, nonoccluded, wet dressings were applied over topical corticosteroid creams applied twice daily. Dressings remained in place about 3 hours, with a 30- to 45-minute interval between changes. The topical corticosteroid creams were triamcinolone 0.025% (3% of patients), 0.05% (27%), or 0.1% (24%) cream, or hydrocortisone 1% (7%) or 2.5% (39%) cream. The regimen was as follows: (1) daily tub bath, (2) application of topical steroid creams, (3) application of wet dressing, usually soaked with warm tap water but occasionally with dilute aqueous solutions of acetic acid, (4) application of cotton flannel clothing over the wet dressings to help retain moisture, and (5) placement of warm blankets for patient comfort. Antibiotics were given to 72% of patients for skin or other infections.
Mean duration of hospitalization was 3.61 days. All patients improved, and about 80% had moderate or marked improvement.
Comment: When hospitalization was more common, I hospitalized many children with atopic dermatitis for this sort of treatment, but I nearly always used 1% hydrocortisone as my steroid. The predictable, rapid, and dramatic response proved to the parents, children, and me that plain old 1% hydrocortisone cream was a very useful topical drug when used under wet compresses. The combination therapy improved dermatitis and reduced itching and sleepless nights. For home, I recommended wet sweat shirts and wet sweat pants as dressings to keep the skin wet, and plastic mattress pads to keep the mattress dry. To make it easier, it would still be effective even it is just left on for 30 mins.
modified from Mark Dahl MD, Published in Journal Watch Dermatology