Wet wrap treatment for eczema: a guide

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If you or your child have a severe flare-up of atopic dermatitis, commonly known as eczema, ask your doctor about a wet wrap treatment. This short-term supplemental relief remedy can be a safe and quick way to rehydrate the skin, relieve severe itching and pain, and improve the effectiveness of topical medications.

According to the National Eczema Association, wet wrap therapy involves applying moisturizer and medication to a flare-up, then wrapping the area with a warm, moist cloth or gauze and a second layer of dry cloth, such as cotton pajamas. cotton. You can use cotton gloves, gauze, or tube socks on your hands and feet.

Patients typically keep wraps moist for two hours to overnight.

Wraps act as a barrier, retaining medication and moisture and protecting the skin from excessive scratching. Scratching can lead to more itching, called the “itch-scratch cycle.”

Most patients can do wet wrap therapy themselves at home, but dermatologists and allergists can apply wet wraps in their office or in a hospital setting if needed.

Melissa Piliang, MD, a dermatologist at the Cleveland Clinic in Ohio, recommends wet wraps for people with moderate to severe eczema who experience extreme itching or pain. “Warm, moist wraps can be very soothing to irritated and inflamed skin,” says Dr. Piliang, noting that the therapy is particularly helpful for generalized flare-ups, such as those covering a large area on an arm or leg. .

Wet wrap therapy is best used with topical corticosteroids and for up to two weeks at a time, says Piliang. Using wet bandages for too long or too often can lead to infection.

Wet wrap therapy may be an eczema treatment option for young children

A study published in the Journal of Allergy and Clinical Immunology in Practice which included 72 children with moderate to severe atopic dermatitis found that wet wrap therapy reduced the severity of symptoms.

“The typical candidate for wet wrap therapy is a young child with a severe eczema flare, especially if they have previously used topical steroids and/or topical calcineurin inhibitors,” says Breanne Mordorski, MD , a dermatologist at the Montefiore Health System and an assistant professor of dermatology at the Albert Einstein College of Medicine in New York.

“For these patients, wet wraps are a good second-line option when traditional topical treatments fail,” says Dr. Mordorski.

She adds that wet wraps may also be helpful for children during a severe eczema flare-up when there are delays in accessing systemic medications such as Dupixent (dupilumab). This prescription injectable biologic has been approved by the US Food and Drug Administration (FDA) for children as young as 6 months of age.

Doctors recommend that a parent administering wet wrap therapy start by soaking the child in the tub and washing them with unscented soap, making sure to wet their entire body and face and pat them dry. tapping it gently. The parent should then apply any topical medications prescribed or recommended by the child’s doctor, followed by a thick layer of unscented ointment or moisturizer, such as Vaseline, Aquaphor, or CeraVe.

After that, the parent fills a basin with lukewarm water, soaks long-sleeved cotton pajamas and long pants, or footed pajamas, and wrings them out. These go on the child like a first layer, under dry pajamas.

If the child’s legs or arms remain exposed, the parent can layer wet and dry tube socks or gauze or cotton tube bandages.

Wet wrap therapy for babies can be a godsend

Atopic dermatitis can start early, appearing in babies as young as 2 to 3 months old. Wet wraps are a great option for babies with severe eczema flare-ups, says Jenny Montejo, MD, pediatric allergist and immunologist and assistant professor of pediatrics at Mayo Clinic, Rochester, Minnesota.

The treatment has few side effects and can reduce itching, oozing and irritation, she says, leading to less crying and better sleep.

Dr. Montejo cautions that wet wrap therapy should only be used for babies and other pediatric patients under the direction of a healthcare professional and with specific instructions for each case.

Wet wrap therapy can be difficult for adults and older children

Adults and older children with larger bodies — and more surface area to wrap — may not fare as well with the wraparound treatment, Mordorski says, especially when applied at home or in an office. medical, but they may do well in the hospital when admitted for a severe flare-up.

“The application is cumbersome and less convenient, and older patients are less likely to follow on an outpatient basis,” she explains. “In the hospital, where there is more support, wet wraps are becoming more feasible for a wider range of patients.”

For older people with severe atopic dermatitis, Mordorski says wet wraps can be used as a palliative to manage a severe flare-up while waiting for longer-term systemic eczema treatment.

A patient who is ill during a severe flare – with fever, chills, loss of appetite, lack of energy or another problem – should see a dermatologist to help determine if they should go to the hospital for follow-up or alternative treatment.

Where to Buy Wet Wrap Therapy Supplies

Before starting wet wrap therapy, contact your doctor. They can advise you on the best products and the best technique for your case. Do not use topical steroids without consulting your doctor.

You can make wraps yourself or shop for special baby or adult clothes and accessories — from pajamas and hats to sleeves, gloves and moisturizers — online at sites like Soothems and AD RescuWear.

If you’re on TikTok or Instagram, Sheilagh Maguiness, MD, a pediatric dermatologist and associate professor of dermatology at the University of Minnesota School of Medicine, offers lots of advice on wet wrap therapy products as well as techniques. .

Advantages and disadvantages of wet wrap therapy

Wet wrap therapy has many benefits: it can prevent scratching as it calms and repairs sore and inflamed skin. Also, unlike some other treatments, there are few side effects.

A downside is that wet wraps are messy and time-consuming, and children may not cooperate.

And while wet wrap therapy is generally safe, there are a few risks to consider. Wet wraps can increase the absorption of topical steroids, which can also increase their potency. If this concerns you, talk to your doctor.

Wet wraps can also trap moisture causing inflammation of the hair follicles which can lead to skin blistering and infection. In rare cases, and especially when wet wraps are used too long or incorrectly, there is a risk of serious infection, says Mordorski.

Some Doctors Are Not Fans of Wet Wrap Therapy

Not all dermatologists recommend wet wraps. A. Yasmine Kirkorian, MD, chief of dermatology at Children’s National Hospital and associate professor of dermatology and pediatrics at the George Washington University School of Medicine in Washington, DC, thinks there are better alternatives.

“In theory, wet wraps can be very effective, but in practice they can be cumbersome and difficult for families to use effectively,” says Dr. Kirkorian. She notes that patients with a severe flare can achieve similar results with a simpler technique called “dip and smear” which involves applying medication and then moisturizer to damp skin before slipping on dry cotton pajamas.

Kirkorian notes that the availability of FDA-approved systemic drugs for the treatment of refractory (treatment-resistant) atopic dermatitis in children may outweigh the need for wet wrap therapy in these patients.

“Any child with severe atopic dermatitis – extensive body surface area, unresponsive to first line treatments, waking up at night itchy, suffering from skin infections, missing school for eczema, going to the emergency room or being hospitalized for eczema – should be evaluated by a board-certified dermatologist or pediatric dermatologist,” says Kirkorian.

The Basics of Wet Wrap Therapy

Talk to your doctor before trying wet wrap therapy. They will tell you if it’s right for you or your child, how and when to do it, and how to look for signs of skin infection.

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