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A pilot study on the use of wet wraps in infants with moderate atopic eczema
1Department of Dermatology, Ninewells Hospital, Dundee, UK. paula_e_beattie@hotmail.com
Insights
Wet wrap therapy (WWT) is not more effective than standard hydrocortisone treatment for moderate childhood eczema. This pilot study suggests standard care may even be more effective for atopic dermatitis.
Area of Science:
- Dermatology
- Pediatrics
- Clinical Trials
Background:
- Wet wrap therapy (WWT) is established for severe atopic dermatitis (AD).
- Evidence for WWT in less severe eczema is limited.
- Need to compare WWT with standard hydrocortisone for moderate childhood AD.
Purpose of the Study:
- To compare the efficacy of WWT versus standard hydrocortisone treatment for moderate AD in children.
- To evaluate the impact on disease severity, quality of life, and treatment burden.
Main Methods:
- A randomized controlled pilot study involving 19 children under 5 with widespread AD.
- Two groups: one received hydrocortisone with WWT, the other hydrocortisone alone.
- Outcome measures included the Six Area, Six Sign Atopic Dermatitis (SASSAD) score, and quality of life indices.
Main Results:
- No significant difference in SASSAD score reduction between groups (mean difference favoring non-WWT group).
- Quality of life scores (IDQOL, DFI) showed no significant difference.
- Weak evidence suggested standard therapy might be more effective.
Conclusions:
- Conventional therapy with hydrocortisone and emollients alone appears as effective as WWT for moderate, widespread infant AD.
- Routine WWT for moderate eczema is not advocated without further research.
- Standard therapy may offer a more effective and less burdensome approach.
Abstract:
Wet wrap therapy (WWT) is a well-established treatment for severe atopic dermatitis (AD). However little evidence exists to justify widespread use in the community for less severe eczema. We compared the efficacy of WWT with a standard regime of hydrocortisone, to control moderate AD in children. We carried out a single-observer, randomized, controlled pilot study in 19 children under 5 years of age, with AD of 30% or more body surface area, using only 1% hydrocortisone (HC) prior to the study. Group one applied HC once in the morning for 2 weeks, with wet wraps twice daily for week 1, but only at night for week 2. Group two applied HC twice daily without wet wraps. Both applied emollient twice daily and as necessary. The primary outcome measure was the Six Area, Six Sign Atopic Dermatitis (SASSAD) severity score, and the secondary outcome measures were the Infants Dermatology Quality of Life Index (IDQOL), the Dermatitis Family Impact (DFI) score and the weight of topical steroids and emollients used. Over the 2-week active therapy period the mean fall in SASSAD was 8 [95% confidence interval (CI), -18 to +2; P = 0.11] more in the non-WWT group, the median change in the IDQOL was 2 for Group one and 7 for Group two (95% CI for difference, -10 to +3; P = 0.24) and the median change in DFI score was 2 for Group one and 5 for Group two (95% CI for difference, -14 to +2; P = 0.42). This small study has shown that conventional therapy with HC and emollients alone is as effective as WWT for infants with moderately severe, widespread AD, and provides weak evidence to suggest that it may be more effective. We would not advocate routine use of WWT for moderate eczema without further evaluation.
