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The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a
Sherief R Janmohamed1, Arnold P Oranje2, Arjan C Devillers3
1Department of Pediatrics, Division of Pediatric Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; KinderHaven, Havenziekenhuis, Rotterdam, The Netherlands.
Insights
Wet-wrap treatment (WWT) with diluted corticosteroids is an effective therapy for severe atopic dermatitis (AD) in children. This method demonstrated faster and more significant improvements in skin condition and quality of life compared to emollients.
Area of Science:
- Pediatric Dermatology
- Clinical Trials
- Atopic Dermatitis Management
Background:
- Severe atopic dermatitis (AD) in children often requires effective crisis intervention.
- Wet-wrap treatment (WWT) is a recognized approach for managing severe AD.
Purpose of the Study:
- To compare the efficacy of WWT with diluted corticosteroids versus emollients in children with severe AD.
- To evaluate treatment outcomes over a 4-week proactive schedule with tapering corticosteroid frequency.
Main Methods:
- A randomized, double-blind, placebo-controlled study involving children aged 6 months to 10 years with severe AD (objective SCORAD ≥ 40).
- Comparison between WWT with diluted mometasone furoate and WWT with petrolatum-based emollient.
- Primary outcome: improvement in objective SCORAD; secondary outcomes: Patient-Oriented Eczema Measure and quality-of-life index.
Main Results:
- WWT with diluted corticosteroids showed faster and superior efficacy compared to emollients.
- Significant improvements in objective SCORAD and quality of life were observed at all measurement points.
- Optimal results were noted in children aged 6-9 years and 0-3 years.
Conclusions:
- Wet-wrap treatment using diluted corticosteroids is an effective therapeutic option for severe atopic dermatitis in children for at least 4 weeks.
- The study, despite a small group size, supports WWT as a viable treatment strategy.
Background:
Wet-wrap treatment (WWT) has been advocated as a relatively effective treatment in children with severe atopic dermatitis (AD). WWT often serves as crisis intervention for AD.
Objectives:
We sought to evaluate the use of WWT with diluted corticosteroids in comparison with emollient in children with severe AD during 4 weeks in a proactive schedule during which the frequency of corticosteroid applications was tapered.
Methods:
A randomized, double-blind, placebo-controlled study was performed in children aged 6 months to 10 years with severe AD (objective SCORAD at least 40 ± 5), comparing WWT with diluted corticosteroids (1:3 mometasone furoate 0.1% ointment and for the face 1:19 mometasone furoate 0.1% ointment under a mask) with emollient (petrolatum 20% in cetomacrogol cream). The primary outcome was improvement of the objective SCORAD; secondary outcomes included Patient-Oriented Eczema Measure and quality-of-life index.
Results:
WWT with diluted corticosteroids acted faster and was more efficacious than WWT with emollients. Best results were obtained in age groups 6 to 9 years and 0 to 3 years. The difference in efficacy evaluated by objective SCORAD was significant at all measuring points. This also applied to the quality-of-life index.
Limitations:
The study group was relatively small.
Conclusions:
WWT for severe AD is an effective therapy option for at least a period of 4 weeks.
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