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Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program
Noreen Heer Nicol1, Mark Boguniewicz2, Matthew Strand3
1College of Nursing, University of Colorado, Aurora, Colo; Department of Nursing, Children's Hospital Colorado, Aurora, Colo.
Insights
Wet wrap therapy (WWT) significantly improved moderate-to-severe atopic dermatitis (AD) in children. This intervention, part of a multidisciplinary program, showed lasting benefits one month post-treatment without requiring systemic immunosuppressants.
Area of Science:
- Pediatric Dermatology
- Inflammatory Skin Diseases
- Therapeutic Interventions
Background:
- Atopic dermatitis (AD) is a prevalent, chronic, relapsing inflammatory skin condition in children, posing a significant global health challenge.
- Established national and international guidelines recommend a stepwise approach for managing AD.
- Wet wrap therapy (WWT) is a recognized intervention for moderate-to-severe cases of AD.
Purpose of the Study:
- To evaluate the effectiveness of Wet wrap therapy (WWT) within a multidisciplinary atopic dermatitis (AD) treatment program.
- To assess the impact of WWT on disease severity in pediatric patients with moderate-to-severe AD who had previously failed multiple therapies.
Main Methods:
- An observational cohort study design was employed.
- The primary outcome measure was the change in atopic dermatitis severity assessed by SCORAD (Scoring Atopic Dermatitis).
- Comprehensive data on patient demographics, clinical management (including antibiotic and systemic treatment use), and WWT protocols were collected.
Main Results:
- The study included seventy-two children (mean age 4.6 years).
- A statistically significant reduction in SCORAD was observed, decreasing from 49.68 at admission to 14.83 at discharge (P < .001).
- Clinical improvement was sustained for one month post-discharge, as indicated by a parent-administered outcomes tool, with no patients requiring systemic immunosuppressive therapy during the program.
Conclusions:
- This study represents the largest evaluation of Wet wrap therapy (WWT) for pediatric moderate-to-severe atopic dermatitis (AD) using a validated outcomes tool.
- The integration of WWT into a supervised, multidisciplinary AD treatment program demonstrated significant clinical benefits.
- The intervention provided lasting improvements one month after discontinuation, with minimal need for systemic immunosuppressants or oral antibiotics.
Background:
Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD.
Objective:
This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed.
Methods:
An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described.
Results:
Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge.
Conclusion:
To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.
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