3 techniques that can strengthen eczema treatment

Soak and smear

• Child soaks in a tub of plain lukewarm water for up to 20 minutes.
• After the child gets out of the tub, you smear your child’s medicine onto the eczema while the skin is still wet.
• You soak and smear as often as directed by your child’s dermatologist for a few days or a bit longer.

Occlusion

• You apply your child’s medicine as directed.
• You cover difficult-to-clear skin with plastic wrap, securing the plastic wrap with tape.
• You leave the plastic wrap on for a short time, usually a few hours or overnight.

Wet wrap therapy

• Medicine is applied to child’s eczema.
• Child is dressed in wet gauze, bandages, or clothes.
• A dry layer of gauze, bandages, or clothing is placed over the wet layer.
• A nurse’s expertise is required; A child may receive this when hospitalized for severe eczema
• Some parents are taught how to use this technique.

Why do dermatologists recommend these techniques?

• Can treat severe eczema

• Allows treatment applied to the skin to work better — often when the same treatment failed to work before

• Can work when other treatments (phototherapy, pills) have failed

These techniques can:

• Hydrate the skin

• Reduce the inflammation (redness, swelling, heat)

• Alleviate itch, so a child can get a restful sleep

• Decrease staph (bacteria) on the skin

• Avoid the need for medicine that works throughout the body

• Protect the skin from a child’s scratching

If you would like to use one of these techniques, it is important to know that these techniques can be:

• Messy

• Time-consuming

• Involved, so you’ll need training first

Safety and effectiveness

Research studies conducted by dermatologists show:

• These techniques are safe and effective with proper use.

• Wet-wrap therapy offers a relatively safe and effective treatment for severe eczema. In one study, children improved in about 3 days. All had received wet-wrap therapy while hospitalized for severe eczema. For these children, other treatments failed to work.

• Soak and smear can be effective when other treatments fail. In a study of 28 adults with a severe skin condition that had not responded to other treatments, all patients had clearing or dramatic improvement. This happened within a few days to 2 weeks. Most patients had some relief after the first treatment.

• Eczema dries the skin. When you can keep skin moist, the skin can absorb the medicine more efficiently. Medicine that failed to work before can work quickly.

How to use

If one of these therapies is right for your child:

• You will receive instructions from a dermatologist, nurse, or other health care provider.

• It is very important to use the technique exactly as instructed.

• To avoid a relapse, you will need to follow the skin care plan recommended by your child’s dermatologist.

Possible side effects

Using these techniques exactly as instructed will greatly reduce the risk of side effects. Still, every medicine can cause side effects. Possible side effects from these techniques include:

• Infection (risk increases because the skin stays moist)

• Skin burns or stings

• The side effects possible when applying a topical corticosteroid to the skin, which includes skin thinning and stretch marks

To reduce the risk of possible side effects, these techniques are used for a short time and parents are taught exactly how to use the recommended technique before using it at home.

When to call your child’s dermatologist

• Signs of infection (red bumps on the skin, skin leaking fluid or pus, yellow crusts)

• Skin looks worse than before

• Your child resists, so you cannot use the technique

Related AAD resources

• Eczema treatment: Corticosteroids applied to the skin

• Is that eczema or an infection on my child’s skin?

• Massage and acupressure may help child with eczema

Images
Soak and smear and occlusion: Getty Images
Wet wrap: J Am Acad of Derm. 2012;67:100–6.

References
Dabade TS, Davis DMR, et al. “Wet dressing therapy in conjunction with topical corticosteroids is effective for rapid control of severe pediatric atopic dermatitis: Experience with 218 patients over 30 years at Mayo Clinic.” J Am Acad of Derm. 2012;67:100–6.

Eichenfield LF, Tom WL. “Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies.” J Am Acad Dermatol. 2014 Jul;71(1):116-32.

Gutman AB, Kligman, AM, et al. “Soak and smear: a standard technique revisited.” Arch Dermatol. 2005 Dec;141(12):1556-9.

Habif TP, Campbell JL, et al. “Topical corticosteroids.” Dermatology DDxDeck. 2006, Mosby | Elsevier.

Kaufmann R, Bieber T, et al. “Treatment with pimecrolimus cream 1%, with overnight occlusion, of moderate to severe atopic dermatitis for 8.5 days did not measurably increase systemic exposure.” Poster presented at the 2009 Annual Meeting of the American academy of Dermatology in San Francisco. J Am Acad of Derm. 2009;60 (Supp 1), page AB67. Commercial support: Novartis Pharma paid for poster production.

Maguiness S. “Severe and refractory atopic dermatitis: Now what?” (2014, August). In Lio PA (Chair), “What's boiling over: Atopic dermatitis and other eczematous conditions.” Forum presented at the Summer Academy Meeting of the American Academy of Dermatology, Chicago, IL.

Mallon E, Powell S, et al. “Wet-wrap dressings for the treatment of atopic eczema in the community.” J Dermatolog Treat. 1994; 5: 97–98.

Pei, AY, Chan HH, et al. “The effectiveness of wet wrap dressings using 0.1% mometasone furoate and 0.005% fluticasone proprionate ointments in the treatment of moderate to severe atopic dermatitis in children.” Pediatr Dermatol. 2001 Jul-Aug;18:343-8.

Tang W, Chan H, et al. “Outpatient, short-term, once-daily, diluted, 0.1% mometasone furoate wet-wraps for childhood atopic eczema.” J Dermatolog Treat, 1999;10:157-63.