Loading...
Wet dressings placed over topical steroids work well to reestablish control in patients with widespread eczemas, such as atopic erythrodermas. Messy and time-consuming, such treatment has lost favor with dermatologists and with patients. This is unfortunate.
A recent retrospective analysis reviewed the cases of 218 patients with atopic dermatitis (age, <18 years) hospitalized at Mayo Clinic (Rochester, Minnesota) over a 30-year period. Closed, nonoccluded, wet dressings were applied over topical corticosteroid creams applied twice daily. Dressings remained in place about 3 hours, with a 30- to 45-minute interval between changes. The topical corticosteroid creams were triamcinolone 0.025% (3% of patients), 0.05% (27%), or 0.1% (24%) cream, or hydrocortisone 1% (7%) or 2.5% (39%) cream. The regimen was as follows: (1) daily tub bath, (2) application of topical steroid creams, (3) application of wet dressing, usually soaked with warm tap water but occasionally with dilute aqueous solutions of acetic acid, (4) application of cotton flannel clothing over the wet dressings to help retain moisture, and (5) placement of warm blankets for patient comfort. Antibiotics were given to 72% of patients for skin or other infections.
Mean duration of hospitalization was 3.61 days. All patients improved, and about 80% had moderate or marked improvement.
Dabade TS 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 Dermatol 2012 Jul; 67:100.
Comment
When hospitalization was more common, I hospitalized many children with atopic dermatitis for this sort of treatment, but I nearly always used 1% hydrocortisone as my steroid. The predictable, rapid, and dramatic response proved to the parents, children, and me that plain old 1% hydrocortisone cream was a very useful topical drug when used under wet compresses. This cream is effective, relatively safe, and inexpensive. Treatments never seemed to work as well at home, but many parents relied on hydrocortisone cream and wet compress treatments at least overnight. The combination therapy improved dermatitis and reduced itching and sleepless nights. For home, I recommended wet sweat shirts and wet sweat pants as dressings to keep the skin wet, and plastic mattress pads to keep the mattress dry.