Wet-Wrap Treatment with Diluted Corticosteroids in Children

Treatment of severe atopic dermatitis (AD) in children is challenging. Wet-wrap therapy (WWT) with corticosteroids is used increasingly for severe flares. Investigators in the Netherlands performed a randomized, multicenter, double-blind, comparison of WWT with diluted corticosteroids and WWT with emollient in 39 children (age, 6 months–10 years) with severe AD (SCORAD 35–40).

Impetigo was treated with antibiotics for 72 hours before commencing WWT. Patients were randomized to receive either WWT using Tubifast garments with diluted mometasone furoate (1:3 body, 1:19 face) or emollient (petroleum 20% in cetomacrogol cream). In week 1, cream was applied to the whole body once daily; in weeks 2 to 4, application was to lesions only, once daily for 4 consecutive days per week. Emollients were used in both groups on the other 3 days in weeks 2 to 4. Skin was evaluated on days 0, 1, 4, 7, 14, and 28 (end of study). Morning fasting blood cortisol was measured on days 0 or 1, 7, 21, and 28. Patients were withdrawn if any of the following occurred: HPA axis suppression, impetiginization, eczema herpeticum, or severe local reactions, or if SCORAD had not decreased by 10% on day 7. Four patients dropped out of the study, all emollient-only recipients.

Adverse effects included mild-to-moderate folliculitis (2 emollient recipients; 9 corticosteroid recipients); severe folliculitis (1 corticosteroid recipient); impetiginized eczema (2 emollient recipients); and a one-time HPA axis suppression (3 corticosteroid recipients). Although 33 patients started WWT on the face using a mask, most discontinued because of “psychological problems.” SCORAD and quality-of-life scores improved in both groups, but more quickly and more pronouncedly in the treatment group.