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Wet-Wrap Treatment with Diluted Corticosteroids in Children

Summary and Comment |
June 2, 2014

Wet-Wrap Treatment with Diluted Corticosteroids in Children

  1. Mary Wu Chang, MD

This approach should be considered in in therapy-resistant severe childhood atopic dermatitis if proper support is available.

  1. Mary Wu Chang, MD

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 Patients were withdrawn if any of the following occurred: HPA axis suppression, impetiginization, eczema herpeticum, or severe local reactions, or if SCORAD had not decreased by 10%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.

Comment

This study supports the general experience that wet-wrap therapy with low-strength corticosteroids is effective for severe flares in atopic dermatitis. HPA axis suppression was uncommon and occurred mostly in the first week, when larger amounts of corticosteroid were used. Treatment duration was longer than t is typical in the U.S. This approach is particularly appealing for severe AD patients who might otherwise need systemic immunosuppressants. WWT with low-strength topical corticosteroids produces results but requires proper parental and patient education, support, and follow-up.

  • Disclosures for Mary Wu Chang, MD at time of publication Consultant / Advisory board Pierre Fabre; Valeant Speaker’s bureau Galderma

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Reader Comments (1)

ratna susanti, dr Resident, Dermatology, general hospital

thank you for the information

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