Background: According to the American Academy of Dermatology between 10-20% of children and 1-3% of adults suffer from atopic dermatitis. Wet wrap therapy, a lesser known treatment, is usually reserved for children and adults with severe atopic dermatitis. The mainstay of treatment for atopic dermatitis has been emollients and topical corticosteroids. However, corticosteroids, especially when used long-term can have side effects that are a cause for concern. What additional benefits can be seen when adding a topical steroid to wet wrap therapy versus using emollient with wet wrap therapy alone?
Methods: An exhaustive search of available medical literature was conducted using MEDLINE-Ovid, CINAHL, and Web of Science using the keywords: wet wrap(s), atopic dermatitis, and eczema. Only articles in English that were conducted on humans were included. Articles with primary data evaluating the effects of wet wrap therapy without corticosteroids directly compared to wet wrap therapy with corticosteroids in patients were included. Relevant articles were assessed for quality using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE).
Results: Three studies met inclusion criteria and were included in this systematic review. One randomized, double blind, placebo-controlled trial with 20 participants found that the addition of corticosteroid to wet wrap therapy significantly improved eczema in the category of edema/population but otherwise there was no other significant statistical difference between the two treatments. A second randomized, double blind, placebo-controlled trial with 39 participants demonstrated a statistically significant reduction in atopic dermatitis in the group treated with topical corticosteroid and wet wrap therapy vs. treatment with emollients and wet wrap therapy alone. An observational study with 8 participants observed that after one week the emollient only wet wrap therapy group showed only minor improvement while the steroid wet wrap group showed major improvement.
Conclusion: Wet wrap therapy is effective in treating refractory atopic dermatitis and in combination with diluted fluticasone proprionate 0.05% cream or diluted mometasone furoate 0.1% cream there can be significant improvement in just a week. Wet wrap therapy has minimal side effects and topical corticosteroid adverse drug events can be limited by diluting them and either using them for a short amount of time or gradually wean off of them when using it in combination with wet wrap therapy.
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