Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program

J Allergy Clin Immunol Pract. 2014 Jul-Aug;2(4):400-6. doi: 10.1016/j.jaip.2014.04.009.

Abstract

Background: Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD.

Objective: This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed.

Methods: An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described.

Results: Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge.

Conclusion: To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.

Keywords: Atopic dermatitis; Management; Outcomes; Wet wrap therapy.

Publication types

  • Evaluation Study

MeSH terms

  • Adolescent
  • Algorithms
  • Bandages / statistics & numerical data
  • Child
  • Child, Preschool
  • Cohort Studies
  • Combined Modality Therapy
  • Dermatitis, Atopic / therapy*
  • Disease Progression
  • Female
  • Humans
  • Hydrotherapy*
  • Infant
  • Interdisciplinary Communication
  • Male
  • Practice Guidelines as Topic
  • Treatment Outcome