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Dermatology Education & Practice from NADNP

Wet Wraps

Published September 28, 2015 2:35 PM by Guest Blogger

By Darrel Arthurs, ARNP, DCNP

Recently there has been a surge of information touting the effectiveness of wet wraps for childhood eczema. The treatment has been utilized for years by dermatology professionals but now it is becoming more of a main stream treatment. Researchers at the National Jewish Health in Denver, Colo., recently published a study on the effectiveness of wet wraps. They found that the treatment could reduce symptoms by as much as 71% if utilized correctly.

Some providers may not be aware of exactly what wet wraps are and how they are utilized. They are dressings that are often made of clothing that have been soaked in warm water and applied over a topical steroid or thick, creamy, moisturizer. After they are applied to the child a dry layer is added over the areas of treatment in order to entrap all of the moisture on the skin. The wet wraps can encompass large body areas such as the trunk and extremities or they can be used only over specific areas such as the antecubital or popliteal fossa's. In either case they are typically reserved for more severe cases of eczema. 

While this is an easy treatment which can be performed at home Mark Boquniewicz, MD, a pediatric allergist and immunologist who coauthored the study strongly recommends supervision by the family's dermatology provider in order to determine if the treatment is appropriate for their condition. He also states that more harm can be done to the child if the treatment is used incorrectly or overly used.

The exact details used in the study involves allowing the affected areas of the child to soak in lukewarm water for 20 minutes prior to applying creams and or prescribed topical steroid ointments.  The child is then immediately dressed with a wet cloth (gauze or surgical netting can also be used) which seals in the moisture. There is no drying performed after soaking the skin. Next a dry layer of clothing is applied and the patient is instructed to have minimal activity for two hours after which time the clothing is removed. As the water evaporates from the bandages the skin will cool thus decreasing inflammation. At the same time a significant amount of moisture will be absorbed by the skin allowing healing to occur.

Many of the patients in the study returned home and continued to have clearance of symptoms for nearly a month even without the use of topical steroids. During the study period the wet wraps were applied 2-3 times per day depending on severity of the child. After four days of treatment dramatic results were noted with the majority of children. With the numerous documented side effects of both oral and topical steroids wet wraps offer a workable alternative for those families that are concerned about possible side effects and their children's health.

Arthurs' passion for dermatology developed while he was serving in active duty in the U.S. Navy. Since then he has accumulated over 11 years' experience in medical and surgical dermatology. Currently he works independently in a small city in northeastern Oklahoma. Arthurs is on the NADNP Board of Directors.


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