The red itchy blisters of eczema can really make a child's life miserable. The discomfort usually starts with a rash and develops into red oozing bumps that constantly itch. Children often try to relieve the itching by scratching the areas with anything within reach - making the problem worse.
Eczema is usually treated with topical corticosteroids, antihistamines and oral or topical antibiotics to prevent infection, but an older therapy known as "wet-wrapping" may be making a comeback as an alternative to drug therapy.
"Those medications can be effective, but they also can be a cause for concern for a lot of parents, especially when they're used long term," said Dr. Mark Boguniewicz, a pediatric allergist and immunologist at National Jewish Health in Denver. "Many families worry about the side effects those drugs might have on their child's blood pressure, or on their bones and kidneys," Boguniewicz said. "The problem is, there aren't many effective alternatives."
First described in 1987, wet wrap therapy never became a mainstream treatment for eczema. However, researchers at National Jewish Health decided to give it another look and evaluate whether it might be an effective alternative.
The process is as simple as it sounds and involves wrapping the affected parts with a wet bandage. First, the child soaks in lukewarm water for about 20 minutes. After that, lotions or medicated emollients are applied to the affected areas while still damp. Afterward, the child is immediately dressed in wet clothing or wraps to seal in the moisture, followed by a layer of dry clothing. After at least two hours, the clothing is removed.
According to the researchers, the results of the review were pretty astounding. Children who participated in the study saw their symptoms reduced by 71 percent.
The effects remained for almost a month after they returned home even without the use of medications prescribed for this condition.
"We took a step up, step down sort of approach to managing their symptoms in this study," Boguniewicz said. "We would apply the wet wraps two to three times a day, depending on the severity of the case, then we would taper the therapy down and only treat the affected areas as time went on. Over roughly four days we saw dramatic improvements."
Wet wraps work by cooling, moisturizing and absorption. The water gradually evaporates from the bandages and cools the inflamed skin. The lotions keep the skin moisturized for a longer period of time and penetrate to the deeper layers.
As part of the study, 72 children with severe to mild eczema were evaluated. Their severity was measured using SCORAD (Scoring Atopic Dermatitis) and ADQ (AD Quickscore) measurements. The most severe cases were given a score of 50 and over, moderate cases between 25-49, and mild cases were those that scored less than 25.
"When these children arrived, their mean score was right around 50, so they were severe cases," Boguniewicz said. "When they left, their mean score was less than 15. That kind of improvement, in just a short amount of time, was very, very dramatic."
While the procedure sounds simple, treatment needs to be supervised. This is not something that parents or caregivers should attempt on their own.
"You can't just try this on your own because overuse can do more harm than good," Boguniewicz said. "You first want to familiarize yourself with the concept at our website and talk to a specialist about it. We have a lot of material that can help you determine if this is the right approach for your child."
While children often grow out of eczema, it can be physically and psychologically painful during outbreaks. Wet wrap therapy may be an excellent alternative to drugs such as steroids, antihistamines and antibiotics but should be administered and supervised by a physician until parents and caregivers have a good understanding of the techniques and how often it should be applied.
The study was published in the July issue of the Journal of Allergy and Clinical Immunology.
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