Why Do Dermatologists Recommend These Techniques
Can treat severe eczema
Allows treatment applied to the skin to work better often when the same treatment failed to work before
Can work when other treatments have failed
These techniques can:
Reduce the inflammation
Alleviate itch, so a child can get a restful sleep
Avoid the need for medicine that works throughout the body
Protect the skin from a childs scratching
If you would like to use one of these techniques, it is important to know that these techniques can be:
Involved, so youll need training first
Fighting Inflammation Like A Fire
How do we fight a house fire? With water. We also use water when tending to atopic dermatitis. We need to rehydrate that dry skin and no moisturizer is as effective at rehydrating dry skin than plain water.
You need to bathe and soak in lukewarm water for 10 to 15 minutes, which is long enough to rehydrate but not so long as to further weaken the skin barrier significantly. When you add bleach to the water, you have a low-risk treatment that bacteria can never become resistant to.
Another way to fight fire is with a fire extinguisher. Thats how I think of topical steroids and other anti-inflammatory medications. We must learn to use them cautiously but effectively, in pulses, like fire extinguishers.
You also can fight fire by smothering it my analogy for eczema skin occlusion with barrier ointments, clothing, or plastic wrap. Occlusion helps retain moisture, blocks entry of irritants, allergens and microbes, and promotes healing by creating a physical barrier against scratching.
Pros And Cons Of Wet Wrap Therapy
Wet wrap therapy has many upsides: It may prevent scratching as it calms and repairs painful and inflamed skin. Plus, unlike some other treatments, there are few side effects.
One downside is that wet wraps are messy and time-consuming, and children may not cooperate.
And while wet wrap therapy is generally safe, there are a few risks to consider. Wet wraps can increase the absorption of topical steroids, which can also increase their potency. If this is a concern, discuss it with your doctor.
Wet wraps can also trap moisture, causing inflamed hair follicles that can lead to blistered skin and infection. In rare cases, and especially when wet wraps are used too long or incorrectly, there is a risk of serious infection, Mordorski says.
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A Compromised Skin Barrier
A basic skin care regimen should focus on the fundamental aspects of atopic dermatitis. In atopic dermatitis theres a skin barrier function problem. The people with the worst atopic dermatitis have absent or abnormal skin proteins in which the cells at the upper layers of the skin, called keratinocytes, are not producing appropriate proteins. That can reduce the skins ability to do all of the things that its supposed to do.
For example, because were mostly made of water, normally the skin is supposed to keep water in. When you have the impaired skin barrier that comes with atopic dermatitis, the skin isnt able to hold water in, and so it gets very dry.
Whats more, that compromised skin barrier allows for the penetration of many chemical irritants and potential allergens, which may become true allergens for an individual. On top of that, once those microbes have gotten through, an increased number of microbes can penetrate the skin barrier, and the skin is less capable of combatting bacteria and viruses to prevent a full-blown infection.
Wet Wrap Therapy Might Be Challenging For Adults And Older Children
Adults and older children with larger bodies and more surface area to wrap may not fare as well with wrap treatment, Mordorski says, especially when its applied at home or in a doctors office, but they may do well in the hospital when admitted for a severe flare.
The application is cumbersome and less practical, and older patients are less likely to follow through in the outpatient setting, she explains. In the hospital, where theres more assistance, wet wraps become more feasible for a broader range of patients.
For older people with severe atopic dermatitis, Mordorski says wet wraps can be used as a stop-gap to manage a severe flare-up during the wait for longer-term systemic eczema therapy to take effect.
A patient who is ill during a severe flare with a fever, chills, loss of appetite, low energy, or other issue should see a dermatologist to help determine whether to go to a hospital for monitoring or alternative treatment.
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Kinder Gentler Bleach Baths
We love to recommend bleach baths but know these dont work for everyone. Bleach baths can be painful because theyre often called for at the time when the skin is flaring and has a lot of open wounds.
One tip I like to suggest is to get into the bath with dressings still on. This will allow the skin to re-equilibrate and help alleviate some of that initial discomfort of getting into the bath, before you start pulling the wraps off.
Another way to help tolerate getting into bleach baths is to put a little antibacterial ointment or petroleum jelly in the cracks of the skin.
For children, you can distract the child with toys or an activity during the first couple of minutes of a bleach bath, so theyre focused on something other than the changing skin sensation that takes place in the first few minutes after getting in the tub.
Why Wet Wrap Therapy
Those with eczema, sometimes called atopic dermatitis, usually suffer from side effects such as itchy skin, skin infections and eczema flare-ups. To help manage your eczema symptoms, a dermatologist may prescribe topical corticosteroids. Yet topical steroids arent always effective on their own, especially for severe eczema. Because of this, you might also consider wet water therapy which provides hydration and itch relief. In fact, wet wrap therapy reduces eczema symptoms in over 70% of kids who try it!
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Why Do Kids Get Eczema
Skin has special cells that react when they come in contact with anything that irritates them. They make the skin inflamed to protect it. If you have eczema, these cells overreact when something triggers them and they start to work overtime. Thats what makes your skin red, sore, and itchy.
No one is really sure why people get eczema. Its not contagious no one can catch it from you and you cant catch it from anyone else. Kids who get eczema often have family members with hay fever , asthma , or other things known as atopic conditions.
More than half of the kids who get eczema will also someday develop hay fever or asthma themselves. Eczema is not an allergy itself, but allergies can be a trigger for eczema. That means that if you have allergies to things like dust or animal dander, your eczema may flare up sometimes.
Aside from allergies, some things that can set off eczema include:
- soaps, detergents, or perfumes
- dry winter air with little moisture
- other things that can irritate your skin, like scratchy fabrics
Two: Distraction Action/focus On Something Else
As soon as youve treated the skin the way that is right for you, know that the itch isnt going to settle down instantaneously. Treatment needs a few minutes to work. While your skin action take effect, do something fun to distract the mind from the itch.
Try a relaxing activity before bed, like reading a book or telling a story, doing meditation, or listening to music. The idea is to find as many healthy ways as possible to forget about scratching. Laughing and doing fun or relaxing things increases dopamine, serotonin, and endorphins. All these brain chemicals can make you feel better and reduce itch.
Sometimes you might be able to notice that youre itchy, accept that youre an itchy person, and just let it be. If youve taken action to help provide relief, believing in it and giving it time to work can sometimes quell the compulsion to scratch. There is no one answer. Youve got to find what works for you.
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An Increased Itch Factor
People with atopic dermatitis skin are fundamentally more physically sensitive to sensations and itch. Over the years, publications have shown that with atopic dermatitis, you may have increased proteins that signal for itch and increased nerve endings that help pick up the itch sensation and transmit that sensation to your brain.
Who Does Wet Wrap Therapy Help
Wet wrap therapy is best for people that have moderate to severe atopic dermatitis.
If your prescription-strength creams or topical medications donât help, your doctor may want you to try wet wrap therapy before stepping up to medication like biologic drugs.
Wet wrap therapy works well during intense flares of atopic dermatitis. When you have severe pain or itching, it hydrates and soothes your skin. Itâs good for small or widespread areas.
You can do wet wrap therapy at home, without a prescription. You put the dressings on your skin after you apply moisturizer and topical medication.
If the atopic dermatitis is on your face, a medical professional trained in wet wrap therapy will use gauze and surgical netting to apply a face wrap.
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Follow These 3 Tips For An Effective Wet
This treatment is naturally suited to the evening, before going to bed for the night. Being all covered in cream is hardly the time to do your more energetic activities. Rather, this is the ideal time to relax before settling in for a great, itch-free night.
Can You Cover Up Eczema
When it comes to foundation and concealer, both liquid and stick formats are safe to use, as long as theyre balanced with hydrating ingredients that will work to heal scaly patches. A color-correcting concealer with yellow or green undertones can help neutralize the redness from facial eczema flare-ups, too.
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Should I Cover My Eczema At Night
Judith Mcdonald | Answered March 7, 2021
Leaving the wrap on overnight can help keep the skin hydrated. Avoiding harsh fabrics: Avoid sheets or pajamas made from fabrics that can irritate the skin, such as wool or polyester. Clothing and linens made from 100% cotton are gentler on the skin.Aug 22, 2022
How Long Do Eczema Flare
Beatrice French | Answered February 26, 2021
With proper treatment, most eczema flare-ups should clear up in one to three weeks. If symptoms persist, seek medical attention. What does an eczema flare-up feel like? Common symptoms of an eczema flare-up include red, itchy skin, and dry skin.Nov 16, 2021
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Wet Wrap Therapy: A Step By Step Guide
What equipment is required?
Ensure all surfaces are clean and dry and that there is plenty of room for the carer and patient to manoeuvre around the room. You will need clean warm water, the emollients and/or topical steroid treatment , plus two layers of the chosen garment such as ComfiWEAR and ComfiKIDS.
How long should the garments be worn?
The garments can be worn continuously for up to 24 hours at a time.
The garment may begin to feel dry, if this happens, the layer of garment next to the skin can be dampened this can be done by rolling up the top layer of garment and using a spray bottle with warm water to re-dampen the under layer. If extra emollient needs to be applied whilst wearing the garment, roll the garment up or down to access the skin.
In many cases, Wet Wrap Therapy is usually used for short periods of time to help an eczema flare settle e.g. each night for a week at a time.
How should the garments be removed?
Garments should be removed in the same way as clothes. To protect the fragile skin, they should be removed with care. If the garment is stuck to the skin, soaking it with warm water will help.
Can the garments be used again?
What Are Dry Eczema Wraps
Dry wraps are either clothes or bandages used to wrap and protect eczema skin. Because eczema can be exacerbated from various clothing materials, you want to make sure youre opting for clothing that is soft and made specifically with dermatitis in mind, like TENCEL, bamboo or cotton.
Thesedry wraps by Remedywear are made with TENCEL plus zinc and work great to soothe the skin. You can also dry wrap with items you already have at home such as pajamas, tube socks and more. Just make sure the clothing is form fitting. Loose clothing will rub against the skin and essentially remove your emollients.
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A Blend Of Creams In A Wrap
For more severe forms of eczema, cortisone creams are sometimes applied under a dressing for several hours to promote better skin absorption.A cortisone cream alone, or a mix of cortisone cream and emollient, is applied to the body then covered in a wet material, dampened with hot water. For the material, you can use either bandages or cotton clothing.
This wet material is then covered with a second layer of dry material to keep the water from evaporating or to prevent the sheets or surroundings from getting wet.
Are Wet Wraps A Good Treatment For Eczema
You can include wet wrap therapy in your eczema treatment plan to manage flare-ups and ease symptoms. The treatment provides a soft layer of protection that may improve comfort, prevent skin damage, and increase the effectiveness of topical medications. It also locks in moisture and protects against irritants, allergens, and microbes.
Wet wrapping helps to soothe, calm, and rehydrate skin during moderate to severe eczema flares. It also reduces skin damage by preventing itching, scratching, and picking. This is especially beneficial for people who subconsciously scratch at night. Wet wraps work to cool the skin, which also makes them helpful for people who overheat at night.
Wet wrap therapy is commonly prescribed for children, and it has shown to be effective for adults as well:
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Wet Wrap Therapy For Babies Can Be A Boon
Atopic dermatitis can start early, appearing in babies as young as 2 to 3 months. Wet wraps are a super option for babies with a severe eczema flare, says Jenny Montejo, MD, a pediatric allergist and immunologist and an assistant professor of pediatrics at the Mayo Clinic, in Rochester, Minnesota.
The treatment has few side effects and can reduce itching, oozing, and irritation, she says, leading to less crying and better sleep.
Dr. Montejo warns that wet wrap therapy should be used for babies and other pediatric patients only under the direction of a medical provider and with specific instructions for each case.
Preventing The Fire From Erupting
In order to prevent the fire, or eczema flare-ups from appearing, many of the same strategies apply: you need to soak in water to hydrate, reduce microbes with bleach or soap-free cleansers, and protect the skin barrier with barrier creams, ointments, and other forms of occlusion.
For some patients who have eczema that really bounces back, using the fire-extinguisher approach short, strong bursts of corticosteroid or regular pulsed use of medications can be very helpful. A schedule can be worked out with your physician, and just how many medications are included in the regimen depends on the patient.
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When To Call Your Childs Dermatologist
Signs of infection
Skin looks worse than before
Your child resists, so you cannot use the technique
Related AAD resources
ImagesSoak and smear and occlusion: Getty Images Wet wrap: J Am Acad of Derm. 2012 67:1006.
ReferencesDabade TS, Davis DMR, et al. Wet dressing therapy in conjunction with topical corticosteroids is effective for rapid control of severe pediatric atopic dermatitis: Experience with 218 patients over 30 years at Mayo Clinic. J Am Acad of Derm. 2012 67:1006.
Eichenfield LF, Tom WL. Guidelines of care for the management of atopic dermatitis: section 2. Management and treatment of atopic dermatitis with topical therapies. J Am Acad Dermatol. 2014 Jul 71:116-32.
Gutman AB, Kligman, AM, et al. Soak and smear: a standard technique revisited. Arch Dermatol. 2005 Dec 141:1556-9.
Habif TP, Campbell JL, et al. Topical corticosteroids. Dermatology DDxDeck. 2006, Mosby | Elsevier.
Kaufmann R, Bieber T, et al. Treatment with pimecrolimus cream 1%, with overnight occlusion, of moderate to severe atopic dermatitis for 8.5 days did not measurably increase systemic exposure. Poster presented at the 2009 Annual Meeting of the American academy of Dermatology in San Francisco. J Am Acad of Derm. 2009 60 , page AB67. Commercial support: Novartis Pharma paid for poster production.
Mallon E, Powell S, et al. Wet-wrap dressings for the treatment of atopic eczema in the community. J Dermatolog Treat. 1994 5: 9798.
Eczema Treatments And Covid
When taking systemic medication, it is advised that you avoid live vaccines. None of the COVID-19 vaccines authorized for use in the United States contain a live virus. Therefore, if you are taking a treatment that affects the immune system, it is advised that you can safely receive the COVID-19 vaccine.
Even though it is considered safe to have the COVID-19 vaccine, clinicians advise they still do not know whether being on an immunosuppressant or biologic treatment will reduce the vaccines effectiveness. Research is still ongoing in this area.
If you take immunosuppressants, systemic, or biologic medication for your eczema and are concerned about whether you are more at risk from COVID-19, then speak to your healthcare professional for support and advice.
Some clinicians advocate taking extra safety precautions to reduce the risk of contracting COVID-19 if you are on multiple medications or have additional underlying health conditions.
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