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Eczema Treatment Wet Wrap Therapy

How Are Paste Bandages And Wet Wraps Used

Wet Wrap Therapy for Atopic Dermatitis – Eczema – Nemours Children’s Health System

Viscose tubular bandages and therapeutic garments can be helpful as they hinder scratching and aid the absorption of emollients, thereby helping to control the itchscratch cycle and eczema flares. However, bandaging and wrapping should only be used under the supervision of your healthcare professional.

Bandages and wraps can be used to cover the whole body in children, but adults tend to use them only over patches of eczema.

In wet wrapping, warm, wet tubular bandages are applied to the body over a generous layer of emollient and sometimes a mild or moderately potent topical steroid . A dry layer of bandage is then placed over the wet layer. Wet wraps are particularly helpful at night as they also cool the skin.

Paste bandages for eczema come impregnated with ingredients that soothe the itch and calm irritation. There are several types of paste bandages available, such as icthopaste , viscopaste and Zipzoc , which is more like a stocking than a bandage. Paste bandages can be used for whole limbs or patches of eczema to which a normal amount of emollient and prescribed topical steroid is applied . Since paste bandages are messy, secondary bandages are necessary these also help to hold the paste bandages more securely in place.

CAUTION: Covering up the skin makes topical treatments more potent, so you should only use topical steroids under bandages and wraps as advised by your healthcare professional. Do not use paste bandages or wet wraps if your skin is infected.

How Do I Use Wet Wraps For Eczema

Before starting wet wrap therapy, talk with a healthcare professional. They can teach you the correct technique, tell you how often to do it, and advise you on which type of topical product to use.

You can use products such as coconut oil, apple cider vinegar, and hydrocortisone creams to treat eczema. Other options include petroleum jelly, essential oils, and witch hazel. Do not use a topical steroid cream without your doctors recommendation and supervision.

You can use the following materials for dressings:

  • viscose tubular bandages, which are available by prescription or over the counter from your local pharmacy or online
  • medical-grade viscose garments, such as vests and leggings
  • gauze from a roll
  • clean, white cotton clothing

For hands and feet, you can use cotton gloves or socks for the wet layer. For the dry layer, use vinyl gloves or food-grade plastic wrap.

Here are the basic steps of wet wrap therapy:

  • After bathing, use a towel to gently pat dry the affected area.
  • Use clean hands to apply a generous layer of topical moisturizer to the affected area.
  • Soak the dressings in warm water and gently squeeze out any excess water.
  • Wrap your skin using warm, wet dressings.
  • Wrap a dry layer over the wet layer.
  • Use care when getting dressed.
  • As long as the wet wraps stay moist, you can keep them on for several hours or overnight.
  • Continue treatment for up to 2 weeks.
  • How Do Wet Wraps Work

    Wet-wrap dressings create a moist, physical barrier that has several benefits, including:

    • Cooling the skin
    • Increasing moisturization and softening of skin, which makes medicine penetrate better
    • Serving as a physical barrier against scratching

    Some wet wraps are created using moistened gauze, cotton, or bandages. Another technique involves using wet pajamas as the physical barrier. While it may sound strange at first, wet pajamas can actually be an effective wet-wrap dressing.

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    Risks Of Wet Wrap Therapy

    Talk to your doctor before trying wet wrap therapy. Theyâll tell you if itâs right for you, how and when to do it, and how to look for signs of skin infection.

    Avoid using wet wrap therapy for more than 1-2 weeks. Doing it too long or too often can lead to side effects like skin infection.

    Call your doctor if you still have symptoms or if you have a fever, redness, or pain. They may be signs of infection.

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    For Children & Adults

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    • Apply creams as directed by your doctor
    • Use tubular bandages from the pharmacy which can be cut to size or cotton pyjamas in warm water and squeeze as dry as possible or spin in the washing machine
    • Put on damp clothing then a layer or dry clothing
    • Leave on for minimum 30 minutes up to 2 hours depending on comfort level. For some sufferers it may be an overnight treatment
    • Remove wet clothing
    • Pat skin dry then apply a generous layer of moisturiser

    As skin improves, taper off wet wrap frequency rather than stopping abruptly. Moisturisers should be applied 3-4 times a day otherwise the skin will become dry and itchy again.

    • Wet dressings will dry after a few hours
    • Do not leave the dressings on dry as dry dressings can irritate the skin by causing it to become hot, dry and itchy
    • Use a spray bottle of warm water to moisten bandages
    • Crepe bandages used for wet dressings may be washed in the washing machine
    • Do not wash or reuse the disposable towels
    • Do not use antiseptic bath oils in the wet dressings as these may irritate and burn your childs skin

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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?

    ComfiWEAR and ComfiKIDS garments can be washed in the washing machine and re-used. The instructions on how to do this can be found in the instructions leaflet inside the garment box.

    Wet Wrap Therapy For Children

    Wet wrap therapy works for children. It may help with itching, crying, and irritability. It may also help your child sleep better because it relieves their symptoms.

    Your doctor may recommend wet therapy for your child at night, after you put on a topical corticosteroid. Avoid doing it for more than 1 week. If your child likes the feeling of wet wrap therapy and it helps their skin stay moist and less itchy, you can do it longer by using moisturizer instead of corticosteroids.

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    Tips For Bathing And Moisturizing With Eczema

    Although there have not been comparative studies to pinpoint the best frequency or duration of bathing, the Soak and Seal method of treating eczema is recommended by many healthcare providers to combat dry skin and reduce flares.

    To get the full therapeutic benefit of Soak and Seal, follow these steps in order:

    • Bathe or shower in lukewarm water for a short period of time at least once per day.
    • Avoid scrubbing your skin with a washcloth or loofah.
    • Use a gentle cleanser that is unscented, fragrance-free and dye-free.
    • Lightly pat dry with a towel leaving the skin damp. Do not rub the skin.
    • Apply prescription topical medication to the affected areas of skin as directed.
    • Liberally apply a high-oil content moisturizer all over the body to seal in moisture. Try to do this within 3 minutes to limit the amount of moisture lost from the skin.
    • Let the moisturizer absorb into the skin for a few minutes before dressing or applying wet wraps. Wear cotton gloves over your hands while you sleep to help lock in the moisturizer and prevent scratching.

    Visit our Product Directory for a list of cleansers and moisturizers that fulfill the requirements of NEAs Seal of Acceptance program.

    Bathing Moisturizing And Wet Wraps

    Wet Wrap Therapy

    People with eczema tend to have very dry skin in general. This is because the disease causes defects in the stratum corneum, or the skin barrier. The skin barrier is the outermost layer of the skin that serves a dual purpose: it protects irritants, bacteria, viruses and allergens from getting into our bodies and it keeps moisture from getting out. Genes, skin trauma such as from scratching or rubbing and inflammation caused by the immune system can all contribute to this defective or leaky skin barrier in people with eczema.

    The most effective way to treat dry skin is to give it the moisture it needs and help it to retain it. Proper bathing and moisturizing are important for this reason especially if you have eczema. The best way to replace and retain moisture in the skin is to moisturize immediately after taking a bath or shower.

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    Some Doctors Are Not Fans Of Wet Wrap Therapy

    Not all dermatologists recommend wet wraps. A. Yasmine Kirkorian, MD, the chief of dermatology at Childrens National Hospital and an associate professor of dermatology and pediatrics at George Washington University School of Medicine in Washington, DC, believes there are better alternatives.

    In theory, wet wraps can be very effective, but in practice, they can be cumbersome and difficult for families to use effectively, Dr. Kirkorian says. She notes that patients with a severe flare can get similar results with a simpler technique called soak and smear that involves applying medication and then moisturizer to damp skin before sliding on dry cotton pajamas.

    Kirkorian notes that the availability of FDA-approved systemic medications for the treatment of refractory atopic dermatitis in children may override the need for wet wrap therapy in these patients.

    Any child with severe atopic dermatitis extensive body surface area involved, not responding to first-line treatments, waking up nightly from itching, sustaining skin infections, missing school for eczema, going to the ER or being hospitalized for eczema should be evaluated by a board-certified dermatologist or pediatric dermatologist, Kirkorian says.

    Learn More About The Advantages Of Wet Wrap Therapy

    Dr. Mark Boguniewicz from National Jewish Health, talks about the advantages of wet wrap therapy:

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    Less Cortisone Than In A Tablet

    In some cases, an entire tube of topical corticosteroids is needed for the first application. But dont worry: the amount of cortisone in a tube of cream is less than that ingested in a single 20 mg tablet! Plus, very little cortisone is actually absorbed into the skin when applied topically, with most staying on the surface to combat inflammation. This means you have no risk of developing the side effects observed with oral cortisone treatments.

    Why Do Dermatologists Recommend These Techniques

    Food Allergy Buzz: New Atopic Dermatitis / Eczema Wet Wrap Therapy Garments
    • 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

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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.

    How Does Wet Wrapping Work

    Wet wraps work via three different ways:

    • Cooling as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness.
    • Moisturising emollients covered over with wet bandages are deeply absorbed into the skin to provide a longer lasting moisturizing effect.
    • Steroid absorption enhanced absorption of topical steroid molecules into both the superficial and deeper layers of skin where inflammation is present.

    In addition, the bandages provide protection from the itching and scratching cycle so that skin gets a chance to heal properly.

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    How Do You Apply Wet Wraps

    Wet wraps are most often applied in a hospital for severe eczema. However, wet wraps may also be applied in the community or at home at the first signs of a worsening condition to reduce the need for hospital admission.

    There are different methods and bandages used for wet wrapping but the basic technique is as follows.

    • Depending on the area being treated the patient may first soak in a bath with bath oil or emollientsolution
    • An emollient and/or steroid cream is liberally applied to the area
    • Bandages soaked in warm water are wrapped or applied over the top of the creams
    • Dry bandages are placed over the top of the wet bandages to protect clothing
    • Later on, the dry bandage may be removed and water sprayed on the underneath layer to keep it damp, before reapplying the dry outer bandage.

    Convenient eczema garments have been developed for wet wrapping children with eczema, e.g. Ad RescueWear, Comfifast Easywrap and Tubifast. Medical-grade silk garments are not suitable for wet wrapping.

    Applying tubular dressings

    Wet Wrap Therapy Can Be An Eczema Treatment Option For Young Children

    Eczema Wet Wrap Therapy with Dr Mohana

    A study published in the Journal of Allergy and Clinical Immunology in Practice that included 72 children with moderate to severe atopic dermatitis found that wet wrap therapy reduced symptom severity.

    The typical candidate for wet wrap therapy is a young child with a severe eczema flare, especially if theyve already been using topical steroids and/or topical calcineurin inhibitors, says Breanne Mordorski, MD, a dermatologist at Montefiore Health System and an assistant professor of dermatology at the Albert Einstein College of Medicine in New York City.

    For these patients, wet wraps are a good second-line option when traditional topical treatments fail, Dr. Mordorski says.

    She adds that wet wraps can also be helpful for children during a severe eczema flare-up when there are delays in access to systemic medications such as Dupixent . This prescription injectable biologic has been approved by the U.S. Food and Drug Administration for children as young as 6 months.

    Doctors recommend that a parent administering wet wrap therapy begin by soaking the child in the bathtub and washing them with unscented soap, making sure to get their full body and face wet, and gently patting them dry. The parent should then apply any topical medications prescribed or recommended by the childs doctor, followed by a thick layer of unscented ointment or moisturizer, such as Vaseline, Aquaphor, or CeraVe.

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    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!

    Controlling Eczema By Moisturizing

    Keeping your skins moisture intact is one of the most important things you can do to help control your eczema. Its important to understand how and when to properly moisturize and which products are best to use when you have eczema.

    Tips when moisturizing

    • If you use a prescription topical medication, apply it as directed, before you moisturize.
    • Apply a thick layer of moisturizer all over your skin within three minutes of bathing or showering to lock in moisture and protect the skin barrier.
    • Moisturize your skin at least twice a day.
    • Soften moisturizer by rubbing it between your hands and then apply it to your body using the palm of your hand.
    • If the moisturizer feels tacky on your skin, dont remove the excess. It will be absorbed within a few minutes.
    • Moisturize your hands every time you wash them or when they come into contact with water.

    Finding the right moisturizer

    Finding a moisturizer that works can be a challenge. What works for one person may not work for another and as the condition of your skin changes, so can the effectiveness of a product. A manufacturer may also change the formulation of a product periodically as well.

    Ointments

    Ointments such as petroleum jelly and mineral oil are usually the first choice for eczema treatment as they have the highest oil content and are very good at sealing in moisture. If you dont like how ointments feel on your skin, the next best alternative is a cream.

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