Wet wrapping in atopic eczema

Wet wrapping in atopic eczema


Wet wrapping overview

Wet wraps are a bandaging technique that may be used as part of treatment for moderate to severe atopic eczema. Wet wrapping is believed to work by evaporation, rehydration and protection.

Atopic eczema management

Healthcare professionals should use a stepped approach to manage atopic eczema in children. This means tailoring the treatment step to the severity of the atopic eczema. Emollients should form the basis of atopic eczema management and should always be used, even when the atopic eczema is clear. Management can then be stepped up or down, according to the severity of symptoms, with the addition of the other treatments.

Healthcare professionals should offer children with atopic eczema and their parents/carers information on how to recognize flares of atopic eczema (increased dryness, itching, and redness, swelling and general irritability). They should give clear instructions on how to manage flares according to the stepped-care plan, and prescribe treatments that allow children and their parents or carers to follow this plan.

Frequent and generous use of emollients helps the skin to feel more comfortable and less itchy. They keep the skin moist and flexible, helping to prevent cracks. Emollients are available as creams, ointments and lotions, any or all of which might be suitable to use at different times, depending on whether a person’s eczema reacts to a specific ingredient in an emollient. When applying emollients, in order to prevent contamination of bacteria from the skin to the cream, it is vital that you do not use your hands to apply the emollient. The cream should be removed from the tub with a clean spatula/spoon.

Topical corticosteroids in atopic eczema

Topical corticosteroids (TCs) block some of the effects of the chemicals used by the immune system to trigger the process of inflammation, and make the immune system less sensitive, meaning it is less likely to cause symptoms that affect the skin. They help to regulate the production of new skin cells and narrow the blood vessels in the affected areas of skin, thus reducing the amount of inflammatory chemicals sent to the skin. Topical steroid preparations are divided into four categories according to how strong or potent they are: mild, moderately potent, potent and very potent. The potency of topical corticosteroids should be tailored to the severity of the child’s atopic eczema, which may vary according to body site.

Potency of topical corticosteroids

  • Use mild potency for mild atopic eczema.
  • Use moderate potency for moderate atopic eczema.
  • Use potent TCs for severe atopic eczema
  • Use mild potency for the face and neck, except for short-term (3–5 days) use of moderate potency for severe flares.

Fear of side effects can make people under-treat their eczema by stopping treatment too soon or not using the steroid they have been given. This can affect the overall management of the condition and may mean that a stronger preparation has to be used to bring the eczema under control again. If potent topical steroids are used for a long period of time, particularly to the face and flexures, without adequate supervision, skin thinning can occur. If atopic eczema is not controlled by topical corticosteroids and if there is risk of important adverse effects from topical corticosteroid treatment, then treatment with topical calcineurin inhibitors should be considered. These are immune-modulatory drugs, which means it modulates or changes the immune system to reduce skin inflammation.

Treatment using wet wrapping

Wet wraps are particularly useful for children with moderate to severe eczema whose skin is not made comfortable with the sole application of moisturizers and appropriate topical steroids. A particular indication for wet wrapping is severe night-time itching where the family is kept awake by the child’s inability to sleep due to the cycle of itching and scratching.

An emollient or topical steroid should be applied to the skin after the bath and before the inner layer of the wet wrap is applied to the skin. The inner layer is soaked in warm tap water and gently squeezed out before being applied to the trunk and limbs. The wet layer is applied first and the dry layer is folded back on itself to cover the hands and feet. The wraps create a warm humid environment, which encourages bacterial growth, and this can spread the infection. They should therefore not be used in the visible presence of any bacterial, fungal or viral infection.

The advantages of wet wrapping are:

  • Evaporation: The gradual drying out of the wet layer has a cooling effect on the skin, therefore reducing itching and discomfort. It is therefore essential that the bandages are remoistened and not allowed to completely dry out.
  • Rehydration: This is putting moisture back into the skin. The skin absorbs the large amount of emollient used and so in general will soften the skin, when a wet wrap is used.
  • Protection: The body suit puts a barrier between the child’s fingers and the skin, thus reducing any damage to the skin caused by scratching and so encourages the damaged skin to heal.
Oct 25, 2018 | Posted by in NURSING | Comments Off on Wet wrapping in atopic eczema
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