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Wet Wrap Therapy for Eczema

Wet to Dry Dressings for Eczema

During particularly intense eczema flares with severe itch or pain, wet wrap therapy can work wonders to rehydrate and calm the skin and help topical medications work better. The fabric wraps are soaked in water and applied to the affected skin on the body. Face wraps use gauze and surgical netting, and are made and applied by nurses trained in this treatment.

Link to Wet Wrap Therapy.

 

S.A.D.: Severe Atopic Dermatitis

In today's NY Times, there is an incredible article about S.A.D. by science writer Ingfei Chen.  It touches on the role of staph in exacerbating the eczema, the need for soothing baths, the role of antibiotics in treatment and more.  Ms. Chen's article could be a primer for starting to learn about SAD.

In some way, SAD, and related inflammatory dermatoses, are orphan diseases.  At present, they don't have really expensive therapies that would induce drug companies to throw money at them (for secondary gain).  These patients take time and are very complex, and we dermatologists want to see a new patient everey ten to fifteen  minutes.

If you want to start to understand S.A.D. please read this article.  It can be accessed at Permalink.

Classic Wet Dressings

WET DRESSINGS

Wet dressings are used for acutely inflamed skin conditions. These rashes have varying degrees of redness, swelling, blistering, oozing, crusting, infection, and itching. The dressings cool and dry the skin. In addition, they cleanse the skin of exudates, crusts, and debris and help to maintain drainage of infected areas. Various medications may be added to the solution, but water is the most important ingredient.

The most common types of wet dressings I use are Domeboro powder packets or tablets (aluminum acetate) and normal saline, which can be mixed up by dissolving one teaspoon of slat in a pint of water. Directions for the Domeboro is to dissolve a packet or tablet in a pint or quart of water.

Method:

1. The dressing need not be sterile. Gauze, Kerelix, soft linen (such as old sheeting, pillowcases, handkerchiefs, or shirts) are acceptable. If cloth is used, it may be washed and reused. I recently heard that toilet paper can be folded and used, in addition.
2. Moisten the dressings by immersing them in the solution and gently ring them out. They should be sopping wet, not dripping. The solution should be warm and tepid. Cover with a soft towel or a cloth that will allow evaporation.
3. Apply or wrap skin loosely. Multiple layers (6-8) should be applied to prevent rapid drying or cooling.
4. The dressings should be removed, remoistened, and reapplied every 10-15 minutes for 1/2 to 2 hours three times a day.
5. After the dressing is removed, a lotion or cream may be applied to the skin as directed.

For some skin infections and abscesses (boils) the technique for wet dressings is modified somewhat. Follow steps 1-3, but then cover the warm dressings with plastic or Saran wrap. This helps to localize and heal the infection.

Reason used:___________________________________
Type solution:___________________________________
Use:____times a day for _________minutes for ________days.
____Cover ________Do not cover the dressing with plastic or Saran Wrap.

You many contact me with questions:  DJE

Soak and Smear

Old Wine in New Bottles

Recently, Dr. William James, Professor of Dermatology at the University of Pennsylvania has resurrected and improved a method to treat many  chronic inflamed skin disorders.  He has kindly made this Public Domain.  Your physician will give you specific guidelines.  Dr. James' handout is as follows:

Soak and Smear Educational Instruction Sheet
Prepared by William James, U Penn Dept. of Dermatology

Eczema is a chronic condition of the skin that can cause itchiness and redness.  Patients with eczema have sensitive skin, more sensitive than normal skin.  Sensitive skin is more easily irritated (which causes the itchiness) by dryness and irritants in the environment (such as wool in clothing or chemicals in lotions).  Eczema can be controlled with good skin care and environmental measures (avoiding things that irritate your skin).

Soaking & Smearing
This is an aggressive treatment that is both messy (find an old pair of pajamas) and time consuming.  This regimen may use a medication you have used before without success.  But this medicine is being used in a different way as part of an intensive treatment regimen that must be followed exactly to work.  This treatment can lead to marked improvement in even a couple of days.  The number of nights of soaking and smearing depends on the severity of the disease and how long it takes to get under control.  Usually patients do the soaking and smearing at night for 4 nights to 2 weeks.  The soaking and smearing treatments are done at night because the ointment on your skin will get on your pajamas instead of your clothes (that you wear during the daytime) and the ointment will be on your skin for several hours while you sleep.  After the skin is under control, the soaking is stopped but the nighttime smears with an ointment or moisturizer should continue.

Soak in a bath (not a shower) in plain water for 20 minutes (use a timer) at night, THEN Smear immediately, without drying the skin, with the ointment prescribed by your doctor (steroid) for the number of days recommended by your doctor. 

For hand dryness and cracking, soak your hands continuously in a pan of water for 20 minutes at night and follow with the smearing as above.  Use of thin cotton gloves worn over the ointment will be helpful. 

After the skin is under control, the soaks at night can be stopped.  But continue to smear the ointment each night.  Throughout the treatment period you can apply an emollient cream to the worst areas in the morning. The soaking will allow water to go into the skin and hydrate it, then smearing on the ointment will (1) trap the water in the skin (because water cannot move through oil) and moisturize the skin and (2) allow the anti-inflammatory ingredient in the ointment to get deep into the skin.

Maintenance Treatment:  Prevent Drying/Irritation.  Repeated wetting (i.e. baths, showers, swimming) without moisturization will actually dry out the skin more.  So when showering or washing your hands, it is necessary to apply a moisturizer such as Aquaphor of Hydrophilic Ointment on your slightly moist skin to prevent drying.  These less thick moisturizers may be used during the daytime, with Vaseline® petroleum jelly always available for more intense moisturization at night.
SOAP:  Using soap in the shower can further dry out the skin by removing the oils the skin naturally produces.  There are three types of glands found in the skin.  The sebaceous gland produces an oily substance, called sebum, which is the body’s natural moisturizer.  The sebaceous glands are found over most of the body with the highest amount on the face and upper trunk and the fewest on the arms and legs.  These latter places are usually the sites that become dry the earliest.  The second kind of gland is the eccrine sweat gland, which produces sweat when we are hot.  The sweat that is made has the same consistency as water so will be removed from your skin when water (no soap needed) runs over your skin in the shower.  The third gland is the apocrine gland.  This gland is responsible for producing the odor known as “body odor.”  The apocrine glands are found only in the armpits and groin, not on the arms or legs.  Therefore, you can get clean and help your skin by limiting the use of soap to the armpits and groin.  You should then pat dry (preferably leaving some water on the skin surface) and apply moisturizer.  This should be the way you shower from now on to help prevent future breakouts.

This treatment is simple, safe and remarkably effective.  Good Luck!  We will value your feedback.