Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta‐analysis

Abstract

Wet wrap therapy (WWT) consists of topical steroids administered under a layer of wet cotton bandages or garments. Several trials with WWT have reported promising results in atopic dermatitis (AD). However, no systematic review and meta-analysis on its efficacy and safety has been published. Our objective was to conduct a systematic review of the literature on WWT in AD to assess its efficacy and safety. We included randomized controlled trials among patients of all ages with a diagnosis of AD based on predefined criteria or made by a dermatologist. Electronic searches were performed from 1970 to 30 March 2016 in the Cochrane Central Register of Controlled Trials, MEDLINE, Embase and the World Health Organization International Clinical Trials Registry. Selection of studies and data extraction were performed independently by two researchers, and discrepancies were resolved by consensus. Six trials comparing WWT with topical steroids in children or adults with AD were included. Sample sizes ranged from 19 to 51 patients. Results on clinical severity and quality of life were reported incompletely and proved heterogeneous across studies. A nonsignificant tendency to increased risk of mild skin infections was observed in those treated with WWT (pooled relative risk 6·35, 95% confidence interval 0·83-48·55). The overall grade of quality of evidence for the efficacy and safety outcomes was low. In conclusion, the evidence that WWT is more effective than conventional treatment with topical steroids in AD is of low quality. Further clinical trials should establish the efficacy of WWT in AD.

Consensus‐based European guidelines for treatment of atopic eczema (atopic dermatitis) in adults and children: part I

“…Wet‐wrap medications are highly effective in acute AE and improve tolerance. The use of wet‐wrap dressings with diluted corticosteroids for up to 14 days (usual is rather up to 3 days) may be a safe crisis intervention treatment of severe and/or refractory AE with temporary systemic bioactivity of the corticosteroids as the only reported serious side‐effects . However, this treatment approach is not standardized yet, and the evidence that it is more effective than conventional treatment with topical steroids in AE is not of high quality.…”

“…The use of wet-wrap dressings with diluted corticosteroids for up to 14 days (usual is rather up to 3 days) may be a safe crisis intervention treatment of severe and/or refractory AE with temporary systemic bioactivity of the corticosteroids as the only reported serious side-effects. [102][103][104][105] However, this treatment approach is not standardized yet, and the evidence that it is more effective than conventional treatment with topical steroids in AE is not of high quality. Simple or occlusive medications in less sensitive skin areas and for brief time periods may also increase efficacy and speed up lesion resolution.…”

What's new in atopic eczema? An analysis of systematic reviews published in 2016. Part 1: treatment and prevention

“…One meta‐analysis evaluated wet‐wrap therapy for AE, consisting of topical steroid application under a layer of wet cotton bandages or garments (6 RCTs, 208 participants). A pooled estimate of the efficacy of wet‐wrap therapy could not be calculated due to the high trial heterogeneity.…”

Itching at night: A review on reducing nocturnal pruritus in children

“…As inflammation dermatoses improve, pruritus tends to decrease . WWT has the added benefit of providing a physical barrier to prevent the child from scratching, although a meta‐analysis of six randomized controlled trials (RCTs) from 2016 demonstrated that the grade of evidence for WWT relieving pruritic symptoms in children with AD is low, suggesting that further studies are needed to establish its efficacy in reducing nocturnal itching . Wet wrap therapy should be limited to less than 1 week at a time because of the risk of mild skin infections such as folliculitus …”