title: Prehydration is effective for rapid control of recalcitrant atopic dermatitis.
abstract: BACKGROUND
  Skin care remains a key component in atopic dermatitis (AD) management; there are no data available guiding optimal bathing recommendations.
  
  
  OBJECTIVE
  This study aims to determine whether 15-minute to 20-minute baths followed by topical corticosteroid application (prehydration therapy) are effective for clearing moderate to severe AD.
  
  
  METHODS
  In the Oregon Health & Science University outpatient dermatology clinic, a retrospective review was done of the health records of patients with AD seen first between January 1, 2007, and December 31, 2011, who were then reevaluated within 1 to 3 weeks of starting the therapy. Qualifying patients underwent the prehydration regimen and were reevaluated. The primary outcome was therapeutic response using the Investigators' Global Assessment Scale. Secondary outcomes were measured using the dynamic Treatment Response Scale. Of 110 distinct electronic records, 35 patients were excluded. At the initial visit, 75 patients were evaluated with the Investigators' Global Assessment Scale. Forty-eight patients (64%) were severe, and 27 patients (36%) were moderate. All subjects began prehydration therapy followed by topical corticosteroid. At follow-up visit in 1 to 3 weeks when using the patient's or provider's assessment of treatment response, 59 patients (79%) had marked improvement, and 3 patients (4%) were clear.
  
  
  CONCLUSIONS
  Prehydration followed by topical corticosteroid therapy seems to be a highly effective regimen that achieves rapid control of moderate to severe disease.
authors.affiliation: From the Department of Dermatology, Oregon Health & Science University, Portland, OR.
authors.forename: Tamar
authors.initials: T
authors.lastname: Hajar
authors.forename: Jon M
authors.initials: JM
authors.lastname: Hanifin
authors.forename: Susan J
authors.initials: SJ
authors.lastname: Tofte
authors.forename: Eric L
authors.initials: EL
authors.lastname: Simpson
mesh_terms: D000293:Adolescent; D000328:Adult; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D001494:Baths / Q000379:methods*; D001623:Betamethasone / Q000008:administration & dosage / Q000031:analogs & derivatives*; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000628:therapy*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014222:Triamcinolone Acetonide / Q000008:administration & dosage*; D055815:Young Adult
chemical_list: D000893:Anti-Inflammatory Agents; C011175:betamethasone-17,21-dipropionate; D001623:Betamethasone; D014222:Triamcinolone Acetonide