The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled trial.
BACKGROUND
Wet-wrap treatment (WWT) has been advocated as a relatively effective treatment in children with severe atopic dermatitis (AD). WWT often serves as crisis intervention for AD.


OBJECTIVE
We sought to evaluate the use of WWT with diluted corticosteroids in comparison with emollient in children with severe AD during 4 weeks in a proactive schedule during which the frequency of corticosteroid applications was tapered.


METHODS
A randomized, double-blind, placebo-controlled study was performed in children aged 6 months to 10 years with severe AD (objective SCORAD at least 40 ± 5), comparing WWT with diluted corticosteroids (1:3 mometasone furoate 0.1% ointment and for the face 1:19 mometasone furoate 0.1% ointment under a mask) with emollient (petrolatum 20% in cetomacrogol cream). The primary outcome was improvement of the objective SCORAD; secondary outcomes included Patient-Oriented Eczema Measure and quality-of-life index.


RESULTS
WWT with diluted corticosteroids acted faster and was more efficacious than WWT with emollients. Best results were obtained in age groups 6 to 9 years and 0 to 3 years. The difference in efficacy evaluated by objective SCORAD was significant at all measuring points. This also applied to the quality-of-life index.


CONCLUSIONS
The study group was relatively small.


CONCLUSIONS
WWT for severe AD is an effective therapy option for at least a period of 4 weeks.
Department of Pediatrics, Division of Pediatric Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; KinderHaven, Havenziekenhuis, Rotterdam, The Netherlands.
Sherief R
SR
Janmohamed
Department of Pediatrics, Division of Pediatric Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; KinderHaven, Havenziekenhuis, Rotterdam, The Netherlands; Department of Dermatology, Maasstad Ziekenhuis, Rotterdam, The Netherlands. Electronic address: a.oranje@inter.nl.net.
Arnold P
AP
Oranje
Department of Dermatology, Maasstad Ziekenhuis, Rotterdam, The Netherlands.
Arjan C
AC
Devillers
Department of Biostatistics, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.
Dimitris
D
Rizopoulos
Department of Dermatology, Sint Franciscus Gasthuis, Rotterdam, The Netherlands.
Marinus C G
MC
van Praag
Department of Pediatrics, OLV Hospital, Aalst, Belgium.
Dirk
D
Van Gysel
Department of Dermatology, AZ Sint-Jan Brugge Oostende AV, Campus Brugge, Brugge, Belgium.
Marleen
M
Goeteyn
Department of Dermatology, Erasmus MC, University Medical Center, Rotterdam, The Netherlands; KinderHaven, Havenziekenhuis, Rotterdam, The Netherlands.
Flora B
FB
de Waard-van der Spek
D000287:Administration, Topical; D000305:Adrenal Cortex Hormones / Q000008:administration & dosage*; D001458:Bandages; D002648:Child; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000175:diagnosis / Q000188:drug therapy* / Q000628:therapy; D004311:Double-Blind Method; D004643:Emollients / Q000008:administration & dosage*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D000068656:Mometasone Furoate; D010577:Petrolatum / Q000008:administration & dosage; D011244:Pregnadienediols / Q000008:administration & dosage*; D011446:Prospective Studies; D012016:Reference Values; D018570:Risk Assessment; D016896:Treatment Outcome
D000305:Adrenal Cortex Hormones; D004643:Emollients; D011244:Pregnadienediols; D000068656:Mometasone Furoate; D010577:Petrolatum
atopic dermatitis; diluted corticosteroids; eczema; emollients; long-term-intervention; wet-wrap treatment