title: Wet wrap therapy in children with moderate to severe atopic dermatitis in a multidisciplinary treatment program.
abstract: BACKGROUND
  Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD.
  
  
  OBJECTIVE
  This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed.
  
  
  METHODS
  An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described.
  
  
  RESULTS
  Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge.
  
  
  CONCLUSIONS
  To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.
authors.affiliation: College of Nursing, University of Colorado, Aurora, Colo; Department of Nursing, Children's Hospital Colorado, Aurora, Colo. Electronic address: Noreen.nicol@ucdenver.edu.
authors.forename: Noreen Heer
authors.initials: NH
authors.lastname: Nicol
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors.forename: Mark
authors.initials: M
authors.lastname: Boguniewicz
authors.affiliation: Department of Biostatistics, National Jewish Health, Denver, Colo.
authors.forename: Matthew
authors.initials: M
authors.lastname: Strand
authors.affiliation: Department of Pediatrics, National Jewish Health, Denver, Colo.
authors.forename: Mary D
authors.initials: MD
authors.lastname: Klinnert
mesh_terms: D000293:Adolescent; D000465:Algorithms; D001458:Bandages / Q000706:statistics & numerical data; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003876:Dermatitis, Atopic / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D006801:Humans; D006875:Hydrotherapy; D007223:Infant; D033183:Interdisciplinary Communication; D008297:Male; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
keywords: Atopic dermatitis; Management; Outcomes; Wet wrap therapy