A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD).
BACKGROUND
Soak and smear (SS), a technique whereby a bath is followed by topical corticosteroid (TCS) application to wet skin, is reported to be a beneficial adjunctive therapy for patients with recalcitrant atopic dermatitis (AD).


OBJECTIVE
We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD.


METHODS
A randomized, investigator-blinded, controlled study was performed in children with AD. Patients were randomized to apply TCS either via SS (n = 22) or to dry skin (n = 23) for 14 days. The primary outcome was an improvement in the Eczema Area and Severity Index score. Secondary outcomes included assessments of disease burden, pruritus, and sleep; morning cortisol levels; and adverse effects.


RESULTS
Patients with AD severity who applied TCS via SS or to dry skin improved 84.8% (95% confidence interval 77.5-92.1) and 81.4% (95% confidence interval 70.3-92.4) by Eczema Area and Severity Index score, respectively. There was no statistical difference between the 2 groups (P value = .85).


CONCLUSIONS
Small sample size limited the power of our study.


CONCLUSIONS
We did not find that application of TCS to presoaked skin works better than application to dry skin for the treatment of AD in children.
Yale University School of Medicine, New Haven, Connecticut.
Lucinda L
LL
Kohn
Yale University School of Medicine, New Haven, Connecticut.
Yanna
Y
Kang
Department of Dermatology and Pediatrics, New Haven, Connecticut; Yale University School of Medicine, New Haven, Connecticut. Electronic address: richard.antaya@yale.edu.
Richard J
RJ
Antaya
D000279:Administration, Cutaneous; D002675:Child, Preschool; D003876:Dermatitis, Atopic / Q000188:drug therapy*; D003879:Dermatologic Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D006801:Humans; D006854:Hydrocortisone / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D007223:Infant; D008297:Male; D055118:Medication Adherence; D009824:Ointments; D012720:Severity of Illness Index; D016037:Single-Blind Method; D014222:Triamcinolone Acetonide / Q000008:administration & dosage* / Q000009:adverse effects / Q000097:blood; D014867:Water
D003879:Dermatologic Agents; D005938:Glucocorticoids; D009824:Ointments; D014867:Water; D014222:Triamcinolone Acetonide; D006854:Hydrocortisone
atopic dermatitis; bath; corticosteroids; eczema; hydration; soak and smear