It's a Wrap: The Use of Wet Pajamas in Wet-Wrap Dressings for Atopic Dermatitis

Kelly L. Barham; Gil Yosipovitch

Disclosures

Dermatology Nursing. 2005;17(5):365-367. 

In This Article

Introduction

Atopic dermatitis (AD) is a skin disease of chronic inflammation exacerbated by acute flares that commonly affects infants, children, and adults. Therapies generally include emollients, topical corticosteroids, topical immunomodulators, and systemic immunomodulators, along with recognition and avoidance of aggravating factors. The usefulness of wet-wrap dressings, which employ the use of a moist physical barrier, usually incorporating a topical corticosteroid, was described in 30 children with AD by Goodyear, Spowart, and Harper (1991). Since that time, wet wraps of various forms have been used in cases of AD flares unresponsive to conventional therapies, such as topical medications, or in those cases with unbearable itch (Goodyear & Harper, 2002).

Wet-wraps work by a variety of mechanisms: (a) cooling the skin by evaporation, thus decreasing itch; (b) increased moisturization and softening of the skin, thereby enhancing the penetration of medications; and (c) serving as a mechanical barrier against scratching (Pei, Chan, & Ho, 2001). Considering that AD is the interplay between external stimuli and an internal hypersensitivity, we feel that simply occluding plaques of atopic dermatitis is beneficial, as it improves barrier function. This has been illustrated in psoriatic plaques, which demonstrated a normalization of the permeability barrier following occlusion (Hwang, Ahn, Menon, Choi, & Lee, 2001).

In this article the use of wet wraps for short-term outpatient treatment of moderate-to-severe AD is described. Nurses play an invaluable role in educating patients and parents about the proper use of wet-wraps in treating AD, and thus can increase both compliance and the effectiveness of the treatments.

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