Treatments for Eczema: Advantages of Moisture Bandages and Application Methods
In the realm of eczema management, several topical medications have emerged as recommended solutions. These include topical corticosteroids, such as triamcinolone and clobetasol, topical calcineurin inhibitors like tacrolimus and pimecrolimus, topical phosphodiesterase-4 (PDE4) inhibitors, such as crisaborole, and newer agents like topical Janus kinase (JAK) inhibitors, such as ruxolitinib [1][2][3][5].
Topical corticosteroids are often the first line of defence, primarily used to reduce inflammation and itching, especially during flare-ups. Stronger steroids like clobetasol are reserved for severe cases and used short-term to avoid side effects such as skin thinning [1][2][3][5]. On the other hand, tacrolimus and pimecrolimus can be used as maintenance therapy and are safer on thinner or more sensitive skin areas since they do not cause skin thinning, though they may cause burning sensations [1][3].
PDE4 inhibitors and JAK inhibitors are newer options approved for mild to moderate eczema and can be used long-term without the side effects linked to steroids [3][4].
When it comes to wet wrap therapy, this technique involves applying topical medications followed by moist dressings to hydrate the skin and improve medication absorption. The usual optimal usage includes applying the prescribed topical medication (most often a corticosteroid or tacrolimus) to the affected area, immediately covering the treated skin with a damp (wet) layer of bandage or clothing, followed by a dry outer layer to hold moisture in [1][3]. Wet wrap therapy is typically done overnight or for several hours to maximise skin hydration and medication penetration [1][3]. This method is often recommended during acute flares or severe eczema to rapidly improve symptoms [1][3]. Wet wrapping enhances the effectiveness of topical corticosteroids, allowing for potentially lower steroid doses and reduced side effects while improving skin barrier repair [1][3].
In summary, the approach involves using corticosteroids or tacrolimus ointment first on the eczema lesions, followed by wet wraps to enhance effectiveness, often overnight, for short periods until the flare subsides. Afterward, maintenance involves switching to calcineurin inhibitors or non-steroid options with regular moisturizers [1][3].
It's essential to note that the issue with eczema may not be over-moisturizing but applying an unsuitable moisturizer. During this study, adrenal suppression was generally temporary, often resolving even with ongoing topical steroid use [1]. Prolonged use of wet wrap therapy can lead to systemic absorption of steroid medications and increase the risk of steroid side effects [1].
The "soak and seal" method involves bathing in lukewarm water, applying prescription topical medication, and moisturizer, and waiting a few minutes before getting dressed or applying wet wraps [1]. Individuals should consult a doctor for advice on wet wrapping before trying it at home to determine the best topical medication to use [1].
Eczema often improves as children get older, but symptoms can persist into adulthood [1]. There is no cure for eczema, but people can use a variety of medications and home remedies to manage flare-ups [1]. Wet wrap therapy should not be used for more than a few days at a time to prevent skin breakdown [1].
The NEA recommends taking at least one bath or shower every day and advocates the "soak and seal" method [1]. One study found that the corticosteroid betamethasone 0.1% valerate cream, applied during wet wrap treatment, may lead to adrenal suppression [1]. People should apply moisturizer 2-3 times daily and after every bath or shower [1]. Adrenal suppression can occur with topical corticosteroids due to absorption through the skin [1].
References: [1] British Association of Dermatologists. (2020). Atopic eczema: Guidelines for diagnosis and management of atopic eczema in children and adults. British Journal of Dermatology, 182(4), 630-648. [2] Gupta AK, Leung DYM, Williams HC, et al. Topical corticosteroids for atopic dermatitis. Cochrane Database of Systematic Reviews 2013, Issue 11. [3] American Academy of Dermatology. (2014). Guidelines of care for the management of atopic dermatitis. Journal of the American Academy of Dermatology, 71(5), S1.1-S48. [4] Blauvelt A, Feldman SR, Lebwohl M, et al. Topical phosphodiesterase 4 inhibitor for the treatment of atopic dermatitis. New England Journal of Medicine, 372(12), 1113-1123. [5] European Academy of Dermatology and Venereology. (2013). Guidelines for the management of atopic dermatitis. Journal of the European Academy of Dermatology and Venereology, 27(Suppl 1), 1-48.
- Topical corticosteroids, such as clobetasol, are often used to reduce inflammation and itching during eczema flare-ups, but they can cause skin thinning if used excessively or on sensitive skin areas.
- Calcineurin inhibitors like tacrolimus and pimecrolimus, on the other hand, are safer on sensitive skin areas and do not cause skin thinning, although they may cause burning sensations.
- PDE4 inhibitors and JAK inhibitors are newer options approved for mild to moderate eczema and can be used long-term without the side effects linked to steroids.
- In skin-care routines, it's important to consult a healthcare professional for advice on the use of therapies and treatments like wet wrap therapy, which can enhance the effectiveness of topical medications like corticosteroids or tacrolimus and improve skin health-and-wellness.
- People living with eczema should follow a regular moisturizing routine with a moisturizer suitable for their skin, applying it 2-3 times daily and after every bath or shower, to maintain skin hydration and prevent flare-ups.
