Wet dressing therapy in conjunction with topical corticosteroids is effective for rapid control of severe pediatric atopic dermatitis: Experience with 218 patients over 30 years at Mayo Clinic

• Published in: Journal of the American Academy of Dermatology Vol. 67; no. 1; pp. 100 - 106
• Main Authors: Dabade, Tushar S., MD, Davis, Dawn M.R., MD, Wetter, David A., MD, Hand, Jennifer L., MD, McEvoy, Marian T., MD, Pittelkow, Mark R., MD, el-Azhary, Rokea A., MD, Davis, Mark D.P., MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01.07.2012; Elsevier
• Subjects: Administration, Topical; Adolescent; adverse effects; Allergic diseases; atopic dermatitis; Bandages; Biological and medical sciences; Child; Child, Preschool; corticosteroids; Dermatitis, Atopic - pathology; Dermatitis, Atopic - therapy; Dermatologic Agents - administration & dosage; Dermatology; efficacy; Female; General aspects; Glucocorticoids - administration & dosage; Humans; Immunopathology; Infant; Male; Medical sciences; recalcitrant; Skin allergic diseases. Stinging insect allergies; wet dressings; adverse effects; atopic dermatitis; wet dressings; corticosteroids; efficacy; recalcitrant; Human; Allergy; Immunopathology; Corticosteroid; Pediatrics; Skin disease; Dermatology; Check; Atopy; Prevention; Dressing; Local administration; Treatment; Atopic dermatitis; Child
• ISSN: 0190-9622; 1097-6787
• DOI: 10.1016/j.jaad.2011.06.025

Background At our institution, hospitalization for intensive treatment (combining wet dressings and topical corticosteroids) is a primary intervention for severe pediatric atopic dermatitis. Prior reports of this treatment are limited. Objective We sought to review the efficacy of wet dressings for pediatric atopic dermatitis. Methods We reviewed records of pediatric patients hospitalized from January 1, 1980, through April 20, 2010, who received intensive topical treatments for atopic dermatitis. Results In total, 218 pediatric patients had widespread atopic dermatitis severe enough to warrant hospitalization, despite prior outpatient topical treatments and other interventions such as immunomodulating agents, phototherapy, dietary manipulation, or contact allergen avoidance. Mean (SD) age was 5.97 (4.91) years (range, 2 months-17 years); 141 patients (65%) were female. There were 266 hospitalizations: 192 patients (72%) had one admission, 15 (6%) had two admissions, and 11 (4%) had 3 or more admissions. Mean (SD) duration of hospitalization was 3.61 (2.23) days (range, 1-16 days). Upon discharge, all patients showed improvement. In 239 of 266 hospitalizations, patient records showed quantification of improvement (global assessment): 121 (45%) had 75% to 100% improvement, 102 (38%) had 50% to 75% improvement, and 16 (6%) had 25% to 50% improvement. Limitations This was a retrospective study. Conclusion Intensive inpatient treatment (with wet dressings and topical corticosteroids) was highly effective in controlling severe and recalcitrant atopic dermatitis. Intensive topical treatment, although underused, is an effective first-line approach for patients with severe atopic dermatitis.