Eczema Research

Atopic dermatitis (AD), is a very common skin disease occurring in infants, children, and adults. Nearly 31 million Americans suffer from AD-related symptoms. It is so common that people have given it a few names: atopic eczema, dermatitis, or just eczema (pronounced “EK-zema” or eg-zuh-MUH). Atopic dermatitis is the medical term but eczema is the name most people use. The word “eczema” is derived from a Greek word meaning “to boil over,” which is a good description for the red, inflamed, itchy patches that occur during flare-ups. Eczema can range from mild, moderate, to severe. There are eight types of eczema: atopic dermatitis, contact dermatitis, dyshidrotic eczema, hand eczema, lichen simplex chronicus, nummular eczema, seborrheic dermatitis and stasis dermatitis. Atopic dermatitis/eczema is a term that also refers to a larger group of skin conditions that cause the skin to become red, itchy, and inflamed including "infantile eczema," "flexural eczema," "Besnier prurigo," "allergic eczema," and "neurodermatitis.”

Diagnosing AD is typically based on signs and symptoms that include a type of inflammation of the skin (dermatitis, the medical term). Many skin diseases can have similar symptoms and even follow similar treatments so proper diagnosis must exclude other skin diseases such as contact dermatitis, psoriasis, and seborrheic dermatitis to best treat eczema. An outbreak of eczema results in red, swollen and cracked skin most often accompanied by an almost insatiable itch. A clear fluid may come from the affected areas, which often thickens over time causing a scabbing texture of the skin. When talking about the thickened skin, your dermatologist may use the word lichenification which is the medical terminology for a thickened skin. The thickened skin can itch even when the AD is not flaring. Dry and damaged from scratching, the skin is left with rashes, changes in pigment, and sometimes scars. Embarrassing patches of rough, reddened, intensely itchy skin can keep eczema sufferers from enjoying their lives. For a parent, it’s difficult to watch your child go through it.

The exact cause of AD is not known, but it is widely accepted in the medical community that AD results from a combination of genetics (heredity: If other family members or relatives have AD, asthma, or hay fever, the diagnosis of AD is more likely), immune system dysfunction, environmental exposures (temperature, humidity, and stress levels) and a variety of conditions in everyday life (certain foods, and even intense exercise) that triggers the red, itchy rash. AD is long-lasting (chronic) and tends to flare periodically.

The exact cause of eczema is still a mystery to doctors and there is no known true cure, but they have identified key factors in what is happening to the skin and some of the triggers that cause eczema outbreaks or flare-ups (as they are sometimes called). Typically, people with eczema do not produce as much fat and oils as other people and therefore their skin retains less water. The skin’s water loss is called Trans Epidermal Water Loss (TEWL). TEWL from the stratum corneum (outer layer of the epidermis) is the human skin trying to protect itself from irritants and is one of the major factors responsible for dry, cracked, scaly skin and irritant dermatitis. The skin becomes more sensitive to irritants that can include soaps, detergents, shampoos, and disinfectants. The skin can also be irritated by allergens such as pollen, pets, dandruff, dust mites, and mold.

Once these irritants pass through the weakened protective barrier of the skin, they trigger our immune system to respond by swelling the affected area with blood which makes the skin feel itchy. Scratching worsens symptoms and affected people have an increased risk of bacterial infections, viruses, and staph infection. Repeated scratching can lead to permanent scarring of the skin.

Atopic dermatitis is a very common skin disease and is estimated to affect almost 20 percent of the people in the United States at some point in their lives. Currently, there are approximately 31 million people in the U.S. dealing with eczema symptoms. The condition typically starts in childhood with changing severity over the years. Generally, males and females are equally affected and the majority (approximately 60 percent) of people outgrow the condition around puberty.

Eczema is an international health issue with AD cases found to range between 8 percent to 21 percent in Canada, England, Japan, Korea, Australia, and New Zealand among other countries. Interestingly, eczema cases are more prevalent in affluent countries than developing countries.

Historically, people who live in cities with dry climates have been more likely to be affected by atopic dermatitis. Lately, more and more cases of eczema are being diagnosed in high-density, urban areas with warmer climates where there are higher levels of humidity, significant air pollution, and the continual use of indoor air conditioners blowing airborne allergens. Exposure to certain chemicals or frequent hand washing can make symptoms worse and studies have shown a clear connection that emotional stress makes eczema symptoms worse. Other things that commonly make it worse include wool clothing, soaps, perfumes, dust, chlorine, and cigarette smoke. The disorder is not contagious. Many people with AD develop hay fever and/or asthma. 

Infants

Atopic dermatitis can begin early. A child may be two or three months old when AD begins. When AD begins early, it often causes:

• A rash that appears suddenly and:
• Makes the skin dry, scaly, and itchy.
• Forms on the scalp and face, especially on the cheeks (can appear on other areas of the body).
• Can bubble up, then ooze and weep fluid.
• Causes itching that may come and go.
• Rubbing against bedding, carpeting, and other things in order to scratch the itch.
• Trouble sleeping.
• Skin infections, common due to rubbing and scratching.

Parents often worry that their babies are getting AD in the diaper area. Babies rarely get AD in the diaper area because the skin stays too moist.

Children

When Atopic Dermatitis begins between two years of age and puberty, the child often has these signs and symptoms: 

• A rash that often begins in the creases of the elbows or knees. Other usual places for the rash to appear are the neck, wrists, ankles, and/or crease between the buttocks and legs.
• Itchy, scaly patches where the rash appeared.

In time, skin with AD can:

• Get bumpy, looking like permanent goosebumps.
• Lighten (or darken) where AD appears.
• Thicken, turning leathery to protect itself from constant scratching.
• Develop knots (only on the thickened skin).
• Itch all the time (only on the thickened skin).

It is very important to be sure to get your child diagnosed by a physician before assuming that the condition is atopic dermatitis.

Adults

It is rare for adults to get Atopic Dermatitis. Most people (90 percent) get AD before age five. About half (50 percent) of people who get AD during childhood continue to have milder signs and symptoms of AD as an adult. When an adult has AD, it often looks different from the AD of childhood. For adults, AD often:

• Appears in the creases of the elbows or knees and nape of the neck.
• Covers much of the body.
• It can be especially noticeable on the neck and face.
• It can be especially bad around the eyes.
• It causes very dry skin.
• Causes non-stop itch.
• Causes scaly skin — scalier than in infants and children.
• Leads to skin infections. 

If a person has had AD for years, patches of skin may be thick and darker than the rest of the skin (or lighter). Thickened skin can itch all the time.

Adults who had AD as a child and no longer have AD can have the following:

• Extremely dry skin.
• Skin that is easily irritated.
• Hand eczema.
• Eye problems (eczema on eyelids, cataracts).

Itch-Scratch Cycle and sleep pattern disruption an unmitigated nightmare!

No matter where it appears, Atopic Dermatitis is often very itchy. In some cases, the itch gets so bad that people scratch it until it bleeds, which can make your eczema worse. This is called the “itch-scratch cycle.” In children of all ages, they typically are distracted by daily activities and are not as focused on the itch until it is time for bed and then the itch can be so intense that a child cannot sleep. Sleep pattern disruption leads to additional stress which in turn can intensify the eczema flare-up, which eventually affects the entire family – as a sleep-deprived child with itchy skin needs a lot of special attention, care, and extra loving.

At Soothems LLC, we believe in the therapeutic power of an imaginative story that entertains, empathizes, and normalizes life with eczema and other skin conditions. Our solution for easing the discomfort of itchy skin from Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Xerosis (dry skin), and other skin sensitivity issues — and the related high stress levels and loss of sleep that can occur as a result— is to have your child put on their SOOTHEMS™ garment and then read them one of our special Soothems bedtime story books. The combination of the Soothems garment with the magic disappearing print and our storybooks will delight and comfort your child to a more restful night’s sleep. As a result, the entire family will be less stressed and happier in the morning. The Soothems garments made with TEWLTect™ smart fabric will therapeutically help make your child’s skin healthier. What better way to make your child more comfortable and happier! Less Itch, More Smile!

Who gets atopic dermatitis?

Around the world, between 10 percent to 20 percent of children have atopic dermatitis. About 1 percent to 3 percent of adults have AD. People of all skin colors get AD.

AD is much more common today than it was 30 years ago. Dermatologists are not sure why. They do know that some children have a greater risk of getting AD. The following seems to increase a child’s risk of getting AD:

• Family members have AD, asthma, or hay fever: Does the child’s mother or father have AD? Does a parent have asthma or hay fever? A family history of these diseases remains the strongest risk factor. If one or both parents have AD or an allergic condition, the child is much more likely to get AD. Some children get all three diseases. Asthma and hay fever usually appear before the age of 30. People often have asthma and hay fever for life.
• Where a child lives: Living in a developed country, living in a city (especially one with higher levels of pollution), or living in a cold climate seems to increase the risk. For example, Jamaican children living in London are twice as likely to develop AD as those who live in Jamaica.
• Mother’s age when the child born: When the mother gives birth to the child later in her childbearing years, a child is more likely to get AD.
• Social class: AD seems more common in higher social classes.

What causes atopic dermatitis?

Researchers are still studying what causes atopic dermatitis but through their studies, they have learned that AD:

• Is not contagious: There is no need to worry about catching it or giving it to someone.
• Runs in families: People who get AD usually have family members who have AD, asthma, or hay fever. This means that genes play a role in causing AD.
• Children are more likely to develop AD if one or both parents have AD, asthma, or hay fever.
• About half (50 percent) of the people with severe AD (covers a large area of the body or is very troublesome) will get asthma and about two-thirds (66 percent) will get hay fever.

Can certain foods cause atopic dermatitis?

Foods do not cause Atopic Dermatitis. But some studies suggest that food allergies can make AD worse. Children who have AD often have food allergies to these foods — milk and foods that contain milk (e.g., yogurt and cheese), nuts, and shellfish.

Before you stop feeding your child any foods, talk to your child’s dermatologist. Children need certain foods to grow and develop normally.

Researchers continue to study what causes this complex disease. They believe that many things interact to cause AD. These things include our genes, where we live, and the way our immune system works.

Trigger factors may be different in different people. Most children get worse when they get a cold or other infection. Most have worse problems in the winter; but others simply cannot stand the sweating during hot, humid summer weather.

Trigger factors that seem to affect every child with Eczema:

DRY SKIN: The skin’s main function is to provide a barrier against dirt, germs, and chemicals from the outside. We don’t notice this barrier unless it gets dry, and then it’s scaly rough and tight. Dry skin is brittle — moist skin is soft and flexible. People with AD have a defect in their skin so it won’t stay moist. It is especially bad in winter when the heat is on in the house and the humidity drops. Other things that dry the skin are too much bathing without proper moisturizing. The challenge: Prevent skin dryness.

IRRITANTS: Irritants are any of the substances outside the body that can cause burning, redness, itching, or dryness of the skin. The challenge: Avoid irritating substances.

STRESS: Emotional stress comes from many situations. People with AD often react to stress by having red flushing and itching. Special problems for children with AD include frustration, anger, or fear. Of course, AD and its treatments are a source of stress! The challenge: Recognize stress and reduce it.

HEAT AND SWEATING: Most people with AD notice that when they get hot, they itch. They have a type of prickly heat that doesn’t occur just in the humid summertime but anytime they sweat. It can happen from exercise, from too many warm bedclothes, or rapid changes in temperature from cold to warm.

INFECTIONS: Bacterial “staph” infections are the most common, especially on arms and legs. Such infections might be suspected if areas are weeping or crusted or if small “pus-bumps” is seen. Common virus infection in children, molluscum contagiosum. tends to be more severe in children with AD. Molluscum infections look like small bumps, often with a central white core. Herpes infections (such as fever blisters or cold sores) and fungus (ringworm or athlete’s foot) can also trigger AD. If some lesions look different ask your doctor. If they turn out to be infected, they can be treated with antibiotics or other effective medications. These are generally benign, superficial infections for AD patients and they do not seem to be especially contagious for other people. The challenge: Recognize and treat pustules or crusted lesions in consultation with a physician.

ALLERGENS: Allergens are materials (such as pollen, pet dander, foods, or dust) that cause allergic responses. Allergic diseases such as asthma and hay fever, which flare quickly, are easy to tie to allergens. Allergic symptoms, such as itching and hives, appear soon after exposure to airborne allergens and last only briefly. But the slower, continuing, chronic eczema of AD may be difficult to tie to specific allergens. Food allergies can trigger flares, especially for children with moderate to severe AD. Pollens, dust mites, and pets can seldom be shown to trigger eczema in young children. Of the available tests for allergy, scratch tests and RAST tests are only brief reactions and do not diagnose allergen-triggered eczema. Patch tests, by contrast, can diagnose eczema response in some cases such as allergies to skin care products.

Are there other trigger factors?
Children with AD will be helped by reducing the major trigger factors described above. But individuals may be subject to other trigger factors, and it is important to be alert for these as well.

1. Keep the skin barrier intact. MOISTURIZE!

2. Wear soft clothes that “breathe.” Avoid fabrics of wool, nylon, or stiff material. SOOTHEMS™ garments have been developed as a therapeutic treatment to help people with, particularly sensitive skin, like those suffering from Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Xerosis (dry skin), and a wide range of skin allergies. SOOTHEMS help reduce itchiness by protecting moisture levels of the skin, controlling bacteria growth and soothing the skin during recovery. SOOTHEMS garments are made from TEWLTect™ smart fabric which offers maximum wearing comfort because the yarns are soft, pliable, symmetrically rounded, smooth, breathable, and virtually friction-free to reduce chafing.

3. If sweating causes itching, find ways to keep cooler: Reduce exertion, especially during times of flare. Layer clothing and adjust to temperature change. Don’t overheat rooms, especially the bedroom. Use light bedclothes from SOOTHEMS that are made from TEWLTect.
   The cellulose fibers used in TEWLTect smart fabric have been independently tested showing they will absorb 50 percent of their own weight in moisture before feeling damp, making them far superior to cotton, polyester, nylon, and even silk. They allow the release of moisture to aid in preserving skin moisture thereby promoting an excellent climate for the human skin flora and the appropriate transepidermal water loss (TEWL) balance on the skin. The result helps regulate body temperature for greater comfort and can stop skin irritation.
   
   TEWLTect^® smart fibers — TENCEL™  with Chitosan and TANBOOCEL® — have hollow structures and are inherently thermo-regulating and boast clinically proven advantages for breathability and coolness compared to other fibers including cotton, polyester, nylon, and silk. Breathability (airflow) increases the speed of healing. Heat can aggravate eczema, dermatitis, and psoriasis and the wicking properties of TEWLTect fibers trap and release moisture, providing a cool feeling that increases a pleasant sensation on the skin and can significantly reduce itching for individuals with skin problems.
   
   According to authoritative testing figures, apparel made from a lyocell and viscose made from bamboo fibers are typically 1- 2o C degrees lower (1.8 - 3.6oF) than normal apparel in hot humid summer weather. A four-week scientific study conducted by Dr. Imke Konig from the Spa Health Centre in Stegersbach, Austria of children age 2 1/2 to 14 years concluded that the special TENCEL® sleepwear designed for the research project offered positive effects for patients suffering from mild to moderately severe dermatitis; scratching that happens in extreme climatic conditions and even disturbs the sleep behavior can be reduced. Over 58 percent of the participants felt the TENCEL fibers were smoother, 65 percent thought they were softer and 88 percent thought they were cooler to wear than cotton.

4. When itching from sweating, dust, pollen or other exposures, take a cooling shower or tub bath. Don’t forget to moisturize afterward — within three minutes after the child has been gently toweled.

5. Learn to recognize signs of infection and treat early.

6. If you suspect a food allergy, be systematic. Likely offenders are eggs, milk, peanuts, soy, wheat, and seafood, but any food can do it. Can you exclude the most likely offender for a week? Substitute hydrolysate (e.g. Alimentum® or Nutramagen®) for cow’s milk formula. Keep a food diary. When the skin clears up, try the food. Watch for signs of itching or redness over the next two hours. Eliminate a food group if it causes hives or face swelling. Don’t exclude multiple food groups at the same time — it’s rare to have more than one or two food allergies that impact eczema, and your child can become malnourished with prolonged avoidance of many foods. Always make sure that any food manipulation is performed with the advice of a physician.

7. With allergy-prone kids, furry animals are a risk. If you must have pets, keep them outside or at least off beds, rugs, and furniture where the child plays. Dust mites collect in bedroom carpets and bedding. Simple control measures include coverings for pillows and mattresses, removing bedroom carpets, and frequent washing of bedclothes in hot water. 
8. Think about stress-causing events and ways to cope with them. Review problems with your doctor or mental health professional. Consider clinicians who specialize in approaches including mindfulness. Try to make Atopic Dermatitis treatments part of a daily, family routine. Encourage children with AD to do what they can on their own. 

For many parents, curling up with a book for a bedtime story with their child is a daily ritual. For others, it is the perfect time to spend time with their children after a busy day. For some, it is something they should do but are not entirely sure why. SOOTHEMS has taken this experience to a new level of love, comfort, and care.

At SOOTHEMS, we believe in the soothing power of story. SOOTHEMS books are written to be paired with our TEWLTect smart fabric SOOTHEMS garments which ease the discomfort of your child’s sensitive skin flare-ups from Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Xerosis (dry skin), and a wide range of skin allergies.

The tandem act of having your child wear SOOTHEMS made from TEWLTect smart fabric with the special disappearing prints and reading them one of our bedtime storybooks will delight and comfort your child into a more restful night's sleep.

How do dermatologists diagnose atopic dermatitis?

To diagnose Atopic Dermatitis (AD), a dermatologist begins by looking at the child’s skin. The dermatologist will look for a rash. The dermatologist also will ask questions. It is important for the dermatologist to know whether the child has itchy skin. The dermatologist also needs to know whether blood relatives have had AD, asthma, or hay fever. 

Sometimes a dermatologist will perform a patch test. This medical test is used to find allergies. It involves placing tiny amounts of allergens (substances that cause allergies for some people) on the child’s skin. The dermatologist will check the skin for reactions. Checks are often done after a few hours, 24 hours, and 72 hours. Studies suggest that some allergens can make AD worse.

How do dermatologists treat atopic dermatitis?

Treatment cannot cure AD, but they can control AD. Treatment is important because it can:

• Prevent the AD from getting worse.
• Calm the skin, relieving pain and itch.
• Reduce emotional stress.
• Prevent infections.
• Stop the skin from thickening. Thickened skin often itches all the time — even when the AD is not flaring.

A treatment plan often includes medicine, skin care, and lifestyle changes. Skin care and lifestyle changes can help prevent flare-ups. Many patients receive tips for coping. Doing all of this may seem bothersome, but sticking to the plan can make a big difference. 

SOOTHEMS has been developed as a therapeutic treatment to help people with particularly sensitive skin, such as those suffering from Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Skin Allergies and Xerosis (dry skin). SOOTHEMS are made from a proprietary smart fabric called TEWLTect™, a blend of high performance sustainable cellulosic polymer fibers enhanced with Chitosan and Zinc Oxide. The curative properties of TEWLTect™ smart fabric provide a positive, soothing effect when the skin naturally releases moisture — there is an active exchange between human skin and the unique properties of TENCEL® with Chitosan lyocell fibers, TANBOOCEL® viscose made from bamboo pulp fibers, and the zinc oxide. 

TEWLTect™ smart fabric can be used as an occlusive barrier — wet or dry and with or without emollients and topical steroids as prescribed by a medical professional for people suffering from skin diseases such as Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Skin Allergies and Xerosis (dry skin).

SOOTHEMS is the result of years of textile research with smart fabrics to improve the health of human skin and garment design development to solve fit and comfort challenges. SOOTHEMS are made from TEWLTect smart fabric to help preserve skin moisture, reduce itching, control bacterial growth, and soothe the skin during the healing process. Our hope is to inspire your child to imagine their skin healing and feeling less itchy the moment they step into the “magical powers” of our SOOTHEMS garments. The “magic print” found on our TEWLTect smart fabric reacts to body temperature, causing some print color images to “disappear” right before your child’s eyes — reinforcing healing imagery with visible change.  A dermatologist will create a treatment plan tailored to the patient’s needs. Medicine and other therapies will be prescribed as needed to:

• Control itching.
• Reduce skin inflammation (redness and swelling). 
• Clear infection. 
• Loosen and remove scaly lesions.
• Prevent new lesions from forming.

SOOTHEMS can be eligible on a case-by-case basis for health insurance reimbursement from some carriers. Ask the consulting physician willing to recommend SOOTHEMS to write a letter to the insurance carrier (downloadable form letter link) on the patient’s behalf. These products can also qualify for a Health Saving Account (HSA) payment with a similar letter from the referring physician.

Outcome

Studies have found that when AD develops in an infant or young child, the child tends to get better with time. For some children, the condition completely disappears by age two. 

About half (50 percent) of the children who get AD will have it as an adult. The good news is that the AD often becomes milder with age.

There is no way to know whether the AD will go away or be a lifelong disease. This makes treatment very important. Treatment can stop AD from getting worse. Treatment also helps to relieve the discomfort

It is very important to be sure to get your child diagnosed by a physician before assuming that the condition is Atopic Dermatitis.

Most children’s eczema does not have a clear cause, such as an allergy, but most eczema will improve with good skin care. Good skin care is a key part of gaining control of your child’s eczema. If skin care has not been a regular part of your child’s treatment, you should make an appointment for your child to see a dermatologist. These tips from dermatologists can reduce the severity and frequency of your child's flare-ups.

Bathing tips

• Bathe your child in warm — not hot — water.
• Limit your child’s time in the bath to 5 or 10 minutes.
• Use cleanser only when needed and make sure the cleanser is mild and fragrance-free. Do not use bubble bath. 
  • If your child’s eczema is frequently infected, twice-weekly bleach baths may be beneficial. Discuss this option with your child’s dermatologist.
• After bathing, gently pat your child’s skin partially dry.
• If your child has medicine that you apply to the skin, apply medicine when your child’s skin is almost dry and use the medicine as directed.
• Apply moisturizer on top of the medicine and to the rest of your child’s skin.

TEWLTect™ smart fabric can be used as an occlusive barrier, wet or dry, with or without emollients, creams and lotions as advised by a healthcare professional for people suffering from skin diseases like Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Xerosis (dry skin), and a wide range of skin allergies. Please seek advice from a healthcare professional before the use of a Soothems garment either wet or dry.

CAUTION: Consult a healthcare professional to decide if wet wrapping therapy would be beneficial for your child prior to starting a wet wrap therapy. Wet wrapping should only be done under the advice and instructions of healthcare professional.

Soothems garments wet use suggestions:

• Wash your Soothems garment according to care instructions prior to use.
• Bathe and pat skin dry before applying emollients, lotions, or creams to affected areas as directed by a healthcare professional.
• Never leave a child unattended in a bath or around water.
• For comfort keep ambient room temperature between 68oF/20oC - 78oF/25oC when using Soothems.
• Soak the Soothems garment in warm water. Squeeze out excess water; you want garment damp, not soaking wet.
• Soothems garments should fit snugly, but comfortably.
• Cover the affected areas with the warm, damp Soothems garment.
• Then cover the damp Soothems garment with a dry layer of Soothems garment or regular sleepwear.
• Depending on the dry over the garment’s design, it will generally be more comfortable for your child to wear a slightly larger size for the second layer.
• Discontinue the use of wet wrap therapy and Soothems garments and contact a qualified healthcare professional at the first signs of irritation, rash or discomfort.
• If rewetting is necessary during treatment, use a gentle spray bottle with clean, warm water to dampen the fabric or completely remove garment and re-soak in warm water, removing excess water before redressing.
• Consult a healthcare professional regarding the length of treatment.

Soothems garments dry use suggestions:

• Wash your Soothems garment prior to use, according to care instructions.
• Bathe and pat skin dry before applying emollients, lotions, or creams to affected areas as directed by a healthcare professional.
• Never leave a child unattended in a bath or around water.
• Cover the affected areas with your dry Soothems garment.
• Soothems garments should fit snugly, but comfortably.
• Discontinue use and contact a qualified healthcare professional at the first signs of irritation, rash or discomfort.
• For comfort keep ambient room temperature between 65^oF/18.3^oC - 70^oF/21.1^oC when using Soothems dry.
• Consult a healthcare professional regarding the length of treatment.

Tips for choosing a moisturizer

• When selecting a moisturizer, consider choosing a thick cream or ointment.
• Some children do better with fragrance-free products, so consider petroleum jelly— an inexpensive, fragrance-free product that works well for many children. 
• When selecting a product, “trial and error” sampling of different types may help to identify the best moisturizer for your child.

Tips to ease discomfort

• For best results, apply moisturizer at least twice a day. This prevents dryness and cracking. It also can decrease the need for eczema medications.
• If your child has severe itching and scratching, ask your child’s dermatologist about wet wrap therapy. This can reduce swelling and lessen the desire to scratch.
• Keep your child’s fingernails short and smooth. This decreases the likelihood that scratching will puncture the skin. Putting cotton gloves on your child’s hands at night may help prevent scratching during sleep.
• Keep temperature and humidity levels comfortable. Avoid situations in which the air is extremely dry, or where your child may sweat and overheat. This is the most common trigger of the itch/scratch cycle. 

Clothes-washing tips

• Using a laundry detergent made for sensitive skin may be beneficial. Scented fabric softener or dryer sheets may contribute to irritation.
• Only use the recommended amount of detergent.
• Use enough water for adequate rinsing.
• Buy clothes without tags because tags can rub against the skin, causing irritation. 
• Wash your child’s new clothes before wearing. This will remove excess dyes and fabric finishers, which can irritate the skin.

Soothems Garment Care

• Wash your Soothems garments prior to use following the care instructions: Machine wash in hot water (140F/ 60C); only non-chlorine bleach when needed; rinse twice to remove residual detergent; lay flat to dry to avoid shrinkage.
• To keep Soothems looking new and fresh we recommend that you launder Soothems garments inside out and in a mesh lingerie/delicate laundry bag.
• Soothems garments can be washed over 40 times without significant degradation to functional performance if care instructions are followed.
• Many laundry detergents have harsh ingredients that can leave residual soap on fibers. We suggest using a non-bio mild, fragrance-free, hypoallergenic, liquid detergent (Attitude Sensitive Skin Natural Baby Laundry, or Better Life Laundry Detergent, Unscented or Persil Pro Clean Power or the like) when laundering Soothems garments and rinse twice to remove all remaining residual soap before allowing to dry.
• Do not use fabric softeners or conditioners as these leave a coating on fibers that can reduce absorbency and breathability.
• For stubborn stains, create a mixture of baking soda, lemon juice, and vinegar (or plain water) into a paste for a natural, all-purpose cleaner and stain remover. Gently rub the paste into the stain and let soak overnight. Follow the normal care instructions to wash and rinse the remaining paste.
• Wash Soothems garments after every use or as needed according to the care instructions.

Researchers continue to study what causes Atopic Dermatitis, a complex disease that has many different things that can seemingly trigger a flare-up. The spectrum is broad and can include our genes, where we live, environmental factors like pollen, air pollution, pet dander, and the way our immune system works.

Although it has been well established that foods do not cause Atopic Dermatitis, there are some studies that suggest that food allergies can make AD worse. Children who have AD often have food allergies to these foods — wheat, gluten, soy, milk, and dairy-based products like yogurt and cheese, eggs, tree nuts, peanuts, certain fish, and shellfish. Right about now you are thinking, “What can I feed my child?” Before you stop feeding your child any foods, talk to your child’s dermatologist. Children need certain foods to grow and develop normally.

"There is an increased association of food allergies in children with eczema, but the overwhelming majority of children with eczema do not have food allergies,” says Daniela Kroshinsky, MD, director of pediatric dermatology at Massachusetts General Hospital in Boston. “In general, children with more severe eczema are more at risk for developing food allergies," she says.

In addition, a July 2013 study published in the Journal of Investigative Dermatology found that infants with eczema had a higher risk of developing food allergies. Researchers theorize that the breakdown in the skin barrier may contribute to an allergic immune response in food.

If your child does have food allergies, they could be making the skin rash worse. Daniel Searing, MD, a pediatrician and assistant professor in the department of pediatrics, division of allergy and immunology at National Jewish Health in Denver, says double-blind, placebo-controlled food challenges (the gold standard of allergy testing) have confirmed that food allergens can trigger atopic dermatitis, the most common type of eczema.

The connection between food allergies and an eczema rash is complicated. According to the American Academy of Dermatology, food allergies and a flare-up of eczema don’t always go hand-in-hand. For the majority of people with both eczema and food allergies, eating a food they are allergic to will not cause a skin rash to flare. Research shows that a food allergy is most likely to bring on a flare of eczema skin rash only in infants and in those with severe eczema.

Food allergy reactions can range from mild to potentially life-threatening and usually happen a few hours after eating. Typical food allergy symptoms can include:

• Vomiting, diarrhea, and cramps
• Hives
• Swelling or itching of the lips, tongue, mouth, or throat
• Wheezing or difficulty breathing
• Lowered blood pressure

Diet and Eczema: The Facts - WebMD

https://www.webmd.com/skin-problems-and-treatments/eczema/treatment.../eczema-diet

Eczema Diet: Foods to Eat and Foods to Avoid - Healthline

https://www.healthline.com/health/skin-disorders/eczema-die

The Link Between Food Allergies and Eczema | Everyday Health

https://www.everydayhealth.com › Eczema

Eczema and Diet: The Top 8 Food Triggers - The Healthy Home ...

https://www.thehealthyhomeeconomist.com/eczema-and-diet-top-food-triggers/

Atopic dermatitis is often characterized by incessant itching, which is caused by an overactive immune response. The overwhelming need to itch becomes an urgent need to scratch for relief, but sometimes the need to relieve that itch is, so you scratch. Scratching, which is an automatic response, can feel good and it does relieve the itch. But the irony is that scratching makes your body release certain chemicals that cause you to itch more and increases the severity of a related rash. When you scratch you are literally damaging the protective outer layer of your skin, causing more irritation and more itching. The dilemma becomes a never-ending cycle of itching and scratching which is a very hard cycle to break.

• When you have atopic dermatitis, your immune system is overactive and sends chemicals to the surface of the skin, resulting in inflammation that causes you to itch
• When you scratch, you are breaking down the outer layer of skin. This allows germs, viruses, and allergens to get into your body.
• In response to these foreign invaders, your immune system continues to send chemicals to the surface, where they cause the redness and itching you associate with eczema and atopic dermatitis. These chemicals can also travel through the blood, making you itch in places where you don’t yet have a rash.
• You scratch the itch, further breaking down the skin’s barrier. More foreign invaders get in. More chemicals are released in response, which leads to more redness, and more itching. And the cycle continues.

The itch-scratch cycle is real and there are scientific reasons, but studies have demonstrated mind over matter really helps. No matter where it appears, Atopic Dermatitis is often very itchy. In some cases, the itch gets so bad that people scratch it until it bleeds, which can make your eczema worse. This is called the “itch-scratch cycle.” In children of all ages, they typically are distracted by daily activities and are not as focused on the itch until it is time for bed and then the itch can be so intense that a child cannot sleep. Sleep pattern disruption leads to additional stress which in turn can intensify the eczema flare-up, which eventually affects the entire family –  as a sleep-deprived child with itchy skin needs a lot of special attention, care, and extra loving.

Distraction can be powerful. Finding a distraction helps you redirect your attention away from the pain and itch of atopic dermatitis to something else. Reading a book or visual or auditory distractions can relax your heart rate, slow your breathing, and even reduce skin temperature and sensitivity. Distractions can also lower stress, another trigger for flare-ups.

Although your pain and itching are from your body’s overactive immune response caused by atopic dermatitis, how you feel them is based on how your brain interprets the pain and itching signals. By distracting your brain, you may interrupt these signals for a little while, which means that you may not notice the pain and itch as much.

At Soothems LLC, we believe in the therapeutic power of an imaginative story that entertains, empathizes, and normalizes life with eczema and other skin conditions. Our solution for easing the discomfort of itchy skin from Atopic Dermatitis, Eczema, Psoriasis and Neurodermatitis, Xerosis (dry skin), and other skin sensitivity issues — and the related high stress levels and loss of sleep that can occur as a result— is to have your child put on their SOOTHEMS™ garment and then read them one of our special Soothems bedtime story books. The combination of the Soothems garment with the magic disappearing print and our storybooks will delight and comfort your child to a more restful night’s sleep. As a result, the entire family will be less stressed and happier in the morning. The Soothems garments made with TEWLTect™ smart fabric will therapeutically help make your child’s skin healthier. What better way to make your child more comfortable and happier! Less Itch, More Smile!

The Soothems team has worked encapsulating Zinc Oxide onto textiles for over 15 years and has learned the following facts about the benefits zinc oxide beyond sun protection which is why we encapsulate all the fibers in TEWLtect fabric with ZnO. All Soothems garments use TEWLTect fabric.

ZnO – helps lower skin inflammation associated with rashes, allergies or irritation (including diaper rash)

Zinc Oxide improves wound healing and helps prevent bacterial infections

ZnO aides in the recovery of burns and damaged tissue

Zinc Oxide helps keep moisture locked into dry skin (including reducing conditions like dandruff)

ZnO lowers inflammatory dermatoses (including rosacea)

To learn more about the benefits of Zinc Oxide and its wide-ranging therapeutic medical uses see Dr. Axe’s article Zinc Oxide Benefits for Protecting Your Skin from the Sun + More!

Cleaning & Household

1. Use a humidifier in dry or heated rooms to keep the air moist
2. Wear cotton liners under rubber gloves to avoid reaction to the rubber
3. Remove carpets and rugs from the house where possible
4. Damp dust regularly – dry dusting only spreads the dust further
5. Keep the house well ventilated
6. Vacuums rather than sweeping to prevent stirring up the dust
7. Wash pillows, under blankets and duvets regularly
8. Avoid household cleaners and detergents as they will irritate the skin
9. Vacuum mattresses regularly
10. Keep pets off beds and other furniture
11. Avoid feather filled pillows
12. Change bed linen regularly
13. Launder cloths in a mild detergent
14. Wash curtains regularly
15. Wash new bed sheet before sleeping in them
16. Wear vinyl gloves in place of rubber gloves as the vinyl is less irritating
17. Use washable quilts in preference of blankets
18. Put fabric toys in the freezer overnight to kill dust mites

Hygiene

19. Avoid using overly hot water
20. Gently pat skin after showering don’t rub
21. Use soft towels not old scratchy ones
22. Apply moisturizers immediately after showering or washing
23. Use mild soaps or soap substitutes when washing
24. Use bath oil to soften bath water
25. Shower or bath in luke-warm water
26. Don’t soak in water that doesn’t contain oil because it will dry the skin
27. Keep your skin clean to help minimize infection
28. Keep fingernails short to min skin damage from scratching
29. Be careful of perfumes and aftershaves as they may irritate the skin

Clothing

30. Wear 100 percent cotton when possible
31. Avoid tight clothing
32. Wash new clothes before wearing
33. Avoid wearing scratchy fibers
34. Avoid woolen clothing
35. Wear cotton undergarment under your winter woolens to keep the wool from irritating the skin
36. Avoid tight clothing

Emollients

37. Rub moisturizer in the direction of hair growth to minimize irritation
38. Keep your skin moisturized at all times
39. Carry a small amount of moisturizer with you so you can keep your skin moisturized at all times
40. Always patch test new topical applications before using them on the affected areas
41. Be careful using creams around the eyes and mouth
42. Read instructions carefully and only use emollients as directed
43. Do not share emollients as this may cause cross infection
44. Bath oils can be applied directly to the skin as well as to the bath water
45. Be cautious of natural remedies that don’t reveal all the ingredients used
46. Water-based emollients are less likely to irritate your eczema than sorbolene or glycerin-based emollients

Elderly

47. The elderly need to take extra care of their skin as it heals much slower

Food

48. Keep a food diary to help determine food that causes a flare up in your eczema
49. Wash hands and face after eating as some foods will irritate sensitive skin
50. Introduce each new solid food slowly to babies to assess for negative reactions
51. To help your body heal your eczema it is important to eat a nutritious diet
52. Exclusions diets should never be undertaken without the guidance of your healthcare provider

Seasons

53. Avoid rapid changes in temperature
54. Wear a water-based sunblock
55. Avoid overly windy conditions
56. Avoid getting sunburnt as it will damage your skin further
57. Wear a wide-brimmed hat to protect against sunburn
58. Holiday in warmer climates as warmer weather is generally more beneficial to eczema sufferers
59. Pollen and new growth in Spring is a common trigger of eczema

Teenagers

60. Eczema is easier to cope with if you talk to your friends and family about it

Children

61. Gain children’s cooperation when treating their eczema
62. Have children wear long sleeves and pants to minimize scratching
63. Avoid stuffed toys which may collect dust mites
64. Avoid sharp toys that could scratch the skin
65. Put mitts on babies especially at night to minimize scratching
66. Try to keep children occupied so they are less likely to scratch
67. Clean baby's skin thoroughly at each nappy change
68. Wash soft toys regularly
69. Adults holding babies should cover their clothes with a cloth nappy if wearing wool or course fabrics
70. If your baby is still in nappies, apply a thick layer of moisturizer at every change
71. Leave baby’s nappy off at every opportunity to allow the skin to breathe
72. Teach children about their eczema so they can learn to care for their skin themselves
73. Ensure emollients are well rubbed in and or covered to avoid any being swallowed by young children
74. If your child suffers from eczema, do the cleaning when they are not in the house
75. Don’t leave a baby in a wet nappy as it will irritate the sensitive skin
76. Keep in mind a breastfed baby’s eczema may be irritated by the mother's diet
77. Avoid using bubble bath
78. For eczema on the scalp, it is important that you use a pH neutral shampoo and conditioner
79. For babies, apply the emollients just before bedtime, as it can be soothing and may help your baby get a better night’s sleep

Lifestyle

80. Adopt relaxation methods to help control stress
81. Learn what triggers your eczema and how to control it
82. Seek medical advice as soon as skin becomes broken to prevent infection
83. Minimize daily stress when possible
84. Read and learn as much about eczema as you can so you are better able to cope with your condition
85. Avoid activity that raises a sweat
86. After physical activity, be sure to shower and re-moisturize
87. Shower and moisturize immediately after swimming in chlorine
88. Most emollients are safe to use during pregnancy, but should always be discussed with your healthcare provider before being applied
89. Not all treatments will work for everyone; it is a matter of trial and error
90. Drink plenty of water and stay well hydrated
91. Respond quickly to any eczema outbreaks so it isn’t given to chance to develop
92. Be cautious of treatments offering an eczema cure
93. Place a layer of oil or petroleum-based emollients before swimming to protect the skin
94. Avoid Chinese medicines used for treating eczema as they may not be safe during pregnancy
95. The key to all eczema treatment it that you have to be consistent
96. Stay positive

5 More…

97. If you can’t tolerate wool against your skin, you may also be hypersensitive to lanolin based soaps and lotions
98. Choose t-shirts and underwear made of undyed cotton
99. Cut tags off new clothes as they may be scratchy and irritate the skin
100. Turn undergarments inside out if the seams irritate the skin
101. When washing, double rinse clothes, towels, and bedding to prevent chemicals from laundry products irritating the skin

Arjan C. A. Devillers, M.D., Ph.D.,* and Arnold P. Oranje, M.D., Ph.D._*Department of Dermatology, Maasstad Hospital, Rotterdam, The Netherlands, _Department of Dermatology and Venereology, Pediatric Dermatology Unit, Erasmus MC, University Medical Center, Rotterdam, The Netherlands Abstract: Treatment of children with severe atopic dermatitis (AD) can be especially challenging because several possible intervention treatments have (relative) contraindications in childhood. In recent years, wet-wrap treatment (WWT) has been advocated as a relatively safe and efficacious intervention in children with severe or refractory AD. The goal of this article is to provide a practical guideline as a starting point for clinicians who are interested in using WWT in their own clinical practice. We will address several practical issues surrounding the use of WWT by describing our own experiences, supplemented with data from the literature.

Treatments in patients with severe atopic dermatitis (AD) include photochemotherapy or systemic treatments such as oral corticosteroids, cyclosporine, or azathioprine. In childhood, these interventions all have (relative) contraindications, which can make the treatment of children with severe AD especially challenging.

In recent years, wet-wrap treatment (WWT) has been advocated as a relatively safe and efficacious intervention in children with severe or refractory AD (1). WWT is defined as a treatment modality using a double layer of tubular bandages or gauze, with a moist first layer and a dry second layer. Despite this general definition, there is still considerable variation in the reported methodology of WWT, as we described previously in a systematic review of the literature (2). Important variables include the topical products and the bandages used, occlusion time, and treatment duration.

The goal of this article is to provide a practical guideline as a starting point for clinicians who are interested in using WWT in their own clinical practice. We will address several practical issues surrounding the use of WWT by describing our own experiences, supplemented with data from the literature. The methodology described below is the one that has been used in recent years in the Pediatric Dermatology unit of the Erasmus MC – Sophia Children’s Hospital, Rotterdam, the Netherlands (3). The treatment protocol is summarized in Table 1 and will be described in more detail below.

PATIENT SELECTION BASED ON SEVERITY OF ATOPIC DERMATITIS

Wet-wrap treatment was originally developed as an intervention treatment for children with widespread, severe AD (4). Although its use has been spreading, we believe that WWT should be used only in this select group of difficult-to-treat patients. Recent publications that have stressed that WWT treatment should be reserved as a second-line treatment and is not to be used as a first-line treatment in AD supports this view (5,6). In Rotterdam, we select only patients aged 6 months and older with severe AD, as reflected in an objective Scoring AD score of 35 or more (7). This scoring system combines the extent of skin lesions with the intensity of six clinical features of AD. In addition to a lower age threshold of 6 months, we also maintain an upper age threshold at the start of puberty, which is usually around 11 years of age. We consider puberty a relative contraindication for the treatment because of the a priori greater risk for striae distensae at this age.

MATERIALS NEEDED IN WWT

In our recent review, we found WWT with diluted topical corticosteroids to be more effective as a short-term intervention treatment in children with severe or refractory AD than WWT with emollients alone (2). The most commonly reported topical products are 10 percent dilutions of potent topical corticosteroids (2). We advocate the use of dilutions of fluticasone propionate (FP) or mometasone furoate based on their known pharmacological properties (8,9) Our own current product consists of a 10 percent (one part: nine parts) dilution of FP 0.05 percent cream (one part) in petrolatum 20 percent cetomacrogol cream*(nine parts), which are pharmacist compounds. The concentration of FP cream* is decreased to 5 percent (one part:19 parts) if facial lesions are treated. Alternative treatment options for facial lesions without using a facial mask include low-potency topical corticosteroids or topical calcineurin inhibitors. We prefer the last option and use pimecrolimus 1 percent or tacrolimus 0.03 percent ointment (10). Any type of close-fitting TENCEL bandages could, in theory, be used in a WWT.  

METHODOLOGY OF APPLICATION AND (RE)WETTING

Patients may be treated on an inpatient basis or in a day-care unit. If the choice is available, we believe that inpatient treatment is preferable because of the complex and time-consuming nature of the treatment. Each day starts by bathing the patients for five to ten minutes in lukewarm water with additional bathing oil by Balneum Hermal. After the children are briefly toweled dry, the cream is applied directly to the skin in the direction of hair growth to avoid occlusion of hair follicles. Then the first layer of TENCEL garments is wetted in lukewarm water and put on the skin after gently squeezing out all excess water. This is followed by the application of a second, dry layer of regular pajamas. The first layer of a bandage is rewetted every two to three hours by peeling back the second, dry layer and spraying lukewarm water with a plant sprayer. During the night, rewetting is stopped to ensure that patients can sleep through the night. It is reported that bandages remain applied from three to 24 hours a day (2). Longer application times are probably more efficacious, although there is no clear evidence to support this. In a hospital setting, a 24-hour treatment schedule is feasible and, in our opinion, is advisable. This is more difficult when patients are treated on an outpatient basis and schedules have to be incorporated into daily life, when shorter application times are often preferable.

TREATMENT DURATION

WWT interventions of two to 14 days have been published in clinical studies (2). When diluted topical corticosteroids are used, we advocate an intervention treatment of seven days, with a possible extension to a maximum of 14 days in severe cases. A standardized period of seven days is consistent with the study of Wolkerstorfer et al (11) who reported substantial improvement during the first week of treatment and little further improvement in the second week. Other authors have also described good clinical efficacy with limited treatment periods of up to one week (1,2). In severe and recalcitrant cases, one can try to use WWT for a prolonged maintenance phase by tapering off the frequency of applications. We have personal experience using once-daily applications for a maximum of four to five consecutive days in the week (12). During the remaining days of the week, patients are allowed to use only emollients. Evidence of the effectiveness of this approach is lacking, and we have had variable results. In general, the results during a prolonged maintenance phase as described above seem to be less impressive than during a short-term intervention.

SAFETY AND POSSIBLE ADVERSE EVENTS

The use of wet-wrap dressings with diluted topical corticosteroids for up to 14 days is a safe intervention in children with severe or refractory AD (2). Reported adverse events are not common and are usually mild and temporary in nature. Transient systemic absorption of the topical corticosteroids, resulting in the temporary early morning fasting serum cortisol levels below the detection threshold, is the only reported serious side effect (2). Because of this, the use of diluted topical corticosteroids should be limited to once-daily applications. Concomitant use of corticosteroids, for instance through inhalation, should be taken into account when starting treatment. Measurement of early morning fasting serum cortisol before and after treatment may be used to assess systemic bioactivity. Growth retardation due to WWT treatment has not been reported (1,2,13). Other possible adverse events are listed in Table 2.

Discomfort is most frequent and almost invariably due to chills after application of the first moist layer of a bandage. This can be reduced by closely monitoring the temperature of the water used. Induction of folliculitis is probably due to the occlusive effect of the treatment and may be reduced by using creams instead of ointments and the application of the topical product in the direction of hair growth. This occlusive effect of ointments is the main reason we use a hydrophilic cream–based emollient such as petrolatum 20 percent cetomacrogol cream as the basis for our topical product. Possible irritants of inflamed skin, such as alcohol, propylene glycol, and urea should be avoided. Secondary skin infections with Pseudomonas aeruginosa appear to be rare but may be linked to the treatment through the moist environment induced by the bandages. Insufficient cleaning of the water sprayers used to rewet the first layer of bandages may constitute a cause of infection and frequent cleaning of these sprayers is advised. Refractory skin lesions on areas not covered by bandages were sometimes seen if solitary arm and leg pieces of the bandages were not adequately attached to the central body piece. When using the garments made from TENCEL, this problem does not occur. Whether there is a greater risk of other skin infections, such as bacterial impetigo or eczema herpeticum, is unclear. Both events are well-known complications in children with AD, but there is no data suggesting that they occur more frequently during WWT. If these or other secondary skin infections, such as molluscumcontagiosa or viral warts, occur during WWT, the treatment should be (temporarily) stopped and, if possible, adequate treatment of the secondary skin infection started. Although striae distensae have not been reported during WWT, we observed them during long-term intermittent treatment in an adult (12). Because children entering puberty are already at risk of developing striae, we advocate caution at this age and consider it to be a relative contraindication for WWT.

REFERENCES

1. Oranje AP, Devillers ACA, Kunz B et al. Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel’s opinion and review of the literature. J Eur Acad Dermatol Venereol 2006;20:1277–1286.

2. Devillers AC, Oranje AP. Efficacy and safety of wet-wrap dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature. Br J Dermatol 2006;154:579–585.
3. Oranje AP, Wolkerstorfer A, De Waard-van der Spek FB. Treatment of erythrodermic atopic dermatitis with ‘‘wet wrap’’ fluticasone propionate 0,05% cream ⁄ emollient 1 ⁄ 1 dressings. J Dermatol Treat 1999;10:73–74.
4. Goodyear HM, Spowart K, Harper JL. Wet-wrap dressings for the treatment of atopic eczema in children. Br J Dermatol 1991;125:604.
5. Goodyear HM, Harper JL. ‘‘Wet-wrap’’ dressings for eczema: an effective treatment but not to be misused. Br J Dermatol 2002;146:159.
6. BeattiePE,Lewis-JonesMS.A pilot study on the use of wet wraps in infants with moderate atopic eczema. Clin Exp Dermatol 2004;29:348–353.
7. Kunz B, Oranje AP, Labreze L et al. Clinical validation and guidelines for the SCORAD index: consensus report of the European Task Force on Atopic Dermatitis. Dermatology 1997;195:10–19.
8. Friedlander SF, Hebert AA, Allen DB et al. Safety of fluticasone propionate cream 0.05% for the treatment of severe and extensive atopic dermatitis in children as young as 3 months. J Am Acad Dermatol 2002;46:387–393.
9. Prakash A, Benfield P. Topical mometasone. A review of its pharmacological properties and therapeutic use in the treatment of dermatological disorders.Drugs 1998;55:145–163.

10. Ashcroft DM, Dimmock P, Garside R et al. Efficacy and tolerability of topical pimecrolimus and tacrolimus in the treatment of atopic dermatitis: a meta-analysis of randomized controlled trials. BMJ 2005;330:516.
11. Wolkerstorfer A, Visser RL, De Waard-van der Spek FB et al. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: influence of corticosteroid dilution. Br J Dermatol 2000;143:999–1004.
12. McGowanR, Tucker P, JosephDet al. Short-term growth and bone turnover in children undergoing occlusive steroid (‘‘wet-wrap’’) dressings for treatment of atopic eczema. J Dermatol Treat 2003;14:149–152.
13. Devillers ACA, De Waard-van der Spek FB, Mulder PGH et al. Treatment of refractory atopic dermatitis using ‘‘wet wrap’’ dressings and diluted corticosteroids: results of standardized treatment in both children and adults. Dermatology 2002;204:56–59. 

From wet wraps to bleach baths, here is a primer on some more practical steps to take in AD management.

By Wynnis Tom, MD and Lawrence F. Eichenfield, MD

Management of Atopic Dermatitis

(AD) typically requires a multi-faceted approach. While prescription agents constitute the majority of first-line therapies, patients can also try a number of other practical approaches. Some of these, such as wet wraps and bleach baths, have

proven useful as adjuncts to other therapies and have garnered more attention in clinical practice and research. Ahead, we will provide a glimpse of the latest in non-prescription approaches to AD care.

As a companion to this article, video content demonstrating the techniques described is available at DermTube.com. The videos are part of a video training module at the Rady Children's Hospital Eczema Center Website (www.eczemacenter.org), and they provide an essential visual aid for administering and discussing techniques, such as wet wraps and bleach baths.

Proper Bathing and Moisturizing Techniques

There are varying viewpoints on when and how often patients with AD should be moisturizing and bathing. In particular, much discrepancy exists regarding bathing, because while the bathing process itself can hydrate the outer layer and can also help take off crusts, scale, etc., it also dries out the skin once the water evaporates post-bathing. This can cause patients greater discomfort. But the key when bathing is for patients to apply ample amounts of moisturizers immediately after bathing before all the water dries or is toweled off. This can help maintain hydration/decrease water loss. Regarding moisturization, our general advice is to moisturize at least three times daily and especially after bathing/showers. For babies, it is sometimes helpful to tell parents to check for any dry areas at diaper changes and apply emollients to any such areas. This seems to help in terms of timing and frequency. Parents should choose a dye-free, fragrance-free emollient, such as a cream, ointment, or oil, but not lotion. A good rule of thumb is to use the formulation that your child will let you apply, because even if something is fancier or more expensive if it doesn’t actually get applied on the skin, it will not help. Also, we find that kids are more amenable to moisturization when the parents try to make it a fun process, like giving small treats or having the child play an active part in the process. 

Wet Wraps

Wet wrap therapy has been a focus of renewed interest and can be helpful especially for acute or severe flares. It can help to calm inflammation quickly. The ideal patients for wet wrap therapy are actually infants because they are less able to self-remove the wraps, which allows for a longer duration of application. Also, if most of the body is affected, it is much easier to use a one-piece all-cotton pajama as the “wrap.” Wet wraps also have the potential to help localized areas that the child keeps scratching, (such as an arm or leg) to reduce access to that area. In addition, wet wraps can be particularly useful for children with moderate to severe AD, because of the time involved; those with the only mild disease often improve with topical agents alone. It is important to note that the literature varies in terms of how to perform wet wrap therapy. Most experts advocate wet wrap therapy following the application of topical corticosteroids, while others use emollients underneath the wet wraps. Much of the literature shows the utility of topical corticosteroids directly to wet skin, with wet wraps placed on top of the corticosteroids, often followed with a dry wrap. When it comes to technique, we see creativity on the part of parents in how they “wrap”—from special garments to even one parent using a cotton towel with holes cut for the eyes, nose, and mouth to use for the face!

Bleach Baths

Periodic use of bleach baths has been shown to be effective in improving AD, perhaps by influencing S aureus colonization and infection. In one study, 0.5 cups of household bleach per full tub of water were used several times per week, in addition to mupirocin ointment twice daily to the nares for five days each month. We find bleach baths most beneficial when used one to two times per week in those with frequent infections, or those with a lot of open excoriated areas at risk for infection. Importantly, rinsing off the chlorinated water well after bathing and applying a lot of emollients as it is drying is key to success. Interestingly, speculation appears to be growing that bleach baths, in addition to reducing harmful S aureus colonization, may also affect the normal skin flora and in turn have negative effects. This will likely be clarified in greater detail when more research is done on the subject.

Take-Home Tips. While prescription agents constitute the majority of first-line therapies, patients can also try a number of other practical approaches. Some of these, such as wet wraps and bleach baths, have proven useful as adjuncts to other therapies and have garnered more attention in clinical practice and research.

To see how to perform wet wraps, visit DermTube.com.

National Eczema Association
Offers support groups and telephone support for people living with atopic dermatitis 

Other resources from the American Academy of Dermatology:

Coping with atopic dermatitis
This video explains tips to reduce your atopic dermatitis symptoms.

Camp Discovery
The American Academy of Dermatology's free summer camp exclusively for kids living with a chronic (long-lasting) skin disease.

Eczema: Itchy Skin
Written especially for kids to help them understand why their skin itches and what they can do to feel better.