‘Wet wraps’ are wet bandages wrapped over emollients and/or topical steroid creams to areas of red, hot, weeping eczema (most often due to atopic dermatitis). It may also be valuable in erythroderma, whatever its cause.
How does wet wrapping work?
Wet wraps work via three different ways:
- Cooling – as water gradually evaporates from the bandages this cools the skin and helps relieve inflammation, itching and soreness.
- Moisturising – emollients covered over with wet bandages are deeply absorbed into the skin to provide a longer lasting moisturizing effect.
- Steroid absorption – enhanced absorption of topical steroid molecules into both the superficial and deeper layers of skin where inflammation is present.
In addition, the bandages provide protection from the itching and scratching cycle so that skin gets a chance to heal properly.
How do you apply wet wraps?
Wet wraps are most often applied in a hospital for severe eczema. However, wet wraps may also be applied in the community or at home at the first signs of a worsening condition to reduce the need for hospital admission.
There are different methods and bandages used for wet wrapping but the basic technique is as follows.
- Depending on the area being treated the patient may first soak in a bath with bath oil or emollient solution
- An emollient and/or steroid cream (as prescribed by the doctor) is liberally applied to the area
- Bandages (often a tubular bandage is used) soaked in warm water are wrapped or applied over the top of the creams
- Dry bandages are placed over the top of the wet bandages to protect clothing
- Later on, the dry bandage may be removed and water sprayed on the underneath layer to keep it damp, before reapplying the dry outer bandage.
Convenient eczema garments have been developed for wet wrapping children with eczema, e.g. Ad RescueWear™, Comfifast™ Easywrap™ and Tubifast™. Medical-grade silk garments are not suitable for wet wrapping.
Generally, wet wraps are used for a few days until the redness, swelling and weeping has settled down. To maintain results, emollients should be applied frequently throughout the day to the affected areas.
What are the benefits of wet wrapping?
The benefits of wet wrapping include:
- Reduced itching and scratching
- Reduced redness and inflammation
- Skin rehydration
- Better skin healing process
- Reduced steroid usage once the condition is controlled
- Improved sleep
Are there any side effects from wet wrapping?
Currently there is little evidence to show that a topical steroid under wet wraps produces more side effects than if applied normally to skin without wet wraps. Minor side effects of topical steroids include burning, irritation and stinging when first applied. If the coldness is unpleasant, two layers of dry wraps may be used.
One study found that a wet wrap with steroid, used for prolonged periods, was linked with bacterial infection and a drop in cortisol levels.