BACKGROUND: The wet-wrap treatment involves emollients or corticosteroid dilutions under occlusive wet dressings, and has been reported to be highly effective in severe refractory atopic dermatitis (AD). OBJECTIVES: To investigate the influence of different corticosteroid dilutions on the efficacy and hypothalamic-pituitary-adrenal (HPA) axis suppression in children with severe refractory AD having wet-wrap dressings. METHODS: Eighteen children were treated with a 50% dilution of fluticasone propionate (FP) 0.05% cream for 2 weeks. In another five children a side-to-side comparison was conducted with 10%, 25% and 50% dilutions of FP cream under wet wrap. A third group of eight children was treated with 0% (= emollient), 5%, 10% or 25% dilutions of FP cream applied on the whole body under wet wrap. RESULTS: After 1 week, a major improvement averaging 74% was observed, without apparent differences between 5%, 10% or 25% dilutions of FP cream under wet wrap, with less improvement in the second week of treatment. The first and second group of children showed HPA axis suppression in only three of 23 children using measurements of 09.00 h serum cortisol after 2 weeks. The third group of children showed HPA axis suppression, as indicated by 06.00 h serum cortisol levels, which was related to the absolute amount of FP applied. CONCLUSIONS: This suggests that weaker corticosteroid dilutions had comparable high efficacy, but lower risk of HPA axis suppression.
BACKGROUND: The wet-wrap treatment involves emollients or corticosteroid dilutions under occlusive wet dressings, and has been reported to be highly effective in severe refractory atopic dermatitis (AD). OBJECTIVES: To investigate the influence of different corticosteroid dilutions on the efficacy and hypothalamic-pituitary-adrenal (HPA) axis suppression in children with severe refractory AD having wet-wrap dressings. METHODS: Eighteen children were treated with a 50% dilution of fluticasone propionate (FP) 0.05% cream for 2 weeks. In another five children a side-to-side comparison was conducted with 10%, 25% and 50% dilutions of FP cream under wet wrap. A third group of eight children was treated with 0% (= emollient), 5%, 10% or 25% dilutions of FP cream applied on the whole body under wet wrap. RESULTS: After 1 week, a major improvement averaging 74% was observed, without apparent differences between 5%, 10% or 25% dilutions of FP cream under wet wrap, with less improvement in the second week of treatment. The first and second group of children showed HPA axis suppression in only three of 23 children using measurements of 09.00 h serum cortisol after 2 weeks. The third group of children showed HPA axis suppression, as indicated by 06.00 h serum cortisol levels, which was related to the absolute amount of FP applied. CONCLUSIONS: This suggests that weaker corticosteroid dilutions had comparable high efficacy, but lower risk of HPA axis suppression.
Authors: Lawrence F Eichenfield; Wynnis L Tom; Timothy G Berger; Alfons Krol; Amy S Paller; Kathryn Schwarzenberger; James N Bergman; Sarah L Chamlin; David E Cohen; Kevin D Cooper; Kelly M Cordoro; Dawn M Davis; Steven R Feldman; Jon M Hanifin; David J Margolis; Robert A Silverman; Eric L Simpson; Hywel C Williams; Craig A Elmets; Julie Block; Christopher G Harrod; Wendy Smith Begolka; Robert Sidbury Journal: J Am Acad Dermatol Date: 2014-05-09 Impact factor: 11.527
Authors: Anna B Fishbein; Kelly Mueller; Jennifer Lor; Patricia Smith; Amy S Paller; Aaron Kaat Journal: J Pediatr Nurs Date: 2019-04-23 Impact factor: 2.145
Authors: Danilo Augusto Teixeira; Gisele Gargantini Rezze; Maria Aparecida Silva Pinhal; Francisco Macedo Paschoal Journal: An Bras Dermatol Date: 2018 Jul-Aug Impact factor: 1.896
Authors: Emma Axon; Joanne R Chalmers; Miriam Santer; Matthew J Ridd; Sandra Lawton; Sinead M Langan; Douglas J C Grindlay; Ingrid Muller; Amanda Roberts; Amina Ahmed; Hywel C Williams; Kim S Thomas Journal: BMJ Open Date: 2021-07-07 Impact factor: 2.692