Noreen Heer Nicol1, Mark Boguniewicz2, Matthew Strand3, Mary D Klinnert2. 1. College of Nursing, University of Colorado, Aurora, Colo; Department of Nursing, Children's Hospital Colorado, Aurora, Colo. Electronic address: Noreen.nicol@ucdenver.edu. 2. Department of Pediatrics, National Jewish Health, Denver, Colo. 3. Department of Biostatistics, National Jewish Health, Denver, Colo.
Abstract
BACKGROUND: Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD. OBJECTIVE: This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed. METHODS: An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described. RESULTS: Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge. CONCLUSION: To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.
BACKGROUND:Atopic dermatitis (AD) is the most common chronic, relapsing inflammatory skin disease of children and is a global public health problem. National and international AD guidelines address AD care in a stepwise fashion. Wet wrap therapy (WWT) is a therapeutic intervention for moderate-to-severe AD. OBJECTIVE: This cohort study evaluated the effectiveness of WWT as part of a multidisciplinary AD treatment program to improve disease severity. Patients treated in this unique outpatient program had moderate-to-severe AD and had multiple therapies that failed. METHODS: An observational cohort study was completed. The primary outcome was improvement in AD severity as measured by SCORAD (Scoring Atopic Dermatitis). Demographics; clinical management of AD, including use of antibiotics and systemic treatments; and WWT methodology were comprehensively described. RESULTS: Seventy-two children with a mean ± SD age of 4.6 ± 3.12 years were included. By using a paired t test, the SCORAD at admission and at discharge showed significant differences in mean ± SD values, of 49.68 ± 17.72 versus 14.83 ± 7.45, respectively (t, 18.93; df, 71; P < .001). None of these patients required systemic immunosuppressive therapy during the treatment program. By using a previously published parent-administered outcomes tool, patients were shown to maintain clinical improvement of their AD 1 month after discharge. CONCLUSION: To our knowledge, this study is the largest to date of WWT for pediatric patients with moderate-to-severe AD by using a validated outcomes tool. None of the patients required systemic immunosuppressive therapy, and only 31% were treated with an oral antibiotic. This study demonstrated the benefit of incorporating WWT as an acute intervention in a supervised multidisciplinary AD treatment program with lasting benefit 1 month after discontinuing this intervention.
Authors: Jung Eun Kim; Hyun Jeong Kim; Bark-Lynn Lew; Kyung Ho Lee; Seung Phil Hong; Yong Hyun Jang; Kui Young Park; Seong Jun Seo; Jung Min Bae; Eung Ho Choi; Ki Beom Suhr; Seung Chul Lee; Hyun Chang Ko; Young Lip Park; Sang Wook Son; Young Jun Seo; Yang Won Lee; Sang Hyun Cho; Chun Wook Park; Joo Young Roh Journal: Ann Dermatol Date: 2015-10-02 Impact factor: 1.444