Electronic ISSN 2287-0237

VOLUME

COMPREHENSIVE APPROACH OF TREATMENT OF ATOPIC DERMATITIS INCLUDING INTENSIVE SKIN HYDRATION THERAPY (WET WRAP THERAPY–WWT) – A REVIEW.

SEPTEMBER 2016 - VOL.12 | REVIEWS ARTICLE

Atopic dermatitis (AD), the most common skin disease in children, is the earliest presentation of allergic diseases among childhood. Although AD is commonly seen within the infantile age group, it can manifest its initial presentation in late childhood and in adulthood. The classic sites of the rash, the chronic relapsing nature of the disease along with itching establishes the diagnosis of AD. Despite the fact that ‘atopic’ denotes the relationship with IgE-mediated mechanism, atopy could be demonstrated in approximately 50% of AD cases. Common allergens found in association with infantile AD are food allergens (commonly cow’s milk and eggs) whereas inhalant allergens are found among AD cases of older ages. Recently, defects of skin barrier proteins which protect the transepidermal loss of water were found among skin of AD patients. The classic molecule that has been extensively studied was filaggrin. With the combination of defective skin barrier protein and altered immune mechanism, AD skin became dry, itchy and inflamed. Treatment of AD requires several modalities of approach including hydration of skin, use of moisturizers, use of anti-inflammatory agents, treatment of skin infections, and avoidance of allergens. This multilevel approach, although difficult to accomplish, can be adequately arranged even in busy clinics and thus leading to a higher level of success in the treatment of severe AD cases. Hydration of dry skin is an important step in the treatment of AD and in severe cases, a more complex hydration approach is needed. This can be achieved by comprehensive hydration therapy with prolonged wrapping with saline or water (wet wrap therapy–WWT). This article reviews important salient points for the pathogenesis of AD and also in-depth discussion on techniques of WWT. Effective therapy of AD can be achieved in a short period of time using WWT and can help sustain an optimal use of moisturizers and intermittent inflammatory agents.

Keywords:

atopic dermatitis, moisturizers, topical corticosteroids, food allergens, house-dust mites, topical calcineurin inhibitors, wet wrap therapy, WWT

MEDIA
Figure 2:
The dry-itch-scratch-inflammation cycle. Increase in transepidermal water loss leads to skin drying, scratching and absorption of microbes and allergens. These result in alteration of immunological response of the skin causing inflammation in AD.
Figure 3:
Pictures of an AD patients wet wrap therapy (WWT) (3A) prior to WWT (3B) during and (3C) after one day of WWT – with permission from the family.
Figure 4:
Materials for use in performing WWT. These include (A) Saline (B) Undercast cotton roll (C) Stretchable bandage roll (D) Tubular stretchable net dressing (E) the Duangnetr’s mask (F) hydration arm sleeves
Table 1 :
Characteristics of AD patients who underwent WWT at SAI in 2015 (n =23).
SEARCH VOLUME & NUMBER
GO
RECENT VOLUME & NUMBER