Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: influence of corticosteroid dilution

Background The wet-wrap treatment involves emollients or corticosteroid dil utions under occlusive wet dressings, and has been reported to be highly ef fective in severe refractory atopic dermatitis (AD). Objectives To investigate the influence of different corticosteroid dilutio ns on the efficacy and hypothalamic-pituitary-adrenal (HPA) axis suppressio n in children with severe refractory AD having wet-wrap dressings. Methods Eighteen children were treated with a 50% dilution of fluticasone p ropionate (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 u nder wet wrap. A third group of eight children was treated with 0% (= emoll ient), 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, witho ut 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 2 3 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 app lied. Conclusions This suggests that weaker corticosteroid dilutions had comparab le high efficacy, but lower risk of HPA axis suppression.