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Done With Steroids for Eczema? Try Wet Wraps and Other Alternative Treatments

Eczema is an annoying and ongoing condition. Doctors will usually prescribe topical steroid creams like hydrocortisone for treatment. But are there alternatives? These medicated creams and ointments obviously have side effects when used long term. How else can this annoying itchy skin condition be treated?

What causes eczema?

To further explore this we first have to understand what the underlying problem is in eczema. Atopic dermatitis – as eczema is called in medical terms – is a combination of an allergic reaction and a skin barrier dysfunction.

First I want to focus on the skin barrier dysfunction. The skin of patients with atopic dermatitis loses water, and therefore becomes dry and itchy. So any effort keeping the skin hydrated helps. Of course, frequent moisturizing is the first step. However, wet wrap treatments are a more intense and more successful approach, pioneered by the allergy department at National Jewish Medical Center in Colorado (further info and video here).

What are wet wrap treatments?

This is definitely time intensive, but well worth it. The regimen should be followed for at least 2 weeks daily for successful treatment. It starts with a long bath in warm, but not hot, water. All areas affected by eczema need to be well soaked (until the skin gets wrinkly). After the bath, the skin should be patted dry (not rubbed!) and moisturizer should be applied immediately (ie, within 4 minutes).

During bad eczema flares, moisturizer can be temporarily replaced by topical steroid ointment or cream. Then, a wet layer of clothing should be used to cover all areas of the body affected by eczema. This could be a wet pajama set, long johns, or simply socks or bandages covering arms or legs. Supplies can also be ordered online.

“Wet” does not mean dripping or soaking wet, but the kind of wet you get when taking clothes out of the laundry after the spin cycle. A dry layer of clothing can be worn on top for comfort during the night. The wet wrap should be kept on at least 2 hours, but is best worn overnight. The next morning, the wet clothing gets removed and moisturizer (or steroid cream) applied immediately.

Yes, it is a lot of work, but if done consistently for 14 days, it leads to major improvement of eczema and may reduce the need for steroid creams. The coolness of the wet clothing may actually soothe the itch associated with eczema flares.

Allergies and Eczema

As mentioned above, eczema is also worsened by allergies. These can be directed against foods or allergens in our environment like dust mite. This makes allergy testing an important step in treating the disease. Once the causative allergen is identified symptoms can be controlled by avoidance. Putting on dust mite covers and washing sheets in hot water may help eczema sufferers who are allergic to dust mite. Avoiding egg or peanut in their diet is often a “cure” for children suffering from food-induced eczema.

Beyond the Basics: Creams and Injections

Mild to moderate eczema can usually be controlled by treating the two pillars of disease (skin barrier dysfunction and allergies) with the strategies mentioned above. There are newer treatments on the market now for treating eczema including creams without steroids and injections to reduce inflammation. Review of these medications goes beyond the scope of this post, and should be discussed with your allergist or dermatologist.

Dr. Corina Bowser

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