A. C. A. Devillers

Efficacy and safety of 'wet-wrap' dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature.

Background  During the last two decades wet‐wrap treatment (WWT) has been advocated as a relatively safe and effective treatment modality in children with severe and/or refractory atopic dermatitis (AD). Unfortunately, there are still many unsolved issues concerning the use of wet‐wrap dressings in patients with AD.

Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel's opinion and review of the literature

Background  The use of dampened bandages to reduce inflamed eczema (synonyme dermatitis) is an old remedy. In order to evaluate the current indications for so‐called wet‐wrap treatment (WWT) for atopic dermatitis (AD), and to compare the different currently recognized methods, a group of experts critically reviewed their own expertise on WWT in respect to the existing literature on the subject.

Treatment of Refractory Atopic Dermatitis Using ‘Wet-Wrap’ Dressings and Diluted Corticosteroids: Results of Standardized Treatment in both Children and Adults

Background: ‘Wet-wrap’ dressings with diluted corticosteroids form an alternative treatment in patients with refractory atopic dermatitis (AD). Objective: To evaluate a standardized treatment, using wet-wrap dressings with diluted corticosteroids, in patients with refractory AD. Methods: Results of treatment, complications and possible side effects were retrospectively evaluated in 14 children and 12 adults. Results: Skin lesions improved dramatically during 1 week of inpatient treatment. A significant decrease in early-morning serum cortisol levels was measured. Levels below the normal range were only observed after 1 week in 2 adults and on day 4 in 3 children. Suppression of the hypothalamus-pituitary-adrenal-cortex axis in 1 adult and a new exacerbation of AD in 2 children and 3 adults complicated long-term treatment at home. Additional complications included folliculitis, a Pseudomonas aeruginosa infection, a secondary bacterial infection and refractory skin lesions between bandages. Conclusion: Wet-wrap dressings and diluted corticosteroids form an effective treatment in patients with refractory AD.

The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: A prospective, randomized, double-blind, placebo-controlled trial

BACKGROUND Wet-wrap treatment (WWT) has been advocated as a relatively effective treatment in children with severe atopic dermatitis (AD). WWT often serves as crisis intervention for AD. OBJECTIVES We sought to evaluate the use of WWT with diluted corticosteroids in comparison with emollient in children with severe AD during 4 weeks in a proactive schedule during which the frequency of corticosteroid applications was tapered. METHODS A randomized, double-blind, placebo-controlled study was performed in children aged 6 months to 10 years with severe AD (objective SCORAD at least 40 ± 5), comparing WWT with diluted corticosteroids (1:3 mometasone furoate 0.1% ointment and for the face 1:19 mometasone furoate 0.1% ointment under a mask) with emollient (petrolatum 20% in cetomacrogol cream). The primary outcome was improvement of the objective SCORAD; secondary outcomes included Patient-Oriented Eczema Measure and quality-of-life index. RESULTS WWT with diluted corticosteroids acted faster and was more efficacious than WWT with emollients. Best results were obtained in age groups 6 to 9 years and 0 to 3 years. The difference in efficacy evaluated by objective SCORAD was significant at all measuring points. This also applied to the quality-of-life index. LIMITATIONS The study group was relatively small. CONCLUSIONS WWT for severe AD is an effective therapy option for at least a period of 4 weeks.

Wet‐Wrap Treatment in Children with Atopic Dermatitis: A Practical Guideline

Abstract:  Treatment of children with severe atopic dermatitis (AD) can be especially challenging because several possible intervention treatments have (relative) contraindications in childhood. In recent years, wet‐wrap treatment (WWT) has been advocated as a relatively safe and efficacious intervention in children with severe or refractory AD. The goal of this article is to provide a practical guideline as a starting point for clinicians who are interested in using WWT in their own clinical practice. We will address several practical issues surrounding the use of WWT by describing our own experiences, supplemented with data from the literature.

Diagnostic tests in children with atopic dermatitis and food allergy

Background Skin testing is a common diagnostic procedure in food allergy. The skin prick test is the test of first choice for investigating the immediate IgE‐mediated reaction, TTie skin application food test (SAFT) has been developed on the basis of the mechanism of the contact urticaria syndrome (CUS), Methods We studied the relevance of the SAFT in children younger than 4 years with atopic dermatitis and (suspected) food allergy as compared with the prick‐prick test, the radioallergosorbent test (RAST), and the oral challenge. In the skin tests, we used fresh food, in the same state as it was consumed.

Delayed‐ and immediate‐type reactions in the atopy patch test with food allergens in young children with atopic dermatitis

In recent years, the atopy patch test (APT) has been suggested as an addition in the allergological work‐up of children with atopic dermatitis (AD) and suspected food allergy. We initiated a prospective clinical study in children with AD younger than 3 yr, to evaluate the additional clinical value of the APT next to our own standardized allergological work‐up in case of a suspected food allergy. One hundred and thirty‐five children were included in the study. They were tested using the skin application food test (SAFT), the APT and measurement of specific IgE. The allergens used in the skin tests were freshly prepared food stuffs and included commercially available cow’s milk (CM), the egg white of a hard boiled hen’s egg and mashed peanuts in a saline solution. Allergy was defined using a flowchart incorporating the results from the SAFT, oral challenges (OCs) and elimination and (re)introduction periods. To determine the additional value of the APT next to the SAFT, we analyzed the SAFT negative patients per allergen and used an exact binary logistic analysis to evaluate the simultaneous effects of the APT and measurement of specific IgE, calculating mutually adjusted odds ratios (ORs) for positive APTs and specific IgE levels above 0.70 U/l. We found clinically relevant food allergies in 23% (egg white) to 28% (CM and peanut) of our study population. Positive SAFT reactions were observed in 14% (peanut), 16% (egg white) and 21% (CM) of our patient population. Next to the SAFT, we did not observe a significant additional value of the APT for the diagnosis of CM or egg white allergy, but we did find a significant additional value for the diagnosis of peanut allergy (OR = 11.56; p < 0.005, 2‐sided). In clinical practice this statistically significant value does not exclude the need for OC and controlled elimination and (re)introduction periods due to the presence of false‐negative as well as false‐positive results in the APT. In conclusion, we could not find enough support for the current addition of the APT to our standardized allergological work‐up in young children below the age of 3 yr with AD and suspected food allergy. At the moment the additional value of the classical delayed‐type APT next to the SAFT seems to be very limited at best in this study population and does not justify the time‐consuming nature of the skin test.

Elevated levels of plasma matrix metalloproteinase-9 in patients with atopic dermatitis: a pilot study

Matrix metalloproteinase (MMP)‐9 has been shown to play a role in the infiltration of inflammatory cells in various tissues. It is thus part of the pathogenesis of many inflammatory diseases, including asthma and allergic rhinitis/conjunctivitis. We compared plasma MMP‐9 levels of 20 patients with atopic dermatitis (AD) with that of 17 control subjects. Additional outcome parameters consisted of the modified objective SCORing Atopic Dermatitis and the Three Item Severity score in patients, and peripheral blood leucocytes and eosinophils in both groups. Plasma MMP‐9 levels were found to be significantly higher in patients compared with controls, supporting a role for MMP‐9 in the pathogenesis of AD.

Treatment and Pain Relief of Ulcerative Hemangiomas with a Polyurethane Film

Background: Hemangiomas are the most common tumors occurring in young children. The most common complication in the growing phase of hemangioma is ulceration. Aim and Method: We report healing, pain relief and evolutive effects of a polyurethane film in 8 cases with ulcerative hemangiomas. Results: In all 8 infants, prompt pain relief and healing within 1–2 months were observed. An increased regression was also noted within 2–4 months, when the hemangiomas were in the normal proliferative phase. Conclusion: As far as the authors know, there is no explanation for the effectiveness of polyurethane film. Explanations could be the occlusive effects of the film inhibiting proliferation or the decrease in blood flow. As primary initial therapeutic approach in ulcerative hemangiomas, we advocate the application of a polyurethane film. This therapy is painless and suitable for children.

Atopy patch tests with aeroallergens in children aged 0-3 years with atopic dermatitis.

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