Wet Wraps for Pediatric Eczema

Wet wraps are a treatment used in pediatric eczema where moisturizers are applied to the body, then wet bandages are applied and then a layer of dry bandages are applied. Your child can look like a mummy once the wet wraps are applied and she is all bandaged up.

Do wet wraps work?

Wet wraps have been shown to improve pediatric eczema in some cases. Some studies have shown that although wet wraps show an improvement in pediatric eczema, it is no better than the improvement you see with steroids and moisturizers used without the wraps.

I think wet wraps are particularly useful for infants and toddlers who scratch a lot, particularly at night. With wet wraps, they can't scratch.

I have also seen thick skin as a result of scratching improve and soften after a course of wet wraps.

How do wet wraps work?

Wet wraps work in pediatric eczema in several ways:

• they prevent scratching
• they cool the skin which may reduce itching
• they increase the moisture of the skin by improving the absorption of the moisturizers
• they increase the absorption of steroids applied to the skin making their action stronger

How are wet wraps applied?

Your child should have a bath using a soap substitute. Pat the skin dry after the bath and apply the moisturizers all over the body. Then a wet (damp rather than soaking so squeeze out) layer of bandages is applied and then a dry layer of bandages is put over that.

Tubular bandages, like Tubifast and Comfifast, make it relatively easy as they are an all-in-one bandage, but they are expensive. The photos show a tubular bandage on the body tied to bandages on the arms. The leg bandages are also tied to the body bandage and then a diaper (nappy) can be put on as shown in the photo below.

One layer of the Tubifast is applied wet and another dry one is put over it.

The bandages should be left overnight but for no longer than 24 hours.

It is probably best if you watch an experienced person, like a nurse, apply the bandages the first time.

What length of tubular bandages is necessary?

• Measure the legs from the top of the thigh to the tips of the toes and add 5 cm (2 inches) - cut four
• Measure the arms from the top of the shoulder to the tips of the fingers and add 5 cm (2 inches) - cut four
• Measure the body from the base of the neck to the base of the bottom cut two
• Make 8 ties form strips of the bandage measuring about 2 cm (3/4 inch) - use 4 for attaching arms to body (front and back) and 4 for attaching body to legs (front and back)

How long should wet wraps be used for?

It is generally thought that wet wraps are most beneficial in pediatric eczema when used intermittently for up to 2 weeks at a time. They are time consuming so short bursts is easiest.

Can steroids be used under the wet wraps?

Yes, but this should be under the supervision of a doctor as we know that steroids under wet wraps can be absorbed into the body, although the effects of this disappear quickly once the wet wraps are discontinued. Strong steroids (more potent than 1% hydrocortisone) need to be diluted first if they are to be used under wet wraps for pediatric eczema.

In most cases, using the wet wraps overnight with a moisturizer and then applying the steroids in the morning (without wraps) is effective.

Are there any side effects of wet wraps?

Wet wraps have occasionally increased skin infection so should not be applied to weepy infected skin.

If steroids are used under the wet wraps, the steroid can be absorbed into the body, so medical supervision is required for this.

How should wet wraps be washed?

The wet wraps will be greasy when you remove them. To avoid clogging up your washing machine, soak the wraps in hot soapy water before washing in the machine. Pour the used water down an external drain so you don't block your plumbing. Then wash the wraps in the washing machine.

Is there a cheaper alternative to tubular bandages for wet wraps in pediatric eczema?

Yes. Get some cotton clothing that is now a size too small for your child, eg. a long sleeved cotton top or leggings. Bath her with soap substitute and pat her dry. Apply the moisturizers.

Then take the top (or leggings) and wet them and then put them on your child damp (but not soaking). Because they are a size too small the fit will be snug and she won't be able to get her fingers underneath to scratch.

Then cover with dry clothing - the closer the fit the better to avoid your child getting her fingers underneath.

You can keep the wet layer moist as it dries out using a water spray.

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