If you have suffered with eczema, or have cared for someone who has, you have more than likely encountered the term “wet wrap therapy.” This common eczema treatment has become increasingly common over the past several years, especially for severe cases of eczema.
You may have wondered what wet therapy is, how it works, and whether it’s an option for you or your child. We’ve gathered information about wet wrap therapy and its benefits. Read along to learn more about wet wrap theory and decide if it’s right for you or your child.
Wet Wrap Therapy: What It Is
Wet wrap therapy is a technique for managing eczema, and as its name suggests, it involves dampening and wrapping the affected skin. Typically, it is used for patients with moderate-to-severe eczema, and it’s most frequently recommended when symptoms don’t respond satisfactorily to topical treatment. It’s also used for patients with severe itching, as it can both relieve the itch and prevent them from scratching their skin and damaging it further.
Wet wrap therapy has become more prevalent since the early 2000s, but similar therapies have existed for thousands of years. Wet compresses have a long tradition as a treatment for skin disorders. In ancient Egypt, there are records of people treating eczema-like symptoms with applications of beans or onions. Fortunately, today’s treatments do not come with the side-effect of smelling like dinner.
Modern wet wrap treatment involves the application of moisturizer and/or topical corticosteroids to areas of skin affected by eczema. Damp dressings are then placed on top of the moisturized skin. This is then covered by dry dressings. The dressings are left in place for several hours, or even overnight. This isn’t a long-term treatment; wet wrap therapy should be used for no longer than two weeks at a time.
How Wet Wrap Therapy Works
Wet wrap therapy appears to help the skin absorb medication and emollients more efficiently. The dressings act as an occlusive that prevents moisture from escaping dry skin. While using both corticosteroids and emollients seems to be the most advantageous approach, many benefit from treatments using emollients alone.
Research suggests that corticosteroids are more readily absorbed and are more effective when used with wet wraps. Some scientists believe that wet wrap therapy triggers lamellar body secretion–which is the academic way of saying that it triggers the production of oils and other lipids by skin cells.
Lamellar body secretions play a role in the skin’s barrier function, which prevents water from evaporating too rapidly from skin cells and protects the skin from external irritants. Those with eczema have impaired barrier function and suffer from dry, easily irritated skin. Wet wrap therapy could possibly help restore the skin’s barrier function and accelerate healing.
Wet wrap therapy’s strength lies in its ability to hold moisture against the skin. This is also one of its weaknesses; moisture and lack of air circulation often create conditions favorable to disease-causing bacteria and fungus. Folliculitis, which is inflammation and sometimes infection of the hair follicles, is a commonly-seen adverse effect of wet wrap therapy.
Using Wet Wrap Therapy for Children
A 2012 study on children between the ages of 1 and 7 years found that wet wrap therapy significantly improved severe or refractory eczema symptoms. To top it off, improvements continued for at least a month after treatment.
Wet wrap therapy can reduce itching and prevent scratching. Anyone who’s parented a child with eczema understands what a monumental boon this is; itching often disturbs children’s sleep, and they don’t always understand why they can’t scratch.
Wet wrap therapy does require time, though. Small children may find the dressings uncomfortable or limiting. They may become impatient with the treatment and attempt to remove the dressings. If your child’s eczema symptoms are severe or resistant to treatment, ask their doctor about wet wrap therapy. If they recommend wet wrap therapy, ask for clear, step-by-step instructions and follow them faithfully.
Once again, wet wrap therapy is a short-term intervention and should be used at a maximum of two weeks.
Wet Wrap Therapy At Home
Your doctor can apply wet wrap dressings in their office as an outpatient treatment. You can also apply the dressings yourself at home, though. Wet wrap therapy requires a large investment of time, so you’ll want to plan your day accordingly. Gather your supplies ahead of time, and make sure you have everything you need to stay comfortable during the treatment.
If you are interested in doing wet wrap therapy at home, follow the steps below for maximum benefit.
1. Gather Supplies ahead of time
Before you begin, you should ascertain that you have everything you need on-hand. You will need the following:
- Moisturizing cream and/or topical steroids
- Gauze bandages or clean, white fabric
- 2 tubular bandages (alternatively, two pairs of cotton gloves or two pairs of unused cotton socks)
- 2 towels (for use on face or other hard-to-wrap areas)
All of this should be assembled and set out in a convenient place in or near your bath before you begin.
To start with a clean canvas, take a brief, 10-20 minute lukewarm shower or bath (no hot water!). Pat dry when you are finished; do not vigorously rub your skin or dry it completely.
3. Apply moisturizer and cortisone cream
Put your favorite gentle moisturizer (HarlanMD now offers an amazing moisturizer called Perfect Repair™–more details later) on the affected skin. Give your skin a minute or two to absorb the moisturizer; then apply SmartLotionⓇ or your prescription topical steroid. Do not use calcineurin inhibitors (tacrolimus, ElidelⓇ)!
You can do wet wraps using emollients only.
4. Dampen the first layer
Take a set of bandages or clean, white cotton cloth and moisten them with lukewarm water. It should be damp, not dripping wet (perhaps it should be called “damp wrap therapy” instead). Place the damp bandages or cloth on the area you are treating.
5. Put on Dry Layer
Place a dry tubular bandage, new cotton sock, or white cotton glove over the damp layer. This stage of the process can be awkward if you are treating your hands; plan in advance to have someone help you if you can..
6. Settle In and wait
The bandages should be left in place for several hours or overnight. Settle into a comfortable spot where you can rest and/or distract yourself from the bandages. Lay towels down on your bed or furniture to keep them dry.
The damp bandages can become uncomfortably cool, so make sure that you have blankets or throws in case you need them.
Take a nap (or go to sleep for the night), read a book, or binge your favorite series to make the time pass pleasurably. If you plan to sleep, be sure that loose bandages or towels cannot obstruct your mouth and nose as you sleep.
7. Remove dressings
When time is up, remove both your wet and dry dressings. Get dressed as usual in clean, dry clothes. Congratulations, you’ve completed your home wet wrap session!
Wet Wrapping Hard-to-Wrap Places
Some parts of the body–the face, hands, neck, and shoulders–are harder to wrap than others. If you need to treat one of these areas, read ahead for tips.
You may want to have your doctor wet wrap your face, as many find it difficult to do effectively at home. There are some special considerations to make when wet wrapping your face. Facial skin is thinner and more easily damaged than skin on your limbs or trunk.
Facial skin may require less treatment time than other parts of the body. Wraps should be left in place for a minimum of 4 hours and a maximum of 8.
Your doctor may recommend a less potent steroid cream for facial wet wrap treatments (SmartLotionⓇ uses only 0.75% hydrocortisone with no risk of topical steroid withdrawal or atrophy); discuss this with them ahead of time. This consideration is especially important if you are treating a child.
If you are the rugged, DIY-type and are dead-set on home wet wrap therapy, you might want to purchase special wet wrap garments. These are available online. If this is not an option, you can use several small washcloths or hand towels. Drape one each over your cheeks, forehead, and chin. It can be difficult to keep such dressings on your face for several hours (especially if you’re doing an overnight treatment).
Do not allow any dressings to obstruct the nose or the mouth or to wrap around the neck. Parents treating children should monitor their child closely during treatment. If facial wraps shift, they can pose a strangulation or asphyxiation hazard.
Neck and Shoulders
The neck and the shoulders are other challenging areas to treat, and you might prefer to have your healthcare provider wrap these areas for you. You can, however, do it yourself. Either purchase a covering made for wet wrapping these areas or use towels. For your neck, wrap them as if you’re wrapping a winter scarf, taking care that they are not too tight.
Wet wrapping the hands can significantly curtail your activity. A pair of cotton gloves is invaluable. Snipping the fingertips off of the gloves can free you to use touchscreens, type, game, or read during treatment
Soak and Seal: an alternative to wet wrap therapy
If you would like the benefits of wet wrap therapy but cannot invest the time, the “soak and seal” treatment method might be a good alternative for you. Soak and seal helps the skin lock in moisture so that the skin barrier can be repaired.
For this method, take a brief (maximum 20 minute) bath or shower in lukewarm water. When you are finished, pat dry. Apply moisturizer (we highly recommend HarlanMD Perfect Repair™) while the skin is still damp; when your skin has had time to absorb the moisturizer (one or two minutes), apply SmartLotionⓇ or your prescription hydrocortisone cream.
That’s it! That’s all there is to soak and seal. This is a simple, effective way to jump-start healing.
Perfect Repair™ and SmartLotionⓇ: a winning combination for wet wrap therapy
Helping patients battle eczema inspired board-certified dermatologist Steve Harlan, MD to develop a steroid cream that would relieve inflammation without the risk of skin atrophy and topical steroid withdrawal when used properly. SmartLotionⓇ is the result of his expertise and dedication to his patients.
Dr. Harlan formulated SmartLotionⓇ with prebiotic ingredients. This helps balance the skin’s microbiome, which helps the skin barrier repair itself.
Because it promotes the skin’s overall health, SmartLotionⓇ can effectively treat inflammation with a much smaller dose of hydrocortisone (0.75%) than most all other corticosteroid creams.
SmartLotionⓇ therefore does not cause topical steroid withdrawal or skin atrophy, even when used as needed long term, with a Dermatology Provider’s supervision.
Dr. Harlan now brings us HarlanMD Perfect Repair™ moisturizing cream, the perfect companion for SmartLotionⓇ in wet wrap treatments.
When the skin barrier is damaged, water evaporates rapidly from vulnerable skin cells, leading to dry, sensitive skin. Damage to the skin barrier is one of the chief features of eczema–that’s why eczema-prone skin is so often dry and sensitive.
That’s why Perfect Repair™ is loaded with natural ceramides. It also contains fragrance-free coconut oil for its powerful healing benefits on eczema. Like our eczema cream, SmartLotionⓇ, Perfect Repair™ incorporates a prebiotic strategy for reducing harmful bacteria and yeast in the skin. There really is nothing like it for healing and repairing dry, injured skin.
Use Perfect Repair™ and SmartLotionⓇ with your wet wrap treatments to maximize rehydration and healing!