Clinical Edge

Summaries of Must-Read Clinical Literature, Guidelines, and FDA Actions

Wet-Wrap Dressings for Improving Pediatric AD

In a randomized controlled study of pediatric patients with atopic dermatitis (AD), no difference was found in efficacy between triamcinolone acetonide wet wraps with cream vs ointment. Researchers compared the efficacy of 0.1% triamcinolone acetonide ointment vs cream with wet wraps in pediatric patients with AD, and examined patient preference. Patients were instructed to apply a topical steroid cream to 1 extremity and apply the same topical steroid in an ointment vehicle to the other extremity using the wet-wrap technique once or twice daily for 3 to 5 consecutive days. Patients were evaluated at a follow-up visits. Among the findings:

  • The study included 39 pediatric patients experiencing symmetric, bilateral AD flares.
  • A comparison of the change in Investigator’s Global Assessment scores disclosed no significant difference between efficacy ratings of cream and ointment when used with wet wraps.
  • Patients preferred ointments for future prescriptions, despite finding them more difficult to apply.

Citation:

Cadmus SD, Sebastian KR, Warren D, et al. Efficacy and patient opinion of wet-wrap dressings using 0.1% triamcinolone acetonide ointment vs cream in the treatment of pediatric atopic dermatitis: A randomized split-body control study. [Published online ahead of print April 14, 2019]. Pediatr Dermatol. doi:10.1111/pde.13830.

Commentary:

Wet wraps are often recommended to treat acute flares of AD. The formulation of topical corticoid used along with the wraps was evaluated here, with one extremity receiving triamcinolone (TMC) ointment and another receiving a TMC cream product. Efficacy was similar. Although the ointment was harder to apply, more patients preferred it to the cream. The conclusion is that whichever formulation the patient prefers should work equally well. — Joseph Fowler, Jr., MD, Clinical Professor of Dermatology, University of Louisville, KY