Can Wet Wrap Therapy Help Severe Eczema (Atopic Dermatitis) Flares?
Here’s the lowdown on who might benefit most from this treatment and how to do it at home.
If you or your child is having a severe flare-up of atopic dermatitis — commonly known as eczema — ask your doctor about wet wrap therapy. This short-term complementary rescue remedy can be a safe and fast way to rehydrate the skin, relieve intense itching and pain, and make topical medications work better.
According to the National Eczema Association, wet wrap therapy involves applying moisturizer and medication to a flare-up, then wrapping the area with warm, damp fabric or gauze and a second layer of dry cloth, such as cotton pajamas. You can use cotton gloves, gauze, or tube socks on hands and feet.
Patients typically keep wet wraps on for anywhere from two hours to overnight.
The wraps act as a barrier, holding in medication and moisture and protecting skin from excessive scratching. Scratching can lead to more itchiness, called the “itch-scratch cycle.”
Most patients can do wet wrap therapy on their own at home, but dermatologists and allergists can apply wet wraps in their office or in a hospital setting when necessary.
Melissa Piliang, MD, a dermatologist at the Cleveland Clinic in Ohio, recommends wet wraps for people with moderate to severe eczema who are experiencing extreme itchiness or pain. “The warm, wet wraps can be very soothing to the irritated, inflamed skin,” Dr. Piliang says, noting that the therapy is especially helpful for flare-ups that are widespread, such as those covering a large area on an arm or leg.
Wet wrap therapy is best used with topical corticosteroids and for up to two weeks at a time, Piliang explains. Utilizing wet wraps for too long or too often can lead to infection.
Wet Wrap Therapy Can Be an Eczema Treatment Option for Young Children
A study published in the Journal of Allergy and Clinical Immunology in Practice that included 72 children with moderate to severe atopic dermatitis found that wet wrap therapy reduced symptom severity.
“The typical candidate for wet wrap therapy is a young child with a severe eczema flare, especially if they’ve already been using topical steroids and/or topical calcineurin inhibitors,” says Breanne Mordorski, MD, a dermatologist at Montefiore Health System and an assistant professor of dermatology at the Albert Einstein College of Medicine in New York City.
“For these patients, wet wraps are a good second-line option when traditional topical treatments fail,” Dr. Mordorski says.
She adds that wet wraps can also be helpful for children during a severe eczema flare-up when there are delays in access to systemic medications such as Dupixent (dupilumab). This prescription injectable biologic has been approved by the U.S. Food and Drug Administration (FDA) for children as young as 6 months.
Doctors recommend that a parent administering wet wrap therapy begin by soaking the child in the bathtub and washing them with unscented soap, making sure to get their full body and face wet, and gently patting them dry. The parent should then apply any topical medications prescribed or recommended by the child’s doctor, followed by a thick layer of unscented ointment or moisturizer, such as Vaseline, Aquaphor, or CeraVe.
After that, the parent fills a basin with warm water, soaks a pair of cotton pajamas with long sleeves and long pants, or footed pajamas, then wrings them out. These go on the child as a first layer, underneath dry pajamas.
If the child’s legs or arms remain exposed, the parent can layer on wet and dry tube socks or gauze or tubular cotton bandages.
Wet Wrap Therapy for Babies Can Be a Boon
Atopic dermatitis can start early, appearing in babies as young as 2 to 3 months. Wet wraps are a super option for babies with a severe eczema flare, says Jenny Montejo, MD, a pediatric allergist and immunologist and an assistant professor of pediatrics at the Mayo Clinic, in Rochester, Minnesota.
The treatment has few side effects and can reduce itching, oozing, and irritation, she says, leading to less crying and better sleep.
Dr. Montejo warns that wet wrap therapy should be used for babies and other pediatric patients only under the direction of a medical provider and with specific instructions for each case.
Wet Wrap Therapy Might Be Challenging for Adults and Older Children
Adults and older children with larger bodies — and more surface area to wrap — may not fare as well with wrap treatment, Mordorski says, especially when it’s applied at home or in a doctor’s office, but they may do well in the hospital when admitted for a severe flare.
“The application is cumbersome and less practical, and older patients are less likely to follow through in the outpatient setting,” she explains. “In the hospital, where there’s more assistance, wet wraps become more feasible for a broader range of patients.”
For older people with severe atopic dermatitis, Mordorski says wet wraps can be used as a stop-gap to manage a severe flare-up during the wait for longer-term systemic eczema therapy to take effect.
A patient who is ill during a severe flare — with a fever, chills, loss of appetite, low energy, or other issue — should see a dermatologist to help determine whether to go to a hospital for monitoring or alternative treatment.
Where to Buy Wet Wrap Therapy Supplies
Before starting wet wrap therapy, reach out to your doctor. They can advise you on the best products and best technique for your case. Do not use topical steroids without consulting your physician.
You can make wraps yourself or purchase special clothing and accessories online for babies or adults — from sleep suits and caps to sleeves, gloves, and moisturizers — from sites such as Soothems and AD RescuWear.
If you’re on TikTok or Instagram, Sheilagh Maguiness, MD, a pediatric dermatologist and an associate professor of dermatology at University of Minnesota Medical School, offers lots of advice on products for wet wrap therapy as well as techniques.
Pros and Cons of Wet Wrap Therapy
Wet wrap therapy has many upsides: It may prevent scratching as it calms and repairs painful and inflamed skin. Plus, unlike some other treatments, there are few side effects.
One downside is that wet wraps are messy and time-consuming, and children may not cooperate.
And while wet wrap therapy is generally safe, there are a few risks to consider. Wet wraps can increase the absorption of topical steroids, which can also increase their potency. If this is a concern, discuss it with your doctor.
Wet wraps can also trap moisture, causing inflamed hair follicles that can lead to blistered skin and infection. In rare cases, and especially when wet wraps are used too long or incorrectly, there is a risk of serious infection, Mordorski says.
Some Doctors Are Not Fans of Wet Wrap Therapy
Not all dermatologists recommend wet wraps. A. Yasmine Kirkorian, MD, the chief of dermatology at Children’s National Hospital and an associate professor of dermatology and pediatrics at George Washington University School of Medicine in Washington, DC, believes there are better alternatives.
“In theory, wet wraps can be very effective, but in practice, they can be cumbersome and difficult for families to use effectively,” Dr. Kirkorian says. She notes that patients with a severe flare can get similar results with a simpler technique called “soak and smear” that involves applying medication and then moisturizer to damp skin before sliding on dry cotton pajamas.
Kirkorian notes that the availability of FDA-approved systemic medications for the treatment of refractory (treatment-resistant) atopic dermatitis in children may override the need for wet wrap therapy in these patients.
“Any child with severe atopic dermatitis — extensive body surface area involved, not responding to first-line treatments, waking up nightly from itching, sustaining skin infections, missing school for eczema, going to the ER or being hospitalized for eczema — should be evaluated by a board-certified dermatologist or pediatric dermatologist,” Kirkorian says.
The Bottom Line on Wet Wrap Therapy
Talk to your doctor before trying wet wrap therapy. They’ll tell you if it’s right for you or your child, how and when to do it, and how to look for signs of skin infection.