Comprehensive Approach of Treatment of Atopic Dermatitis including Intensive Skin Hydration Therapy (Wet Wrap Therapy–WWT) – A Review.

Main Article Content

Pakit Vichyanond, MD
Duangnetr Soipetr, LPN
Rattanasuda Promchana, RN
Sirirat Weeravejsukit
Natchaya Santichaiyanant, RN
Pimjai Sinthao, LPN
Chulamanee Chairattananon, MD
Chanthana Suratannon, MD
Voravich Luangwedchakran, MD

Abstract

Atopic dermatitis (AD), the most common skin disease in children, is the earliest presentation of allergic diseases among childhood. Although AD is commonly seen within the infantile age group, it can manifest its initial presentation in late childhood and in adulthood. The classic sites of the rash, the chronic relapsing nature of the disease along with itching establishes the diagnosis of AD. Despite the fact that ‘atopic’ denotes the relationship with IgE-mediated mechanism, atopy could be demonstrated in approximately 50% of AD cases. Common allergens found in association with infantile AD are food allergens (commonly cow’s milk and eggs) whereas inhalant allergens are found among AD cases of older ages. Recently, defects of skin barrier proteins which protect the transepidermal loss of water were found among skin of AD patients. The classic molecule that has been extensively studied was filaggrin. With the combination of defective skin barrier protein and altered immune mechanism, AD skin became dry, itchy and inflamed. Treatment of AD requires several modalities of approach including hydration of skin, use of moisturizers, use of anti-inflammatory agents, treatment of skin infections, and avoidance of allergens. This multilevel approach, although difficult to accomplish, can be adequately arranged even in busy clinics and thus leading to a higher level of success in the treatment of severe AD cases. Hydration of dry skin is an important step in the treatment of AD and in severe cases, a more complex hydration approach is needed. This can be achieved by comprehensive hydration therapy with prolonged wrapping with saline or water (wet wrap therapy–WWT). This article reviews important salient points for the pathogenesis of AD and also in-depth discussion on techniques of WWT. Effective therapy of AD can be achieved in a short period of time using WWT and can help sustain an optimal use of moisturizers and intermittent inflammatory agents.

Downloads

Download data is not yet available.

Article Details

How to Cite
1.
Vichyanond P, Soipetr D, Promchana R, Weeravejsukit S, Santichaiyanant N, Sinthao P, Chairattananon C, Suratannon C, Luangwedchakran V. Comprehensive Approach of Treatment of Atopic Dermatitis including Intensive Skin Hydration Therapy (Wet Wrap Therapy–WWT) – A Review. BKK Med J [Internet]. 2016Sep.20 [cited 2020Jul.15];12(1):97. Available from: https://he02.tci-thaijo.org/index.php/bkkmedj/article/view/221580
Section
Reviews Article

References

1. Williams H, Robertson C, Stewart A, et al. Worldwide variations in the prevalence of symptoms of atopic ecze- ma in the International Study of Asthma and Allergies in Childhood. J Allergy Clin Immunol 1999;103 (1 Pt 1): 125-38.
2. Vichyanond P, Jirapongsananuruk O, Visitsuntorn N, et al. Prevalence of asthma, rhinitis and eczema in children from the Bangkok area using the ISAAC (International Study for Asthma and Allergy in Children) question- naires. J Med Assoc Thai 1998;81:175-84.
3. Illi S, von Mutius E, Lau S, et al. The natural course of atopic dermatitis from birth to age 7 years and the associa- tion with asthma. J Allergy Clin Immunol 2004;113(5): 925-31.
4. Sampson HA, McCaskill CC. Food hypersensitivity and atopic dermatitis: evaluation of 113 patients. J Pediatr 1985;107:669-75.
5. Hill DJ, Heine RG, Hosking CS, et al. IgE food sensitiza- tion in infants with eczema attending a dermatology department. J Pediatr 2007;151:359-63.
6. Hill DJ, Hosking CS. Food allergy and atopic dermatitis in infancy: an epidemiologic study. Pediatr Allergy Immunol 2004;15:421-7.
7. Akdis CA, Akdis M, Bieber T, et al. Diagnosis and treat- ment of atopic dermatitis in children and adults: European Academy of Allergology and Clinical Immunology/Ame- rican Academy of Allergy, Asthma and Immunology/PR- ACTALL Consensus Report. J Allergy Clin Immunol 2006;118:152-69.
8. Brough HA, Simpson A, Makinson K, et al. Peanut allergy: effect of environmental peanut exposure in chil- dren with filaggrin loss-of-function mutations. J Allergy Clin Immunol 2014;134:867-75.
9. Sybilski AJ, Zalewska M, Furmanczyk K, et al. The prevalence of sensitization to inhalant allergens in chil- dren with atopic dermatitis. Allergy Asthma Proc 2015; 36:e81-5.
10. Jin S, Park CO, Shin JU, et al. DAMP molecules S100 A9 and S100A8 activated by IL-17A and house-dust mites are increased in atopic dermatitis. Exp Dermatol 2014;23:938-41.
11. De D, Kanwar AJ, Handa S. Comparative efficacy of Han- ifin and Rajka’s criteria and the UK working party’s diag- nostic criteria in diagnosis of atopic dermatitis in a hos- pital setting in North India. J Eur Acad Dermatol Venereol 2006;20:853-9.
12. Severity scoring of atopic dermatitis: the SCORAD index. Consensus Report of the European Task Force on Atopic Dermatitis. Dermatology 1993;186:23-31.
13. Hanifin JM, Thurston M, Omoto M, et al. The eczema area and severity index (EASI): assessment of reliabil- ity in atopic dermatitis. EASI Evaluator Group. Exp Der- matol 2001;10:11-8.
14. Trakultivakorn M, Sangsupawanich P, Vichyanond P. Time trends of the prevalence of asthma, rhinitis and ecz- ema in Thai children-ISAAC (International Study of Asthma and Allergies in Childhood) Phase Three. J Asth- ma 2007;44:609-11.
15. Teeratakulpisarn J, Pairojkul S, Heng S. Survey of the prevalence of asthma, allergic rhinitis and eczema in schoolchildren from Khon Kaen, Northeast Thailand. an ISAAC study. International Study of Asthma and Aller- gies in Childhood. Asian Pac J Allergy Immunol 2000;18: 187-94.
16. Teeratakulpisarn J, Wiangnon S, Kosalaraksa P, et al. Sur- veying the prevalence of asthma, allergic rhinitis and ec- zema in school-children in Khon Kaen, Northeastern Thailand using the ISAAC questionnaire: phase III. Asian Pac J Allergy Immunol 2004;22:175-81.
17. Sampson HA. Food hypersensitivity as a pathogenic fac- tor in atopic dermatitis. N Engl Reg Allergy Proc 1986;7: 511-9.
18. Cevikbas F, Wang X, Akiyama T, et al. A sensory neuron- expressed IL-31 receptor mediates T helper cell-depen- dent itch: Involvement of TRPV1 and TRPA1. J Allergy Clin Immunol 2014;133:448-60.
19. Moran TP, Vickery BP. The Epithelial Cell-Derived Atop- ic Dermatitis Cytokine TSLP Activates Neurons to Induce Itch. Pediatrics 2014;134 Suppl 3:S160-1.
20. Mollanazar NK, Smith PK, Yosipovitch G. Mediators of Chronic Pruritus in Atopic Dermatitis: Getting the Itch Out? Clin Rev Allergy Immunol 2015.
21. Leung DY, Guttman-Yassky E. Deciphering the comple- xities of atopic dermatitis: shifting paradigms in treatment approaches. J Allergy Clin Immunol 2014;134:769-79.
22. Tauber M, Balica S, Hsu CY, et al. Staphylococcus aureus density on lesional and nonlesional skin is strongly assoc- iated with disease severity in atopic dermatitis. J Allergy Clin Immunol 2016:137(4):1272-4.
23. Ong PY, Ohtake T, Brandt C, et al. Endogenous antimi- crobial peptides and skin infections in atopic dermatitis. N Engl J Med 2002;347:1151-60.
24. Schlievert PM, Case LC, Strandberg KL, et al. Superanti- gen profile of Staphylococcus aureus isolates from pa- tients with steroid-resistant atopic dermatitis. Clin Infect Dis 2008;46:1562-7.
25. Irvine AD, McLean WH, Leung DY. Filaggrin mutations associated with skin and allergic diseases. N Engl J Med 2011;365:1315-27.
26. Ahrens B, Staab D. Extended implementation of educa- tional programs for atopic dermatitis in childhood. Pediatr Allergy Immunol 2015;26:190-6.
27. Eigenmann PA, Sicherer SH, Borkowski TA, et al. Preva- lence of IgE-mediated food allergy among children with atopic dermatitis. Pediatrics 1998;101:E8.
28. Spergel JM, Boguniewicz M, Schneider L, et al. Food Al- lergy in Infants With Atopic Dermatitis: Limitations of Food Specific IgE Measurements. Pediatrics 2015;136:e 1530-8.
29. Varothai S, Nitayavardhana S, Kulthanan K. Moisturizers for patients with atopic dermatitis. Asian Pac J Allergy Immunol 2013;31:91-8.
30. Lindh JD, Bradley M. Clinical Effectiveness of Moistur- izers in Atopic Dermatitis and Related Disorders: A Sys- tematic Review. Am J Clin Dermatol 2015;16:341-59.
31. Czarnowicki T, Malajian D, Khattri S, et al. Petrolatum: Barrier repair and antimicrobial responses underlying this “inert” moisturizer. J Allergy Clin Immunol 2015.
32. Nicol NH, Boguniewicz M, Strand M, et al. Wet wrap therapy in children with moderate to severe atopic der- matitis in a multidisciplinary treatment program. J Allergy Clin Immunol Pract 2014;2:400-6.
33. Devillers AC, Oranje AP. Wet-wrap treatment in children with atopic dermatitis: a practical guideline. Pediatr Der- matol 2012;29:24-7.
34. Leloup P, Stalder JF, Barbarot S. Outpatient Home-based Wet Wrap Dressings with Topical Steroids with Children with Severe Recalcitrant Atopic Dermatitis: A Feasibility Pilot Study. Pediatr Dermatol 2015;32:e177-8.
35. Schiffner R, Schiffner-Rohe J, Gerstenhauer M, et al. Dead Sea treatment - principle for outpatient use in atopic dermatitis: safety and efficacy of synchronous balneopho- totherapy using narrowband UVB and bathing in Dead Sea salt solution. Eur J Dermatol 2002;12:543-8.
36. Lee JH, Lee SJ, Kim D, et al. The effect of wet-wrap dressing on epidermal barrier in patients with atopic der- matitis. J Eur Acad Dermatol Venereol 2007;21:1360-8.
37. Rademaker M. Face-masks for facial atopic eczema: con- sider a hydrocolloid dressing. Australas J Dermatol 2013; 54:222-4.