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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.
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