When Should You Use Wet Wraps for Eczema?

Millions of patients with eczema understand the frustration and pain of intense flares that significantly disrupt their lives. Luckily, wet wrap therapy has shown to be an effective option to ease uncomfortable symptoms during moderate to severe eczema flares, and it can help topical medications work better.

Wet wraps can help patients with atopic dermatitis — the most common type of eczema — decrease the total amount of corticosteroids used during a flare, according to a review of 24 medical publications on wet wrap therapy.¹ In addition, a widely-cited study by National Jewish Health found more than 70% of children experienced reduced symptoms after trying the therapy for two weeks.²

Before starting a regular wet wrap therapy routine, it’s recommended that patients talk to their provider about it. “Always ask for your doctor’s advice and for specific instructions on using wet wraps, and then it can be done at home,” said Dr. Vivian Shi, professor of dermatology and director of clinical trials at the University of Washington in Seattle.

How do wet wraps help eczema?

During a severe flare, the desire to itch can feel all-encompassing. Wet wraps help the skin heal by providing a barrier that stops patients from scratching the affected areas.

Wet wraps also allow topical medications to work more effectively because the creams or ointments are better able to penetrate the skin.³  

“Wet wraps work best when used in conjunction with topical steroids and a soaking bath,” explained Emily Cole, BSN, RN, a registered pediatric asthma and allergy nurse at National Jewish Health in Denver. “They work to absorb the topical steroid into the skin, put moisture back into the skin and help build up the broken-down skin barrier.”

What are the best materials to use for wet wraps?

The wet wrap technique involves using two layers of clothing — the wet material that is applied directly to the skin and a second dry layer.

For the wet layer, specialists recommend cotton clothing, gauze or bandages. “You want soft, breathable fabric, and avoid using fabric that has dyes in it,” Dr. Shi advised. 

Cole suggested tube socks for arms and legs, and long-sleeve thermal cotton layers for the rest of the body. “Think long underwear, kids’ pajama sets and onesies for babies,” Cole said. For eczema outbreaks on the face, she advised “using wet kerlix dressing and a surgical netting to keep it all in place.”

For the dry layer, thicker clothing such as hoodies and sweatpants are a good option to help the patient stay warm. 

Both experts also emphasize that wet wraps only need to be applied to the affected area. For example, if a patient has a flare on part of their leg, they don’t need to soak the whole pant leg. Instead, they can just soak the area that will touch the inflamed part of the skin.

How do you apply wet wraps for eczema?

There are a few easy-to-follow steps that specialists recommend for applying wet wraps:

1. Soak in plain, warm bathwater for about 20 minutes and ensure all affected skin areas are submerged.
2. After getting out of the bathtub, gently pat the skin to dry.
3. Apply topical steroids, ointments or creams quickly, while the skin is still damp. 
4. Moisten the bandage or article of clothing in warm water until it is damp and put it on, followed by the dry clothes.
5. Leave the wet wraps on for at least two hours or overnight.
6. After removing the wet wraps, apply moisturizer all over.

 Download a step-by-step guide to wet wraps here.

When applying wet wraps on yourself, patients should apply them to their feet and legs first, and their arms and hands last. 

Cole offered additional guidance for applying wet wraps to young children. She always puts socks on the child’s hands first, even if they don’t have eczema on their hands. This prevents them from scratching, putting fingers in their mouth, rubbing ointment in their eyes or ripping the wraps off. 

“Children can be fussy but if you can find a way to distract them, like putting on a movie or having a fun activity planned, then they’ll tolerate the process,” she added. “Once done a few times, the wet wraps become routine and kids realize it is helping them feel better.” 

When using wet wraps on infants, Cole also advised using a heavier dry layer such as fleece to ensure they stay warm.

As for how long to use wet wraps, Dr. Shi said it “depends on the severity of the eczema, especially how thick the eczema lesion is, and what type of medications or topical products are being used inside the wet wrap.” Patients can stop the wet wrap therapy when the acute eczema flare has healed.

Dr. Shi and Cole also agree that it’s OK to use wet wraps on broken skin. They say this technique can provide cooling relief and prevent further skin damage from scratching.

Who benefits most from wet wrap therapy?

Wet wrap therapy is most often used to address atopic dermatitis. Cole said she and her colleagues have also used wet wraps to treat patients with dyshidrotic eczema and nummular eczema. 

“We recommend wet wraps for moderate to severe eczema flares and definitely when there is inflamed, irritated skin,” Cole said.

Dr. Shi added, “Wet wraps could be helpful with any type of skin damage or inflammation where the goal is to help the topical medications soak in better and prevent further physical trauma.”

Patients with mild eczema symptoms, however, may not experience the same benefits. A study published in the international peer-reviewed journal Acta Dermato-Venereologica found that patients with mild symptoms who tried wet wrap therapy had similar outcomes as patients who used medication alone.⁴

What are the risks of wet wrap therapy for eczema?

The primary risk of wet wraps is overuse because they can obstruct hair follicles. “By having too much ointment and too many wet wraps, the hair follicles can become inflamed and you may notice sterile bumps called folliculitis,” Cole said. “At that point, it is recommended to stop wet wraps until bumps have cleared.”

Another concern relates to potential side effects from topical steroids. “We need to be mindful about the potential systemic absorption of topical medications,” Dr. Shi said, “especially when it’s used with a wet wrap, which increases topical medication absorption.” 

Dr. Shi added that while most people tolerate wet wraps well and find them soothing, not everyone is comfortable sleeping in damp clothing. She said if that’s the case, “it’s OK to do wraps without soaking the fabric.” 

If wet wrap therapy isn’t bringing relief, patients should contact their dermatologist to make sure there isn’t another complication, such as a skin infection or contact dermatitis, that could be hindering the healing process. And of course, consult with your provider before starting wet wrap therapy.

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References:

1. Goddard A, Lio P. Alternative, Complementary, and Forgotten Remedies for Atopic Dermatitis. Evidence-Based Complementary and Alternative Medicine. 2015 Jul 15; 676897. https://pmc.ncbi.nlm.nih.gov/articles/PMC4518179/

2. National Jewish Health. Wet wraps cut need for drugs in kids with eczema. ScienceDaily. 8 July 2014. https://www.sciencedaily.com/releases/2014/07/140708092916.htm

3. Lax S, Harvey J, Axon E, Howells L, Santer M, Ridd M, Lawton S, Langan S, Roberts A, Ahmed A, Muller I, Ming L, Panda A, Chernyshov P, Carter B, Williams H, Thomas K, Chalmers J. Strategies for using topical corticosteroids in children and adults with eczema. Cochrane Database of Systemic Reviews. 2022, March 11. https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD013356.pub2/full

4. Anderson R, Thyssen J, Maibach H. The Role of Wet Wrap Therapy in Skin Disorders – A Literature Review. Acta Dermato-Venereologica. 2015, May 5. https://www.medicaljournals.se/acta/content/html/10.2340/00015555-2134