Eczema Photo Essay

People with severe eczema often are placed on highly restrictive diets because of the fear that certain foods may trigger a flare-up. In addition to the nutritional deficiencies and quality-of-life issues associated with a restrictive diet, the expense of the foods and supplements needed for such a diet can cause financial hardship. Of course, people with known severe reactions to food must still avoid those foods, but in most cases, diet has little—if any—impact on improving skin health and reducing eczema flare-ups.

Although eczema is a common condition, severe forms of the disease can significantly affect health and quality of life. One common problem is the inability to sleep through the night because of extreme itching. This has detrimental effects not only on the eczema sufferer, but also on his or her parents or caregivers. After two days of wet wrap therapy at the NIH Clinical Center, this young eczema patient is resting comfortably after sleeping through the night.

Many people with severe eczema have high levels of an antibody called immunoglobulin E (IgE). Patients often receive multiple medicines in an attempt to bring their IgE levels back to normal. In addition to the usual corticosteroids prescribed for eczema, some patients take immunosuppressants, antihistamines, and other drugs.

Immunosuppressants are very strong and can have serious side effects. Wet wrap therapy allowed this patient to stop taking antihistamines and cyclosporine, an anti-rejection drug commonly prescribed to transplant recipients.

One of the keys to wet wrap therapy is soaking in a lukewarm bath for approximately 15 minutes, three times a day. This patient is covered in wet towels to ensure that his skin remains moist. NIAID researchers have determined that long soaks are vital to allowing topical medicines (applied after each bath) to penetrate the outer layer of the skin. In severe cases, bleach may be added to the water to combat skin infections.

Once the soak is finished, the patient’s skin is patted dry, leaving it a little moist. Then, topical medicine is applied to the body. A milder medicine is applied to the face. This is followed by a generous application of an unscented moisturizer to the affected areas of the patient’s body.

Once the patient's skin has been treated with topical medicine and moisturizer, it is time to apply the wet wrap, which keeps the creams in contact with the skin. Here, to cover the majority of the body, the patient is dressed in his pajamas, which also have been soaked in warm water. The rest of his skin is covered by wet gauze. The patient then dresses in dry clothes and wraps up in blankets to stay warm. The wrap is worn for about two hours. The wrap may also be worn overnight, depending on the severity of the condition.

NIAID researchers focus not only on bringing the patient’s symptoms under control with wet wrap therapy, but also on training the caregiver to continue treatment once the patient is released. By managing severe eczema at home, a family can avoid certain medical costs and experience less disruption to its routine.

This is an example of an eczema management plan provided by NIAID scientists. The color-coded sections help the caregiver identify the severity of eczema flare-ups and begin the proper treatment. This plan and in-depth training are critical elements in the success of wrap therapy.

Wet wrap therapy can produce dramatic results during the course of a five-day treatment regimen. It greatly reduces eczema symptoms and can do so for a long time. However, the therapy is not a cure. In most cases, patients will experience periodic flare-ups that need to be treated.

NIAID's eczema treatment protocol not only provides relief to the patient, it is part of a larger effort to better understand the causes of eczema and develop new strategies to prevent and treat the disease.