摘要
Objective To evaluate prospectively the efficacy of a two week course of once daily ‘wet wrap’ treatment for children with moderate to severe atopic dermatitis (AD) using diluted preparations of 1% mometasone furoate. Methods Six female and six male children of three to 12 years of age (mean 8.5 yr) with moderate to severe atopic dermatitis were recruited after conventional topical steroid and emollient treatments failed. A two week course of once daily 10 12 hours' wet wrap dressings using 10 15% diluted 1% mometasone furoate ointment was performed on an out patient basis. The severity of five physical parameters: erythema, surface damage, exfoliation, lichenification and eczematous papules; together with patient symptomatology that included intensity of itchiness and scratching, sleep disturbance and mood and social perturbation, was recorded immediately before treatment, and then one week and two weeks after commencement of treatment in an ascending scale of severity from 0 to 3. These were referred to as Clinical Severity Scores (CSS) and patient/parent Self Assessment Scores (SAS) respectively. Social Hygiene Clinic, Lek Yuen Health Centre, Lek Yuen, Shatin, NT, Hong Kong (Tang YM, Lam MF, Wong PL, Hui HY, Chong LY and Lo KK) Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong (Chan HL) Correspondence to: Dr. Tang Yuk Ming, Social Hygiene Clinic, 3/F Lek Yuen Health Centre, Shatin, NT, Hong Kong. Mean scores for these two groups of parameters were analyzed using the Wilcoxon Signed Ranks test. Pre and post treatment eosinophil counts, immunoglobulin IgE levels, morning serum cortisol levels and adverse effects were also recorded. Results Significant improvement of clinical lesions and symptom relief were seen in 11 of the 12 patients. At the end of the second week, the mean total for CSS was 2.75±1.71 (vs a pre treatment value of 10.25±2.14), whilst the mean total for SAS was 2.42±1.24 (vs a pre treatment value of 8.58±2.31). The overall mean score reduction for CSS and SAS were statistically highly significant with P<0.005. Adverse effects were mostly consequent to physical contact with moisture and emollients and the physical constraint of the tubidressings upon the wrapped areas. These effects included sensation of itchiness, heat, cold and tightness, and occlusion folliculitis that were tolerable and acceptable. Eosinophil counts and IgE levels did not change in parallel with the treatment response, and no definite depression of morning serum cortisol levels was noted. Conclusions Our study showed that supervised treatment with wet wrap dressings was a safe and very effective short term treatment modality for moderate to severe atopic eczema in children in whom conventional ‘open’ topical treatment with emollients and steroids failed.
Abstract Objective To evaluate prospectively the efficacy of a two week course of once daily ‘wet wrap’ treatment for children with moderate to severe atopic dermatitis (AD) using diluted preparations of 1% mometasone furoate. Methods Six female and six male children of three to 12 years of age (mean 8.5 yr) with moderate to severe atopic dermatitis were recruited after conventional topical steroid and emollient treatments failed. A two week course of once daily 10 12 hours' wet wrap dressings using 10 15% diluted 1% mometasone furoate ointment was performed on an out patient basis. The severity of five physical parameters: erythema, surface damage, exfoliation, lichenification and eczematous papules; together with patient symptomatology that included intensity of itchiness and scratching, sleep disturbance and mood and social perturbation, was recorded immediately before treatment, and then one week and two weeks after commencement of treatment in an ascending scale of severity from 0 to 3. These were referred to as Clinical Severity Scores (CSS) and patient/parent Self Assessment Scores (SAS) respectively. Social Hygiene Clinic, Lek Yuen Health Centre, Lek Yuen, Shatin, NT, Hong Kong (Tang YM, Lam MF, Wong PL, Hui HY, Chong LY and Lo KK) Department of Medicine, Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, NT, Hong Kong (Chan HL) Correspondence to: Dr. Tang Yuk Ming, Social Hygiene Clinic, 3/F Lek Yuen Health Centre, Shatin, NT, Hong Kong. Mean scores for these two groups of parameters were analyzed using the Wilcoxon Signed Ranks test. Pre and post treatment eosinophil counts, immunoglobulin IgE levels, morning serum cortisol levels and adverse effects were also recorded. Results Significant improvement of clinical lesions and symptom relief were seen in 11 of the 12 patients. At the end of the second week, the mean total for CSS was 2.75±1.71 (vs a pre treatment value of 10.25±2.14), whilst the mean total for SAS was 2.42±1.24 (vs a pre treatment value of 8.58±2.31). The overall mean score reduction for CSS and SAS were statistically highly significant with P<0.005. Adverse effects were mostly consequent to physical contact with moisture and emollients and the physical constraint of the tubidressings upon the wrapped areas. These effects included sensation of itchiness, heat, cold and tightness, and occlusion folliculitis that were tolerable and acceptable. Eosinophil counts and IgE levels did not change in parallel with the treatment response, and no definite depression of morning serum cortisol levels was noted. Conclusions Our study showed that supervised treatment with wet wrap dressings was a safe and very effective short term treatment modality for moderate to severe atopic eczema in children in whom conventional ‘open’ topical treatment with emollients and steroids failed.
