Modified dressings for inflammatory dermatoses

Modified dressings are dressings that are used to treat severe dermatitis. They include wet dressings, the ‘soak and smear’ technique and occlusive dressings. Choice may depend on condition present and patient preference.

Wet dressings and the ‘soak and smear’ technique increase hydration of the epidermis, increasing penetration of topical corticosteroids. They are particularly useful for:

Wet dressings and ‘soak and smear’ technique are usually used for a few days (7 to 10 days) with specialist guidance. The risk of systemic absorption from using a potent topical corticosteroid under a wet dressing or with the ‘soak and smear’ technique is not clinically significant.

Application of wet dressings is time-consuming—it is usually most convenient to apply them once daily at night. Several methods are used to apply wet dressings; see How to apply a wet dressing for an example.
The ‘soak and smear’ technique is described in How to use the soak and smear technique.
Figure 1. How to apply a wet dressing.

[NB1]

Printable PDF

Soak dressings in water that is a comfortable temperature

  • for infants, use a jumpsuit as the dressing
  • for older children and adults, use pyjamas, elasticated tubular bandages, towels, sheets, cotton socks (for feet) or cotton gloves (for hands) as the dressing

Take a bath or shower and lightly pat skin dry

Apply topical corticosteroid to affected skin

If the skin is particularly dry, apply a layer of bland greasy emollient after applying topical corticosteroid

Cover treated skin with damp (wrung-out) wet dressings

Wrap up in a towel or wear dry clothes on top of wet dressings, to keep warm and ensure the damp layer is in close contact with the skin

Remove the wet dressings after 15 to 60 minutes

Dry the skin, then apply an emollient

Note: NB1: This is an example method of applying a wet dressing; there are other methods of applying wet dressings (eg Royal Children’s Hospital [Melbourne] instructions on wet dressings in eczema).
Figure 2. How to use the soak and smear technique.

Printable PDF

Assarian, 2015

Soak in a warm bath of plain water for 20 minutes just before bedtime

Don’t dry skin after getting out of bath

Smear affected skin with large amounts of topical corticosteroid

Put on old pyjamas or loose clothes

Apply an emollient to the skin the following morning

Occlusion with an impermeable film increases absorption of a topical preparation and promotes skin rehydration. Occlusive dressings are particularly useful for:

Clean the skin and apply the topical preparation while the skin is damp. Cover affected skin overnight with a waterproof dressing or plastic film wrap. For fingers or toes, hypoallergenic adhesive tape can be used as an occlusive dressing.

Monitor for possible adverse effects of occlusion, including maceration, folliculitis and miliaria. Occlusion can potentiate adverse effects of topical corticosteroids (eg atrophy, telangiectasia) and should be used with caution in children.