Topical Steroid Formulation and Wet Wraps
Topical Steroid Formulation and Wet Wraps
The purpose of this study is to

 1. Compare efficacy of 0.1% triamcinolone containing wet wrap as an ointment or as a cream
 formulation in patients with moderate to severe atopic dermatitis

 2. The relative patient/subject acceptance and adherence will also be compared between the
 two wet wrap types
In this study, the investigators will examine the effectiveness of wet wraps with topical
 steroids in different formulations for patients with a history of atopic dermatitis who are
 experiencing an acute flare. A validated clinical tool such Investigator's Global Assessment
 (IGA) will be used in order to assess severity of the condition as well as demonstrate the
 appropriateness of using wet wrap therapy as a treatment modality. IGA will measure intensity
 of the atopic dermatitis regarding erythema, lichenification, swelling and excoriation as
 well as subjective symptoms of the patient on a numeric scale. The treating clinician will be
 asked to rate their assessment before and after therapy.

 Patients will be asked to apply a topical steroid in a cream formulation to one extremity and
 then apply the same topical steroid in an ointment formulation to the other using the wet
 wrap technique. One of the investigators or nursing staff will provide detailed instructions
 to the patient and parents on how to perform the wet dressing (this is already routinely done
 for patients initiating wet wrap therapy in the pediatric dermatology clinic). Patients will
 also be given a sealed and coded envelope containing instructions to apply one steroid
 formulation to the right extremity and the other to the left. In this manner the providers
 will be blinded to treatment modality during the follow-up visit. Only the research
 coordinator will have access to the envelope code key. An additional handout will also be
 provided to reinforce appropriate treatment technique. After several days (3-5) the patient
 will return to the dermatology clinic for a nurse visit and evaluation of any improvement of
 the affected areas as well as comparison of improvement of the right and left extremities.
 The physician investigator will examine the patient and measure improvement using the IGA.
 Detailed photos of the affected areas will also be taken. After a certain number of patients
 have enrolled in the study and completed it, the de-identified data will be examined by a
 statistician for comparison. Other studies evaluating the effectiveness of wet wraps have
 commonly had 40-50 patients enrolled which will likely be the target of this study. The
 statistician will compare the IGA before and after treatment on each side to allow for
 interpretation of the data. Stratification of data may include ages and/or severity (moderate
 vs severe).

 Patient Oriented Eczema Measure (POEM) and/or a Quality of Life (QoL) index will also be
 provided to determine the patient's point of view regarding their management using validated
 tools. They will also be asked their opinion regarding if one side was better controlled than
 the other, if at all, as well as their personal preference for treatment of choice.

 Compliance will be determined by weighing the medication before and after each visit and a
 medication calendar.
Inclusion Criteria:

 1. Patients between the ages of 3-17 experiencing a symmetric, bilateral flare of atopic
 dermatitis

 2. The flares must reach a certain threshold for inclusion based on the investigator's
 global assessment scale

 Exclusion Criteria:

 1. Systemic infection or bacterial skin infections

 2. Eczema herpeticum

 3. Evidence of suppression of the Hypothalamic-Pituitary-Adrenal axis

 4. Non-English or Non-Spanish speaking