Wet wrap therapy for eczema — does it work?

Wet wrap therapy is one of those eczema interventions that sounds unusual enough to be either fringe medicine or genuine clinical practice. It's actually the latter — wet wrapping has been used in dermatology departments for decades and has a reasonable evidence base, particularly for severe eczema in children.

What wet wrapping is

Wet wrap therapy involves applying emollient — and sometimes diluted topical steroid — to the skin, then wrapping the treated area in a layer of damp bandage or clothing, followed by a dry layer on top. The damp layer maintains moisture contact with the skin and creates a cooling, anti-itch effect. The dry layer insulates and protects the damp layer.

The technique is most commonly used for severe flares, particularly in children who scratch intensively at night. The physical barrier created by the wrapping prevents scratching, which is often as valuable as the moisturising effect.

The evidence

A 2014 systematic review found that wet wrap therapy produced significant short-term improvements in eczema severity, particularly for acute flares that hadn't responded adequately to standard treatment. The evidence is stronger for children than for adults, partly because most studies have been conducted in paediatric populations.

The Cochrane Collaboration's review of wet wrap therapy found the evidence base to be limited in quality but consistently positive in direction — wet wrapping appears to be effective for short-term management of severe eczema, with the most benefit seen in the first week of use.

How to do it

The standard approach begins with a bath or shower of 10–15 minutes in lukewarm water, which hydrates the skin. Pat dry gently. Apply emollient generously — more than you think necessary — to all affected areas. If using diluted topical steroid as well, apply that first, then emollient on top.

Wet a layer of bandage or cotton clothing (tubular bandages are most convenient) in warm water, wring out so it's damp but not dripping, and apply over the treated skin. Cover with a dry layer — pyjamas work well for the body. Leave in place overnight.

The damp layer should not be cold — this is uncomfortable and defeats the purpose. Using warm water for the damp layer makes the therapy tolerable, particularly for children.

Limitations

Wet wrapping is intensive — it takes time to apply properly and is most practical when done by a carer for a child. For adults self-managing, it's feasible for limited body areas but impractical as a whole-body intervention. It's also a short-term flare management tool, not a maintenance strategy.

If skin shows signs of infection — weeping yellow crust, increased warmth, fever — wet wrapping should not be used as it can worsen bacterial infection. Infected eczema requires treatment before wet wrapping is appropriate.