A randomized, controlled trial comparing topical steroid application to wet versus dry skin in children with atopic dermatitis (AD)

Abstract

Soak and smear (SS), a technique whereby a bath is followed by topical corticosteroid (TCS) application to wet skin, is reported to be a beneficial adjunctive therapy for patients with recalcitrant atopic dermatitis (AD). We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD. A randomized, investigator-blinded, controlled study was performed in children with AD. Patients were randomized to apply TCS either via SS (n=22) or to dry skin (n=23) for 14days. Theprimary outcome was an improvement in the Eczema Area and Severity Index score. Secondary outcomes included assessments of disease burden, pruritus, and sleep; morning cortisol levels; and adverse effects. Patients with AD severity who applied TCS via SS or to dry skin improved 84.8% (95% confidence interval 77.5-92.1) and 81.4% (95% confidence interval 70.3-92.4) by Eczema Area and Severity Index score, respectively. There was no statistical difference between the 2 groups (P value=.85). Small sample size limited the power of our study. We did not find that application of TCS to presoaked skin works better than application to dry skin for the treatment of AD in children.