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Outcome similar when topical steroids applied to wet vs. dry skin for AD

Application of topical corticosteroids via the “soak and smear” technique showed no improvement compared with application to dry skin for the treatment of recalcitrant atopic dermatitis in children, according to a recent study.

“Soak and smear is a technique used to increase the efficacy of topical corticosteroids for atopic dermatitis by the patient soaking in lukewarm water before smearing corticosteroid ointment on wet skin,” Lucinda L. Kohn, MD, of Yale University School of Medicine, and colleagues wrote. “Previous studies have shown that [soak and smear] results in marked improvement or disease clearance in nearly all patients. There is limited evidence of its benefit in the pediatric population; use of [soak and smear] in children is based primarily on uncontrolled case series and expert opinion.”

Researchers performed a controlled, investigator-blinded study to determine whether soak and smear application of topical corticosteroids is a more beneficial treatment for children than dry skin application. The study included 45 children who visited the Yale Pediatric Dermatology Clinic between July 2012 and July 2013 for atopic dermatitis. Twenty-two participants were randomly assigned to topical corticosteroids using the soak and smear technique, while 23 were assigned topical corticosteroids to dry skin. Both groups applied treatment for 14 days.

Both groups displayed improvement in atopic dermatitis severity measured by the Eczema Area and Severity Index score. There was an 84.8% reduction in severity among participants who used the soak-and-smear method, and an 81.4% reduction among those who applied topical corticosteroids to dry skin. There was no significant difference in outcomes between the two groups. In addition, there were similar improvements in pruritus, overall impact of disease, and sleep on days 7 and 14 reported by participants in both groups.

“We did not find that application of [topical corticosteroids] via [soak and smear] works better than applications to dry skin for the treatment of [atopic dermatitis] in children,” Kohn and colleagues wrote. “With more patients, we may have been able to capture a subset for which [soak and smear] could be a better treatment.” – by Alaina Tedesco

Disclosure: The researchers report no relevant financial disclosures.