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Keywords:

  • atopic dermatitis;
  • hypothalamic–pituitary–adrenal axis;
  • topical corticosteroids;
  • wet-wrap dressings

Background The wet-wrap treatment involves emollients or corticosteroid dilutions under occlusive wet dressings, and has been reported to be highly effective in severe refractory atopic dermatitis (AD).

Objectives To investigate the influence of different corticosteroid dilutions on the efficacy and hypothalamic–pituitary–adrenal (HPA) axis suppression in children with severe refractory AD having wet-wrap dressings.

Methods Eighteen children were treated with a 50% dilution of fluticasone propionate (FP) 0·05% cream for 2 weeks. In another five children a side-to-side comparison was conducted with 10%, 25% and 50% dilutions of FP cream under wet wrap. A third group of eight children was treated with 0% (= emollient), 5%, 10% or 25% dilutions of FP cream applied on the whole body under wet wrap.

Results After 1 week, a major improvement averaging 74% was observed, without apparent differences between 5%, 10% or 25% dilutions of FP cream under wet wrap, with less improvement in the second week of treatment. The first and second group of children showed HPA axis suppression in only three of 23 children using measurements of 09·00 h serum cortisol after 2 weeks. The third group of children showed HPA axis suppression, as indicated by 06·00 h serum cortisol levels, which was related to the absolute amount of FP applied.

Conclusions This suggests that weaker corticosteroid dilutions had comparable high efficacy, but lower risk of HPA axis suppression.