COEUR D’ALENE, IDAHO – Topical corticosteroids applied to the dry skin of children with atopic dermatitis proved as effective for clinical improvement as the soak and smear technique favored by many physicians, according to a randomized, investigator-blinded clinical trial.
"The use of corticosteroid application to prehydrated, wet skin is not more efficacious than corticosteroid application to dry skin in pediatric patients with atopic dermatitis," Dr. Richard J. Antaya reported at the annual meeting of the Society for Pediatric Dermatology. "This study suggests that 2 weeks of using either soak and smear or standard topical corticosteroid application techniques results in considerable improvement in atopic dermatitis severity," he said.
Eczema Area and Severity Index (EASI) scores improved to a similarly impressive extent – close to 85% after 2 weeks – regardless of which application method was used, added Dr. Antaya, professor of dermatology, pediatrics, and nursing and director of pediatric dermatology at Yale University in New Haven, Conn.
The study included 47 patients aged 4 months to 16 years with atopic dermatitis and a mean baseline EASI score of 15.5. All were assigned to 2 weeks of twice-daily topical steroid therapy. Those younger than age 2 years received a prescription for a 1-lb jar of hydrocortisone 2.5% ointment; older patients received 1-lb jars of triamcinolone 0.1% ointment, and, for the more sensitive face and intertriginous areas, hydrocortisone 2.5% ointment. Patients were randomized to twice-daily application of their medication to affected dry skin or to a single daily soak and smear session and one application of the medication to dry skin.
Soak and smear entails a 10-minute soak in lukewarm plain water to boost skin hydration, followed by steroid application to the wet skin. Data from several studies conducted in adults concluded that soak and smear is more effective than was conventional steroid application to dry skin. For example, a retrospective study of 28 adults referred to a tertiary dermatologic center for highly refractory atopic dermatitis or other eczematous dermatoses showed 26 of the 28 were clear or at least 90% improved after several days to 2 weeks of soak and smear sessions (Arch. Dermatol. 2005;141:1556-9).
In Dr. Antaya’s pediatric atopic dermatitis study, assessment of EASI scores was performed by a dermatologist blinded to the treatment arm. The profound and similar improvement in EASI scores in the two treatment groups was accompanied by essentially equal improvements in measures of sleep quality, itch, and overall disease impact.
Also, there was no difference in EASI score improvement between the two groups when patients were stratified according to baseline atopic dermatitis severity.
No differences between the groups were noted in treatment days missed or development of folliculitis. Neither group showed any evidence of hypothalamic-pituitary-adrenal axis suppression, he added.
Dr. Antaya attributed the marked improvement in atopic dermatitis seen in both study groups to the fact that, at the study outset, caregivers received education aimed at alleviating steroid phobia. Also, the 1-lb jars of medication encouraged treatment compliance, he noted.
Dr. Antaya reported having no financial conflicts with regard to this study.