VMCE point of view: dressing materials for constitutional eczema (atopic eczema)

Dressing aids have been used for decades as part of the treatment of moderate and severe constitutional eczema. These bandages serve to fix ointments, cover the wounds, prevent scratching and prevent irritation by (seams in) textiles. And dressings are not only used for constitutional eczema, but also for wounds and other skin conditions.

Tubular bandages

Until the 1990’s, these dressing agents for eczema were supplied in the form of so-called tubular bandages. They were available in different diameters: both for the different ages and for different sizes of arms and legs. It was always a big job to apply these tubular bandages to the oily, anointed body in such a way that they both fit and remained in place. A lot of practice was needed to cover an upper body with it. Very often, however, after waking it appeared that they had gone off or dropped off. Very cumbersome, difficult and not always effective.

Modern dressing materials

In the 1990’s it was thought that it would be useful to design these dressing materials as a piece of clothing: trousers, a shirt or a whole suit for babies and young children. This way the ointment was better retained, the seams were on the outside, the material did not irritate and the scratching was prevented as much as possible.

This is how the first “scratch suit” was born. Not pajamas, but intended as an aid to the healing process. An additional advantage of the scratching suits for young children was that the “gloves” were attached to the suit, so that they could not fall off and less scratching was possible. All they could do was rub. This has done a great deal for children with more severe forms of eczema. And it was a huge advance compared to socks or washcloths with tape or plasters to attach the wrists.

New fabrics

The first scratch suit was made of cotton because it was generally well tolerated. Then came the modern dressing materials of viscose and specially prepared silk, for both children and adults. And then came dressing agents with other fabrics that were well tolerated by the special, smooth fibre. Next, dressing agents with antibacterial action were developed to counteract the negative effects of the S. aureus bacterium, which can aggravate or infect eczema.

When use bandages for eczema?

Children

Many children get constitutional eczema, about 1 in 6. Eczema is in second place among the most common chronic diseases in children under 12 after asthma. The vast majority (85%) of children with eczema have a mild form. Modern dressing materials are not required for this group. About 10% of children with eczema have moderate eczema and 5% have severe. The guideline of dermatologists states that dressing can be an option in moderate and severe eczema. In particular to limit scratching and / or to use less potent ointments. Each patient must be judged individually. It is logical to assume that when many steroid ointments or strong steroid ointments are needed, dressing can be an option. This is because Dermatologists guidelines state that bandaging agents can be “hormone ointment-saving” due to their fixative effect.

Bandaging can also be an option if there is a lot of scratching at night. This is not only bad for eczema, but also for (the quality of) sleep. In a VMCE study of dressing materials, many parents cited that as a major advantage of modern dressing materials for their children: they finally sleep through.

The wet dressing method (wet wrapping) can be used for very severe eczema. In that case, bandages are indispensable. The method involves applying two layers of dressing: a wet coat directly onto the anointed skin and a dry dressing over it. The wet dressing must be made wet again every few hours. It is an intensive therapy that can only be performed with expert guidance.

Adults

About 2% of adults have constitutional eczema. They usually have it from childhood, sometimes spontaneously at a later age. It is difficult to say if dressing materials are an option. The severity can change enormously: sometimes the symptoms are less and suddenly it can get out of hand (again). As a rule of thumb, it can be stated that bandaging aids are an option if the therapy with strong steroid ointments does not (or no longer) works well. This means that the symptoms do not disappear well enough or that long-term too much and / or too strong steroid ointments have to be lubricated. Dressings can then be a good option to make the steroid ointments work better – less scratching, better sleep.

Just as with children, the quality of sleep can also be an indication for the use of dressings in adults. With night-time itching and uncontrolled nocturnal scratching, eczema quickly deteriorates, as does the quality of sleep. Moreover, the eczema does not have time to recover because the wounds are scratched open every night. A vicious circle that can be broken with modern dressing materials.

 

Evaluation

In both children and adults, it is important to evaluate after three months whether the dressings contribute to the treatment. It is difficult to estimate this in advance. If the dressings have no effect, then it is not useful to continue with it, and it is necessary to look at what other treatment options are possible.

 

VMCE, August 2016