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

      Background

      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).

      Objective

      We evaluated whether SS is of greater benefit than application of TCS to dry skin for the treatment of childhood AD.

      Methods

      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 14 days. The primary 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.

      Results

      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).

      Limitations

      Small sample size limited the power of our study.

      Conclusions

      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.

      Key words

      Abbreviations used:

      AD (atopic dermatitis), EASI (Eczema Area and Severity Index), SS (soak and smear), TCS (topical corticosteroid)
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      Linked Article

      • On the utility of soak and smear
        Journal of the American Academy of DermatologyVol. 76Issue 1
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          To the Editor: We read with interest the trial that compared topical corticosteroid application with wet versus dry skin in children with atopic dermatitis.1 We congratulate the authors for formally studying the soak and smear method of topical steroid care.2 However, despite the findings of Kohn et al,1 we will continue to use the soak and smear method for multiple reasons, outlined below.
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