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.