Wet wrapping is a two-layer dressing. Emollient, and sometimes a diluted topical steroid, goes on the skin, then a damp inner layer of tubular bandage or cotton garment, then a dry layer over the top. It is an intervention for severe flares in children rather than a routine, and the evidence behind it is consistent in direction but thin in quality (Devillers and Oranje, 2006).
What occlusion does in the skin
Four separate things happen under a wet wrap, and only one of them is moisturising.
Water contact time changes. Emollient applied to open air holds water against the stratum corneum for minutes. Under a damp occlusive layer it holds for hours, because the dressing stops evaporation and keeps a wet interface against skin just hydrated by bathing.
The skin cools. As the inner layer dries it loses water by evaporation, which draws heat out of the skin beneath. Hot skin itches more, so the cooling is part of the mechanism rather than a side effect.
The wrap puts fabric between fingernails and skin. Much of the damage in eczema is self-inflicted through the itch-scratch cycle, and a child asleep cannot choose not to scratch. Interrupting night scratching protects the skin overnight, and the broken sleep that scratching causes feeds a loop of its own, covered in stress and eczema flares.
Anything underneath becomes more potent. The National Eczema Society puts it plainly: "Covering up the skin makes topical treatments more potent, so you should only use topical steroids under bandages and wraps as advised by your healthcare professional." That is why topical steroids used under wraps are diluted rather than applied at their usual strength.
What the NICE guideline says
NICE guideline CG57, atopic eczema in under 12s, updated 22 September 2025, sets four boundaries around wet wrapping.
It is not a starting point. Recommendation 1.5.1.31 rules out whole-body occlusive dressings, "including wet wrap therapy", as first-line treatment for atopic eczema in children, and adds that if they are used, "they should be started by a healthcare professional trained in their use".
It is not for infected skin: "Do not use occlusive medicated dressings and dry bandages to treat infected atopic eczema in children" (1.5.1.28).
Localised use has a wider remit. NICE suggests considering localised medicated dressings or dry bandages with emollients for areas of chronic lichenified eczema, and with emollients and topical corticosteroids for short-term treatment of flares, 7 to 14 days.
Whole-body occlusion with a topical steroid is time-limited: 7 to 14 days initially, specialist dermatological advice before continuing longer, then consideration of stopping the steroid while continuing the dressings alongside emollients until the eczema is controlled (1.5.1.32).
What the trials found
Devillers and Oranje reviewed 24 publications in the British Journal of Dermatology in 2006: 11 original clinical studies and 13 expert opinions, with evidence levels that "did not exceed level 4". Their grade C conclusions were that a moist first layer under a dry second layer is an efficacious short-term intervention in severe or refractory childhood eczema, that diluted topical corticosteroids under the wrap outperform emollients alone, and that up to 14 days of use is safe.
Janmohamed and colleagues then ran the randomised trial the review said was missing, published in the Journal of the American Academy of Dermatology in 2014: double-blind and placebo-controlled, in children aged 6 months to 10 years with severe eczema, defined as an objective SCORAD score of 40 or above. It compared wet wraps with diluted mometasone furoate against wet wraps with a petrolatum-based emollient over four weeks, tapering the application frequency. The corticosteroid arm "acted faster and was more efficacious than WWT with emollients", with the best results in the 6 to 9 and 0 to 3 age groups, and the authors concluded the method is effective for at least four weeks.
Two caveats sit on that evidence. Both papers come from the same Dutch research group, so this is not a field with many independent replications, and almost all of it is paediatric, which is why guidance for adults leans on extrapolation rather than trials.
How it is done in practice
The Newcastle Hospitals dermatology leaflet describes the standard hospital method. Two layers of bandage, the first applied wet with clean warm water and the second dry. When the treatment is first started, the wraps stay in place for 24 hours and are then changed.
Drying out is the practical failure mode. The leaflet advises checking the inner layer regularly, because the bandages "may become hot and uncomfortable if allowed to dry out". To rewet them without undressing, the outer layer is pulled down and the inner layer sprayed with warm water or dampened with a wet sponge.
As with any emollient use, the cream goes on generously within minutes of washing while the skin is still damp, the timing covered in the bath and shower routine.
Limits and risks
Infection is an absolute stop. The Newcastle leaflet is unambiguous: "Do not use if you suspect or have a skin infection (bacterial, fungal or viral)." Occlusion holds warmth and moisture against skin, which suits a barrier and also suits bacteria. If you are not sure whether what you are looking at has become infected, the signs that need same-day help set out what to check before wrapping anything.
Steroid absorption is the documented serious risk. Devillers and Oranje graded up to 14 days of diluted topical corticosteroids under wraps as safe, "with temporary systemic bioactivity of the corticosteroids as the only reported serious side-effect", and noted that cutting to once-daily application and diluting the product further reduces that risk.
Small children can get cold. The British Association of Dermatologists notes: "Wet wraps may upset babies and young children because they can become too cold." This is why rewetting with warm rather than cool water is part of the technique rather than an optional refinement.
The effort is also real. Applying two layers over limbs and trunk takes time, is realistically a carer's job for a young child, and is impractical for an adult managing alone. Every source above frames it in days and weeks, not months, so it is a way to get a severe flare under control rather than a maintenance strategy.
References
- National Institute for Health and Care Excellence. Atopic eczema in under 12s: diagnosis and management. NICE Clinical Guideline CG57, updated 22 September 2025. https://www.ncbi.nlm.nih.gov/books/NBK571009/
- Devillers AC, Oranje AP. Efficacy and safety of 'wet-wrap' dressings as an intervention treatment in children with severe and/or refractory atopic dermatitis: a critical review of the literature. British Journal of Dermatology, 2006, 154:579-585. https://doi.org/10.1111/j.1365-2133.2006.07157.x
- Janmohamed SR, Oranje AP, Devillers AC, et al. The proactive wet-wrap method with diluted corticosteroids versus emollients in children with atopic dermatitis: a prospective, randomized, double-blind, placebo-controlled trial. Journal of the American Academy of Dermatology, 2014, 70:1076-1082. https://doi.org/10.1016/j.jaad.2014.01.898
- Newcastle upon Tyne Hospitals NHS Foundation Trust. Wet wrap bandages. https://www.newcastle-hospitals.nhs.uk/services/dermatology/patient-dermatology-information-leaflets/wet-wrap-bandages/
- British Association of Dermatologists. Atopic eczema patient information leaflet. https://www.bad.org.uk/pils/atopic-eczema/
- National Eczema Society. Paste bandages and wet wraps. https://www.eczema.org.uk/support/paste-bandages-and-wet-wraps