Freelance Writing Jobs | Today's Articles | Sign In

The Two Pajamas Treatment for Eczema

Wet Wrapping Technique to Control Dermatitis

Feb 14, 2009 Hanish Babu

The two pajamas treatment for eczema can be very effective in controlling the dermatitis and providing fast relief when the eczema involves extensive skin surface.

Sometimes topical applications of steroids fail to control the itching and skin inflammation in eczema patients. These may be due to various causes including poor penetration, accidental wiping off of the medication by clothes, or because the strength of the corticosteroid is not enough to suppress the disease activity. In such cases, the two pajamas technique can be very helpful in bringing out fast relief for the patient.

Which Patients Will Benefit From the Two Pajamas Treatment for Eczema?

Eczema patients in all stages of eczema where a large area is involved, e.g. on the legs, arms, trunk etc.
Eczema patients who have severe itching that interfere with their normal sleep.
Chronic eczema patients whose skin is very thick and the absorption of the topical steroids are insignificant.
Patients with extensive eczema who is suffering from hypertension or diabetes, where oral steroids are contra indicated.

The Two Pajamas Treatment for Eczema: How?

First step is to take an oatmeal bath and wipe the excess water off the skin.
Apply a topical steroid of sufficient potency (decided by your dermatologist) in a thin layer over the eczema. Creams are used in acute eczema treatment and sub acute eczema and ointments in chronic eczema.
Next wear a wet cotton pajama over the area (if on legs) and a tubular wet cotton bandage if over the arms or body. Tubular bandage is available with your pharmacist. The pajama cloth should be moderately thick and should cling onto the skin. It should not be dripping wet, just enough that the cream or ointment applied is not absorbed onto the cloth.
Now wear a dry pajama or tubular bandage over the wet one. This will help in avoiding the bed from getting wet and also prevent the wet pajama from getting dried up too fast.
The two pajamas or tubular bandages are kept in position for a period of 4-6 hours.
Once the itching, oozing or crusting is reduced in the acute and sub acute eczema or the thickness of the skin is reduced in the chronic eczema, the strength of the topical steroid can be decreased accordingly.
The topical steroid applications at night can alternate with bland moisturizing emollients in the morning.

Advantages of the Two Pajamas Treatment

Faster relief from itching due to the cooling effect and the anti-inflammatory effect of the topical steroids and emollients.
Faster control of the inflammation.
Less amount of topical steroids required.
The skin damage from too much scratching is avoided.

Disadvantages of the Two Pajamas Treatment

Application over a large area can cause systemic side effects of topical steroids.
If the inner pajama is too wet, it can cause maceration of the skin.
If there is uncontrolled secondary bacterial infection, there is a risk of septicemia.
Fall in body temperature is another complication if a large area is treated at a time.

Precautions While Using the Wet Wrapping Technique

Only mild topical steroids should be used on the face, body folds and near genitals
If secondary infection is present, it should be treated first and only then should the wet wrapping be applied.
Do not let the inner pajama be too wet.
Do not use potent or super potent topical steroids in children and in acute or sub acute eczema. These are reserved for the thick, lichenified skin of chronic eczema.
If, after applying the wet wrapping, there is an increase in stinging or itching, the dressing should be immediately removed and the area washed with fresh water.

Finally, the two pajamas treatment should be carried out only under the supervision of a dermatologist.

Reference: Eczema, in Rook’s Textbook of Dermatology, 7th Edition, 2004

Disclaimer

The information given in this article is for educational purpose only so that patients are aware of the options available. No diagnosis should be made or treatment undertaken without first consulting your doctor. If you do so, the author or suite101 will not be responsible for any consequences. The images provided are for illustration purpose only.

The copyright of the article The Two Pajamas Treatment for Eczema in General Medicine is owned by Hanish Babu. Permission to republish The Two Pajamas Treatment for Eczema in print or online must be granted by the author in writing.

Extensive Eczema : Two Pajamas Treatment.