How Can Wet Wrap Therapy Help Psoriasis?
With all topical treatments for psoriasis, the goal is to soothe, hydrate, and help heal the skin. This is also the theory behind wet wrapping, a technique used to relieve moderate to severe flare-ups of eczema or psoriasis. Wet wrap therapy is a process of covering the skin with a topical treatment, a layer of moistened gauze or clothing, and then a dry layer such as an ace bandage.
The American Academy of Dermatology supports wet wrapping as a treatment for eczema. But wet wrapping can help people with different forms of psoriasis, too, says Rhonda Q. Klein, M.D., board-certified dermatologist and co-owner of Modern Dermatology in Westport, Connecticut.
“This treatment can be very effective at hydrating and soothing inflammation and discomfort on the skin, as well as optimizing the penetration of your topical corticosteroid,” Klein says.
How Wet Wrapping Works
Before trying the wet wrap technique at home, talk to your dermatologist to see whether this therapy is right for you. There are a few risks if you do wet wrapping incorrectly, too often, or for too long, such as skin thinning and infection. (Very rarely, it may lead to a condition called adrenal insufficiency, in which chronic use of topical steroids triggers your body to make less of the steroid hormone cortisol.)
With your doctor’s go-ahead, you can apply the following wet wrap technique:
- The first step of wet wrapping is to take a bath in lukewarm water.
- Then, apply a topical treatment—such as a steroid cream prescribed by your doctor, or a fragrance-free hypoallergenic moisturizer or ointment—to the affected areas of skin, says Arianne Shadi Kourosh, M.D., founding director of the Pigmentary Disorder and Multiethnic Skin Clinic at Massachusetts General Hospital in Boston, assistant professor at Harvard Medical School, and author of Facing Psoriasis.
Some people who use prescription treatment may opt to apply an added layer of petroleum jelly or coconut oil on top of their treatment to help further moisturize the skin.
- After applying the topical treatment, wet a piece of gauze, squeezing out the excess water so it’s only slightly damp, and place it over the moisturized skin.
- Finally, wrap dry gauze wraps, plastic wrap, or an ace bandage over the wet gauze to keep it in place.
“A lot of people with psoriasis will do this wet wrap technique on their worst psoriasis spots on the arms or legs at bedtime and go to sleep with the wraps in place,” Kourosh says. “When they wake up in the morning, they often see a noticeable improvement in their skin.”
Most of the time, doctors recommend doing the wet wrap treatments once or twice daily for less than a week, since it can lead to increased penetration and absorption of topical steroids.
Making Adjustments to Your Wet Wrap Therapy
The wet wrapping process can also be altered somewhat for convenience. For example, for children, you can use a topical cream or ointment, followed by a pair of slightly damp pajamas, followed by dry pajamas.
If the skin on your hands or feet is affected, the National Eczema Association suggests wrapping them in a wet layer of cotton gloves or socks, topped with a dry layer of vinyl gloves or food-grade plastic wrap.
As the wet step can be a little complicated to do, some may choose to exclude this step altogether. In that case, you’d apply the prescription-strength topical treatment, followed by a dry layer such as an adhesive bandage (if the area is small) or plastic wrap (if the area is larger).
Benefits of Wet Wrap Therapy for Psoriasis
Covering the skin with wet wraps maintains skin hydration by helping to seal in moisture much more effectively than by just applying an ointment or a cream. And by locking in topical treatments and preventing them from rubbing off onto clothing or bedding, wet wrapping may allow the active ingredients to better absorb into the skin and protect or restore the skin barrier.
“For both eczema and psoriasis, keeping the skin moisturized and protected with wraps is key for preventing flares and helping the skin recover,” Kourosh says. “This technique can truly make a difference.”
Wet wrapping also reduces the risk of injury to the skin, which is critical for improving psoriasis. “The skin of people with psoriasis is vulnerable to something called the Koebner phenomenon,” explains Kourosh. Koebnerization is when new spots of psoriasis develop and worsen at sites of even mild trauma or injury to the skin, like a scratch.
“Dry skin is particularly prone to cracks and breaks, so keeping it hydrated and moisturized is very important—in particular for people with psoriasis,” Kourosh says. “Wet wraps protect the skin from getting scratched or injured and thus help prevent new psoriasis spots from developing or worsening.”
If you experience itching as a symptom of psoriasis, wet wrapping can help to reduce injury from rubbing and scratching by forming a physical barrier on top of the skin.
What the Research Says
More large-scale studies are required, but there is some research to back up the use of wet wrap therapy for psoriasis.
In a small 2018 study, researchers looked at wet wrapping as a therapy among seven people with erythrodermic psoriasis, a rare and aggressive form of psoriasis that can cover the entire body with a red, peeling rash. Wet wraps were applied two to four times per day, for an hour per each application.
Within two to three days, all participants’ psoriasis symptoms significantly improved, suggesting that wet wrapping for psoriasis is an effective option. This study also suggests that wet wrapping can be effective even if it isn’t used as an overnight treatment.
And in a 2020 survey of 105 dermatologists and allergists, 90% of them agreed that wet wraps increase the efficacy of topical steroid creams.
A Potential Drawback to Wet Wrapping
Klein says that using the wet wrap therapy technique at home can be very helpful, but she points out that the process can be a lot of work if you are treating large areas of your body. “I mainly recommend it to patients with severe cases,” she says, for whom the extra effort may be especially worthwhile.
If you’d like to try wet wrapping for your psoriasis, talk to your dermatologist about whether it’s right for you. Your doctor may be able to demonstrate the technique and give personalized directions based on their knowledge of your medical history.
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