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Prehydration is Effective for Rapid Control of Recalcitrant Atopic Dermatitis

Hajar, Tamar MD; Hanifin, Jon M. MD; Tofte, Susan J. FNP-C; Simpson, Eric L. MD, MCR

doi: 10.1097/DER.0000000000000019

Background Skin care remains a key component in atopic dermatitis (AD) management; there are no data available guiding optimal bathing recommendations.

Objective This study aims to determine whether 15-minute to 20-minute baths followed by topical corticosteroid application (prehydration therapy) are effective for clearing moderate to severe AD.

Methods In the Oregon Health & Science University outpatient dermatology clinic, a retrospective review was done of the health records of patients with AD seen first between January 1, 2007, and December 31, 2011, who were then reevaluated within 1 to 3 weeks of starting the therapy. Qualifying patients underwent the prehydration regimen and were reevaluated. The primary outcome was therapeutic response using the Investigators’ Global Assessment Scale. Secondary outcomes were measured using the dynamic Treatment Response Scale. Of 110 distinct electronic records, 35 patients were excluded. At the initial visit, 75 patients were evaluated with the Investigators’ Global Assessment Scale. Forty-eight patients (64%) were severe, and 27 patients (36%) were moderate. All subjects began prehydration therapy followed by topical corticosteroid. At follow-up visit in 1 to 3 weeks when using the patient’s or provider’s assessment of treatment response, 59 patients (79%) had marked improvement, and 3 patients (4%) were clear.

Conclusions Prehydration followed by topical corticosteroid therapy seems to be a highly effective regimen that achieves rapid control of moderate to severe disease.

From the Department of Dermatology, Oregon Health & Science University, Portland, OR.

Address reprint requests to Jon M. Hanifin, MD, Department of Dermatology, Oregon Health & Science University, CH16D, 3303 SW Bond Ave, Portland, OR 97239-4501. E-mail:

This study was supported in part by a Mentored Patient-Oriented Research Career Development Award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases at the National Institutes of Health (NIH) (5K23AR057486). Support was also obtained from the Oregon Clinical and Translational Research Institute grant number 5 KL2RR024141-04 from the National Center for Research Resources, a component of the NIH, and the NIH Roadmap for Medical Research.

Financial Disclosure: no relevant conflicts for any authors.

© 2014 American Contact Dermatitis Society
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