Soak and smear: A standard technique revisited

Background: Atopic dermatitis, nummular eczema, chronic hand dermatitis, palmar plantar psoriasis, and xerotic eczema are common inflammatory skin conditions. They may be refractory to conventional topical and even systemic treatment. Little evidence is available that demonstrates the benefits of aggressive topical treatment of patients with these disorders. Objective: To describe a simple, inexpensive, effective topical treatment with an accompanying patient educational sheet. Design: A retrospective study of 28 patients referred to a tertiary care center for refractory chronic pruritic eruptions. Intervention with a plain water 20-minute soak followed by smearing of midstrength to high-strength corticosteroid ointment led to clearing or dramatic improvement. Results: Objective and symptomatic improvement was obtained from aggressive topical treatment. It was well accepted in this group of referral patients. Conclusions: Hydration for 20 minutes before bedtime followed by ointment application to wet skin and alteration of cleansing habits is an effective method for caring for several common skin conditions. Prospective studies are needed to further validate these findings.