Eczema and FAB

Itching that won’t let your child sleep. Scratching and rubbing their legs or feet together. Clear or creamy discharge. Redness. Warmth. Reluctance to put on socks and the foot abduction brace. Helplessness. It could be eczema. How can you manage it at home?

The information provided in this article is for educational purposes only and does not replace an individual medical consultation. If symptoms persist, worsen, or new concerning signs appear, consult a physician—even if possible solutions are presented here.

What Is Contact Eczema?

Eczema (dermatitis) is a chronic or recurrent inflammatory skin condition characterized by itching, redness, and skin lesions of varying severity. It is not a single disease, but rather a group of inflammatory skin disorders with a similar clinical presentation.

Contact eczema is skin inflammation caused by direct contact with an irritant or allergen. There are two main types:

Irritant Contact Dermatitis	Allergic Contact Dermatitis
Not allergy-related. Caused by damage to the skin barrier (e.g., sweat, friction, detergents).	Requires prior sensitization to an allergen (e.g., nickel, silicone, latex).
May appear after repeated exposure; usually limited to the area of contact.	Delayed reaction (24–72 hours after contact); may extend beyond the contact area.
Most common type; can occur in anyone.	Less common; limited to children with specific allergies.

Contact Eczema in a Child Wearing a Brace – Why?

In children using a foot abduction brace, ADM orthosis, or AFO/DAFO devices, contact eczema is relatively common due to prolonged skin contact with material, moisture, and friction.

Main causes:

• sweat, moisture, and friction at the back of the shoe (heel counter, ADM mechanism, AFO posterior shell)
• constant rubbing of straps over the ankle or dorsum of the foot
• excessive strap tightness
• moisture trapped inside the shoe
• insufficient drying after bathing
• residue of creams/ointments under straps or inside the shoe
• overheating (especially at night)
• socks made mostly of nylon/elastane rather than breathable natural fibers
• children with atopic dermatitis are at higher risk

Typical locations:

• dorsum of the foot
• around the ankle
• back of the heel and calf
• under strap areas

Symptoms:

• erythema (redness)
• superficial erosions
• small whitish or yellowish vesicles
• oozing
• yellow crusting
• itching
• burning sensation
• Moisture + Microtrauma = Risk of:
• bacterial superinfection (yellow crusts)
• candidiasis (especially in skin folds)

Moisture + Microtrauma =
risk of bacterial superinfection (yellow crusts) and/ or candidiasis (especially in skin folds)

Clues to the Cause:

exactly under a strap →	think pressure/friction first
symmetrical lesions →	more likely moisture/friction
sharply defined borders matching material →	possible allergy
improves quickly after 2–3 days of treatment →	usually irritant dermatitis

Prevention

• thorough drying of the skin before applying socks and brace
• thin, breathable cotton socks
• avoid greasy ointments directly before brace use (apply light emollients 30–60 minutes earlier if needed; e.g., Epaderm by Mölnlycke)
• check strap condition (overstretched or narrow straps increase skin problems)
• daytime airing if treatment schedule allows
• react early to first signs of redness

If Treatment Is Needed

A very common approach to treating this type of skin complication is the “soak and seal” method. It is safe and easy to perform at home.

However, there is also the option of so-called “wet wrap therapy,” which may further increase the likelihood of symptom relief—particularly in cases of intense itching and excessive dryness.

“Soak and Seal” Method

Often recommended to reduce dryness and flare-ups. Can be done several times weekly.

Steps:

1. Fill bathtub with lukewarm water and soak 5–10 minutes.
2. Use gentle fragrance-free cleanser. Do not scrub.
3. Rinse with lukewarm water.
4. Pat dry gently; leave skin slightly damp.
5. Apply prescribed topical medication (if any) to affected areas.
6. Within 3 minutes, generously apply emollient to remaining skin (not over medicated areas).
7. Wait a few minutes before dressing.

Wet Wrap Therapy (WWT)

Commonly used in moderate to severe atopic dermatitis, especially during flares with intense itching. It may also help children wearing braces who struggle with persistent skin complications.

Benefits:

• cools skin and reduces itch
• helps cleanse surface
• increases hydration (if emollient applied underneath)
• protects from scratching
• improves sleep

WWT step-by-Step:

You will need:

• bowl with lukewarm water + bath oil or soap-free cleanser
• prescribed steroid/anti-inflammatory cream (if indicated)
• cotton or bamboo towel
• two-way stretch elastic tubular sleeves (stretching both lengthwise and widthwise), such as Tubifast® bandages by Mölnlycke, cut to the child’s size (two pieces per limb). The sleeve with the red stripe is suitable for infants, while the one with the green stripe is appropriate for older children.

Procedure:

1. Wash your child using a gentle, fragrance-free cleanser.
2. Gently pat the skin dry with a cotton towel by pressing it against the skin (do not rub).
3. Apply the prescribed steroid or anti-inflammatory cream to all affected areas (according to your doctor’s instructions, if one has been prescribed). If no medication has been prescribed, apply a generous layer of emollient to the affected skin instead.
4. Soak one Tubifast® sleeve in lukewarm water and gently wring it out (the material should be damp, not dripping).
5. Place the damp sleeve over the treated skin.
6. Then apply a second, dry Tubifast® sleeve over it to help retain moisture and enhance the hydrating effect.
7. Leave the wet wrap in place for several hours during the day or overnight (the child may wear a foot abduction brace / ADM / AFO if tolerated).
8. Maintain moisture by lightly spraying the wrap with water if needed.
9. If the dressing dries out, dampen it before removal so it does not stick to the skin or cause irritation when taken off.
10. The Tubifast® sleeve can be hand-washed at 40°C (104°F) using a mild detergent and reused. Rinse thoroughly before the next use to remove all detergent residue.

Possible Risks of Wet Wrap Therapy

• folliculitis (small bumps due to prolonged occlusion and ointment use)
• increased absorption of topical steroids (use cautiously and as prescribed)

Discontinue if folliculitis appears and consult your physician.

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RESEARCHES:

1. González-López G, Ceballos-Rodríguez RM, González-López JJ, Feito Rodríguez M, Herranz-Pinto P. Efficacy and safety of wet wrap therapy for patients with atopic dermatitis: a systematic review and meta-analysis. Br J Dermatol. 2017 Sep;177(3):688-695. doi: 10.1111/bjd.15165. Epub 2017 May 19. PMID: 27861727
2. Nicol NH, Boguniewicz M. Wet Wrap Therapy in Moderate to Severe Atopic Dermatitis. Immunol Allergy Clin North Am. 2017 Feb;37(1):123-139. doi: 10.1016/j.iac.2016.08.003. Epub 2016 Nov 1. PMID: 27886902
3. Oranje AP, Devillers AC, Kunz B, Jones SL, DeRaeve L, Van Gysel D, de Waard-van der Spek FB, Grimalt R, Torrelo A, Stevens J, Harper J. Treatment of patients with atopic dermatitis using wet-wrap dressings with diluted steroids and/or emollients. An expert panel’s opinion and review of the literature. J Eur Acad Dermatol Venereol. 2006 Nov;20(10):1277-86. doi: 10.1111/j.1468-3083.2006.01790.x. PMID: 17062046
4. Devillers AC, Oranje AP. Wet-wrap treatment in children with atopic dermatitis: a practical guideline. Pediatr Dermatol. 2012 Jan-Feb;29(1):24-7. doi: 10.1111/j.1525-1470.2011.01691.x. PMID: 22256990.
5. Page B. The benefits of Tubifast Garments in the management of atopic eczema. Br J Nurs. 2005 Mar 10-23;14(5):289-90, 292. doi: 10.12968/bjon.2005.14.5.17667. PMID: 15902045
6. Wolkerstorfer A, Visser RL, De Waard van der Spek FB, Mulder PG, Oranje AP. Efficacy and safety of wet-wrap dressings in children with severe atopic dermatitis: influence of corticosteroid dilution. Br J Dermatol. 2000 Nov;143(5):999-1004. doi: 10.1046/j.1365-2133.2000.03833.x. PMID: 11069509