Where
Plot No D13B, Wellington Rd, Vikrampuri Colony, Karkhana, Secunderabad, Telangana 500009.
- Serves Trimulgherry, West Marredpally, Bowenpally, Alwal
- Formerly BNR Skin & Vitiligo Hospital
Secunderabad
The occlusion protocol for eczema that will not settle
Some eczema does not respond to correctly used emollients and anti-inflammatories, not because the drugs are wrong but because too little of them is reaching skin that is dry, thickened and scratched. Occlusion changes that. It is an established technique, and this is how it is run here.
45 years in dermatologyDermatologist & dermatosurgeonKarkhana, SecunderabadPreparations mixed on the premises
At a glance
- What it is
- Hydration, then a dressing held under occlusion
- Where
- At the clinic — the dressing is prepared on the day
- Sittings
- Eight, across about twelve weeks
- Then
- About eight weeks of treatment continued at home
- Suits
- Eczema that has failed correct standard treatment
- Not for
- Infected eczema, until the infection is treated
Why occlusion
Dry skin is a barrier to its own treatment.
A drug applied to dry, thickened skin largely stays on it. Hydrated skin under a covering absorbs many times more of the same drug, because water in the outer layer opens the route through it and the covering stops that water evaporating away. This is why the technique starts with a soak and ends with a seal.
This is not a house invention. Wet wrapping is described by DermNet, by the National Eczema Association and in NICE guidance for atopic eczema, and it has been used in hospital dermatology for decades. What is uncommon is finding it offered in Indian private practice, where it is generally skipped because it takes clinic time that a prescription does not.
What is prepared here is the dressing itself: mixed on the day it is used, at a strength chosen for the site and for how thickened the skin has become.
Why the dressing is the treatment
Water first, then the medicine.
A preparation spread on dry, thickened skin mostly stays where it was put. The outer layer is a wall of flattened cells packed tight together, and the route between them only opens once those cells have taken up water. Soaking first and then sealing the preparation in is what turns a surface application into something that reaches the tissue underneath.
- 1
- 2
- 3
- 4
- 1Cream stranded on the surface
- 2Cells compacted, no way between them
- 3Sealed under a film
- 4Channels open, medicine passes down
The same preparation and the same quantity, applied two ways. What differs is not the medicine but whether any of it arrives.
- Cream stranded on the surface
- Cells compacted, no way between them
- Sealed under a film
- Channels open, medicine passes down
Illustration, not a photograph.
The procedure
What happens at a sitting
Soak, fifteen minutes
The affected area is soaked in normal saline. This is not cleaning. It is hydration: the outer layer takes up water and becomes far more permeable than it was when you walked in.
The dressing is prepared
A poultice is mixed at the clinic that day for that patient. Preparing it fresh is deliberate — the strength is set against the skin as it is now, not as it was at the last visit.
Applied and occluded
The preparation is applied and covered with fine cellophane. The covering holds the water in and keeps the preparation against the skin, which is what drives absorption through the softened barrier.
Left in place, then reviewed
The dressing stays on for a set time and the skin is looked at before you leave. The strength for the next sitting is decided from what it did at this one.
One sitting, in order
Four stages, in the same order every time.
None of the four is optional and none of them is quick. The soak is the longest part and the part most often cut short at home, which is the usual reason a course of the same preparation has already failed once before the patient reaches the clinic.
- 1
- 2
- 3
- 4
- 1Dry, cracked, thickened
- 2Soaked until it softens
- 3Preparation spread on
- 4Sealed under film
The film comes off at the time given for it. Left on longer it waterlogs the skin, which undoes the sitting it was meant to finish.
- Dry, cracked, thickened
- Soaked until it softens
- Preparation spread on
- Sealed under film
Illustration, not a photograph.
The course
How the twelve weeks are structured
| Stage | What happens | Where |
|---|---|---|
| Weeks 1–4 | Dressings at the shorter interval, while the skin is at its most reactive | At the clinic |
| Weeks 5–12 | Remaining sittings, spaced further apart as the skin settles — eight in total | At the clinic |
| Weeks 13–20 | A steroid-free immunomodulator continued daily, with no clinic visits | At home |
| Throughout | Emollient, generously and every day, including on skin that looks clear | At home |
| At the end | Reviewed, and a maintenance plan set for the sites that flare most | At the clinic |
Eight sittings is the usual course, not a fixed rule. How many are needed and over what area is decided at examination, and that is also what the cost depends on — which is why, as with every other treatment on this site, the figure is quoted after examination rather than published here.
Who it is for
This is a second-line treatment, on purpose.
Most eczema does not need this. Emollient used generously every day, an anti-inflammatory of the right potency for the site, used for long enough and stepped down properly, controls the large majority of it. Where that has genuinely been done and the skin is still not settling, occlusion is the next step rather than the first.
It suits thickened, intensely itchy, well-defined areas — lower legs, forearms, hands — better than eczema that is faint and spread over the whole body. It is also useful where scratching has become the main driver, because settling the itch breaks the loop that keeps the rest going.
Start with standard eczema treatmentBest suited
Thickened, localised, stubbornly itchy patches that have not responded to correct standard treatment.
Not suited
Infected skin, widespread faint eczema, or eczema that has simply not been treated properly yet.
Where to book
One clinic, in Secunderabad
Dressings are prepared and applied at one address in Secunderabad. The practice was formerly known as BNR Skin & Vitiligo Hospital.
How to book
On WhatsApp: one number, answered by the clinic team, who confirm a time and say what to bring.
- Photographs welcome before you travel
- Video consultation arranged the same way
Questions patients actually ask
Occlusion protocol questions
Will the itching stop?
Itch usually settles before the rash looks better, and that is the change most patients notice first. How much and how quickly varies between people, and no particular figure is promised.
Is this steroid treatment?
The dressing is prepared for the individual and what it contains is written down for you. After the clinic sittings, the home phase uses a steroid-free immunomodulator specifically so that long-term use does not rely on steroids.
Why does it have to be done at the clinic?
Because the preparation is mixed on the day, the strength is chosen against the skin as it presents, and the result is looked at before you leave. Wet wrapping done wrong — over infection, or at the wrong strength on thin skin — does harm.
Can children have this?
Yes, and children are a substantial part of who it is used for. Strength and duration are set differently for a child, and NICE guidance on eczema in the under-twelves is the reference point.
What happens after the twenty weeks?
Most people move to maintenance: emollient daily, and treatment twice a week to the sites that flare most. Eczema is controlled rather than cured, and the plan is written on that basis.
References
The clinical statements on this page follow the guidance and evidence below. They are independent sources. None of them is connected to this clinic, and none of them sells the treatments described here.
- Wet wrapsDermNet (New Zealand Dermatological Society)
- Wet wrap therapyNational Eczema Association
- Atopic eczema in under 12s: diagnosis and management (CG57)National Institute for Health and Care Excellence
- Atopic dermatitisDermNet (New Zealand Dermatological Society)
- Emollients and moisturisersDermNet (New Zealand Dermatological Society)
Keep reading
Related on this site
The first appointment is a diagnosis.
Not a treatment plan sold on the spot. Message the clinic and bring your history.