Atopic dermatitis (AD) is usually managed with topical corticosteroids, though their long-term use carries potential adverse effects.¹ Enhanced external counterpulsation (EECP) is a non-invasive modality that applies electrocardiogram-triggered pressure to the lower extremities during diastole to augment blood flow, enhance organ perfusion, and reduce systolic afterload.¹ EECP has also been shown to increase circulating nitric oxide levels, which exert antiatherogenic, antithrombotic, and anti-inflammatory effects.¹ Given the association between vascular inflammation and increased type 2 helper T-cell (Th2) responses in moderate-to-severe AD, improved circulation through EECP may offer an alternative approach to enhancing AD control.¹ At the EADV Congress 2026, Dr. Wong, Sze-Man Christina presented findings from a prospective, single-center randomized controlled study evaluating the efficacy and safety of EECP in eczema control compared with wet wrap therapy (WWT).¹

The study enrolled 35 patients with clinically diagnosed AD/eczema (mean age, 33.3 ± 13.7 years), randomized to receive EECP (Steno™; n=17) or WWT (n=18).¹ Patients in the EECP arm received three 45-minute sessions per week, while those in the WWT arm underwent three days per week of 45-minute WWT using aqueous cream.¹ Assessments of Eczema Area and Severity Index (EASI), Dermatology Life Quality Index (DLQI), blood cell counts, and immunoglobulin E (IgE) levels were conducted at baseline, days 7 and 14, and one week after treatment completion.¹ Patients in the EECP arm with an EASI score >10 or affected body surface area (BSA) >10% on day 7 received an additional three EECP sessions in the subsequent week.¹ Existing topical and systemic treatments were permitted throughout the study.¹

Baseline characteristics were generally comparable between groups, including EASI score (16.2 vs. 20.6; p=0.33) and affected BSA (26.1% vs. 23.8%; p=0.77) in the EECP and WWT arms, respectively.¹ However, topical corticosteroid use was significantly lower in the EECP arm (35.3% vs. 77.8%; p=0.011), whereas baseline systemic therapy use was higher (58.8% vs. 27.8%; p=0.062).¹

Following three EECP sessions, 58.8% of patients receiving EECP achieved EASI25, defined as a ≥25% reduction in EASI score, compared with 22.2% in the WWT arm at week 1 (p=0.027).¹ This difference persisted following up to six EECP sessions, with 64.7% achieving EASI25 vs. 22.2% in the WWT arm (p=0.011).¹

Improvements with EECP extended beyond EASI response.¹ At week 1, 58.8% of patients in the EECP arm experienced a ≥5% reduction in affected BSA compared with 33.3% in the WWT arm (p<0.001).¹ At the end-of-treatment visit, 64.7% of patients in the EECP arm achieved a >3-point improvement in Dermatology Life Quality Index (DLQI) score, compared with 50.0% in the WWT arm (p<0.05).¹ EECP was well tolerated, with no major adverse events reported during the study.¹

Overall, these findings suggest that EECP may be considered an adjunctive non-pharmacological therapy to enhance AD control.¹ Further studies involving larger patient populations and combined treatment with topical regimens are warranted.¹