Determining Effects of Superfine Sheep wool in INfantile Eczema (DESSINE): a randomized paediatric crossover study

Abstract

SummaryBackground Despite limited evidence, woollen clothing has traditionally been considered to be an irritant that should be avoided by individuals with atopic dermatitis (AD). Wool fibres come in a range of diameters, and have beneficial thermodynamic and moisture transport properties. Objectives This study examines the effects of superfine merino wool on symptoms in participants with mild-to-moderate AD. Methods The trial was a 12-week, randomized, assessor-blinded, crossover, prospective, cohort study of 39 patients with mild-to-moderate AD, aged between 4 weeks and 3 years, comparing superfine merino wool ensembles with standard cotton clothing chosen by parents. Participants were assigned to wool or cotton clothing and assessed every 3 weeks for 6 weeks, before crossing over to wear the other clothing material for a further 6-week period, with similar 3-weekly reviews. The primary end point was the SCORing Atopic Dermatitis (SCORAD) index after each 6-week period, with Atopic Dermatitis Severity Index (ADSI), Infants' Dermatitis Quality Of Life Index (IDQOL) and topical steroid use as secondary end points to measure AD severity and quality of life. Results Overall, compared with baseline, superfine wool ensembles were associated with a reduction in mean SCORAD of 2Á5 [95% confidence interval (CI) À4Á7 to À0Á4] at 3 weeks and 7Á6 (95% CI À10Á4 to À4Á8) at 6 weeks when compared with the cotton ensembles. A similar change was observed in ADSI and IDQOL scores for the same period. Body steroid use was also reduced. Conversely, changing ensembles from wool to cotton resulted in an increase in scores. Conclusions Superfine merino wool may assist in the management of childhood AD.

Debunking the Myth of Wool Allergy: Reviewing the Evidence for Immune and Non-immune Cutaneous Reactions

“…Coarse diameter fibres of any fabric may irritate, but irritation is neither a general nor a specific property of wool. In fact, recent studies suggest that superfine or ultrafine Merino wool with finer fibre diameters may benefit AD management (85). Known allergens associated with textile processing are minimally present in wool garments today given current industry practices and are unlikely to lead to allergic reactions.…”

“…Recent Australian studies have demonstrated that the wearing of superfine Merino wool garments next to the skin may significantly reduce AD severity in children under 3 years with mild AD (85) and in persons aged between 6-81 years of age with mild-severe AD (86). In these studies, the superfine Merino wool fibre did not produce cutaneous irritation in patients with AD.…”

ETFAD/EADV Eczema task force 2020 position paper on diagnosis and treatment of atopic dermatitis in adults and children

“…258 Stress and conflicts in the family may trigger AD in young children. Flares are associated with contact to non-familiar pets, swimming in chlorinated pools and direct skin exposure to wool (except superfine merino wool 259 ) and nylon textiles. 260 Prevention and early recognition of atopic respiratory diseases and food allergies are important during childhood and adolescence.…”

Effects of Merino Wool on Atopic Dermatitis Using Clinical, Quality of Life, and Physiological Outcome Measures

“…Interestingly, a recent study of the use of silk clothing in individuals with moderate to severe atopic dermatitis showed no demonstrable benefit from wearing silk. 16 This study and those of Su et al 11 and Spelman et al 17 show that fine-diameter Merino wool clothing should be considered acceptable for people with eczema and seems to be therapeutic to patients with mild to moderate atopic dermatitis.…”

“…9,10 Properly sourced and manufactured Merino wool clothing may be well tolerated and may actually be beneficial as an adjunct to other treatments. Su et al 11 showed an improvement in SCORing Atopic Dermatitis scores in children wearing superfine Merino wool as compared with cotton clothing. Properties of wool fabrics including heat transmission and release of perspiration may increase skin comfort and reduce pruritus, compared with other fabrics.…”