Efficacy and functionality of silver‐coated textiles in patients with atopic eczema

Gauger, Anke; Fischer, S.; Mempel, Martin; Schaefer, Timothy J.; Foelster-Holst, Regina; Abeck, Dietrich; Ring, Johannes

doi:10.1111/j.1468-3083.2006.01526.x

Cited by 64 publications

(28 citation statements)

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“…Today, metallic silver and silver compounds are predominantly used in antibacterial fabrics by contrast with other biocides, that is, in sport and leisure wear as well as in fabrics for the treatment of atopic dermatitis [3, 6–8, 11]. As the use of silver products increases, it is becoming more important to develop standard procedures to measure the efficacy of each product in order to discuss questions concerning comparability, mechanisms and risks [21].…”

Section: Discussionmentioning

confidence: 99%

“…Many lines of evidence suggest a role for microorganisms in noninfectious skin diseases, such as atopic dermatitis, rosacea and acne [33, 34] Therefore, antiseptic therapies using liquid skin disinfectants and systemic antimicrobials are essential for the efficient dermatotherapy of affected lesions of atopic dermatitis patients [3]. Hartmann [35] has shown that liquid antimicrobials may have a short-term impact on the ecosystem of the skin flora, a view which is supported by our results taken with the antibacterial silver deodorant.…”

Section: Discussionmentioning

confidence: 99%

“…The application of therapy-enhancing antimicrobial fabrics in dermatology came up in 2006, when Gauger et al used form-fitting antimicrobial textiles, based on silver-coated yarns in the treatment of atopic dermatitis [3]. In this double-blind, placebo-controlled trial with 68 atopic dermatitis patients, they were able to show that antimicrobial fabrics, worn for 2 weeks tightly on the skin, may reduce the nonphysiological colonization of the patients skin with the microorganism Staphylococcus aureus [4, 5].…”

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Active Clothes Display No Adverse Effects on the Ecological Balance of the Healthy Human Skin Microflora

Hoefer

Hammer

2011

ISRN Dermatology

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The progressive public use of antimicrobial clothes has raised issues concerning skin health. A placebo-controlled side-to-side study was run with antimicrobial clothes versus fabrics of similar structure but minus the antimicrobial activity, to evaluate possible adverse effects on the healthy skin microflora. Sixty volunteers were enrolled. Each participant received a set of form-fitting T-shirts constructed in 2 halves: an antibacterial half, displaying activities of 3–5 log-step reductions due to silver-finishes or silver-loaded fibres and a nonantibacterial control side. The microflora of the scapular skin was analyzed weekly for opportunistic and pathogenic microorganisms over six weeks. The antibacterial halves did not disturb the microflora in number or composition, whereas a silver-containing deodorant displayed a short-term disturbance. Furthermore, parameters of skin morphology and function (TEWL, pH, moisture) did not show any significant shifts. In summary, antimicrobial clothes did not show adverse effects on the ecological balance of the healthy skin microflora.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Antimicrobial Active Clothes Display No Adverse Effects on the Ecological Balance of the Healthy Human Skin Microflora

Hoefer

Hammer

2011

ISRN Dermatology

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“…Gauger and colleagues 343 in Germany compared Padycare ® (TEXAMED ® GmbH), a polyamide and LYCRA ® (INVISTA, Wichita, KS, USA) material with silver filaments woven in to produce a silver content of 20% in total, with a cotton textile. Both were worn day and night for 2 weeks as either an all-in-one suit for infants or a long-armed and long-legged suit.…”

Section: Harmsmentioning

confidence: 99%

Scoping systematic review of treatments for eczema

Nankervis

Kim

Delamere

et al. 2016

Programme Grants Appl Res

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BackgroundEczema is a very common chronic inflammatory skin condition.ObjectivesTo update the National Institute for Health Research (NIHR) Health Technology Assessment (HTA) systematic review of treatments for atopic eczema, published in 2000, and to inform health-care professionals, commissioners and patients about key treatment developments and research gaps.Data sourcesElectronic databases including MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Skin Group Specialised Register, Latin American and Caribbean Health Sciences Literature (LILACS), Allied and Complementary Medicine Database (AMED) and Cumulative Index to Nursing and Allied Health Literature (CINAHL) were searched from the end of 2000 to 31 August 2013. Retrieved articles were used to identify further randomised controlled trials (RCTs).Review methodsStudies were filtered according to inclusion criteria and agreed by consensus in cases of uncertainty. Abstracts were excluded and non-English-language papers were screened by international colleagues and data were extracted. Only RCTs of treatments for eczema were included, as other forms of evidence are associated with higher risks of bias. Inclusion criteria for studies included availability of data relevant to the therapeutic management of eczema; mention of randomisation; comparison of two or more treatments; and prospective data collection. Participants of all ages were included. Eczema diagnosis was determined by a clinician or according to published diagnostic criteria. The risk of bias was assessed using the Cochrane Collaboration risk-of-bias tool. We used a standardised approach to summarising the data and the assessment of risk of bias and we made a clear distinction between what the studies found and our own interpretation of study findings.ResultsOf 7198 references screened, 287 new trials were identified spanning 92 treatments. Trial reporting was generally poor (randomisation method: 2% high, 36% low, 62% unclear risk of bias; allocation concealment: 3% high, 15% low, 82% unclear risk of bias; blinding of the intervention: 15% high, 28% low, 57% unclear risk of bias). Only 22 (8%) trials were considered to be at low risk of bias for all three criteria. There was reasonable evidence of benefit for the topical medications tacrolimus, pimecrolimus and various corticosteroids (with tacrolimus superior to pimecrolimus and corticosteroids) for both treatment and flare prevention; oral ciclosporin; oral azathioprine; narrow band ultraviolet B (UVB) light; Atopiclair™ and education. There was reasonable evidence to suggest no clinically useful benefit for twice-daily compared with once-daily topical corticosteroids; corticosteroids containing antibiotics for non-infected eczema; probiotics; evening primrose and borage oil; ion-exchange water softeners; protease inhibitor SRD441 (Serentis Ltd); furfuryl palmitate in emollient; cipamfylline cream; andMycobacterium vaccaevaccine. Additional research evidence is needed for emollients, bath additives, antibacterials, specialist clothing and complementary and alternative therapies. There was no RCT evidence for topical corticosteroid dilution, impregnated bandages, soap avoidance, bathing frequency or allergy testing.LimitationsThe large scope of the review coupled with the heterogeneity of outcomes precluded formal meta-analyses. Our conclusions are still limited by a profusion of small, poorly reported studies.ConclusionsAlthough the evidence base of RCTs has increased considerably since the last NIHR HTA systematic review, the field is still severely hampered by poor design and reporting problems including failure to register trials and declare primary outcomes, small sample size, short follow-up duration and poor reporting of risk of bias. Key areas for further research identified by the review include the optimum use of emollients, bathing frequency, wash products, allergy testing and antiseptic treatments. Perhaps the greatest benefit identified is the use of twice weekly anti-inflammatory treatment to maintain disease remission. More studies need to be conducted in a primary care setting where most people with eczema are seen in the UK. Future studies need to use the same core set of outcomes that capture patient symptoms, clinical signs, quality of life and the chronic nature of the disease.FundingThe National Institute for Health Research Programme Grants for Applied Research programme.

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“…10,11 To identify RCTs published prior to the CLOTHES trial, we searched the Global Resource of Eczema Trials database. 12 At the time of starting the CLOTHES trial, 14 small RCTs assessing the effects of therapeutic clothing had been published: three RCTs investigated silk clothing [DermaSilk TM (AlPreTec Srl, San Donà di Piave, Italy)]; [13][14][15] two investigated silver-coated textiles; 16,17 three investigated cellulose seaweed fibres with silver; [18][19][20] one investigated cellulose; 21 one investigated an anion textile; 22 two investigated types of ethylene vinyl alcohol fibre; 23,24 one investigated borage oil-coated garments; 25 and one investigated cotton and synthetic fibres. 26 Since the start of the trial, an additional study on chitosan-coated textiles has been published.…”

Section: Chapter 1 Introductionmentioning

confidence: 99%

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

Kim

Bradshaw

Sach

et al. 2017

Health Technol Assess

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Background: Atopic eczema (AE) is a chronic, itchy, inflammatory skin condition that affects the quality of life of children and their families. The role of specialist clothing in the management of AE is poorly understood.Objectives: To assess the effectiveness and cost-effectiveness of silk garments for the management of AE in children with moderate to severe disease.Design: Parallel-group, observer-blind, randomised controlled trial of 6 months’ duration, followed by a 2-month observational period. A nested qualitative study evaluated the beliefs of trial participants, health-care professionals and health-care commissioners about the use of silk garments for AE.Setting: Secondary care and the community in five UK centres.Participants: Children aged 1–15 years with moderate or severe AE.Interventions: Participants were randomised (1 : 1 using online randomisation) to standard care or standard care plus 100% silk garments made from antimicrobially protected knitted sericin-free silk [DermaSilkTM (AlPreTec Srl, San Donà di Piave, Italy) or DreamSkinTM (DreamSkin Health Ltd, Hatfield, UK)]. Three sets of garments were supplied per participant, to be worn for up to 6 months (day and night). At 6 months the standard care group received the garments to use for the remaining 2-month observational period.Main outcome measures: Primary outcome – AE severity using the Eczema Area and Severity Index (EASI) assessed at 2, 4 and 6 months, by nurses blinded to treatment allocation. EASI scores were log-transformed for analysis. Secondary outcomes – patient-reported eczema symptoms (Patient Oriented Eczema Measure); global assessment of severity (Investigator Global Assessment); quality of life of the child (Atopic Dermatitis Quality of Life, Child Health Utility – 9 Dimensions), family (Dermatitis Family Impact Questionnaire) and main carer (EuroQoL-5 Dimensions-3 Levels); use of standard eczema treatments (e.g. emollients, topical corticosteroids); and cost-effectiveness. The acceptability and durability of the clothing, and adherence to wearing the garments, were assessed by parental/carer self-report. Safety outcomes – number of skin infections and hospitalisations for AE.Results: A total of 300 children were randomised (26 November 2013 to 5 May 2015): 42% female, 79% white, mean age 5 years. The primary analysis included 282 out of 300 (94%) children (n = 141 in each group). Garments were worn for at least 50% of the time by 82% of participants. Geometric mean EASI scores at baseline, 2, 4 and 6 months were 8.4, 6.6, 6.0, 5.4 for standard care and 9.2, 6.4, 5.8, 5.4 for silk clothing, respectively. There was no evidence of difference between the groups in EASI score averaged over all follow-up visits adjusted for baseline EASI score, age and centre (ratio of geometric means 0.95, 95% confidence interval 0.85 to 1.07; p = 0.43). This confidence interval is equivalent to a difference of –1.5 to 0.5 in the original EASI scale units. Skin infections occurred in 39 out of 141 (28%) and 36 out of 142 (25%) participants for sta...

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Efficacy and functionality of silver‐coated textiles in patients with atopic eczema

Abstract: In conclusion, silver-coated textiles are able to improve objective and subjective symptoms of AE significantly within 2 weeks, showing a good wearing comfort and functionality comparable to cotton.

Cited by 64 publications

References 31 publications

Antimicrobial Active Clothes Display No Adverse Effects on the Ecological Balance of the Healthy Human Skin Microflora

Antimicrobial Active Clothes Display No Adverse Effects on the Ecological Balance of the Healthy Human Skin Microflora

Scoping systematic review of treatments for eczema

Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial

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