What is the best clothing for atopic dermatitis?

It is common for patients or parents of children to ask us what is the best clothing for atopic dermatitis.

Classically, dermatologists recommend cotton clothing and, on the other hand, patients often report intolerance to wool. The scientific literature can to surprise regarding this recommendation.

A usual question in the consultation

Patients with moderate-severe atopic dermatitis often consult us about factors that can aggravate or improve their dermatitis.

A common question in everyday dermatology is whether there are more suitable garments. In a traditional way we suggest cotton or natural fiber clothing, which is breathable and does not increase itching or cause skin irritation.

I also recommend cotton pajamas to go to bed after bathing and moisturizing the skin, with or without corticosteroid cream, I find them very practical to make a slight occlusion of the applied cream and facilitate its penetration.

But if we review the quality scientific literature, what studies do we find of clothing in atopic dermatitis?

What the science says about the best clothes for atopic dermatitis

I find the Study DESSINE published in the magazine of the British Association of Dermatology in 2017 (1), one of the most impressive in dermatology.

In this work, they study two groups of pediatric patients with moderate-severe atopic dermatitis. One group of patients wears cotton clothes and another group is dressed in superfine sheep's wool clothes.

They study the two groups and measure in them the severity of atopic dermatitis with normalized indices, the SCORE, the atopic dermatitis severity index (ADSI) and the quality of life index in children with dermatitis.

Surprisingly, they find that patients using wool clothing his dermatitis improves throughout follow-up.

Despite limited evidence, dermatologists have considered wool an irritating fabric that should be avoided in patients with atopic dermatitis.

At the same time, in Hanifin and Rajkapara criteria the diagnosis of atopic dermatitis, one of which is included is wool intolerance.

Wool fibers are composed of keratin, have insulating capacity, have a greater composition of water than cotton fibers, are thermoregulatory and transport moisture.

These qualities of wool can be beneficial in patients with atopic dermatitis and have been shown in children and adults (2). This study makes us reflect on the traditional recommendation to wear cotton clothing.

Other studies

In addition there are other interesting studies on textiles in atopic dermatitis in the literature:

• Textiles with an antimicrobial effect, coated with antiseptic substances (3), have shown to be beneficial, despite everything there are still studies to recommend their use on a regular basis and they are not included in the Management Guidelines (4).
• The CLOTHES study evaluates therapeutic silk garments, without showing improvement with them in children with atopic dermatitis (5).
• Another recent study finds benefits in clothing made from cellulose fibers enriched with silver-containing algae (6).

Conclusions on what is the best clothing for atopic dermatitis

We can conclude that the classic recommendation to use cotton fabrics in atopic dermatitis is mainly based on the sensation subjective of the patient, who feels more comfortable, but fine wool clothing may be beneficial in these patients.

Other tissues and components are being studied without there being any specific recommendation in the management guidelines at the moment. studies are missing to establish the best clothing for atopic dermatitis on a solid foundation.

References

1 His JC, Dailey R, Zallmann, et al. Determination of the effects of superfine sheep's wool on childhood eczema (DESSINE): a randomized pediatric crossover study. Br J Dermatol 2017; 177: 125-133.

two Griplas L. Changing perceptions of wool. Sydney: Woolmark, 2012. Available at:. [8 May 2014].

3 Lopes C, Soares J, Tavaria F, et al. Chitosan-coated textiles may improve the severity of atopic dermatitis by modulating the staphylococcal profile of the skin: a randomized controlled trial. Pls One 2015; 30: 1-14.

4 Lopes C, Silva D, Delgado L, Correia O, Moreira A. Functional textiles for atopic dermatitis: a systemic review and meta-analysis. Pediatr Allergy Immunol. 2013; 24(6):603-13.

5 Thomas K, Bradshaw L, Sach T, et al. Randomized controlled trial of therapeutic silk garments for the treatment of atopic eczema in children: the CLOTHES trial. Health Technology Assessment 2017; 9:16 p.m.

6 Portela Araujo C, Gomes J, Paula Vieira F, Fernandes JC, Brito C. An initiative for the use of novel silver algae cotton fibers in the treatment of atopic dermatitis. Cutan Ocul Toxicol, 2013; 32: 268-274.