Clothing fabrics interact closely with the skin to shape our cutaneous microenvironment. Cotton and silk have been traditionally recommended for patients with atopic dermatitis because of reported patient comfort. New synthetic fabrics combine anti-microbial, anti-inflammatory, moisture-wicking, and soothing properties that may augment conventional management strategies in atopic patients.
We review existing and emerging evidence for fabric selection in patients with atopic dermatitis including cotton, wool, lyocell, silk, anionic, cellulosic/cellulose based, zinc oxide coated, citric acid coated, chitosan coated, silver coated, borage seed oil coated, ethylene vinyl, and polyurethane and offer practical suggestions for clothing and bedding choices.
A systematic search was conducted on PubMed and EMBASE electronic databases for articles from 1 January, 1994 to 1 January, 2020. Studies were included based on the following inclusion criteria: clinical trial, published in English, and fabric as the main agent being evaluated. Case reports, case series, conference abstracts, reviews, animal studies, and duplicates were excluded. Studies were then manually screened by title, abstract, and full-text articles and selected to specifically describe the effects of fabrics in patients with atopic dermatitis. Both adult and pediatric patient studies were included.
There appears to be an advantage to modern fabric manufacturing and processing techniques that have created smaller diameter, smoother fibers such as super- and ultrafine merino wool and anti-microbial finishes. Traditional cotton and silk fabrics have mixed evidence in improving atopic dermatitis symptoms and severity but have shown to be generally safe. Large-diameter wool has been shown to induce itching and irritation; ultra- or superfine merino wool is non-pruritic and may be recommended as an alternative. Emerging fabrics with potential efficacy in reducing atopic dermatitis severity and Staphylococcus aureus burden include silver-coated, chitosan-coated, and cellulose-based fabrics. Zinc oxide-coated, acid-coated, polyurethane-coated, borage seed oil-coated, anionic, lyocell, and ethylene vinyl fabrics have sparse evidence and require further study before conclusions can be made.
Appropriate fabric selection can reduce the symptom severity and exacerbations of atopic dermatitis.
This is a preview of subscription content,to check access.
Access this article
Zhu TH, Zhu TR, Tran KA, Sivamani RK, Shi VY. Epithelial barrier dysfunctions in atopic dermatitis: a skin-gut-lung model linking microbiome alteration and immune dysregulation. Br J Dermatol. 2018;179(3):570–81. https://doi.org/10.1111/bjd.16734.
Mobolaji-Lawal M, Nedorost S. The role of textiles in dermatitis: an update. Curr Allergy Asthma Rep. 2015;15(4):17. https://doi.org/10.1007/s11882-015-0518-0.
Srour J, Wollenberg A. Evaluation of antimicrobial textiles for atopic dermatitis. Br J Dermatol. 2018;179(1):e19. https://doi.org/10.1111/bjd.16718.
National Eczema Association. Itching and scratching. 2019. http://www.eczema.org/itching-scratching. Accessed 7 Nov 2019.
Ricci G, Patrizi A, Bendandi B, Menna G, Varotti E, Masi M. Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis. Br J Dermatol. 2004;150(1):127–31.
Isoda K, Takagi Y, Kitahara T, Sano Y, Sugano I, Umeda-Togami K, et al. Treatment of cloth with a fabric softener ameliorates skin dryness. J Dermatol. 2011;38(7):685–92. https://doi.org/10.1111/j.1346-8138.2010.01084.x.
Fowler JF Jr, Fowler LM, Lorenz D. Effects of merino wool on atopic dermatitis using clinical, quality of life, and physiological outcome measures. Dermatitis. 2019;30(3):198–206. https://doi.org/10.1097/DER.0000000000000449.
Garnsworthy RK, Gully RL, Kenins P, Mayfield RJ, Westerman RA. Identification of the physical stimulus and the neural basis of fabric-evoked prickle. J Neurophysiol. 1988;59(4):1083–97. https://doi.org/10.1152/jn.19184.108.40.2063.
Naylor GRS. Fabric-evoked prickle in worsted spun single jersey fabrics part 4: extension from wool to OptimTMfine Fiber. Text Res J. 2009;80(6):537–47. https://doi.org/10.1177/0040517509337635.
Naylor G, Veitch C, Mayflcld R, et al. Fabric-evoked prickle. Text Res J. 1992;62:487–93.
Su JC, Dailey R, Zallmann M, Leins E, Taresch L, Donath S, et al. Determining effects of superfine sheep wool in INfantile Eczema (DESSINE): a randomized paediatric crossover study. Br J Dermatol. 2017;177(1):125–33. https://doi.org/10.1111/bjd.15376.
McGregor BA, Naebe M, Stanton J, Speijers J, Beilby J, Pieruzzini S, et al. Relationship between wearer prickle response with fibre and garment properties and Wool ComfortMeter assessment. J Text Inst. 2013;104(6):618–27. https://doi.org/10.1080/00405000.2013.780764.
Mason R. Fabrics for atopic dermatitis. J Fam Health Care. 2008;18(2):63–5.
Wakelyn PJ. Cotton. In: Kirk-Othmer A, editor. Encyclopedia of chemical technology. Hoboken: Wiley; 2002.
Fluhr JW, Breternitz M, Kowatzki D, Bauer A, Bossert J, Elsner P, et al. Silver-loaded seaweed-based cellulosic fiber improves epidermal skin physiology in atopic dermatitis: safety assessment, mode of action and controlled, randomized single-blinded exploratory in vivo study. Exp Dermatol. 2010;19(8):e9–15. https://doi.org/10.1111/j.1600-0625.2009.00943.x.
Park KY, Jang WS, Yang GW, Rho YH, Kim BJ, Mun SK, et al. A pilot study of silver-loaded cellulose fabric with incorporated seaweed for the treatment of atopic dermatitis. Clin Exp Dermatol. 2012;37(5):512–5. https://doi.org/10.1111/j.1365-2230.2011.04273.x.
Araujo CP, Gomes J, Vieira AP, Ventura F, Fernandes JC, Brito C. A proposal for the use of new silver-seaweed-cotton fibers in the treatment of atopic dermatitis. Cutan Ocul Toxicol. 2013;32(4):268–74. https://doi.org/10.3109/15569527.2013.775655.
Yao L, Tokura H, Li Y, Newton E, Gohel MD. Effect of wearing cotton or polyester pajamas on stratum corneum water content under mildly cold conditions. J Am Acad Dermatol. 2006;55(5):910–2. https://doi.org/10.1016/j.jaad.2006.04.066.
Hendricks AJ, Vaughn AR, Clark AK, Yosipovitch G, Shi VY. Sweat mechanisms and dysfunctions in atopic dermatitis. J Dermatol Sci. 2018;89(2):105–11. https://doi.org/10.1016/j.jdermsci.2017.11.005.
Dawn A, Papoiu AD, Chan YH, Rapp SR, Rassette N, Yosipovitch G. Itch characteristics in atopic dermatitis: results of a web-based questionnaire. Br J Dermatol. 2009;160(3):642–4. https://doi.org/10.1111/j.1365-2133.2008.08941.x.
Love WE, Nedorost ST. Fabric preferences of atopic dermatitis patients. Dermatitis. 2009;20(1):29–33.
Coman G, Blattner CM, Blickenstaff NR, Andersen R, Maibach HI. Textile allergic contact dermatitis: current status. Rev Environ Health. 2014;29(3):163–8. https://doi.org/10.1515/reveh-2014-0061.
Zallmann M, Smith PK, Tang MLK, Spelman LJ, Cahill JL, Wortmann G, et al. Debunking the myth of wool allergy: reviewing the evidence for immune and non-immune cutaneous reactions. Acta Derm Venereol. 2017;97(8):906–15. https://doi.org/10.2340/00015555-2655.
Improving the properties of natural fibres by chemical treatments. In: Kozlowski RM, editor. Handbook of natural fibres. Processing and applications, vol. 2. . Cambridge: Woodhead Publishing Limited Ingram Publisher Services; 2012.
Hanifin JMRG. Diagnostic features of atopic dermatitis. Acta Derm Venereol (Stockh). 1980;92(44):7.
Ramirez MA, Eller JJ. Intradermal, scratch, indirect and contact tests in dermatology. JAMA. 1930. https://doi.org/10.1001/jama.1930.02720150020007.
Eichenfield LF, Tom WL, Chamlin SL, Feldman SR, Hanifin JM, Simpson EL, et al. Guidelines of care for the management of atopic dermatitis: section 1. Diagnosis and assessment of atopic dermatitis. J Am Acad Dermatol. 2014;70(2):338–51. https://doi.org/10.1016/j.jaad.2013.10.010.
Stanley TRD, Dellabarca K, Causer S. Can preschool children with atopic eczema tolerate superfine merino wool cloth next to their skin? A pilot study: 219. Allergy. 2011;66:105–6.
Blackburn RS, Textile I. Biodegradable and sustainable fibres. Cambridge: Woodhead: Lightning Source UK Ltd.; 2012.
Ricci G, Patrizi A, Mandrioli P, Specchia F, Medri M, Menna G, et al. Evaluation of the antibacterial activity of a special silk textile in the treatment of atopic dermatitis. Dermatology. 2006;213(3):224–7. https://doi.org/10.1159/000095040.
Fu E, McCue K, Boesenberg DF. 1. Chemical disinfection of hard surfaces: household, industrial and institutional settings. In: Johansson I, Somasundaran P, editors. Handbook for cleaning/decontamination of surfaces. Amsterdam: Elsevier Science B.V.; 2007. p. 573–92.
Makvandi P, Jamaledin R, Jabbari M, Nikfarjam N, Borzacchiello A. Antibacterial quaternary ammonium compounds in dental materials: a systematic review. Dent Mater. 2018;34(6):851–67. https://doi.org/10.1016/j.dental.2018.03.014.
Stinco G, Piccirillo F, Valent F. A randomized double-blind study to investigate the clinical efficacy of adding a non-migrating antimicrobial to a special silk fabric in the treatment of atopic dermatitis. Dermatology. 2008;217(3):191–5. https://doi.org/10.1159/000141648.
Koller DY, Halmerbauer G, Bock A, Engstler G. Action of a silk fabric treated with AEGIS in children with atopic dermatitis: a 3-month trial. Pediatr Allergy Immunol. 2007;18(4):335–8. https://doi.org/10.1111/j.1399-3038.2006.00511.x.
Fontanini C, Berti I, Monasta L, Longo G. DermaSilk in long-term control of infantile atopic dermatitis: a double blind randomized controlled trial. G Ital Dermatol Venereol. 2013;148(3):293–7.
Senti G, Steinmann LS, Fischer B, Kurmann R, Storni T, Johansen P, et al. Antimicrobial silk clothing in the treatment of atopic dermatitis proves comparable to topical corticosteroid treatment. Dermatology. 2006;213(3):228–33. https://doi.org/10.1159/000095041.
Kurtz EJ, Yelverton CB, Camacho FT, Fleischer AB Jr. Use of a silklike bedding fabric in patients with atopic dermatitis. Pediatr Dermatol. 2008;25(4):439–43. https://doi.org/10.1111/j.1525-1470.2008.00717.x.
Thomas KS, Bradshaw LE, Sach TH, Cowdell F, Batchelor JM, Lawton S, et al. Randomised controlled trial of silk therapeutic garments for the management of atopic eczema in children: the CLOTHES trial. Health Technol Assess. 2017;21(16):1–260. https://doi.org/10.3310/hta21160.
Kramer A, Guggenbichler P, Heldt P, Junger M, Ladwig A, Thierbach H, et al. Hygienic relevance and risk assessment of antimicrobial-impregnated textiles. Curr Probl Dermatol. 2006;33:78–109. https://doi.org/10.1159/000093938.
Berardesca E, European Group for Efficacy Measurements on Cosmetics and Other Topical Products (EEMCO). EEMCO guidance for the assessment of stratum corneum hydration: electrical methods. Skin Res Technol. 1997;3(2):126–32. https://doi.org/10.1111/j.1600-0846.1997.tb00174.x.
Rogiers V, Group E. EEMCO guidance for the assessment of transepidermal water loss in cosmetic sciences. Skin Pharmacol Appl Skin Physiol. 2001;14(2):117–28. https://doi.org/10.1159/000056341.
Kim SH, Hwang SH, Hong SK, Seo JK, Sung HS, Park SW, et al. The clinical efficacy, safety and functionality of anion textile in the treatment of atopic dermatitis. Ann Dermatol. 2012;24(4):438–43. https://doi.org/10.5021/ad.2012.24.4.438.
Hipler UC, Elsner P, Fluhr JW. A new silver-loaded cellulosic fiber with antifungal and antibacterial properties. Curr Probl Dermatol. 2006;33:165–78. https://doi.org/10.1159/000093944.
Gunawan C, Teoh WY, Marquis CP, Amal R. Induced adaptation of Bacillus sp. to antimicrobial nanosilver. Small. 2013;9(21):3554–60. https://doi.org/10.1002/smll.201300761.
Wiegand C, Hipler UC, Boldt S, Strehle J, Wollina U. Skin-protective effects of a zinc oxide-functionalized textile and its relevance for atopic dermatitis. Clin Cosmet Investig Dermatol. 2013;6:115–21. https://doi.org/10.2147/CCID.S44865.
Jaeger T, Rothmaier M, Zander H, Ring J, Gutermuth J, Anliker MD. Acid-coated textiles (pH 5.5–6.5) – A new therapeutic strategy for atopic eczema? Acta Derm Venereol. 2015;95(6):659–63. https://doi.org/10.2340/00015555-1916.
Jagadish R, Fabien S, Stéphane G, Ada F, Guan J. Chitosan-based sustainable textile technology: process, mechanism, innovation, and safety. Rijeka: InTech Open; 2017.
Costa EM, Silva S, Veiga M, Tavaria FK, Pintado MM. Exploring chitosan nanoparticles as effective inhibitors of antibiotic resistant skin microorganisms from in vitro to ex vitro testing. Carbohydr Polym. 2018;201:340–6. https://doi.org/10.1016/j.carbpol.2018.08.083.
Lopes C, Soares J, Tavaria F, Duarte A, Correia O, Sokhatska O, et al. Chitosan coated textiles may improve atopic dermatitis severity by modulating skin staphylococcal profile: a randomized controlled trial. PLoS One. 2015;10(11):e0142844. https://doi.org/10.1371/journal.pone.0142844.
Morganti P, Morganti G, Colao C. Biofunctional textiles for aging skin. Biomedicines. 2019;7(3):51. https://doi.org/10.3390/biomedicines7030051.
Daeschlein G, Assadian O, Arnold A, Haase H, Kramer A, Junger M. Bacterial burden of worn therapeutic silver textiles for neurodermitis patients and evaluation of efficacy of washing. Skin Pharmacol Physiol. 2010;23(2):86–90. https://doi.org/10.1159/000265679.
Gauger A, Mempel M, Schekatz A, Schafer T, Ring J, Abeck D. Silver-coated textiles reduce Staphylococcus aureus colonization in patients with atopic eczema. Dermatology. 2003;207(1):15–21. https://doi.org/10.1159/000070935.
Gauger A, Fischer S, Mempel M, Schaefer T, Foelster-Holst R, Abeck D, et al. Efficacy and functionality of silver-coated textiles in patients with atopic eczema. J Eur Acad Dermatol Venereol. 2006;20(5):534–41. https://doi.org/10.1111/j.1468-3083.2006.01526.x.
Juenger M, Ladwig A, Staecker S, Arnold A, Kramer A, Daeschlein G, et al. Efficacy and safety of silver textile in the treatment of atopic dermatitis (AD). Curr Med Res Opin. 2006;22(4):739–50. https://doi.org/10.1185/030079906x99990.
Pluut OA, Bianco C, Jakasa I, Visser MJ, Krystek P, Larese-Filon F, et al. Percutaneous penetration of silver from a silver containing garment in healthy volunteers and patients with atopic dermatitis. Toxicol Lett. 2015;235(2):116–22. https://doi.org/10.1016/j.toxlet.2015.03.014.
Nawaz T, Sengupta S. Silver recovery from laundry washwater: the role of detergent chemistry. ACS Sustain Chem Eng. 2017;6(1):600–8. https://doi.org/10.1021/acssuschemeng.7b02933.
Kanehara S, Ohtani T, Uede K, Furukawa F. Clinical effects of undershirts coated with borage oil on children with atopic dermatitis: a double-blind, placebo-controlled clinical trial. J Dermatol. 2007;34(12):811–5. https://doi.org/10.1111/j.1346-8138.2007.00391.x.
Henz BM, Jablonska S, van de Kerkhof PC, Stingl G, Blaszczyk M, Vandervalk PG, et al. Double-blind, multicentre analysis of the efficacy of borage oil in patients with atopic eczema. Br J Dermatol. 1999;140(4):685–8.
Yip J. 1. Advanced textiles for intimate apparel. In: Yu W, editor. Advances in women’s intimate apparel technology. Sawston: Woodhead Publishing; 2016. p. 3–23.
Yokoyama Y, Kimata H, Mitarai S, Hirano S, Shirakawa T. Ethylene vinyl alcohol (EVOH) fiber compared to cotton underwear in the treatment of childhood atopic dermatitis: a double-blind randomized study. Indian Pediatr. 2009;46(7):611–4.
Holm L, Öhman S, Bengtsson Å, Van Hage-Hamsten M, Scheynius A. Effectiveness of occlusive bedding in the treatment of atopic dermatitis: a placebo-controlled trial of 12 months’ duration. Allergy. 2001;56(2):152–8. https://doi.org/10.1034/j.1398-9995.2001.056002152.x.
Tan BB, Weald D, Strickland I, Friedmann PS. Double-blind controlled trial of effect of housedust-mite allergen avoidance on atopic dermatitis. Lancet. 1996;347(8993):15–8. https://doi.org/10.1016/s0140-6736(96)91556-1.
Shi VY, Nanda S, Lee K, Armstrong AW, Lio PA. Improving patient education with an eczema action plan: a randomized controlled trial. JAMA Dermatol. 2013;149(4):481–3. https://doi.org/10.1001/jamadermatol.2013.2143.
Bolognia JL, Schafferm JV, Cerroni L. Dermatology. Amsterdam: Elsevier-Health Sciences Division; 2017.
We thank Jennifer Roberge for stimulating discussions on this topic.
No funding was received for the preparation of this article.
Conflict of interest
Claire Wilson has no conflicts of interest that are directly relevant to the content of this article. Vivian Y. Shi, MD is a stock shareholder of Dermveda, has served as an advisor for Sanofi Genzyme/Regeneron, Abbvie, Novartis, SUN Pharma, Pfizer, Menlo Therapeutics, Burt’s Bees, GpSkin, the National Eczema Association, and Global Parents for Eczema Research, is an investigator for AbbVie, Regeneron, Novartis, and LEO Pharma, and has received research funding from the Foundation for Atopic Dermatitis and Skin Actives Scientific. There were no incentives or transactions financial or otherwise, relevant to this manuscript. Joanna Jaros has no relevant conflicts of interest to disclose. She is a consultant for obVus solutions, LLC (a fitness tracker) and a content editor for the blogs/websites: “The Eczema Company” and “It’s an Itchy Little World.”
Electronic supplementary material
Below is the link to the electronic supplementary material.
About this article
Cite this article
Jaros, J., Wilson, C. & Shi, V.Y. Fabric Selection in Atopic Dermatitis: An Evidence-Based Review. Am J Clin Dermatol 21, 467–482 (2020). https://doi.org/10.1007/s40257-020-00516-0