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Fabric Selection in Atopic Dermatitis: An Evidence-Based Review

  • Evidence-Based Review Article
  • Published:
American Journal of Clinical Dermatology Aims and scope Submit manuscript

Abstract

Background

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.

Objective

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.

Methods

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.

Results

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.

Conclusions

Appropriate fabric selection can reduce the symptom severity and exacerbations of atopic dermatitis.

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Acknowledgements

We thank Jennifer Roberge for stimulating discussions on this topic.

Funding

No funding was received for the preparation of this article.

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Authors and Affiliations

  1. University of Illinois College of Medicine, 808 S. Wood St. - 380 CME, Chicago, IL, 60612-7307, USA

    Joanna Jaros & Claire Wilson

  2. Eczema and Skin Barrier Research Program, Dermatology Division, Department of Medicine, University of Arizona, 7165 N Pima Canyon Drive, Tucson, AZ, 85718, USA

    Vivian Y. Shi

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Correspondence to Vivian Y. Shi.

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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.”

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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

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