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Children with eczema who wore silk clothing had no improvement in their condition compared with those who wore regular clothes, a randomized trial from the U.K. found.
There was no significant difference in Eczema Area and Severity Index (EASI) scores between children randomized to wear silk clothing on top of usual care and those who only received usual care (adjusted ratio of geometric means 0.95, 95% CI 0.85-1.07, P=0.43), reported Kim Thomas, MD, of the University of Nottingham in the U.K., and colleagues.
There were also no significant between-group differences in eczema severity, quality of life, or medication use, the authors wrote in PLoS Medicine.
Some work has suggested that clothing may play a role in improving or worsening eczema symptoms, as patients with eczema are advised to avoid wool and use cotton or fine-weave materials instead. But prior research has been limited to randomized trials, with 30 participants at most, and they were "generally of short duration," the researchers explained. Also, there's been very little research on the impact of silk clothing, which has been claimed to have benefits for eczema patients because it can help regulate the skin's humidity and temperature, and may lead to less itching owing to its smooth texture.
The CLOTHing for the relief of Eczema Symptoms (CLOTHES) Trial was a multicenter, pragmatic, randomized controlled trial that recruited children ages 1 to 15 with a diagnosis of moderate to severe eczema, according to the U.K. Working Party's Diagnostic Criteria for Atopic Dermatitis. Severity was determined by a score of 9 or more on the Nottingham Eczema Severity Score over the last 12 months.
Overall, researchers analyzed data from 141 children in each group. Participants were a mean age of 5 years, 42% were girls, and 79% were white. Mean baseline EASI score was higher in the intervention group, with more children having a baseline score over 30 (14 children in the intervention versus four in the control group).
The intervention group wore silk garments made by DermaSilk or DreamSkin, which are licensed as a medical device in the EU, and received standard eczema care, while the control group only received standard care. Nurses were blinded to treatment allocation for most participants.
EASI scores averaged over 2-, 4-, and 6-month follow-up periods found no clinical difference between groups. There was also no significant difference in safety outcomes, such as the number of skin infections and hospitalizations due to eczema.
There were significant differences in two secondary outcomes: Patient-Oriented Eczema Measure (adjusted difference in means -2.8, 95% CI -3.9 to -1.8, P<0.001) and participant global assessment (relative risk 0.83, 95% CI 0.70-0.98, P=0.03) between the intervention and control groups. However, the authors characterized these as "small differences."
"[While] these small differences could have been genuine, they are most likely due to an expectation bias that declined with time," they wrote, arguing that their nested qualitative study, which has yet to be published, found that children and parents hoped to be placed in the silk clothing group.
Not surprisingly, they also found the cost of these silk clothes was substantial -- with an incremental cost per quality-adjusted life year of £56,881 (over $71,000).
Limitations included the fact that by emphasizing objective eczema severity outcomes, the study did not measure improvements in quality of life or reduction of symptoms -- which may be important in determining whether or not patients felt the garments were helpful. They also noted that eczema severity scores improved for both groups during the trial, so treatment effects may have been masked by "general trial effects."
The authors concluded that while parents may choose to purchase silk garments for their children suffering from eczema, they found "little evidence of clinical or economic benefit" for healthcare providers to recommend this type of treatment to their patients.
This study was supported in part by the University of Nottingham, the National Institute for Health Research Clinical Research Network and the U.K. Dermatology Clinical Trials Network.
Thomas disclosed no conflicts of interest.
One co-author disclosed support from the Wellcome Trust Senior Research Fellowship in Clinical Science.
- Reviewed by F. Perry Wilson, MD, MSCE Assistant Professor, Section of Nephrology, Yale School of Medicine and Dorothy Caputo, MA, BSN, RN, Nurse Planner