Abstract
BackgroundAtopic dermatitis (AD) patients may benefit from using textiles coated with skin microbiome–modulating compounds. Chitosan, a natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful.ObjectiveThis randomized controlled trial assessed the clinical utility of chitosan-coated garment use in AD.MethodsOf the 102 patients screened, 78 adult and adolescents were randomly allocated to overnight use of chitosan-coated or uncoated cotton long-sleeved pyjama tops and pants for 8 weeks. The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD). Other outcomes were changes in quality of life, pruritus and sleep loss, days with need for rescue medication, number of flares and controlled weeks, and adverse events. Changes in total staphylococci and Staphylococcus aureus skin counts were also assessed. Comparisons were made using analysis of variance supplemented by repeated measures analysis for the primary outcome. Interaction term between time and intervention was used to compare time trends between groups.ResultsChitosan group improved SCORAD from baseline in 43.8%, (95%CI: 30.9 to 55.9), P = 0.01, placebo group in 16.5% (-21.6 to 54.6); P = 0.02 with no significant differences between groups; Dermatology Quality of life Index Score significantly improved in chitosan group (P = 0.02) and a significant increase of skin Coagulase negative Staphylococci (P = 0.02) was seen.ConclusionsChitosan coated textiles may impact on disease severity by modulating skin staphylococcal profile. Moreover, a potential effect in quality of life may be considered.Trial RegistrationClinicalTrials.gov NCT01597817
Highlights
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with a considerable social and economic burden
The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD)
Chitosan group improved SCORAD from baseline in 43.8%, (95%CI: 30.9 to 55.9), P = 0.01, placebo group in 16.5% (-21.6 to 54.6); P = 0.02 with no significant differences between groups; Dermatology Quality of life Index Score significantly improved in chitosan group (P = 0.02) and a significant increase of skin Coagulase negative Staphylococci (P = 0.02) was seen
Summary
Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease with a considerable social and economic burden. While several recent studies have reported the utility of functional textiles with antimicrobial and antipruritic properties in AD [7, 8], a recent systematic review and meta-analysis by our group found that the recommendation for its use was weak due to the low quality of supporting evidence [9]. These results underscored the need for studies with improved methodology and new compounds. A natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful
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