Eczema affects a large proportion of children and adolescents in the United States. New research investigates whether silk clothing improves health outcomes for children with eczema.
Eczema - also known as atopic dermatitis - is a chronic dermatological disease that causes the skin to itch and become very dry. Although the condition is not contagious, people with eczema may be vulnerable to other viral and bacterial skin diseases.
Atopic dermatitis affects approximately 30 percent of the U.S. population, according to the National Institutes of Health (NIH). Children and adolescents seem to be particularly at risk of eczema, the NIH report.
Clothing seems to play an important role in the management of the disease. Patients are routinely advised to wear cotton or smooth fabrics and avoid materials such as wool, which may worsen the itching.
Furthermore, in countries such as the United Kingdom, specialist silk clothing is available on prescription for people with eczema.
As a result, a team of researchers from the University of Nottingham in the U.K. - led by Kim Thomas and colleagues - set out to investigate the benefits of wearing silk garments for children with eczema. The study was published in the journal PLOS Medicine.
Studying the therapeutic effects of silk on children with eczema
Thomas and team conducted a randomized, controlled, and observer-blind trial - that is, the nurses who evaluated the patients were unaware of the treatment that the participants were undergoing - and called it the "CLOTHES Trial."
The team recruited 300 children aged between 1 and 15 who received community and secondary care for moderate to severe eczema across five medical centers in the U.K.
Participants were randomized into two groups: one group received standard care for eczema and wore silk clothing, while the other group received standard care alone.
In the first group, the children wore the silk clothing - which was made of 100 percent sericin-free silk - for 6 months. Using the Eczema Area and Severity Index (EASI), the researchers evaluated the severity of eczema at the beginning of the study, and then at 2, 4, and 6 months, respectively.
The researchers adjusted for the children's age and the medical center from which they were recruited.
Silk garments do not improve eczema outcomes, are not cost-effective
Thomas and colleagues averaged the EASI score for the two groups and found no significant difference between them.
Specifically, 25 percent of the children in the silk garments plus standard care group developed skin infections, compared with 28 percent in the group that received only standard care. The small treatment effect was considered insignificant from a statistical and clinical standpoint, as the 95 percent confidence interval varied from 1.5 points in favor of silk garments to 0.5 in favor of standard care alone - a difference too small to be considered relevant.
Additionally, the study found no difference in the quality of life between the two groups.
Furthermore, the researchers calculated the cost of using silk therapeutically per quality-adjusted life year, and they concluded that silk garments are not cost-effective. The computed yearly cost amounted to £56,881, which corresponds to around $70,550.
The researchers explain the significance of the findings:
"The CLOTHES Trial is the first large, independent [randomized, controlled trial] to have evaluated silk garments for the management of eczema. The results of this trial suggest that silk garments are unlikely to provide additional clinical or economic benefits over standard care for children with moderate to severe eczema."
However, the authors also admit a limitation of the study: although using an objective primary outcome measure - namely, the EASI score, assessed by nurses who were blinded to the treatment - minimized detection bias, it may have also ignored changes in symptoms and underestimated the beneficial effects of the treatment.