A review of clothing materials and their effect on eczematous skin
In a society seemingly obsessed with physical appearance, you could be excused for thinking that the sole purpose of clothes is to make a personal fashion statement. But for the adult or child suffering from eczema there is a lot more to clothes than what they look like. The feel of the fabric and its effect on the skin is crucial. The purpose of this article is to provide guidance on appropriate clothing next to the skin for those who suffer from eczema.
Eczema is a recurrent inflammation of the skin that tends to wax and wan. It is extremely itchy, and often associated with dryness and episodes of bacterial infection of the skin. Everyone’s skin has a moderate growth of bacteria, regardless of personal hygiene, and this normally causes no harm. In eczema one of the bacteria, called staphylococcus aureus, grows in large numbers and seems to act as an irritant to the skin. For this reason antibiotics are often used to keep eczema under control as well as moisturisers, steroids and the newer drugs that affect the immune system.
S. aureus is by no means the only aggravating factor in eczema. Others include the climate, stress, and chemicals. One potential irritant that is often overlooked is clothing. If you suffer from eczema, it is important to wear clothing next to the skin which at least does not aggravate the condition, and at best helps to control it.
The basic choice is between synthetic or natural fabrics. Synthetic fabrics are produced by the chemical processing of petroleum. These polyurethrane materials have a number of practical advantages such as stable colouring and durability, but they are not good for eczema. Nylon has been shown in clinical studies to aggravate the condition causing greater discomfort and itch than cotton.
Natural fabrics are derived from plant fibres, eg cotton and linen, or animal fibres, eg wool and silk. The choice between these can be guided by examining their individual properties.
Interestingly, the main constituent of wool is keratin; the same protein that is the main constituent of human skin. But that link does not result in compatibility. Wool fibre has frequently been shown to irritate eczema, and the intensity of itching from wool fibres has been shown to increase in relation to the coarseness of the fibre.
Cotton is currently one of the most commonly recommended fabrics for people with eczema. It is relatively soft and naturally abundant. However, it is prone to infestation by bacteria and fungi, and has a crucial flaw in its structure; it is made up of numerous short stubby fibres. The fibres extend and contract as they absorb moisture or sweat producing an abrasive rubbing movement that can irritate a sensitive skin. Despite these structural drawbacks, cotton is still better than synthetic fabrics or wool in eczema but it is no longer the best.
Natural silk is a single thread produced by the industrious little silkworm. The single thread is made up of a double filament of protein material called fibroin which is glued together by a sticky substance called sericin. This natural silk is woven into the shiny soft fabric that we are all familiar with. However, sericin is a potential irritant to sensitive skin, so normal silk clothing is unsuitable for eczema patients. Silk for medical use, such as wound stitches, is specially treated to remove sericin and this is what has been knitted into a special fabric which has virtually no allergic potential (only one case of allergy has ever been reported). Unlike the short fibres of cotton, each silk thread is made up of many filaments up to 800 metres long. This produces a fabric that is perfectly smooth and does not cause friction on the skin. It also has greater ability to absorb moisture than cotton, and helps to maintain the body temperature by reducing excessive sweating and moisture loss. These properties make this specially treated silk the natural candidate as an eczema-friendly fabric.
An intriguing recent development is the addition of an antibacterial agent to the silk. The technique of treating fabrics in this way has been used for many years to protect operating theatre linen from contamination. In theory, a fabric with antibacterial properties could also be beneficial in eczema in view of the irritant effect of the overgrowth of S. aureus on the skin described above.
Silk verses cotton
In practice, the comparative effect of this special silk clothing (DermaSilk™) versus cotton clothing on eczema has been investigated in a number of clinical studies with results in favour of silk. One study published in the British Journal of Dermatology1 randomly allocated 46 children with eczema to wear silk or cotton clothing next to the skin. The only medication allowed was a moisturising cream. After one week there was a significant improvement of the eczema in the silk group, but no change in the cotton group.
When it comes to choosing what to wear with eczema, fabric not fashion should be the deciding influence. For many years cotton has been recommended but there is now good evidence to suggest that this new specially treated silk is going to be the fabric of choice.
1. Ricci G, Patrizi A, Bendandi B et al. Clinical effectiveness of a silk fabric in the treatment of atopic dermatitis. Br J Dermatol 2004;150:127-131
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Next review: 24 November 2020