Action of a silk fabric treated with AEGIS TM in children with atopic dermatitis:A3-month trial
Atopic dermatitis is a common,chronic or chronically relapsing,inflammatory skin disor-der.Despite many reports that immunological disturbances contribute to many manifestations (1,2),the pathogenesis is still unclear.However, the clinical manifestations of atopic dermatitis em to depend on a complex inter-relationship among morphologicalfindings and immuno-logical,genetic,physiological and pharmaco-logical factors.
In addition,abnormal bacterial colonization, in particular with Staphylococcus aureus,of the atopic skin has been described as an important factor to maintain skin eruptions in atopic dermatitis(3,4).Systemic antibiotics are often ud in short-term therapy to treat atopic dermatitis,with good results to controlflares. Occasionally,long-term systemic antibiotics are beneficial,but they often lect for methicillin-resistant strains.
Nonetheless,despite immunological factors and bacterial colonization contributing to worning of the skin symptoms in atopic dermatitis,an important factor–but often
Koller DY,Halmerbauer G,Bo ck A,Engstler G.Action of a silk fabric treated with AEGIS TM in children with atopic dermatitis:a3-month trial.
Pediatr Allergy Immunol2007.
小学三年级同步英语
Ó2007The Authors
Journal compilationÓ2007Blackwell Munksgaard
Irritation of the skin of patients with atopic dermatitis by contact with roughfibres of synthetic or woollen clothes is well known.Therefore,it has been recommended that patients should wear cotton clothes. However,cotton also consists of roughfibres able to irritate the skin, whereas silk is characterized by smoothfibres without irritating potential.The aim of our study was to evaluate the clinical effect of DermasilkÒ–a special silk fabric(ricin-free silk treated with AEGIS AEM5772/5which has antibacterial properties)–in children with atopic dermatitis.A total of22children with mild-to-moderate atopic dermatitis were recruited for a study period of3months.All of them received three different tube-fabrics–Dermasilk,ricin-free silk fabric without AEGIS AEM5772/5and cotton,covering the cubital region. Patients were advid to wear the Dermasilk fabric all day long during the whole study period on one arm,whereas the ricin-free AEGIS-free silk tube had to be ud during thefirst2wk only on the other arm followed by the u of the cotton tube for the rest of the study period. Evaluation of the local SCORAD score was carried out at the beginning of the stud
y,after2,4,8and12wk.A significant reduction of the local SCORAD index of the Dermasilk covered arm was obrved after4,8 and12wk in comparison with the cotton-covered arm score[median (quartile1–quartile3)]6.5(5–8)vs.8(7–9),p<0.002;6(5.25–7.75)vs. 8(7–9),p<0.0001;and6(5–6)vs.8(7.25–10),p<0.0001.The u of Dermasilk has a significant beneficial effect in atopic dermatitis becau of the non-irritating properties of silk as well as the antibacterial capacity of AEGIS AEM5772/5.D.Y.Koller,G.Halmerbauer,A.Bçck and G.Engstler
Paediatric Ambulatory Care Unit,Department
of Paediatrics,Medical University Vienna,Vienna, Austria
Key words:atopic dermatitis;silk;quaternary ammonium compound;antibacterial properties Dieter Koller,Paediatric Ambulatory Care Unit, Department of Paediatrics,Medical University Vienna,Währinger Gürtel18-20,A-1090Vienna, Austria
Tel.:+431404003229
Fax:+431404003238
E-mail:dieter.koller@meduniwien.ac.at Accepted26October2006
Pediatr Allergy Immunol2007
DOI:10.1111/j.1399-3038.2006.00511.x
pkm
Ó2007The Authors
Journal compilationÓ2007Blackwell Munksgaard PEDIATRIC ALLERGY AND
IMMUNOLOGY
underestimated–is the u of clothing mater-ial.It is accepted that the u of wool or synthetic acrylic clothing results in worning of itching and skin eruptions in atopic derma-titis.Subjects with atopic dermatitis are thus advid to wear cotton fabrics.However, microscopic examination demonstrated also a harshfibre,whereas in contrast silk is shaped like a cylinder without any skin-irritating properties.Silk contains two major proteins–fibroin and ricin.The latter protein has been assumed to be responsible for skin irritation and allergies(5).Therefore,in an attempt to reduce the skin-irritating or-nsitising potency of silk,a ricin-free silk product has been developed.To combine the skin non-irritating properties of this silk product with antibacterial qualities,it has been treated with AEM5700/ 5772(3-trimethylsilylpropyl-dimethyloctadecyl ammonium chloride),also called AEGIS TM
(AEGIS Environments,Laboratory and Tech-nical Services,MI,USA)which is registered as DermasilkÒ.AEGIS TM is a quaternary ammonium compound ud on textiles(cot-ton/polyester sheeting,carpeting and throw rugs,outerwear fabrics,underwear,nylon hosi-ery,mattress ticking andfilter fabrics)demon-strating antibacterial and antifungal properties (6).Action against many bacteria has been described,especially against S.aureus,but normal skinflora appears to be unaffected (6).AEGIS TM acts by destruction of the bacterial cell membrane via ion exchange.
We investigated in a3-month trial whether Dermasilk is able to control skin manifestations in children with atopic dermatitis.
Materials and methods
Patients
This is a blinded randomized study of efficacy in children with atopic dermatitis,which compared DermasilkÒ(e below)and cotton wool fabrics.
A total of22children(11males,11females;age: mean8.1yr,range5–12yr)with mild-to-mod-erate atopic dermatitis,diagnod according to the criteria of Hanifin&Rajka(7)were enrolled. PatientsÕand parental agreement were obtained in all cas.
The patients were randomized by age group and by dia verity.During the whole study period,only systemic antihistamines and emollients were allowed.Exclusion criteria were the u of topical or systemic antibiot-ics and also the u of anti-inflammatory agents.Asssment of dia verity
The verity of local skin cubital region)was measured by a modified SCORAD index(8)before starting(visit1),after 2(visit2),after4(visit3),after8(visit4)and after12(visit5)weeks.
The highest intensity score(including ery-thema,papulation,exsudation,abrasions,lichen-ification and xerosis)was18and the highest subjective score was10.
The investigator performing the clinical exam-ination did not know which arm had been covered by DermasilkÒ.Clinical evaluations were carried out always by the same medical blinded doctor.
Study design
sunbelt
Patients received differentÔarm tubesÕ–cotton, silk and DermasilkÒ–fabric(kindly provided by AL.PRE.TEC.;S.Dona di Piave,Venice,Italy) from an unblinded investigator.For thefirst 2wk of the study,parents were advid to dress one arm of their children with the simple silk fabric and the other
one with the DermasilkÒfabric.After2wk–throughout the rest of the study–one arm had to be covered with the cotton and the other with the DermasilkÒtube. Parents were instructed of the characteristics of DermasilkÒas well as the importance of dressing the arms all day long for the whole study period.In addition,parents were advid to wash the tubes daily.
Statistical analysis
Results are prented as median(quartile1–quartile3),unless stated otherwi.Differences were detected by the Wilcoxon signed rank test and the two-tailed paired T-test.
The level of significance was considered at the fifth percentile.
Results
During the whole study period,none of the patients ud antibiotic or anti-inflammatory agents–neither topically nor systemically.In addition,no adver reaction to DermasilkÒwas reported or obrved.
Clinical evaluation
goldrush
At the beginning of the study,both intensity and subjective scores of both cubital areas were statistically not different(Tables1and2).After
Koller et al.
2wk,the intensity score of the DermasilkÒ-cov-ered area significantly decread(p<0.05; Fig.1;Tables1and2),whereas the subjective score did not change(Fig.2;Tables1and2). However,changes were not significant when compared with the simple silk or cotton covered arm.Nonetheless,significant clinical improve-ment was obrved within and between the DermasilkÒ-and cotton-covered arms after4,8 and12wk(Figs1and2;Tables1and2).
Discussion
Our study demonstrated a significant clinical improvement of mild-to-moderate atopic derma-titis by covering affected skin areas with Derma-silk which prents thefirst silk product successfully covered with AEGIS TM.This is in agreement with a short-term(1wk)study(9),the positive effect of DermasilkÒ.
Natural silk–creted by the silk worm–consists of a single-thread silk that is increasingly ud in the
www comap com
treatment of skin disorders becau of its unique properties,like its smoothness.How-ever,natural silk contains the protein ricin that posss a high nsitizing capacity(10).
It has been demonstrated that clothes made of softened fabrics have a beneficial effect on the skin of atopic dermatitis patients(11).Moreover, silk-covered wounds healed faster than non-silk-covered skin areas,which has been explained by the fact that silk enhances collagen synthesis and reduces inflammatory process(12).Usual silk fabrics ud for clothes are not recommended for dressing of subjects with atopic dermatitis,as the fabrics reduce transpiration and therefore may cau worning of dia activity. DermasilkÒis a new silk fabric of high quality characterized by being ricin-free–as certified
Table1.Intensity score after2,4,8and12wk in22children with atopic dermatitis.Results are prented as median(quartile1–quartile3)
Dermasilk-covered
arm
Simple
silk/cotton-covered arm p-value
Week09(8–12)9.5(8.25–11.5)0.355 Week27.5(6–9)8(6.25–9.75)0.274 Week4 6.5(5–8)8(7–9)0.002 Week86(5.25–7.75)8(7–9)0.0001 Week126(5–6)8(7.25–10)0.0001 Table2.Subjective score after2,4,8and12wk in22children with atopic dermatitis.Results are prented as median(quartile1–quartile3)
Dermasilk-coveredstumble
arm
Simple
silk/cotton-covered arm p-value
Week05(4–7)5(5–7)0.427 Week25(4–5)4(4–5)0.051 Week44(2.25–4) 5.5(5–6.75)0.0002 Week83(2–4) 5.5(5–6)0.0001 Week123(2–4)6(5–7.75)0.0001
Effect of DermasilkÒin children with atopic dermatitis
by the Stazione Sperimentale per la Seta Milano (9)–to reduce any nsitizing properties of silk. In addition,this silk fabric allows not only adequate skin breathing but also absorption of sweat,which is
important to maintain the water balance of the skin.Furthermore,DermasilkÒis treated with AEM5700/5772(3-trimethylsilyl-propyl-dimethyloctadecyl ammonium chloride), also called AEGIS TM,which is a quaternary ammonium compound.Until now,AEGIS has been ud on other textiles,like cotton/polyester sheeting,carpeting and throw rugs,outerwear fabrics,underwear,nylon hosiery,mattress tick-ing andfilter fabrics.Antibacterial and antifun-gal capacity of quaternary ammonium compounds is known since approximately50yr (6).As many patients with atopic dermatitis are colonized with S.aureus(3),it might be specu-lated that the beneficial effect of DermasilkÒin our study is also becau of the antibacterial properties of AEGIS TM,despite its skin non-irritating properties.
Silk allergy has been reported,especially in silk workers,which is caud by ricin,as we also focud on adver reaction to DermasilkÒ. However,in previous studies,as also in our study,no adver effects were obrved or reported by the parents.We also demonstrated that the effectiveness of DermasilkÒis not reduced by laundering,although the tubes were washed daily.However,according to the manu-facturer’s instructions,the garments must be worn all day long.
In conclusion,DermasilkÒis uful in the treatment of mild-to-moderate atopic dermatitis in children.The effectiveness is becau of the characteristics of this new fabric:(i)smoothness without
skin-irritation,(ii)no nsitizing capa-city becau of it being ricin-free,(iii)mainten-ance of water balance of the skin and absorption of sweat and(iv)antibacterial and antifungal properties becau of the water-resistant treat-ment with AEGIS.Furthermore,the effect of DermasilkÒin vere atopic dermatitis and also its potential anti-inflammatory agents-sparing effect need to be evaluated.
Acknowledgment
We extend our thanks to AL.PRE.TEC.,S.Dona di Piave, Venice,Italy as well as to Menzl GesmbH,Vienna,Austria for providing cotton,silk and Dermasilk fabrics.
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夏虫岂可语冰
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