Antibacterial therapeutic clothing impregnated with chitosan or silver may not improve outcomes in atopic dermatitis

Staphylococcus aureus is a gram-positive bacteria that cause a wide variety of clinical diseases. Infections caused by this pathogen are common both in community-acquired and hospital-acquired settings.

Studies have reported increased Staphylococcus aureus colonisation in patients with atopic dermatitis (AD) is a contributing factor of the disease. Chitosan and silver have been used as antibacterial agents in healthcare, and clothing made with these components is now available to consumers and prescribed to patients.

However Antibacterial clothing impregnated with chitosan or silver is no better than standard therapeutic clothing for reducing atopic dermatitis severity and symptoms, or topical steroid use, reveals a study reported in the British Journal of Dermatology.

Researchers conducted a pragmatic, double-blinded, multicenter, randomized, controlled, trial (NCT04297215) was conducted in patients of all ages with moderate-to-severe AD. Patients were centrally randomized 1:1:1 to receive standard therapeutic clothing, antibacterial clothing based on chitosan or silver. The primary outcome was the between-group difference in Eczema Area and Severity Index (EASI) measured over 52 weeks. Secondary outcomes included patient-reported outcomes, topical corticosteroid use, SA colonization, safety, and cost-effectiveness. Outcomes were assessed by means of (generalized) linear mixed model analyses.

The key findings of the study are

• A total of 171 patients were enrolled. In the analyses 159 patients were included out ofwhich 54 in the standard therapeutic clothing group, and 50 in the chitosan group and 55 in the silver group.

• Adherence was high (median: 7 nights/week, IQR: 3-7). Median EASI scores at baseline, 4, 12, 26 and 52 weeks were in the standard therapeutic clothing group 11.8, 4.3, 4.6, 4.2, 3.6 compared to 11.3, 5.0, 3.0, 3.0, 4.4 in the chitosan and 11.6, 5.0, 5.4, 4.6 and 5.8 in the silver group.

• No differences in EASI over 52 weeks between the standard therapeutic clothing, chitosan (-0.1, 95%CI: -0.3 to 0.2, p=0.53), and silver group (-0.1, 95%CI: -0.3 to 0.2, p=0.58) were found.

• However, a small significant (P=0.035) group-by-time interaction effect between the standard and silver group was found, in which the silver group performed worse after 26 weeks.

• No differences between groups were found in patient-reported outcomes, topical corticosteroid use, SA skin colonization, and healthcare utilization. No severe adverse events or silver absorption were observed.

Researchers concluded that “The results of this study suggest no additional benefits of antibacterial agents in therapeutic clothing in patients with moderate-to-severe AD.”

Reference: Aviël Ragamin, Renske Schappin, Marlies de Graaf, Ron A Tupker, Karin B Fieten, Minke M F van Mierlo, Madelon B Bronner, Geertruida L E Romeijn, Manon M Sloot, Celeste M Boesjes, Lisa van der Rijst, Bernd W M Arents, Thomas Rustemeyer, Marie L A Schuttelaar, Suzanne G M A Pasmans, The effectiveness of antibacterial therapeutic clothing compared with non-antibacterial therapeutic clothing in patients with moderate-to-severe atopic dermatitis: A randomized controlled, observer-blind pragmatic trial (ABC trial), British Journal of Dermatology, 2023, DOI: https://doi.org/10.1093/bjd/ljad437.