Wearing silk clothing offers no additional benefit for children who have moderate to severe eczema, despite previous suggestions to the contrary, according to UK researchers.
Their study found wearing specialist silk garments did not reduce eczema severity, nor did it reduce the amount of creams and ointments used, or the number of skin infections experienced.
“These results provide robust evidence to inform health commissioners and prescribers”
The study authors highlighted that clothing had been thought to play a role in either soothing or making eczema symptoms worse, and specialist clothing was available on prescription in the UK.
Three small clinical trials had also previously suggested that the use of DermaSilk clothing might offer some possible benefits for children with eczema, they noted in the journal PLOS Medicine.
However, these trials were considered insufficient for guiding clinical practice because of limitations in their methodology, prompting the Nottingham study to examine the issue in more detail.
In contrast, the Clothing for the relief of Eczema Symptoms (CLOTHES) study was the first large trial to evaluate silk garments – DermaSilk or Dreamskin – for children with moderate to severe eczema.
“Silk clothing probably does not provide value for money for patients or for the NHS”
The CLOTHEs trial, funded by the National Institute for Health Research, aimed to examine whether adding silk garments to standard eczema care could reduce eczema severity, compared to standard eczema treatment alone, and also looked at whether the use of the silk clothing was cost-effective.
The study took place in five recruiting centres across the UK, and included children aged between one and 15 years of age. The children were randomly given either standard eczema treatment or standard treatment plus the use of silk clothing.
The research involved Nottingham University Hospitals NHS Trust, Cambridge University Hospitals NHS Trust, Royal Free London NHS Foundation Trust, Portsmouth Hospitals NHS Trust, and NHS Tayside’s Ninewells Hospital.
The participants were given either Dermasilk or Dreamskin clothing – the two brands of garments available on prescription at the time the trial was designed.
Both are made with antimicrobially-protected, knitted, sericin-free 100% silk. The participants were given three sets of long-sleeved vest and leggings – or body suits and leggings depending on age – and were instructed to wear the clothing as often as possible during the day and night.
All the children continued with their regular use of emollient creams and topical corticosteroids for controlling inflammation, and were asked not to change their standard treatment during the trial.
The participants’ skin was assessed by nurses every two months using the Eczema Area and Severity Index (EASI).
The nurses were trained in how to make the assessments reliably and did not know which group the children had been allocated to.
In addition to the main outcome measurement of EASI, the trial also assessed eczema symptoms, use of creams and ointments, quality of life and the number of skin infections and admissions.
Use of the garments was good, said the researchers, with 82% of the participants wearing them for at least 50% of the time, although the clothing was worn more often at night than during the day.
However, the trial found no difference between the groups in eczema severity, quality of life and use of medications. The number of skin infections and admissions due to eczema were also similar.
When asked to monitor the severity of their symptoms weekly, those using the silk reported small improvements, but these were small and unlikely to be clinical meaningful, said the study authors.
Meanwhile, at the time the research was commissioned, £840, 272 was spent on prescriptions for silk garments per year in the UK, rising to more than £2m by 2014.
Silk clothing ‘offers no benefit for children with eczema’
The CLOTHES study found that the average cost of garments for six months was £318.52 per participant and was not offset by a reduction in other healthcare costs, such as prescriptions.
Overall the trial concluded that using silk garments for the management of eczema is unlikely to be cost-effective for the NHS.
Lead study author Professor Kim Thomas, from the University of Nottingham, noted that “some may find these results disappointing”.
“Unfortunately, this trial suggests that silk clothing probably does not provide value for money for patients or for the NHS,” she said.
But she added: “These results provide robust evidence to inform health commissioners and prescribers in making informed clinical decisions about the treatment of their patients.”