Fabric Preferences of Atopic Dermatitis Patients

W. Elliot Love; Susan T. Nedorost


Dermatitis. 2009;20(1):29-33. 

In This Article

Abstract and Introduction


Background: Atopic dermatitis (AD) patients have sensitive skin with impaired barrier function. Lyocell is a cellulosic fiber that offers unique characteristics and may be suitable for use by AD patients.
Objective: To compare preferences of subjects with atopic dermatitis and normal skin for 100% lyocell clothing and bedding versus 100% cotton fabrics.
Methods: Thirty subjects were enrolled and randomly selected to use cotton or lyocell shirts, pajamas, and bedding for 1 week. Following a 1-week washout period, participants wore the other fabric for 1 week. At the end of each week, participants completed a preference questionnaire, and AD subjects also rated daily itching on a visual analog scale. A random subset of AD and normal participants underwent measurement of transepidermal water loss (TEWL).
Results: Overall, there was a significant preference for lyocell (vs cotton) for its softness, temperature control, moisture control, and wrinkle resistance. AD subjects did not have stronger fabric preferences than did normal subjects. Although not significant, lower average itching and decreased TEWL were seen in participants while they wore lyocell.
Conclusion: Lyocell is superior to cotton in many performance characteristics and equivalent to cotton for itch reduction. Lyocell is currently available as a beneficial fabric to improve patient comfort.


Atopic dermatitis is a chronic relapsing inflammatory skin condition that usually appears in infancy and is commonly associated with varying combinations of asthma, seasonal allergy, and family history. The etiology of atopic dermatitis is multifactorial and necessitates a variety of treatments aimed at treating the inflammatory skin component coupled with the elimination of triggering factors and the improvement of skin barrier function. Optimal skin barrier function is essential to patients with atopic dermatitis to help prevent exacerbations.

Many different fibers make up textiles, and they can be divided into categories based on their source and composition (Table 1).[1] The effect of textiles on atopic dermatitis (AD) has been evaluated in a small number of studies. Wool has been shown to be irritating to atopic persons and is a minor feature in Hanifin and Rajka's criteria for AD.[2,3] It has also been shown that synthetic fibers such as polyester are irritating to patients with AD and that clothing made with cotton is better tolerated.[4,5]

There have been new advances in using textiles as part of the treatment regimen for AD. DermaSilk clothes (AL.PRE.TEC., S.Dona di Piave, Venice, Italy) are undergarments made of raw silk treated with an antimicrobial finish (AEM 5772, AE6IS, Environmental Management, Millant, MI) that have been shown to decrease the severity of AD.[6,7] In addition, silver-coated textiles have been shown to improve symptoms and decrease the severity of AD.[8,9] Silver absorption through intact skin is minimal, and silver-impregnated textiles are expected to cause less systemic exposure than silver-based burn creams, but long-term safety studies are lacking.[10]

Lyocell (Tencel, Lenzing AG, Lenzing, Austria) is a man-made cellulosic fiber (meaning that it is produced from wood pulp cellulose). Production of lyocell fiber is environmentally sound, and the cellulose polymer is unchanged during processing. The cross section of the fiber is round, and the surface is smooth, which means that the fiber produces fabrics that are soft and smooth. The nanofibrillar structure of lyocell makes it hydrophilic with excellent moisture-wicking capability. Lyocell textiles have been shown to possess excellent comfort and thermoregulatory properties.[11]

The intention of this study was to evaluate the preferences of AD patients for lyocell fabrics versus cotton fabrics and assess how lyocell affects skin barrier function. The study was approved by the University Hospital Case Medical Center Institutional Review Board (#020727).