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Clinical effectiveness of silk fabric in the treatment of atopic dermatitis
Abstract
In children with atopic dermatitis (AD), eczema is easily aggravated by contact with irritant factors (e.g. aggressive detergents, synthetic and woollen clothes, climatic factors).
To evaluate the effectiveness of a special silk fabric (MICROAIR DermaSilk) in the treatment of young children affected by AD with acute lesions at the time of examination.
Forty-six children (mean age 2 years) affected by AD in an acute phase were recruited: 31 received special silk clothes (group A) which they were instructed to wear for a week; the other 15 served as a control group (group B) and wore cotton clothing. Topical moisturizing creams or emulsions were the only topical treatment prescribed in both groups. The overall severity of the disease was evaluated using the SCORAD index. In addition, the local score of an area covered by the silk clothes was compared with the local score of an uncovered area in the same child. All patients were evaluated at baseline and 7 days after the initial examination.
At the end of the study a significant decrease in AD severity was observed in the children of group A (mean SCORAD decrease from 43 to 30; P = 0.003). At the same time, the improvement in the mean local score of the covered area (from 32 to 18.6; P = 0.001) was significantly greater than that of the uncovered area (from 31 to 26; P = 0.112).
The use of special silk clothes may be useful in the management of AD in children.
... Its pathophysiology comprises immunological deregulations such as Th1/Th2 dysbalance and interleukin 31 as a key pruritic skin factor, leading to defects in skin barrier function like reduced water retention [3,4]. The complex network of immunological deregulations may also explain the high rate of cutaneous colonization with Staphylococcus aureus (up to 90% in moderate to severe eczema) and Staphylococcus epidermidis in AD [5][6][7]. Only S. aureus is able to produce virulence factors such as super-antigens and therefore exacerbates the skin inflammation [8]. ...
... To objectively measure the potential antibacterial efficacy of antibacterial fabrics against a S. aureus strain, 5 commercial clothes were enrolled that have documented clinical benefits in treating atopic dermatitis in published reports: Sample #1 (Lyo-Zinc): Benevit Zinc+ (Benevit Van Clewe, Dingden, Germany) which consists of 74% lyocell, 19% SmartCell sensitive fibre, and 7% spandex [16]. Sample #2 (Silk-Aegis): Microair Dermasilk, a pure form of silk consisting exclusively of fibroin and containing a finish of AEGIS AEM 5772/5, an insoluble colorless, odorless ammonium as antibacterial agent [5,13]. Sample #3 (PA-Silver): Padycare (Texamed, Ismaning, Germany), a micromesh material of 82% polyamide, 18% lycra with woven silver filaments with a silver content of 20% in total (130 g/m 2 ) [12]. ...
... For the five selected antibacterial clothes, a total of ten clinical studies concerning treatment of AD were found [5,12,13,15,16,[29][30][31][32][33]. These reports investigated as main endpoint the colonisation with S. aureus by swabbing the skin at affected skin sites of AD patients before and after the application of the clothes. ...
Background:
Antibacterial clothes are classified as a complementary treatment in line with antisepsis, although meta-studies are unable to find significant improvements of eczemas.
Methods:
The antibacterial effectiveness of conventional AD clothes was compared across each other by (i) standard suspension tests for the appraisal of antibacterial products and (ii) a real-life setup of affected AD skin using S. aureus colonised artificial skin, to assess if functional clothes are effective under practical wear conditions. Additionally, the interaction of the fibre types with a moisturising cream was evaluated during a real wearing situation and after domestic laundry.
Results:
In the real-life setup simulating dry skin microenvironment, all samples failed to reduce S. aureus. Silver and zinc-fabrics showed a slight activity only under unrealistic moist conditions. When using standard suspension tests, samples differed considerably in their antibacterial effectiveness, where silver and zinc endowed fibres outperformed AEGIS endowed silk fabrics. Garments absorbed the cream dependent on the particular fibre types. Furthermore, domestic laundry was unable to completely remove the cream.
Conclusion:
Considerable differences in the antibacterial effectiveness of conventional AD clothes were revealed. Under practical (dry) wear conditions, garments were unable to modify skin colonization with S. aureus, although effectiveness can be triggered by wetting the garments. Remnants of moisturising cream remain on the fibres after laundry.
... DermaSilk™ is classified as medical device of Class I and it is reported to be effective in treating several skin conditions that ranges from mild to serious. Several studies were reported in literature on the use of DermaSilk in applications including but not limited to the treating of atopic dermatitis [123,[257][258][259][260][261][262], acne Table 4 Clinical trial on Bombyx mori silk medical devices reported by the FDA (clinicaltrial.org). The state of the study recruitment is encoded as follows: Active Recruiting (A-R), Active Not Recruiting (A-NR), Recruiting Completed (C), Recruiting Terminated (T), Recruiting Unknown (U), Recruiting Withdrawal (W). ...
... While for the other dermal conditions the literature positively evaluate the use of DermaSilk™ in case of atopic dermatitis the literature results seem to be not coherent. While some studies shown an effective decrease of the SCORAD index (an index use to score the atopic dermatitis) in the group waring DermaSilk™ [257,258] even in comparison with similar fabrics without the AEGIS treatment (also in term of pruritus) [258] and in long double-blinded trial (90 days) [261], an independent study on a larger number of children (almost 300) didn't find evidence of difference between DermaSilk™ and other two fibroin made garments and only a small benefit in comparison with the conventional treatment. It should be noticed that in contrast with the other studies, in which the comparison between different garments were made without a topic treatment, in this last case the silk garments were applied in addition to the conventional therapy and a control with the application of the sole fibroin garments was missing [260]. ...
Silk fibroin has become a prominent material in tissue engineering (TE) over the last 20 years with almost 10,000 published works spanning in all the TE applications, from skeleton to neuronal regeneration. Fibroin is an extremely versatile biopolymer that, due to its ease of processing, has enabled the development of an entire plethora of materials whose properties and architectures can be tailored to suit target applications. Although the research and development of fibroin TE materials and devices is mature, apart from sutures, only a few medical products made of fibroin are used in the clinical routines. <40 clinical trials of Bombyx mori silk-related products have been reported by the FDA and few of them resulted in a commercialized device. In this review, after explaining the structure and properties of silk fibroin, we provide an overview of both fibroin constructs existing in the literature and fibroin devices used in clinic. Through the comparison of these two categories, we identified the burning issues faced by fibroin products during their translation to the market. Two main aspects will be considered. The first is the standardization of production processes, which leads both to the standardization of the characteristics of the issued device and the correct assessment of its failure. The second is the FDA regulations, which allow new devices to be marketed through the 510(k) clearance by demonstrating their equivalence to a commercialized medical product. The history of some fibroin medical devices will be taken as a case study. Finally, we will outline a roadmap outlining what actions we believe are needed to bring fibroin products to the market.
... Wounds covered with silk healed faster than those not covered, which can be explained that silk increases collagen production and reduces inflammation (Howells et al., 2018;Koller et al., 2007). Silk film can improve collagen synthesis, reduce eczema and scarring caused by inflammatory responses, and promote epithelialization when used as a skin dressing (Ricci et al., 2004;Stinco et al., 2008; Table 2). ...
... Continuous treatment while simultaneously reducing the risk of infection is possible by using silk-based films infused with drugs (Jao et al., 2017;Pham & Tiyaboonchai, 2020). Moreover, in preclinical animal models of breast cancer and neuroblastoma, anti-cancer drug delivery systems based on silk films, foams, and self-assembling silk hydrogels showed promising results (Howells et al., 2018;Ricci et al., 2004;Wang et al., 2006). While the delivery of active pharmaceutical ingredients is well understood, the delivery of living cells as therapies is more challenging due to the need to ensure that the cells remain viable and can perform their intended functions. ...
Silk worm (Bombyx Mori) protein, have been considered as potential materials for a variety of advanced engineering and biomedical applications for decades. Recently, silkworm silk has gained significant importance in research attention mainly because of its remarkable and exceptional mechanical properties. Silk has already been shown to have unique interactions with cells in tissues through bio-recognition units. The natural silk contains fibroin and sericin and has been used in various tissues of the human body (skin, bone, nerve, and so on). Besides, silk also still has anti-cancer, anti-tyrosinase, anti-coagulant, anti-oxidant, anti-bacterial, and anti-diabetic properties. This article is supposed to describe the diverse biomedical capabilities of Bombyx Mori silk as the appropriate biomaterial among the assorted natural and artificial polymers that are presently accessible, and ideal for usage in regenerative medicine fields.
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... Application of silk is well-known in textile industries as a clothing material. Special silk clothing with the product name MICROAIR DermaSilk® was examined in a clinical study for the treatment of atopic dermatitis in 31 young children (mean age 2 years) [256] . Kids suffering from atopic dermatitis with acute lesions showed better outcomes with significant decrease in the severity of lesions after 7 days. ...
... Kids suffering from atopic dermatitis with acute lesions showed better outcomes with significant decrease in the severity of lesions after 7 days. The study conducted in comparison with cotton clothes indicated that silk material could be a better clothing option in such conditions, especially for children [256] . ...
Silk biomaterials are known for biomedical and tissue engineering applications including drug delivery and implantable devices owing to their biocompatible and a wide range of ideal physico-chemical properties. Herein, we present a critical overview of the progress of silk-based matrices in skin regeneration therapeutics with an emphasis on recent innovations and scientific findings. Beginning with a brief description of numerous varieties of silks, the review summarizes our current understanding of the biological properties of silk that help in the wound healing process. Various silk varieties such as silkworm silk fibroin, silk sericin, native spider silk and recombinant silk materials have been explored for cutaneous wound healing applications from the past few decades. With an aim to harness the regenerative properties of silk, numerous strategies have been applied to develop functional bioactive wound dressings and viable bio-artificial skin grafts in recent times. The review examines multiple inherent properties of silk that aid in the critical events of the healing process such as cell migration, cell proliferation, angiogenesis, and re-epithelialization. A detailed insight into the progress of silk-based cellular skin grafts is also provided that discusses various co-culture strategies and development of bilayer and tri-layer human skin equivalent under in vitro conditions. In addition, functionalized silk matrices loaded with bioactive molecules and antibacterial compounds are discussed, which have shown great potential in treating hard-to-heal wounds. Finally, clinical studies performed using silk-based translational products are reviewed that validate their regenerative properties and future applications in this area. Statement of Significance The review article discusses the recent advances in silk-based technologies for wound healing applications, covering various types of silk biomaterials and their properties suitable for wound repair and regeneration. The article demonstrates the progress of silk-based matrices with an update on the patented technologies and clinical advancements over the years. The rationale behind this review is to highlight numerous properties of silk biomaterials that aid in all the critical events of the wound healing process towards skin regeneration. Functionalization strategies to fabricate silk dressings containing bioactive molecules and antimicrobial compounds for drug delivery to the wound bed are discussed. In addition, a separate section describes the approaches taken to generate living human skin equivalent that have recently contributed in the field of skin tissue engineering.
... knitted silk; cotton, with or without silver enrichment) may reduce the skin irritation [3,243]. Soft fabrics reduce friction, have transpiring properties and allow the absorption of sweat and exudates, which are important in maintaining the hydrolipidic film of the skin [244]. The effectiveness of Dermasilk®, a new knitted silk fabric with antimicrobial properties, has been evaluated in a very limited number of controlled clinical trials. ...
... The effectiveness of Dermasilk®, a new knitted silk fabric with antimicrobial properties, has been evaluated in a very limited number of controlled clinical trials. The studies have shown encouraging results, with improvement of clinical scores and reduction of disease recurrence during the maintenance phase [244][245][246][247]. In a study of Gauger et al. [248], tissues enriched with silver also were effective in improving AD symptoms within 2 weeks of use. ...
The Italian Consensus Conference on clinical management of atopic dermatitis in children reflects the best and most recent scientific evidence, with the aim to provide specialists with a useful tool for managing this common, but complex clinical condition. Thanks to the contribution of experts in the field and members of the Italian Society of Pediatric Allergology and Immunology (SIAIP) and the Italian Society of Pediatric Dermatology (SIDerP), this Consensus statement integrates the basic principles of the most recent guidelines for the management of atopic dermatitis to facilitate a practical approach to the disease. The therapeutical approach should be adapted to the clinical severity and requires a tailored strategy to ensure good compliance by children and their parents. In this Consensus, levels and models of intervention are also enriched by the Italian experience to facilitate a practical approach to the disease.
... Récemment, des bandages protecteurs en soie ont été mis sur le marché. Ceux qui sont tricotés plutôt que tissés (DermaSilk ® , DolcePharma) ont l'avantage d'être extensibles, élastiques et aérés (33). Ils peuvent être utilisés comme pyjama ou comme sous-vêtement *. ...
... En plus de ses qualités tribologiques, les bandages DermaSilk ® possèdent une activité antibactérienne et anti-fongique par l'incorporation d'un antiseptique (Aegis ® ) fixé aux fils de soie(33). Le staphylocoque doré et les levures du genre Malassezia sont inhibés par le contact avec le textile. ...
... These systems include fi ber-based materials. [ 112,[140][141][142][143] Silkbased BTFIs used in the operating theatre include surgeon's gowns, caps and masks, patient drapes, and cover cloths of various sizes. The advantages of silk-based BTFIs include softness, biocompatibility, mechanical performance, and multi-functions such as antibacterial properties of the silk fabric. ...
... • Tracheal/esophagus/bowel Extracorporeal implants Artifi cial kidneys/lungs Silk fi lm from B. mori SF Silk-polylysine block copolymers with plasmid DNA Non-woven/weft knitting/warp knitting/ woven/braiding/textile fi nishing SF fi nishing agents; coated with antimicrobial substances[112,[140][141][142][143] ...
Biomedical textiles and fiber-based implants (BTFIs) have been in routine clinical use to facilitate healing for nearly five decades. Amongst the variety of biomaterials used, silk-based biomaterials (SBBs) have been widely used clinically viz. sutures for centuries and are being increasingly recognized as a prospective material for biomedical textiles. The ease of processing, controllable degradability, remarkable mechanical properties and biocompatibility have prompted the use of SBBs for various BTFIs for extracorporeal implants, soft tissue repair, healthcare/hygiene products and related needs. The present Review focuses on BTFIs from the perspective of types and physical and biological properties, and this discussion is followed with an examination of the advantages and limitations of BTFIs from SBBs. The Review covers progress in surface coatings, physical and chemical modifications of SBBs for BTFIs and identifies future needs and opportunities for the further development for BTFIs using SBBs.
© 2015 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.
... 1,7 Traditionally, cotton and silk are recommended for AD patients. 4,8 However, in recent years, many manufactured fibers have been developed, and many reports on functional clothing have been published. 5 For example, a randomized, single-blind, controlled trial comparing the effects of silver-loaded seaweedbased cellulose fiber (SeaCell ® Active) T-shirts with cotton Tshirts found a significant reduction in Staphylococcus aureus colony formation in those wearing the silver T-shirts. ...
Objectives
Atopic dermatitis (AD) is aggravated by various factors, including perspiration and heat. Thus, it is recommended that AD patients wear breathable clothing to maintain disease remission. Japan has four seasons, so the ideal clothing for individuals with AD may differ throughout the year. The aim of this study was to evaluate the impact of wearing a newly developed performance fabric, named the Comfiknit Atopic Eczema ® T‐shirt, which absorbs excess perspiration from the skin surface and retains moisture within the fabric. We evaluated the effects of the T‐shirts on the clinical characteristics of AD and compared the effects in summer and winter.
Methods
Ten adult outpatients with AD took part in an open‐label pilot study for 4 weeks during the summer and for 4 weeks during the winter. The Eczema Area and Severity Index (EASI), the Patient‐Oriented Eczema Measure (POEM), the itch Visual Analogue Scale (VAS), the stratum corneum water content (SCWC), skin pH, and skin bacterial cultures were evaluated. A Treatment Satisfaction Questionnaire for Medication‐9 (TSQM‐9) was filled out only after the intervention.
Results
The mean EASI, POEM, and itch VAS scores in both summer and winter fell after wearing the Comfiknit Atopic Eczema ® T‐shirts, whereas the SCWC increased. There was no significant difference in the skin surface pH or bacterial cultures before and after the intervention.
Conclusions
Wearing Comfiknit Atopic Eczema ® T‐shirts helped to prevent exacerbation of AD in summer and winter. Thus, wearing T‐shirts made from performance fabric may help to maintain skin homeostasis.
... Within a very short period of time, the combination of load bearing capability and tensile strength of non-mulberry silk has been equally envisioned for bone, cartilage, adipose, and other tissue regeneration. Scientific exploration of non-mulberry silk in tissue engineering, regenerative medicine, and biotechnological applications promises advancement of sericulture industries [5,6,7]. Decorative patterns of clothing silk fabrics in the Qing Dynasty have been described in detail by Herbert [8]. ...
t: The Tasar silk Industry has proved its potential in raising sustainable income and employment in the rural sector of Jharkhand State (India) and is a growing activity in the primary sector which aims more income to the artisans and workers of this industry. This paper entitles an artisanal industry that concentrates on the study regarding the impact of technologies on sericulture in selected area. Sericulture is an agro-industrial activity aiming to produce silk though rearing of silkworm. It involves the raising of food plants (Terminalia arjuna, Terminalia tomentosa, Shorea robusta etc) for silkworm, rearing of silkworm for production of cocoons, reeling and spinning of cocoons for production of yarn for value added benefits such as processing and weaving. The knowledge of technology has found to have greater impact on improving the productivity, production and manufacturing of Tasar Silk Fabric in terms of agriculture as well as its allied activities. This study finds out significant positive impact of knowledge about advanced technology and its adoption on the development of the sector by the artisans so that the Tasar Silk Garment Industry grows and benefit its stakeholders
... In the literature, more attention is focused on the proper selection of raw materials for clothes for premature babies to eliminate irritating and allergic effects [18], as well as the proper design of clothes guaranteeing the child's safety and manageability during medical procedures. The literature shows that seams should be flattened and delicate, all fasteners that facilitate dressing and undressing should be placed on the side or in the front of the product, and clothes should not contain tags and labels, as they may cause skin irritation. ...
Preterm infants, due to immature and dysfunctional skin, have increased water loss through the skin and consequently a decreased body temperature. In order to develop protective garments for preterm infants, it is important to select materials that will protect the child against water and heat loss. The authors are currently involved in the development of protective garments for premature babies, which are similar to baby clothes and contain a membrane that is partially permeable for vapor in combination with textile materials. This article presents the study of materials intended for the production of protective garments for pre-term infants. Samples of materials were investigated to determine biophysical comfort (tests of heat resistance, vapor resistance according to PN-EN ISO 11092:2014-11 and air permeability according to PN-EN ISO 9237) and porosity, surface mass in accordance with PN-EN 12127, and thickness in accordance with PN-EN ISO 5084. In order to determine the porosity of materials and to visualize the structure, tests on computer microtomography were carried out. The mechanical properties of the tested materials and the evaluation of the total hand value were characterized; the samples were tested on the KES device. The aim of this study was to select the most suitable fabrics for protective garments for premature infants to prevent excessive heat and moisture loss from the body, which can lead to hypothermia. For laminates, the optimal results of vapor resistance and heat resistance were obtained for laminate (15 g·m−2 PE foil + 15 g·m−2 PP non-woven), with a level of thermal resistance of 0.0766 m2·K·W−1 and vapor resistance of 188.729 m2·Pa·W−1, and for laminate (15 g·m−2 PE foil + 10 g·m−2 PP non-woven), with a level of thermal resistance of 0.0683 m2·K·W−1 and vapor resistance of 164.085 m2·Pa·W−1. For knitted fabrics, knitwear single cotton 155 g·m−2 showed the highest thermal resistance (0.0296 m2·K·W−1), and knitwear interlock polyester 120 g·m−2 showed the lowest thermal resistance (0.0179 m2·K·W−1). Knitwear cotton 120 g·m−2 had the highest water vapor resistance (8.402 m2·Pa·W−1), while knitwear interlock polyester 130 g·m−2 sample had the lowest resistance (6.356 m2·Pa·W−1). Garments for premature babies should have moisture barrier properties and high thermal insulation. They should also be characterized by optimal air permeability properties. Sample two-layer laminate (15 g·m−2 PE foil + 15 g·m−2 PP non-woven) had the best vapor resistance and thermal insulation properties. Moreover, this sample was characterized by good air permeability and surface weight compared to the other laminate samples. During the design of garments for premature babies, it is important to reduce the surface weight to as low as possible. Among the knitted fabrics, a knitwear single cotton 120 g·m−2 knitwear polyester interlock 120 g·m−2 was selected for having the best THV or tactile comfort. In addition, these knits were chosen for their lower surface weight. Based on the conducted tests, two-layer laminate (15 g·m−2 PE foil + 15 g·m−2 PP non-woven), the knitwear single cotton 120 g·m−2, and knitwear polyester interlock 120 g·m−2 were selected for further research.
... It is important to study the physical and mechanical properties, chemical properties and application of natural silk fibroin. Today, various preparations based on natural silk fibroin have been developed and used in many fields [2][3][4][5][6]. Natural silk fibroin has sorbent properties, and its sorbent properties have been studied. ...
Natural silk is a very expensive material for the textile industry. Silk mills produce large amounts of fibrous waste from natural silk. It is very important to prepare the necessary materials for industry from the fibrous waste of silk. We obtained a multifunctional sorbent from silk fiber waste by various methods to purify vegetable oils. The resulting sorbent was used to purify cottonseed oil instead of bentonite-based sorbents. As a result of the purification of cottonseed oil using sorbent samples from silk fiber waste, we were able to reduce the oil peroxide value from 11 mmol/L to 3,9 mmol/L. Reducing the peroxide value of vegetable oils increases the shelf life of vegetable oils. It is possible to reuse 2-3 times in the purification of vegetable oils by reactivating the sorbent obtained from the fibrous waste of silk, and the sorbent does not affect the composition of the oil, even if it is in the oil environment for a long time. A sorbent derived from the fibrous waste of silk we recommend is used to reduce the waste of silk mills and oil mills.
... Several but similar randomized controlled trials have compared fabrics enriched with quaternary ammonium (MICROAIR DermaSilk ® AlPreTec Srl, San Donà di Piave, Italy) vs untreated cotton or silk fabrics, in pediatric patients with mild to moderate AD [123][124][125][126][127]. These studies have shown encouraging results, reporting improved clinical AD scores and reduced exacerbations associated with the use of such fabrics compared to the control tissue. ...
Currently, there are a few detailed guidelines on the overall management of children and adolescents with moderate-severe atopic dermatitis. AD is a complex disease presenting with different clinical phenotypes, which require an individualized and multidisciplinary approach. Therefore, appropriate interaction between primary care pediatricians, pediatric allergists, and pediatric dermatologists is crucial to finding the best management strategy. In this manuscript, members of the Italian Society of Pediatric Allergology and Immunology (SIAIP), the Italian Society of Pediatric Dermatology (SIDerP), and the Italian Society of Pediatrics (SIP) with expertise in the management of moderate-severe atopic dermatitis have reviewed the latest scientific evidence in the field. This narrative review aims to define a pathway to appropriately managing children and adolescents with moderate-severe atopic dermatitis.
... 66 As such, silk fibroin yarns have been used for making hypoallergenic garments aimed at relieving symptoms of diseases such as atopic dermatitis. 67 In biomedical research, fibroin has been studied extensively and found to be well tolerated in various formats, implantation sites, and time scales. For instance, silk-based electrospun artificial blood vessel implanted subcutaneously in rats showed a mild inflammatory reaction. ...
Over the past few decades, Bombyx mori silk fibroin has become a ubiquitous material for applications ranging from biomedical devices to optics, electronics, and sensing, while also showing potential in the food supply chain and being re-engineered as a functional material for architecture and design-related applications. Its widespread use derives from its unique properties, including biocompatibility, edibility, optical transparency, stabilization of labile compounds, and the ability to controllably change conformation and degrade in a programmed way. This review discusses recent and pivotal silk-based devices in which the presence of silk brings added value in terms of functionality, as demonstrated in a broad variety of fields. First, it gives an overview of silk's natural structure and main properties in terms of cross-linking, biocompatibility, and biodegradability to provide the reader with the necessary toolbox to fully make use of silk's multifaceted properties. Then, multifunctional silk-based devices are discussed highlighting the advantage of using silk over more traditional materials. Representative devices from both established and emerging applications for silk are examined. Finally, a roadmap for the next generation of silk-based devices is laid out.
... The several advantages of these substances include mechanical property, softness and several antibacterial properties of the silk fabric. Special silk fibre (MICROAIR DermaSilk ® ) has been evaluated for its effectivity in the treatment of atopic dermatitis with acute lesions in young children 382 . The results depicted a significant decrease in the severity of atopic dermatitis. ...
Substantial progress in biomaterial research over the years has culminated in revolutionary technological advancements in the healthcare domain. This has triggered the quest for affordable healthcare solutions with focus on sustainable biomaterials with versatile applications endowed with green fabrication strategies. Silk as a biopolymer has garnered special attention which can largely be attributed to the excellent material properties of silk in addition to its affordability and resource ability. Silk fibroin from various silkworm and spider species and sericin from various silkworm species have been researched for their potential applications in the healthcare industry such as tissue-engineered grafts, cancer therapeutics, high-throughput tissue-on-chip models, food preservatives, biomedical imaging, biosensing, biomedical textiles, implants, cosmetics and bioremediation products. The present review mainly focusses on the various sources of silk fibroin and its relevant properties that have been conferred to it by nature. Moreover, recent developments, progress and prevalent modalities of healthcare industry that involve the application of silk fibroin and sericin have been outlined in the present review.
... Our well-controlled study could prove that antimicrobial silk clothing is comparable to topical corticosteroid in the treatment of atopic dermatitis. Also, a number of small but clinically significant studies [5][6][7][8][9] showed that patients wearing DermaSilkâ experienced significant clinical improvement of the atopic eczema when compared to patients wearing cotton clothes. As a result of these differences in experience, we decided to take a close look at the document mentioned in the guidelines. ...
We read with interest and with full consent the new consensus‐based European guidelines for the treatment of atopic eczema, Part II¹. However, we would like to comment on the section on microbial textiles where the recommendation to use silk garments with permanent antimicrobial in the management of children with moderate to severe eczema is raised. On the basis of an UK multicenter clinical trial² which seemed to show that silk garments with permanent antimicrobial were ineffective in the treatment of children with atopic eczema, the guidelines deny now any clinical benefit of AEGIS‐coated silk textiles in children with atopic eczema and this contrary to the previous two guidelines3,4.
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... There is a need for safer and better-tolerated alternatives in the management of AD [6]. There has been a wellestablished assumption that cotton, poly-cotton and silk are the preferred garment fabric choices for people with sensitive skin [7,8]. Superfine Merino Wool (SMW) has been demonstrated to have little or no skin irritancy and has superior thermal and moisture buffering properties than other fabric options and therefore, may be suitable in patients with AD [9,10]. ...
... Such clothing includes fabrics made from silk (DermaSilk, Silk Skinnies), which can serve as an effective barrier to irritants and has additional benefits: breathability, a smooth nonirritating nature, and the capacity to be treated with various antimicrobial and water-resistant compounds. 50 Furthermore, studies have established the efficacy of silk clothing 51,52 in AD, making it a potential consideration as alternative or adjunct therapy. ...
... Silk also helps to maintain the body temperature, by reducing the excessive sweating and moisture loss that can worsen xerosis. [32][33][34] Special type of fabrics such as anion textiles, modified silk fabrics with elastic fibers and antibacterial properties, and silver-coated fabrics are also being investigated for their suitability in atopic dermatitis. But so far, there is no strong evidence to support its use. ...
Atopic dermatitis is an immunologically mediated chronic inflammatory disease which cannot be controlled always with topical agents. Systemic drugs play important role in these difficult to manage cases. Systemic agents are also important in controlling the acute flare. Unfortunately these agents are very limited in number. Moreover none of them starting from corticosteroid to azathioprine can provide complete cure. Continuous research is unfolding different aspects of AD pathogenesis which was not known previously. Scientists are engaged in developing newer molecules targeting those novel pathological pathways thus adding in the armamentarium of existing drugs. This article is dedicated to current systemic treatment options available with their individual merit and demerit along with recent advances in this field.
... Antimicrobial silk clothing was reported to be successfully utilized in the treatment of atopic dermatitis. The severity of eczema was correlated with the quantity of Staphylococcus aureus colonizing the skin of the patients [11,12]. It was shown that silane quaternary ammonium compounds chemisorbed on textile substrates provided for the broad spectrum control of microorganisms and were well suited in a range of applications in the medical industry. ...
Biocidal antimicrobial molecular barrier (BAMB) solutions are known to provide antimicrobial effect on the surfaces in industrial applications. However, there has been a lack of scientific reports about the subject in the literature. In this study, in order to impart an antimicrobial surface property on ceramic surfaces, a BAMB solution was applied on gloss fired ceramic wall tile substrates and the surface antimicrobial activity results were compared with that of plain wall tiles (without BAMB application). The ceramic surfaces were cleaned, and stove dried at120°C prior to spray coating with a BAMB solution. The coated substrates were dried in the ambient. The intactness of the coatings was checked with the bromophenol blue test. The microstructural and molecular characterization of the BAMB coated surfaces were carried out with SEM imaging and surface FTIR, respectively. The antimicrobial activity tests of the surfaces were conducted according to ASTM E2180-07 (Standard Test Method for Determining the Activity of Incorporated Antimicrobial Agent in Polymeric or Hydrophobic Materials). The microorganisms used were Staphylococcus aureus (ATCC 6538) and Pseudomonas aeruginosa (ATCC 15442) bacteria. The BAMB coated surfaces showed less flocculent bacterial growth in comparison to uncoated ceramic surfaces leading to the conclusion that the BAMB improved the antimicrobial property.
... In particular, silk electrospun scaffolds demonstrate good responses as tissue engineering scaffold for wound healing (Wharram et al., 2010;Gil et al., 2013;Lee et al., 2014). Silk promotes collagen synthesis, re-epithelialization, wound healing, atopic dermatitis alleviation, and scar reduction (Ricci et al., 2004;Fini et al., 2005;Roh et al., 2006;Okabayashi et al., 2009). However, pure silk shows negligible or even negative antibacterial properties (Kaur et al., 2014). ...
Silk possesses many beneficial wound healing properties, and electrospun scaffolds are especially applicable for skin applications, due to their smaller interstices and higher surface areas compared to non-electrospun equivalents. However, purified silk promotes microbial growth. In contrast, selenium nanoparticles have excellent antibacterial properties and are a novel antimicrobial chemistry. Here, electrospun silk scaffolds were doped with selenium nanoparticles to impart antibacterial properties to the silk scaffolds. Results showed significantly improved bacterial inhibition and improvement in human dermal fibroblast metabolic activity. These results suggest that the addition of selenium nanoparticles to electrospun silk is a promising approach to improve wound healing with reduced infection, without relying on antibiotics.
... Bei einer randomisierten Studie (Dermasilk versus Baumwolle) an 46 Kindern mit AD (Alter 4 Monate bis 10 Jahre) konnte eine Verminderung der Symptome des atopischen Ekzems beobachtet werden. Es trat eine signifikante Reduktion des SCORAD in der Dermasilk-Gruppe (n = 31; p = 0,003) gegenüber der Baumwollgruppe (n = 15; p = 0,886) auf [65]. In einer kleinen Pilotstudie im Vergleich zur Standardtherapie mit einem topischen Kortikosteroid (DermaSilk vs. Mome-thason) zeigte sich bei Kindern mit AD (n = 15; Alter 6 Monate bis 9,2 Jahre) eine signifikante Besserung nach einer Anwendung über eine und zwei Wochen [66]. ...
Atopic dermatitis (AD) or atopic eczema (AE) is a multifactorial skin disease caused by a variety of factors such as genetic conditions, alterated skin structure, immunologic deviations and environmental factors, among others. According to the new WAO nomenclature, the term "eczema" should be used as the "umbrella" term to cover all different subtypes of atopic dermatitis, i.e. the IgE-associated ("atopic eczema") and the non-IgE-associated type ("non-atopic eczema"). Besides some comments on the new nomenclature and the so-called "atopy march", we provide an overview of the diagnostic importance of atopy patch tests, especially in the formerly called "intrinsic" type of AE and the role of Staphylococcus aureus-enterotoxins with superantigenic activity, and of fungi (Coprinus comatus and Malassezia furfur sive sympodialis) as illness-specific allergens in AD/AE. The use of antiinfectious and antifungal drugs (topic or systemic) may be of notable benefit in some AD/AE patients. Especially in children with AD/AE, eczema is easily aggravated by contact with irritating factors (e.g. aggressive detergents, synthetic and woolen clothes). Also, skin colonization with Staphylococcus aureus is known as a major trigger of the disease. Silver-coated textiles and a silk fabric coated with AEGIS AEM 5772/5, an antimicrobial substance, efficiently reduce Staphylococcus aureus colonization in patients with AD/AE. Some new studies even have shown a superior improvement by treatment with silver-coated textiles or specially manufactured silk clothes compared to cotton textiles or mild topical corticosteroids. Finally, the development of a new class of steroid-free, topic immunomodulatory drugs (tacrolimus and pimecrolimus) has substantially improved the treatment of AD/AE. Nevertheless, patient education is still very important in the management of the disease since it often follows an unpredictable course.
... Wool intolerance is a well known feature of AD [1]. Wearing alternative fabrics such as cotton and silk has been shown to reduce pruritus and aid in emollient absorption [2,3]. A number of sophisticated "functional textiles" have been developed with the intention of aiding in the management of atopic dermatitis. ...
Atopic dermatitis, perhaps more than other dermatologic diseases, has garnered much attention in the realm of alternative medicine. This may be because its etiopathogenesis is incompletely understood, it is increasingly common, and it waxes and wanes often without clear precipitants, opening up many opportunities for misinterpretation. Herein we explore the evidence for a number of different alternative and complementary therapies, from textiles to vitamin supplements. By definition, none have enough data to be deemed "effective" in a conventional sense, but it is hopeful that some show promising evidence that may one day lead to mainstream acceptance with further research.
... Recently, the functionalized bio-active textile products have been increasingly developed [1][2][3]. For examples, the use of special silk clothes may be useful in the management of atopic dermatitis in children [4]. Lee et al. [5] showed that multi-functional fabric wear is effective in inducing deep sleep, increasing growth hormone, and improving the quality of sleep. ...
This study surveys the improvement characteristics in old-aged muscular mitochondria by bio-active materials coated fabric (BMCF). To observe the effects, the fabric (10 and 30%) was worn to old-aged rat then the oxygen consumption efficiency and copy numbers of mitochondria, and mRNA expression of apoptosis- and mitophagy-related genes were verified. By wearing the BMCF, the oxidative respiration significantly increased when using the 30% materials coated fabric. The mitochondrial DNA copy number significantly decreased and subsequently recovered in a dose-dependent manner. The respiratory control ratio to mitochondrial DNA copy number showed a dose-dependent increment. As times passed, Bax, caspase 9, PGC-1α and β-actin increased, and Bcl-2 decreased in a dose-dependent manner. However, the BMCF can be seen to have had no effect on Fas receptor. PINK1 expression did not change considerably and was inclined to decrease in control group, but the expression was down-regulated then subsequently increased with the use of the BMCF in a dose-dependent manner. Caspase 3 increased and subsequently decreased in a dose-dependent manner. These results suggest that the BMCF invigorates mitophagy and improves mitochondrial oxidative respiration in skeletal muscle, and in early stage of apoptosis induced by the BMCF is not related to extrinsic death-receptor mediated but mitochondria-mediated signaling pathway.
... Several studies evaluated the effectiveness of this product in treating children with AD, compared with other forms of clothing such as cotton, with a decrease of the severity of eczema, reduction in bacterial colonization and greater reduction in pruritus. [14][15][16][17][18][19][20] Due to the favorable data demonstrated by the use of special silk fabrics in AD management, a synthetic silk-like fabric (DermaTherapy®) has also been developed and received 510(k) clearance ...
Skin protects its host from its environment and allows their interactions by providing a physical permeability barrier, protection from infectious agents, thermoregulation, and ultraviolet protection. Textiles, in particular clothing, interact with skin functions in a dynamic pattern. For years cotton has been considered as the only comfortable tissue suitable for patients with dermatologic disorders. Nowadays new synthetic fibers with important functions, for example breathability and waterproofing have leaned out and new tissues can be used as a complementary tool in dermatologic treatments. Our purpose is to report the main fibers used for dermatological problems and to review the literature on their use in dermatological field; finally, we also report our personal experience on this topic.
The general management of patients with atopic eczema comprises special diagnostic procedures with a focus on allergy diagnostics using skin tests such as cutaneous (prick) or epicutaneous (classic patch test or atopy patch test) followed by in vitro allergy diagnostics and provocation tests especially when the question of relevant food allergy has to be assessed; the placebo-controlled double-blind oral provocation test is the method of choice. On the basis of allergy diagnostics, it might be possible to give specific recommendations for avoidance strategies regarding irritants (e.g., clothing) but also aeroallergens and food allergens.Beyond allergy testing, no recommendations can be given on the basis of diagnostics. New biomarkers under investigation include NOS2/CCL27, IL-36a, IL-36 g, CCL26, and CXCL9 help in the differentiation from psoriasis. These initial molecular diagnostics might once lead to other biomarkers predicting the need for therapy, therapeutic response, or risk to develop comorbidities. The focus of every therapeutic concept is the basic therapy of the disturbed skin barrier function with the application of emollients in order to apply lipids for restoration of the skin barrier. The galenics of topical basic therapy are crucial with more lipid preparations for more chronic lesions, extensor sites, and during winter months. In acute lesions, in summer, and in skin folds more liquid (oil-in-water emulsions) are preferred.KeywordsGeneral managementAllergy diagnosticsAtopy patch testAvoidance strategiesDietsBasic therapy of disturbed skin barrier functionEmollientsMolecular diagnostics
This article investigates the performance of special knitwear made and recommended for sufferers of atopic dermatitis. Atopic dermatitis is a condition that causes dry, itchy and inflamed skin. Generally, fabrics with hygienic, antimicrobial, and mechanical non-irritating properties are recommended for sufferers from atopic dermatitis. The idea is to find the optimal textile structure that eliminates pain and wearing discomfort (both sensorial and thermo-physiological components). Based on a questionnaire survey of the needs of people with dermatitis, a group of properties was determined that crucially influence total wearing comfort. The measurement of these properties was conducted on eight commercially used knitwear types. Sensorial comfort was represented by parameters of total hand value, subjective wearing value, and warm/cold feeling value; physiological comfort by thermal conductivity, moisture management, water vapor and air permeability, and drying efficiency. The decision-making method Technique for Order of Preference by Similarity to Ideal Solution was used to determine the best solution considering the combination of the properties mentioned above. In summary, high air and water vapor permeability, hand feeling, and especially surface roughness fundamentally affect atopic customer decisions. Further, fabrics made from natural fibers (silk and linen) have a high potential to meet the needs of people with atopic dermatitis conditions. Both materials (M1, M7) show a combination of the high level of air permeability (more than 530 (mm . s ⁻¹ )), a low level of water vapor resistance (in the range of 1.4–3.5 (m ² . Pa . W ⁻¹ )) and provide very good subjective wearing comfort. Therefore, they can be substituted for traditional expert-recommended cotton.
Shoe dermatitis is a type of contact dermatitis precipitated by allergens or irritants found in shoes. Potassium dichromate, commonly used in leather processing, is one of the most prevalent agents responsible for shoe dermatitis; however, it is not the only one. Shoe dermatitis caused by an allergen or an irritant may affect a person of any age, sex, or ethnicity. Numerous treatments exist for shoe dermatitis, the most simple yet important being avoidance of causative agents. Pharmaceutical agents commonly used are emollients, humectants, and topical corticosteroids. In more severe cases, topical calcineurin inhibitors and phototherapy may be used.
Recent advancements in technology have significantly widened the scope of textiles from a mere commodity to advanced applications. Increased healthcare awareness has led to an expansion of the global antimicrobial textiles market. These textiles are not only employed to cope with the perspiration odour but also to prevent and treat infections in various types of wounds. This chapter highlights the role of antimicrobial textiles in managing different wound types. Various natural and synthetic raw materials have been reviewed with a comprehensive discussion of their advantages and disadvantages.
Background
Clothing fabrics interact closely with the skin to shape our cutaneous microenvironment. Cotton and silk have been traditionally recommended for patients with atopic dermatitis because of reported patient comfort. New synthetic fabrics combine anti-microbial, anti-inflammatory, moisture-wicking, and soothing properties that may augment conventional management strategies in atopic patients.Objective
We review existing and emerging evidence for fabric selection in patients with atopic dermatitis including cotton, wool, lyocell, silk, anionic, cellulosic/cellulose based, zinc oxide coated, citric acid coated, chitosan coated, silver coated, borage seed oil coated, ethylene vinyl, and polyurethane and offer practical suggestions for clothing and bedding choices.MethodsA systematic search was conducted on PubMed and EMBASE electronic databases for articles from 1 January, 1994 to 1 January, 2020. Studies were included based on the following inclusion criteria: clinical trial, published in English, and fabric as the main agent being evaluated. Case reports, case series, conference abstracts, reviews, animal studies, and duplicates were excluded. Studies were then manually screened by title, abstract, and full-text articles and selected to specifically describe the effects of fabrics in patients with atopic dermatitis. Both adult and pediatric patient studies were included.ResultsThere appears to be an advantage to modern fabric manufacturing and processing techniques that have created smaller diameter, smoother fibers such as super- and ultrafine merino wool and anti-microbial finishes. Traditional cotton and silk fabrics have mixed evidence in improving atopic dermatitis symptoms and severity but have shown to be generally safe. Large-diameter wool has been shown to induce itching and irritation; ultra- or superfine merino wool is non-pruritic and may be recommended as an alternative. Emerging fabrics with potential efficacy in reducing atopic dermatitis severity and Staphylococcus aureus burden include silver-coated, chitosan-coated, and cellulose-based fabrics. Zinc oxide-coated, acid-coated, polyurethane-coated, borage seed oil-coated, anionic, lyocell, and ethylene vinyl fabrics have sparse evidence and require further study before conclusions can be made.Conclusions
Appropriate fabric selection can reduce the symptom severity and exacerbations of atopic dermatitis.
Thermal analysis is a critical, analytical, and characterization tool in the field of materials sciences. Specific thermal properties of synthetic polymers and biomaterials with different phases and morphology can be determined through this technique. Traditional thermal analysis techniques include differential scanning calorimetry (DSC), thermogravimetric analysis, thermomechanical analysis, and dynamic mechanic analysis. Among these techniques, DSC is the core thermal analysis technique. It was further developed into modulated-temperature DSC, quasi-isothermal DSC as well as fast DSC. The various DSC techniques and methods characterize the temperatures and heats and/or specific heat capacity changes at the thermodynamic and kinetic transitions of different materials such as low-molecular-mass substances, amorphous and semicrystalline synthetic polymers, and also biopolymers. Moreover, DSC can also help monitor the structural changes of polymers during the heating, cooling, and isothermal measurements. In addition, the calculation of the reversing and nonreversing heat flow can help separate the various transitions.
Linked article: This article is commented on by A. Wollenberg et al., p. e169 in this issue. To view this article visit https://doi.org/10.1111/jdv.15401.
Humans have long appreciated silk for its lustrous appeal and remarkable physical properties, yet as the mysteries of silk are unraveled, it becomes clear that this outstanding biopolymer is more than a high-tech fiber. This progress report provides a critical but detailed insight into the biomedical use of silk. This journey begins with a historical perspective of silk and its uses, including the long-standing desire to reverse engineer silk. Selected silk structure-function relationships are then examined to appreciate past and current silk challenges. From this, biocompatibility and biodegradation are reviewed with a specific focus of silk performance in humans. The current clinical uses of silk (e.g., sutures, surgical meshes, and fabrics) are discussed, as well as clinical trials (e.g., wound healing, tissue engineering) and emerging biomedical applications of silk across selected formats, such as silk solution, films, scaffolds, electrospun materials, hydrogels, and particles. The journey finishes with a look at the roadmap of next-generation recombinant silks, especially the development pipeline of this new industry for clinical use.
Careful allergy diagnostics is standard in the management of atopic dermatitis and comprises the four steps from history and skin test to in vitro allergy diagnostics and provocation testing. The most common positive atopy patch test reactions are found against house dust mite, animal epithelia, and pollen. Food allergy can often only be evaluated by placebo-controlled oral provocation tests. This also holds true for food additives which equally can elicit exacerbations of atopic dermatitis. We do not recommend an allergen avoidance diet unless the relevance of this food for triggering an exacerbation of the disease has been clearly established.
Due to the properties of the stratum corneum (SC), only small, lipophilic molecules (<500–800 Da, depending on source and application) can be absorbed through the skin. This excludes amphoteric molecules (like proteins, 300–1,000,000 Da) [1]. However, topical application of peptides/proteins with short half-life was shown to increase their stability while affording controlled delivery from different formulations [2]. Besides applications in the treatment of skin disease and regeneration, a new domain of special interest emerged, using proteins in substitution therapy of proteins which are deficient in the skin due to genetic mutations (e.g. in Ichthyosis vulgaris and others, Chap. 2).
Clothing, or "the second skin," not only provides an additional shield for most parts of the body, but also creates a portable living microclimate that improves human survival. A growing interest in the use of antimicrobial active textiles/clothing has being developed as a desirable goal of prevention and nonpharmacological treatment for the management of atopic dermatitis and skin infective diseases.This review focuses on new development of antimicrobial active textiles using appropriate natural or special-treated fabrics coated with antimicrobial agents or using nanotechnology and nanomaterial in the care of atopic dermatitis or other skin diseases. Clinical evaluations of current available antimicrobial active textiles were summarized according to the aim, design, human subjects, intervention/control, duration, and SCORAD index and other outcomes. Lastly, evaluation of the safety of antimicrobial textiles for humans and the environment is also discussed.
Zusammenfassung
Bei dem Krankheitsbild der Neurodermitis handelt es sich um eine chronische oder chronisch‐rezidivierende, nichtkontagiöse, entzündliche Hauterkrankung mit in der Regel starkem Juckreiz. Darüber hinaus besteht ein Risiko für komplizierte Verläufe mit bakteriellen oder viralen Superinfektionen. Sowohl die genetische Prädisposition als auch zahlreiche Auslösefaktoren spielen für die Erstmanifestation und das Auftreten der Erkrankungsschübe eine wichtige Rolle, so dass auch die Therapiekonzepte vielfältig sind. Bei zahlreichen für die Neurodermitis zur Verfügung stehenden Behandlungsoptionen gilt es, in Abstimmung mit den Patienten bzw. Eltern erkrankter Kinder fallorientiert einen optimalen Behandlungsplan aufzustellen, der im Verlauf ggf. erneut angepasst werden muss.
Die vorliegende Kurzfassung der S2k‐Leitlinie gibt einen Überblick über alle bisher zur Verfügung stehenden, evidenzbasierten Diagnoseverfahren und Therapiemöglichkeiten sowie über die entsprechenden Empfehlungen, die durch die an dieser Leitlinie beteiligten Fachgesellschaften und Verbände ausgesprochen werden. Diese Empfehlungen wurden auf der Grundlage der bislang zu dem jeweiligen Verfahren vorliegenden klinisch‐wissenschaftlichen Datenlage, die in der ausführlichen Fassung dieser Leitlinie (unter www.awmf.org und jddg.org ) beschrieben ist, konsentiert.
Atopic dermatitis/eczema (ADE) is a common condition affecting up to 20% of children in some countries. Atopic dermatitis/eczema impairs quality of life, not only of the patient, but also of family members. Due to the increasing prevalence noticed in westernised populations since the 1940s, particular attention should be paid to triggers, which may be contributing to this rise. Identifying a trigger is fraught with difficulty due to the fluctuating natural course of ADE. Triggers of ADE include irritants (such as soap and detergents), allergens (including standard patch test defined allergens, aeroallergens and food allergens), skin infections (such as Staphylococcus aureus, group A streptococci, herpes simplex virus, malassezia and tinea infections) and others, including cigarette smoke exposure and psychological stress. Many commonly believed triggers, such as extreme temperatures and exposure to sand, have meagre supporting evidence. Nevertheless, they may aggravate the disease. The literature dealing with triggers is sparse. In this article an overview will be given regarding the relevant literature dealing with this difficult topic.
Silk fibroin (SF) from Bombyx mori has an excellent biocompatibility and thus be widely applied in the biomedical field. Recently, various SF-based composite nanofibers have been developed for more demanding applications. Additionally, grape seed extract (GSE) has been demonstrated to be powerful on antioxidation. In the present study, we dedicate to fabricate a GSE-loaded SF/polyethylene oxide (PEO) composite nanofiber by green electrospinning. Our results indicated the successful loading of GSE into the SF/PEO composite nanofibers. The introduction of GSE did not affect the morphology of the SF/PEO nanofibers and GSE can be released from the nanofibers with a sustained manner. Furthermore, comparing with the raw SF/PEO nanofibrous mats, the GSE-loaded SF/PEO nanofibrous mats significantly enhanced the proliferation of the skin fibroblasts and also protected them against the damage from tert-butyl hydroperoxide-induced oxidative stress. All these findings suggest a promising potential of this novel GSE-loaded SF/PEO composite nanofibrous mats applied in skin care, tissue regeneration and wound healing.
The hospital and healthcare system is challenged by the presence of microorganisms and the negative effects they cause. Deterioration, defacement and odors are all dramatic effects which occur from the microbial contamination of surfaces as varied as uniforms and medical nonwoven fabrics to medical devices and hard surfaces i.e., walls, ceilings, and air duct systems. Most significantly, these surfaces can act as microbial “harbors and transfer site (vectors),” offering ideal environments for the proliferation and spread of microorganisms that are harmful to buildings, textiles, and humans. The ability to make microbial resistant surfaces in a healthcare environment has advantages in many applications. This is especially true in healthcare and hospital environments where the emergence of hospital acquired infections caused by MRSA, Aspergillus sp., Clostridium difficile, Mycobacterium spp. (TB), and other drug resistant species have threatened the health of its patients, staff, and visitors. According to a February 2007 National Statistics (UK) report, “The rates for deaths involving MRSA doubled for both male and females between 2001 and 2005.”1
Silk is fast becoming one of the most studied natural materials for biomedical applications. Its exceptional physical and chemical properties have been utilized for centuries for a variety of purposes beyond textiles. The last decade has seen the use of silk in personal care and drug delivery increase exponentially. This could be attributed to the versatile nature of silk, which can be easily tailored and positive effects on the functionality and regeneration of tissues have been shown. Future research will open more avenues for developing personal care products and advanced drug delivery. This chapter presents a overview of silk use and the superior properties that make this material so attractive. A comprehensive review of current pharmaceutical and cosmeceutical formulations that incorporate silk is also given.
The objectives of this study were to evaluate the antimicrobial properties of ZnO/poly(vinyl alcohol) (PVA) nanofibrous membranes by in vitro trials and to investigate the effectiveness and sustainability in the reduction of bacteria by conducting wear trials in real-use situations. Layered fabric systems with a very thin layer of a ZnO/PVA nanofibrous membrane layered onto polypropylene nonwoven substrates were developed and applied to shoe insoles. Eight healthy males participated in seven different wear trials in which they played a basketball game for 2 hours wearing the prototype. In the in vitro testing, ZnO/PVA nanofibrous membranes obtained from an 11 wt% PVA solution containing 3 wt% ZnO nanoparticles with a web area density of 3.0 g/m2 exhibited a 99.9% reduction of Staphylococcus aureus. In the wear trials, the shoe insoles with ZnO/PVA nanofibrous membranes obtained from the same concentration solution at a web area density of 6.0 g/m2 showed 80.9%, 84.8%, and 82.8% reductions of Staphylococcus aureus after 8, 15, and 22 days of use, respectively. In addition, another set of shoe insoles was kept at a constant temperature and humidity level after the third wear trial and resulted in 66.0% and 86.6% reductions of Staphylococcus aureus after 15 and 22 days, respectively. Although the wear trial results showed lower antimicrobial properties compared to the in vitro trials, our findings indicate that the shoe insoles showed a consistent and reasonable level of antimicrobial activity over a period of time. This suggests that ZnO/PVA nanofibrous membranes with an antimicrobial function, which are ultrathin, flexible, and highly porous, have potential for use in sports/outdoor textiles.
To date, there is no simple cure for atopic eczema (AE). Besides the avoidance of specific and unspecific trigger factors the stepped approach to management includes a basic emollients therapy and, according to the severity of symptoms, the addition of antiseptic and/or anti-inflammatory topical treatments. In cases of moderate to severe AE additional systemic treatment is needed to control the disease. Currently only cyclosporine is approved in Germany; oral corticosteroids can be used for a short time for severe acute exacerbations. Systemic immunosuppression with methotrexate, azathioprine, mycophenolat mofetil and leflunomide may also be used with success (off-label use), but these agents remain to be assessed in larger randomized trials. While in the past years a number of biologicals have been developed for the treatment of psoriasis vulgaris, there is currently no biological approved for the treatment of AE. Preliminary data points towards a potential efficacy of alefacept [fusion protein of lymphocyte function antigen (LFA)-3], efalizumab (anti-CD11a antibody, no longer available), rituximab (anti-CD20 antibody) and omalizumab (anti-IgE-antibody) at least in subgroups of AE patients. Apart from the extracorporeal photopheresis immunoadsorption could be an option for cases resistant to other treatments, but needs to be assessed in more detail. In patients with a clinically relevant sensitization towards aeroallergens specific immunotherapy might be an option. Based on many new insights into the pathogenesis currently a number of new therapeutic approaches are being developed; among others, target structures are filaggrin, epidermal proteases, tachykinine receptors, histamine receptor 4, interleukin 31 and phosphodiesterase 4.
Avoiding potentially irritating contact is a key point in vulvar lichen simplex chronicus (VLSC) management. This study aims to assess the use of nonirritating silk fabric underwear (Dermasilk) as an adjuvant tool in the treatment of VLSC.
Twenty women with VLSC were enrolled in a 1-week open-label active treatment phase with topical 0.1% mometasone furoate (MMF) ointment. Participants then entered a 4-week double-blind maintenance phase (MP) in which they were randomized to wear either silk fabric or cotton briefs. During MP, participants were allowed to use MMF on an "as-needed" basis. The main efficacy endpoints were to assess and compare the two intervention groups on the following: (1) number of participants who needed to apply MMF throughout MP; (2) mean number of MMF applications; (3) mean symptom-free interval before MMF reapplication; and (4) changes in the severity of symptoms and signs.
During MP, four women in the silk fabric briefs group applied MMF compared with six women in the cotton briefs group (relative risk, 0.66). The mean number of MMF applications was lower in the silk fabric briefs group than in the cotton briefs group (P = 0.074). VLSC symptom-free interval was 22.5 days in the silk fabric briefs group and 7.2 days in the cotton briefs group (P = 0.0003). At the end of MP, symptom improvement determined after corticosteroid use increased in the silk fabric briefs group but worsened in the cotton briefs group.
Silk fabric underwear may be a useful tool for the management of VLSC by diminishing external sources of irritation and may reduce use of corticosteroids.
Naju Jjok (Polygonum tinctorium Lour.) has been known to treat skin diseases in traditional Korean medicine. A natural textile dye, Niram made from Naju Jjok has traditionally been used to dye clothes. Thymic stromal lymphopoietin (TSLP) plays an important role in the development of atopic dermatitis (AD). Thus, we investigated that Niram might ameliorate AD through regulation of TSLP. Niram significantly inhibited the levels of TSLP through blockade of caspase-1/receptor-interacting protein 2 pathway in stimulated mast cells. Further, Niram ameliorated clinical symptoms in AD mouse. Niram significantly inhibited the infiltration of inflammatory cells in lesional skin. The levels of TSLP, caspase-1, IL-4, and IL-6 were inhibited in lesional skin applied topically with Niram. Niram significantly inhibited the serum levels of IgE and histamine in AD mouse. Finally, Niram significantly inhibited the levels of TSLP in polyriboinosinic polyribocytidylic acid-stimulated human keratinocyte HaCaT cells. These results establish Niram as a functional dye embracing the aspects of not only a traditional use but also a pharmacological effect.
A clinical survey in two silk filatures revealed that 36.2% of the persons engaged in the processing of natural silk were suffering from bronchial asthma, while 16.9% of the total subjects had asthma of occupational origin. Skin prick tests using crude silkworm cocoon and pupal allergen extracts revealed that 28.8% of the subjects were sensitive to the silkworm-derived allergens. IgE antibodies specific to both cocoon and pupal allergens were demonstrable by RAST in the sera of patients with positive skin reactions and occupational asthma.
Delayed-type hypersensitivity with granulomatous lesions to silk sutures is rather rare. Yet, braided silk sutures often act as a non-immunologic foreign-body and cause a granulomatous inflammatory reaction years after surgery. We report here a case of recurrent granulomas with remarkable infiltration of eosinophils that may have resulted from an IgE-mediated hypersensitivity reaction to silk fibroin, a component of the braided silk suture. Under normal circumstances exposure to fibroin is rather rare. Therefore, the present patient may have developed this reaction to the silk sutures used in a previous surgery.
AEM 5700 Antimicrobial (3-trimeth- oxysilylpropyldimethyloctadecyl ammonium chloride)+ imparts a durable, antimicrobial finish to textiles. The finish protects the fabric against bacteria and fungi, which cause deterioration. It also inhibits the growth of odor-causing bacteria in in vitro tests. In vivo organoleptic tests confirm the practicality of this concept under actual use conditions on socks.
The review discusses acute and cumulative irritant, allergic contact dermatitis, contact Urticaria, and exacerbation of atopic dermatitis due to the physical and chemical nature of textile fibers.
Workers who process raw silk are exposed to a fine dust derived from the gum that binds the strands secreted by the silkworm. Fifty-three such workers, all women and non-smokers with an average of 5.8 years of service in the industry, were examined. Eighteen (33.9 per cent) workers had occupational asthma, the highest proportion (48.2 per cent) being in those twisting silk. A lower prevalence (20.0 per cent) was found in workers in the degumming sector, while the least (16.6 per cent) was in weavers. This declining prevalence in the three processing stages appears to be in line with their declining exposure to dust. The occupational asthma was of the intermediate and late types occurring 30 minutes to 6 hours after starting work and subsiding 1 to 8 hours after leaving the factory.
A total of 64 children less than 15 years of age with asthma caused by silk were studied. The diagnosis was based on a history of wheezing, positive skin tests to silk, positive conjunctival or nasal provocation tests, or serum IgE-Sw (silk waste). The average age of onset was 4 years 2 months. Sex ratio (M:F) was 3.6:1. A positive skin test is essential for the diagnosis. Conjunctival provocation tests were performed in 80% of cases because of reliability, safety, and convenience. The first symptom appeared an average of 10 months after initial exposure to silk. In 61% of patients, asthma was accompanied by allergic rhinitis but in only 14% of cases by conjunctivitis. In most cases, asthma occurred in winter, due to seasonal use of bed quilts or clothes filled with silk. Silk is a highly potent allergen. The average mean wheal diameter elicited by silk in prick testing was larger than two histamine equivalent prick tests. A cross reactivity exists among mulberry silk, and silkworm cocoons, batryticated silkworms, and silkworm chrysalis.
In 24 girls with atopic dermatitis and a history of irritation to wool, more intense itching was provoked on normal skin on the abdomen by a material with coarse wool fibres (36 microns) than with thinner fibres (20 microns). The probability of the materials causing itching could be predicted by the girls by handling the materials.
There is a need for surgeons to be able to make a logical decision regarding which suture materials to use in a given clinical situation because the choice of wound-closure materials may make a difference in wound healing and the ultimate functional and cosmetic result obtained. This article will review the basic physical, handling, and tissue-reaction characteristics of commonly used suture materials. Basic suturing techniques are also reviewed. Knowledge of multiple suturing techniques provides versatility, individuality, and optimal closure of surgical wounds.
We examined the effects of the transparent fibroin film (silk film) on full-thickness skin wounds. Full-thickness dermatotomies (15 mm x 9 mm) were prepared on the dorsal wall of CRJ:CD-1 nu/nu (ICR nu/nu) mice. The area of the wounds dressed with silk film was reduced to 10% of that made by the dermatotomy 14 days after the dermatotomy and were covered with regenerated epidermis 21 days after the dermatotomy. In contrast, less recovery and epidermal regeneration were found 14 days after dermatotomy in the wounds dressed with a conventional hydrocolloid dressing (Duro Active). Furthermore, only partial incomplete epidemal growth was obtained 21 days after dermatotomy. Most importantly, the healing time of wounds dressed with silk film was 7 days shorter than those dressed with DuoActive dressing. The silk film showed an almost similar or slightly better promotive effect as the lyophilized porcine dermis (Alloask D), which is used as a dressing for burns, ulcers, and decubitis. Histologic findings revealed that there was greater collagen regeneration and less inflammation and neutrophil-lymphocyte infiltration of the wounds dressed with silk film than with DuoActive dressing. It is clear that regeneration of the epidermis and dermis of the wound beds covered with silk film was faster than with DuoActive dressing. Finally, silk film is easily obtainable, sterilizable, and transparent, and it allows easy observation of tissue recovery. Therefore, silk film offers advantages over other dressings and may be clinically useful for wound treatment.
There is general concern about the possible cutaneous adverse effects of wearing garments treated with household laundry products, particularly on atopic skin. Our objective was to compare softened and non- softened fabrics in a forearm wet and dry test, under conditions simulating real-life conditions. Twenty atopic volunteers entered a single-blind 12-day (3 sessions per day) forearm wetting and drying test. Cotton fabrics were machine washed and liquid fabric conditioner was added or not to the final rinse. To simulate conditions of skin damage, a dilute solution of sodium lauryl sulphate was applied under occlusion to the forearm of each volunteer before the start of the study. Skin effects were evaluated by visual grading (redness, dryness and smoothness), squamometry and in vivo instrumental measurements (capacitance, transepidermal water loss and colorimetry). Rubbing of atopic skin with fabrics generally resulted in discrete to moderate alterations of the structure of the stratum corneum. Both for control and pre-irritated skin, all measured parameters indicated that softened fabric was less aggressive to the skin than unsoftened fabric. In the case of pre-irritated skin, the recovery of the skin was significantly faster when rubbed with softened than with unsoftened fabrics. In conclusion, softened fabrics help mitigate the skin condition in atopic patients.
Sensitization to perennial aeroallergens is associated with asthma in industrialized countries with a Western lifestyle. Because silk products are commonly used in Chinese society, we were interested in examining the relation between sensitization to silk and asthma.
Cross-sectional study of 871 children in 503 families living in Anqing, a predominantly rural province of China.
After adjustment for age, gender, familial correlations, and sensitization to other aeroallergens, skin test reactivity to silk was an independent predictor of asthma (odds ratio = 2.6; 95% confidence interval = 1.2-5.7). This association became stronger after inclusion of the eosinophil count and history of parasitic diseases of the participants in the multivariate model (odds ratio = 3.6; 95% confidence interval = 1.4-8.9).
Because sericulture is an important activity in China and other countries throughout the world, sensitization to silk may influence the pathogenesis and severity of asthma in people living in these nations.
Atopic dermatitis is a common skin disease of unknown etiology with an impaired permeability barrier function. To learn more about the molecular pathology in lesional skin, we analyzed levels of free extractable as well as protein-bound barrier lipids in the epidermis of atopic dermatitis subjects. The amount of protein-bound omega-hydroxyceramides in healthy epidermis comprised 46-53 wt% of total protein-bound lipids, whereas this percentage was decreased to 23-28 wt% in nonlesional areas and even down to 10-25 wt% in affected atopic skin areas of the subjects. Furthermore, the partial amount of free extractable very long chain fatty acids with more than 24 carbon atoms was reduced in affected regions down to 25 wt% and in nonlesional regions of the atopic dermatitis subjects down to 40 wt% compared to healthy controls. This "hydrocarbon chain length deficiency" regarding the barrier lipids in atopic skin was supported by metabolic labeling studies with [14C]-serine in cultured epidermis. The biosynthesis of free glucosylceramides and free ceramides was remarkably decreased in affected skin areas of the atopic subjects compared to healthy control subjects. Especially affected were the de novo syntheses of ceramide 4 (i.e., ceramide EOH, consisting of a very long chain N-acyl omega-hydroxy fatty acid esterified with linoleic acid and 6-hydroxysphingosine as sphingoid base) and ceramide 3 (ceramide NP, consisting of a nonhydroxy N-acyl fatty acid and phytosphingosine). In conclusion, this study revealed that the lesional epidermis in atopic dermatitis has considerable deficiencies within main barrier lipid components, which may contribute to the severely damaged permeability barrier.
Atopic dermatitis is a highly pruritic chronic inflammatory skin disorder affecting 10-20% of children worldwide. Symptoms can persist or begin in adulthood. It is also the most common cause of occupational skin disease in adults. This disease results from an interaction between susceptibility genes, the host's environment, pharmacological abnormalities, skin barrier defects, and immunological factors. New management approaches have evolved from advances in our understanding of the pathobiology of this common skin disorder.
Indumenti di seta nella dermatite atopica
- M Arcangeli
- M Feliciangeli
- Pierleoni
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