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Pharmacology and Treatment
Evaluation of the Antibacterial Activity
of a Special Silk Textile in the Treatment
of Atopic Dermatitis

Giampaolo Ricci a Annalisa Patrizi b Paolo Mandrioli c Fernando Specchia a Matelda Medri b Giuseppe Menna a Massimo Masi a a Department of Pediatrics and b Division of Dermatology, Department of Clinical and Experimental Medicine, University of Bologna and c ISAC-CNR, Institute of Atmospheric Sciences and Climate (ISAC) of the Italian National Key Words
be able to improve skin lesions in AD, we were unable to Atopic dermatitis ؒ Silk textile ؒ Antibacterial properties ؒ demonstrate that such silk fabrics coated with AEGIS AEM Quaternary ammonium ؒ Staphylococcus aureus 5572/5 have an antibacterial activity in vivo, as shown invitro. Abstract
Background: Increased skin Staphylococcus aureus coloniza-
tion is frequently found in atopic patients. The reduction of
local overinfection decreases skin inflammation and im-
proves the flares. Objective: To evaluate the effectiveness of
There are many factors known to worsen atopic der- the antimicrobial activity of a silk fabric (MICROAIR Derma- matitis (AD), including fabrics [1] . A study by Hermanns Silk € ) coated with alkoxysilane quaternary ammonium with et al. [2] assessed the beneficial effects of softened fabrics durable antimicrobial properties (AEGIS AEM 5572/5) in chil- on atopic skin, suggesting that softened fabric is less ag- dren affected by atopic dermatitis (AD). Methods: Sixteen
gressive to the skin than unsoftened fabric. In addition, children, 12 affected by AD with symmetric eczematous le- the increased Staphylococcus aureus colonization of the sions on the antecubital areas and 4 without any cutaneous skin frequently found in patients with AD [3] exacerbates disease, used, for 7 days, tubular arm covers made of this or maintains skin inflammation, so topical and general special silk fabric but only one of each pair was coated with antibacterial drugs are often used to keep the skin under AEGIS AEM 5572/5. Microbiological examinations were done control. Topical steroids and immunomodulators also with standard cultural swabs and by means of quantification appear to be able to reduce the degree of bacterial coloni- of bacterial agents using agar plates at baseline, after 1 h and zation [4–6] , as does the recently proposed use of silver- after 7 days. Results: After 7 days a significant improvement
coated textiles [7] . In a previous work with a special silk in the mean value of the ‘local SCORAD’ index was observed fabric (MICROAIR DermaSilk € ) [8] we observed a clini- in both the covered areas compared to the values obtained cal improvement of eczema in the area covered by the at baseline. The reduction in the mean number of colony textile in 46 children with AD. This fabric also has anti- forming units per square centimetre was similar in both ar- bacterial properties in vitro [9] thanks to a water-resis- eas. Conclusions: Although this special silk fabric seems to
tant treatment with AEGIS AEM 5572/5, a durable anti- Tel./Fax +39 05163 63639, E-Mail microbial finish for textile products that prevents bacte-rial survival (including S. aureus ) and odour. The aim of our work was to evaluate the effectiveness of the antimi- crobial activity of this silk fabric coated with AEGIS AEM Materials and Methods
We studied 12 children aged between 2 and 8 years (mean age 4 years) affected by AD diagnosed by the criteria of Hanifin and Rajka [10] . At the time of examination, they presented eczematous lesions symmetrically located on the flexures of both elbows. No signs of impetiginization were observed even though topical ste- roids, immunomodulators and antibiotics had been excluded for at least 2 weeks, systemic antibiotics for at least 4 weeks and anti- histaminics for at least 2 weeks. Four healthy children, matched for age, were enrolled as normal controls. Each patient received 2 pairs of tubular arm covers made of MICROAIR DermaSilk pro- duced by AL.PRE.TEC (S. Donà di Piave, Venice, Italy). Two dif- ferent sizes were available to suit the dimension of the arm.
All enrolled patients were volunteers and informed consent was obtained from the parents before the children were included in the study. No approval was required from our ethics committee and the authors had no conflict of interest concerning sponsor-ship of any kind in this study.
In each pair of tubular covers the sides were clearly marked Fig. 1. Local SCORAD of the antecubital area in 10 children with
‘right’ or ‘left’, and the parents were asked to always put them on AD in acute phase coated with silk fabrics with AEGIS (mean the respective arms of their child. Only one cover of each pair was value before and after treatment from 7.3 to 4.4; p = 0.019) and treated with AEGIS AEM 5572/5 and the authors and parents did without AEGIS (mean value before and after treatment from 7.1 not know which one had been coated. The main characteristics of these fabrics were clearly explained to the parents and they were also informed that the continuous use of the arm covers for all 7 nights and days (removed only when the child was taking a show-er) was necessary to obtain an improvement and that the covers needed to be changed and washed every day with a mild soap as on the eczematous skin in children with AD. Successively the indicated by the producer. Only moisturizing therapy with Ceta- plates were put into an incubator at 37°C for 48 h and the number fil € was permitted. The patients’ detergents were continued as of bacterial colonies was quantified by microscopic count and ex-usual but none of these contained antiseptics or antimicrobial pressed as colony forming units per square centimetre (CFU/cm 2 ) products. The children did not receive any anti-inflammatory treatment for other lesions on their body during the trial.
The Statistical Package for Social Science (SPSS/PC; SPSS Inc., At baseline (T0) and after 7 days (T2), the local disease sever- Chicago, Ill., USA) was used for statistical analysis. The ␹ 2 test for ity was measured by 2 investigators following the same ‘local non-parametric analysis and Student t test were used for com-SCORAD’ protocol as used by Gauger et al. [7] .
parison. A significant level of p = 0.05 was chosen. We considered The microbiological evaluation of the skin resident flora was a quantitative microbiological improvement significant if the performed by means of two methods. A sterile tampon was wiped number of CFU was reduced at least to half of the baseline over the antecubital areas on the normal skin of the controls and on the eczematous skin in children with AD at baseline (T0), after 1 h (T1) and after 7 days (T2). The culture was made by streaking the skin swab onto blood agar plate and mannitol salt agar. Iden-tification of S. aureus was performed using the GP test VITEK 2 Because the antimicrobial activity of AEGIS AEM 5572/5 is Two atopic children withdrew from the study due to not selective we decided to evaluate the total number of bacterial difficulty in keeping the fabrics on the antecubital folds colonies by the agar plate technique. An agar plate (6 ! 6 cm in diameter) with tryptic soy agar culture media prepared 3 days for all 7 days. The other 14 children completed the study, before was applied on the same antecubital areas. The plates were following the instructions regarding the continuous use applied for a few seconds on the normal skin of the controls and of the silk garments. No local side effects owing to the Use of Silk Textile in Atopic Dermatitis standard cultural method routinely performed to con- firm that the isolated bacteria in our AD patients were mainly S. aureus , in association with the agar plate tech- nique to quantify the number of bacterial colonies for evaluation of the entity of colonization in our cases. The validity of this method is confirmed by the difference ob- served between the atopic patients and controls.
In a previous study [7] with the same silk fabric we observed a clinical improvement in skin lesions in chil-dren with AD and in this study too our data showed a statistically significant clinical improvement but without Fig. 2. Mean number of CFU/cm 2 observed in the anticubital area
any difference between the area covered by the treated in children with AD at the beginning of the study (T0), after 1 h silk fabric and that covered by untreated fabric. More- (T1) and after 7 days (T2) of use of a silk fabric coated or not coat-ed with the antibacterial agent AEGIS. over, the number of cases with evident reduction (to at least half of the previous value) of CFU/cm 2 was similar both in the areas covered by treated fabric (5 cases) and those covered by untreated fabric (4 cases), even if a textile such as acute and cumulative irritation, allergic slight but not significant reduction in the mean number contact dermatitis, or contact urticaria were observed of CFU/cm 2 was present in the area covered by treated and none of the patients presented rhinitis or asthma dur- ing the trial. After 7 days, in the 10 children with AD, a On the basis of the analysis of our data, although the significant improvement in the mean value of the local silk fabric treated with AEGIS AEM 5572/5 shows in vitro SCORAD index was observed in both covered areas antibacterial properties, we were unable to demonstrate ( fig. 1 ) and the reduction in the mean number of CFU/ any such activity in vivo. The most realistic explanation cm 2 was similar in both areas ( fig. 2 ). Microbiological is that the strong adhesion of the fibre does not allow the cultures were positive for S. aureus in 5/12 children (42%) product to penetrate into the skin and to contact bacteria at baseline and in 3/10 atopic children (30%) at the end of sufficiently to kill them, as happens with the silver-coat- the study, without any statistically significant differ- ed textiles [7] . The inability to reach bacteria in the lower layer of the stratum corneum or follicles would therefore In the unaffected subjects no microbiological cultures allow them to survive. On the other hand, the strong ad- resulted positive for S. aureus and the number of CFU/ hesion of AEGIS AEM 5572/5 to the fibre minimizes any cm 2 always remained similar to baseline.
possible toxicological side effects of coated ammonium because the ammonium is so closely covalently bound to the textile fibre that there is no absorption through the Discussion
In any case the use of soft fabric improved the AD rap- The possibility to detect S. aureus varies with the dif- idly and considerably in these patients, probably because ferent methods used. In a previous study [11] using a dry the covering of the affected areas prevents external bacte-standard swab in the antecubital area we observed a pos- rial overinfection and reduces the contact with other itive culture of 38% in children affected by AD and this types of clothes by forming a protective barrier which percentage is similar to that observed in the present paper permits the recovery of the cutaneous barrier. A recent and in the recent work by Patel et al. [12] . Higher percent- study has, in fact, suggested that antimicrobial silk cloth- ages of S. aureus have been detected with the scrub tech- ing in the treatment of AD proves comparable to a topical nique and also with the contact-plate technique. The lat- ter method evaluates a wider sample area with a conse- In conclusion, the improvement seen in the eczema quently higher possibility to detect bacteria. As observed appears to be related to the direct contact with a delicate in a recent paper [13] , S. aureus was isolated from the ma- and soft fabric such as serine-free silk [8] which relieves jority of the bacterial colonies in subjects with AD. In the itching, restores the disrupted cutaneous barrier and, present study we were unable to typify the bacteria from thanks to the AEGIS coaction, protects the area from fur-the isolated bacterial colonies, so we chose to utilize the ther overinfection. References
1 Williams JR, Burr ML, Williams HC: Factor 6 Pournaras CC, Lubbe J, Saurat JH: Staphylo- 12 Patel GK, Wyatt H, Kubiak EM, Clark SM, influencing atopic dermatitis – a question- coccal colonization in atopic dermatitis Mills CM: Staphylococcus aureus coloniza- naire survey of schoolchildren’s perceptions. treatment with topical tacrolimus (Fk506). J tion of children with atopic eczema and their parents. Acta Derm Venereol 2001;81:366– 2 Hermanns JF, Goffin V, Arrese JE, Rodri- 7 Gauger A, Mempel M, Schekatz A, Schafer T, guez C, Pierard GE: Beneficial effects of soft- Ring J, Abeck D: Silver-coated textiles re- 13 Arima Y, Nakai Y, Hayakawa R, Nishino T: ened fabrics on atopic skin. Dermatology duce Staphylococcus aureus colonization in Antibacterial effect of beta-thujaplicin on patients with atopic eczema. Dermatology staplylococci isolated from atopic dermati- 3 Leung DYM, Bieber T: Atopic dermatitis. tis: relationship between changes in the 8 Ricci G, Patrizi A, Bendandi B, Menna G, Va- number of viable bacterial cells and clinical 4 Brockow K, Grabenhorst P, Abeck D, et al: rotti E, Masi M: Clinical effectiveness of a Effect of gentian violet, corticosteroid and silk fabric in the treatment of atopic derma- atopic dermatitis. J Antimicrob Chemother tar preparations in Staphylococcus aureus - titis. Br J Dermatol 2004;150:127–131. colonized atopic eczema. Dermatology 1999; 9 Gettings RL, Triplett BL: A new durable an- 14 Senti G, Steinmann LS, Fischer B, Kurmann timicrobial finish for textiles. AATCC Book 5 Remitz A, Kyllonen H, Granlung H, Reitamo meier P, Wüthrich B, Kündig TM: Anitmi- 10 Hanifin JM, Rajka G: Diagnostic features of crobial silk clothing in the treatment of atop- coccal colonization of atopic dermatitis le- atopic dermatitis. Acta Derm Venereol Suppl sions. J Allergy Clin Immunol 2001;107:196– cal corticosteroid treatment. Dermatology 11 Ricci G, Patrizi A, Neri I, Bendandi B, Masi M: Frequency and clinical role of Staphylo- coccus aureus over-infection in atopic der-matitis of children. Pediatr Dermatol 2003; 20:389–392. Use of Silk Textile in Atopic Dermatitis Reproduced with permission of the copyright owner. Further reproduction prohibited without permission.


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