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Original paper 257
K.P. Walker, U. Amon

Institute

Interdisciplinary Therapy Centre PsoriSol GmbH, Specialist Hospital for Dermatology and Allergology, Hersbruck
Bibliography
time sleep and skin appearance. Approx. 88% DOI 10.1055/s-2008-1077493
of patients with atopic dermatitis rated the This study investigated the additive effects of wearing comfort as pleasant or excellent. Verlag KG Stuttgart ⋅New York ISSN 0340-2541 utilising the known antimicrobial action of Most patients also considered the textiles silver incorporated into textile fibres as part Address for
provided protection against scratching. No correspondence
of a combination therapy for acute inpatients side effects were observed. The study also with atopic dermatitis and other skin diseases. demonstrated benefits for the treatment of Ulrich Amon Interdisciplinary Therapy 125 patients were enrolled. Patients reported patients with hand and foot eczema. extremely positive effect on itching, night- Dermatology and
Allergology
Mühlstrasse 31
Introduction
containing products for atopic dermatitis. In one study, Gauger has already demonstrated With a lifetime prevalence of 10-20% in significant improvements in both objective as children and 1-3% in adults, atopic dermatitis well as subjective symptoms of atopic dermatitis, within only 2 weeks of wearing atory skin diseases [1]. The most significant silver textiles [2]. In 2006, a working group trigger factors are a genetic predisposition, led by Juenger also confirmed significant Type IV sensitisation, irritative-toxic noxious improvements in atopic dermatitis through agents, smoking, stress, diet and climatic silver textiles [10]. The present study effects. Bacterial colonisation of the skin, likewise investigated, under inpatient with staphylococci for example, can also conditions, the efficacy and acceptance of induce atopic eczema and maintain its silver textiles as part of a combined therapy chronic nature [2-4]. Areas of skin affected in atopic dermatitis and other skin diseases by eczema that show a particularly marked where the problem of bacterial colonisation colonisation by bacteria, can also produce and an impaired skin barrier function is For these reasons, it is extremely important to
minimise bacterial colonisation of the skin in
atopic dermatitis. Antimicrobial substances
such as triclosan, quaternary ammonium Methods
compounds and copper have a long history of 
topical use [5]. Silver has also long been From the start of July to the end of August
known to exert an antibacterial action [6,7]. 2007 a total of 125 acute inpatients (71
For instance, it has been used for water women, 54 men, average age 27.6 ± 20.6
purification, wound management with special years) of the PsoriSol Hospital for Derm-
silver-containing dressings, in bone
atology and Allergology in Hersbruck were prostheses, catheters, surgical instruments or enrolled in the prospective recording of data. in reconstructive and cardiological surgery In 76.0% of patients, the diagnosis was atopic [8,9]. It thus seemed obvious to use silver- dermatitis, in 14.4% of cases hand and foot Walker KP, Amon U. Clinical investigation of the effect and acceptance of silver textiles… Akt Dermatol 2008; 257-261 258 Original paper

eczema, and the remaining 9.6% suffered from other
skin diseases.
The average hospitalisation of this group was 14.4 ± 7.3
days. No restrictions on treatment were applied to the
patient group. Specific locally-acting drugs,
phototherapy (UVB 311 nm, UVA-1, Bath-PUVA,
Cream-PUVA) or tap water iontophoresis were used
where appropriate.
All patients enrolled in the study were recommended to
wear silver-containing textiles (Binamed Moll GmbH,
Kulmbacher Strasse 115, D-95445 Bayreuth) as part of
their treatment. Depending on the skin site affected,
shirts (long or short-sleeved), trousers (long or short),
arm and leg gaiters, gloves or mittens and socks or sock
liners were given out by the nursing staff. Patients were
Fig. 1 Wearing comfort of the silver textiles.
asked to wear the garments for as long as possible. When Atopic Hand and Other Total dirty, they were exchanged by the staff. At the times of admission and discharge, the investig- ating physician recorded the skin condition in terms of reddening, flaking, weeping, excoriation caused by scratching and the disease activity score (SCORAD [11,12] and INDEX21 [13]. The weeping tendency, severity of itchiness and pre-hospital treatment were recorded on admission. In addition, the clinical global impression of the effectiveness of the silver textiles was recorded on discharge. Patients themselves had to assess the following points: wearing comfort of the silver textiles, alleviation of itching by them, silver textiles as a protection against scratching the skin, effect of silver textiles on night-time sleep, improvement in skin appearance since wearing the silver-impregnated clothing on the affected sites, and side effects. The silver textiles were also to be graded from 1(best) to 6 (worst). The SPSS program 11.5.1 for Windows was used for the Fig. 2 Alleviation of itching by the combination therapy with silver
statistical analysis. The results shown as mean ± standard textiles.
95 of the 125 patients enrolled in the study had atopic dermatitis (76.0%), 18 hand and foot eczema (14.4%) and the remaining 12 (9.6%) other skin diseases, e.g. palmoplantar psoriasis showing features of eczema with itching and superinfection, which were also appropriate for inclusion in the study. The average serum IgE values in the neurodermatitis (atopic dermatitis) patients were 1900 kU/l ± 4400. Using a visual analogue scale with a minimum of 1 and a maximum of 10, the average score for itching on admission was 6.1 ± 2.6. In neuro-dermatitis this was slightly higher at 6.6 ± 2.1, but lower (5.3 ± 3.2) in patients with hand and foot eczema. A tendency to weep was reported in 56.8% of the neurodermatitis patients, in 83.3% of those with hand and foot eczema and in 50.0% of the remaining patients. Fig. 3 Effect of the silver textiles as part of combination therapy on night-
Topical cortisone and/or immunomodulators had been Atopic Hand and Other Total used immediately prior to hospitalisation in 64.0% of dermatitis foot eczema diagnoses patients. This figure was 55.8% in those with atopic dermatitis, as high as 77.8% in the group with hand and [Replace all "," in the figures by "."] Walker KP, Amon U. Clinical investigation of the effect and acceptance of silver textiles… Akt Dermatol 2008; 257-261 Original paper 259
Fig. 7 Comparison of average scores on admission [Aufnahme] and
discharge
[Entlassung].
foot eczema and 100.0% in the remaining patients.
Fig. 4 The silver textiles as protection against scratching the skin.
During the study, 60.0% of the 125 patients were given gloves, 44.0% received a long shirt, 28.8% long trousers, 28.0% arm gaiters and 16.0% leg excellent stayed about the same considerably better no effect gaiters. The other products were used to a lesser extent. On questioning the patients, the silver-
impregnated textiles were rated very highly. The
individual results regarding wearing comfort,
improvement in itching and night-time sleep can be
found in  Figs. 1-3. The silver textiles were also
used as a type of protection against scratching. The
assessment of this property was predominantly
positive ( Fig. 4). Overall, a marked improvement
and even a healing of the skin under the adjuvant
treatment with silver-containing textiles was seen in
more than ¾ of cases of atopic dermatitis and of
hand and foot eczema ( Fig. 5). The effectiveness
of the silver-impregnated clothing was rated by the
investigating physician as very good or good in
81.0% of cases of atopic dermatitis and in 82.2% of
hand and foot eczema ( Fig. 6). The SCORAD
Fig. 5 Improvement in skin appearance under the combination therapy
with silver textiles.
score improved from 39.4 ± 14.9 to 14.3 ± 10.6 and the Index 21 from 11.4 ± 3.5 to 3.5 ± 1.9 ( Fig. 7).
In 76.0% of cases this improvement occurred without systemic or topical cortisone. In the neurodermatitis group, this figure was even higher at
83.2%. The topical treatment that was used is shown
in  Fig. 8. Between the time of starting therapy
and discharge from inpatient care, marked
improvements in terms of reddening, weeping,
flaking and scratching (excoriation) were recorded.
Whereas on admission, reddening was rated as
massive or moderate in 96.8% of patients, by the
time of discharge this was merely slight or
completely absent in 90.4% of patients. Marked
improvements were also noted in terms of flaking:
on admission this was present in 89.6% of patients,
whilst on discharge it had disappeared in 64.8% of
cases. The proportion also changed with regard to
Fig. 6 Clinical global impression of the doctor of the effectiveness of the weeping: initially 41.6% of patients showed marked silver textiles as part of combination therapy. or moderate weeping, but by the end of treatment this was present in only 0.8%, with 99.2% of patients showing merely slight, if any, weeping. Scratching (excoriation) likewise improved: this was marked or significant in 73.6% of patients on adm- Walker KP, Amon U. Clinical investigation of the effect and acceptance of silver textiles… Akt Dermatol 2008; 257-261 260 Original paper
significant improvement in SCORAD values was also achieved within only 2 weeks and the SCORAD fell from 74.6 to 292.9 [10]. The present study was designed to investigate the effectiveness and acceptance of such silver textiles in atopic dermatitis. However the products were also beneficial in other diseases involving a problem of bacterial colonisation. Hand and foot eczema have a multifactorial genesis and are very difficult to treat [15] so a supportive therapeutic use of silver textiles is certainly an important aspect. Overall, the severity of the patients enrolled in the study could be classed as somewhat marked. This is confirmed by the findings on admission for weeping, intensity of Fig. 8 Topical treatment of the areas in which the silver textiles were
itching, the intensive use of cortisone and/or immunomodulators immediately before admission, as well as the very high disease activity scores. Serum IgE skincare products immunomodulators clioquinol cortisone (clotrimazole-) zinc lotion other values in the neurodermatitis patients were also very high at 1900 kU/l ± 4400. In order to interpret the recorded data on the treatment of silver textiles correctly, it must also be noted that despite the marked severity of the diseases, 76% of patients received no form of systemic or external cortisone treatment during the study. This figure was even higher in the neurodermatitis patients at 83%. Phototherapies, cortisone replacement products, zinc preparations and skincare products were used instead of cortisone. The results demonstrate that in the opinion both of patients as well as of investigators, the silver textiles tested constitute a very good addition to the spectrum of therapy for certain chronic skin diseases. Atopic Fig. 9 Average grade.
dermatitis together with hand and foot eczema, showed the highest significance. Thus on discharge, 88% of all dermatitis foot eczema diagnoses [Schulnote = grade] patients rated the wearing comfort as "outstanding" or "pleasant". Relief of itching through the combination Ission but fell during the course of treatment to affect therapy was also assessed very positively, with it only 3.2% at discharge. Almost all (96.8%) of patients described as "excellent" by 11.6% of neurodermatitis then had only minor, if any, scratching (excoriation). patients and "markedly improved" by 62.1%. In terms of When asked, the average grade patients gave for the improvement in night-time sleep, 53.7% of patients with
silver textiles was 2.1 (i.e. good); a grade of 2.0 was neurodermatitis reported it as "excellent" or "greatly
given by patients with hand and foot eczema ( Fig. 9).
improved". 74.7% of neurodermatitis patients assessed the protection against itching provided by the silver textiles also as "excellent" or "markedly better". Discussion
Furthermore, skin appearance was "markedly improved" or even "healed" in 80% of patients by the combination Several studies have already confirmed that silver- therapy. When rated using the classic German school containing textiles are highly effective in atopic grading system, the average grade awarded to the silver dermatitis. In 2006, Gauger showed significant textiles was 2.1 (i.e. good). improvements in eczema in 68 neurodermatitis patients No side effects were observed in this study. after only 1 week. Furthermore, in terms of wearing At the final clinical evaluation of the silver textiles by comfort, the silver textiles were equal to those made of investigators, the highest effectiveness was recorded in cotton and a significant improvement in itching was atopic dermatitis (81% "very good" and "good") and in recorded compared to a placebo group [2]. The hand and foot eczema (72.2% "very good" and "good"). concentration of Staphylococcus aureus was also If the assessments for all patients are combined, then significantly reduced after only 2 days of wearing silver- 98.4% of patients showed a "very good", "good" or containing textiles [2,14]. Juenger et al. likewise showed "satisfactory" result. significant improvements in itching when silver- During the period of wear, there were also notable containing textiles were worn compared to silver-free. A improvements in reddening, weeping, flaking and Walker KP, Amon U. Clinical investigation of the effect and acceptance of silver textiles… Akt Dermatol 2008; 257-261 Original paper 261

scratching (excoriation). At the time of discharge, 90% References
of all patients said that they wished to continue using the
silver textiles after ending the in-patient therapy.
In view of these numerous reasons, silver textiles should
in future be included in the standard spectrum of
adjuvant treatment for atopic dermatitis and hand and
foot eczema, because they represent a very effective
addition to the therapies available for certain chronic
skin diseases.

Source: http://www.binamed.de/docs/PsoriSol-Studie-engl.pdf

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