title: Silver-loaded seaweed-based cellulosic fiber improves epidermal skin physiology in atopic dermatitis: safety assessment, mode of action and controlled, randomized single-blinded exploratory in vivo study.
abstract: BACKGROUND
  The epidermal part of the skin is the major interface between the internal body and the external environment. The skin has a specific physiology and is to different degrees adapted for protection against multiple exogenous stress factors. Clothing is the material with the longest and most intensive contact to human skin. It plays a critical role especially in inflammatory dermatoses or skin conditions with an increased susceptibility of bacterial and fungal infections like atopic dermatitis. Previously, we have shown a dose-dependent antibacterial and antifungal activity of silver-loaded seaweed-based cellulosic fibres.
  
  
  OBJECTIVE
  We studied the mode of action of silver-loaded seaweed-based cellulosic fiber and performed a broad safety assessment. The principal aim was to analyse the effects of wearing the textile on epidermal skin physiology in 37 patients with atopic dermatitis in a controlled, randomized single-blinded in vivo study. Furthermore, the sensitization potential was tested in a patch test in 111 panellists.
  
  
  RESULTS
  We could demonstrate in vitro a dose-dependent scavenging of induced reactive oxygen species by silver-loaded seaweed-based cellulosic fibers. Safety assessment of these fibres showed no detectable release of silver ions. Furthermore, ex vivo assessment after 24 h application both in healthy volunteers and patients with atopic dermatitis by sequential tape stripping and subsequently raster electron microscopy and energy dispersive microanalysis analysis revealed no detectable amounts of silver in any of stratum corneum layers. Serum analysis of silver showed no detectable levels. The in vivo patch testing of 111 volunteers revealed no sensitization against different SeaCell Active (SeaCell GmbH, Rudolstadt, Germany) containing fabrics. The in vivo study on 37 patients with known atopic dermatitis and mild-to-moderate eczema on their arms were randomly assigned to either silver-loaded seaweed fibre T-shirts or to cotton T-shirts for 8 weeks. A significant reduction in Staphylococcus aureus colonization was detectable for the silver T-shirts compared with cotton T-shirts without any changes in non-pathogenic surface bacteria colonization. Furthermore, a more pronounced improvement in barrier function (transepidermal water loss) was observed in mildly involved eczema areas during the first 4 weeks of the study. Stratum corneum hydration and surface pH improved in both treatment groups over time.
  
  
  CONCLUSIONS
  The tested silver-loaded seaweed fibre can be regarded as safe and seams to be suited for application in bio-active textiles in atopic dermatitis based on its positive in vivo activity.
authors: Department of Dermatology and Allergology, Friedrich Schiller University, Jena, Germany. joachim.fluhr@bioskin.de
authors: Joachim W
authors: JW
authors: Fluhr
authors: Maria
authors: M
authors: Breternitz
authors: Doreen
authors: D
authors: Kowatzki
authors: Andrea
authors: A
authors: Bauer
authors: Joerg
authors: J
authors: Bossert
authors: Peter
authors: P
authors: Elsner
authors: Uta-Christina
authors: UC
authors: Hipler
mesh_terms: D000293:Adolescent; D000328:Adult; D000975:Antioxidants / Q000494:pharmacology; D002482:Cellulose / Q000627:therapeutic use*; D003020:Clothing; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000378:metabolism / Q000503:physiopathology*; D004305:Dose-Response Relationship, Drug; D004485:Eczema / Q000188:drug therapy / Q000378:metabolism / Q000503:physiopathology; D004817:Epidermis / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010328:Patch Tests; D017382:Reactive Oxygen Species / Q000378:metabolism; D012624:Seaweed; D012834:Silver / Q000627:therapeutic use*; D016037:Single-Blind Method; D013211:Staphylococcus aureus / Q000187:drug effects; D013784:Textiles; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000975:Antioxidants; D017382:Reactive Oxygen Species; D012834:Silver; D002482:Cellulose