title: Chitosan Coated Textiles May Improve Atopic Dermatitis Severity by Modulating Skin Staphylococcal Profile: A Randomized Controlled Trial.
abstract: BACKGROUND
  Atopic dermatitis (AD) patients may benefit from using textiles coated with skin microbiome-modulating compounds. Chitosan, a natural biopolymer with immunomodulatory and antimicrobial properties, has been considered potentially useful.
  
  
  OBJECTIVE
  This randomized controlled trial assessed the clinical utility of chitosan-coated garment use in AD.
  
  
  METHODS
  Of the 102 patients screened, 78 adult and adolescents were randomly allocated to overnight use of chitosan-coated or uncoated cotton long-sleeved pyjama tops and pants for 8 weeks. The primary outcome was change in disease severity assessed by Scoring Atopic dermatitis index (SCORAD). Other outcomes were changes in quality of life, pruritus and sleep loss, days with need for rescue medication, number of flares and controlled weeks, and adverse events. Changes in total staphylococci and Staphylococcus aureus skin counts were also assessed. Comparisons were made using analysis of variance supplemented by repeated measures analysis for the primary outcome. Interaction term between time and intervention was used to compare time trends between groups.
  
  
  RESULTS
  Chitosan group improved SCORAD from baseline in 43.8%, (95%CI: 30.9 to 55.9), P = 0.01, placebo group in 16.5% (-21.6 to 54.6); P = 0.02 with no significant differences between groups; Dermatology Quality of life Index Score significantly improved in chitosan group (P = 0.02) and a significant increase of skin Coagulase negative Staphylococci (P = 0.02) was seen.
  
  
  CONCLUSIONS
  Chitosan coated textiles may impact on disease severity by modulating skin staphylococcal profile. Moreover, a potential effect in quality of life may be considered.
  
  
  BACKGROUND
  ClinicalTrials.gov NCT01597817.
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.|Immunoallergology Unit, Hospital Pedro Hispano, Matosinhos, Portugal.
authors.forename: Cristina
authors.initials: C
authors.lastname: Lopes
authors.affiliation: CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.
authors.forename: Jose
authors.initials: J
authors.lastname: Soares
authors.affiliation: CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.
authors.forename: Freni
authors.initials: F
authors.lastname: Tavaria
authors.affiliation: Dermatology Center Epidermis, Instituto CUF, Porto, Portugal.
authors.forename: Ana
authors.initials: A
authors.lastname: Duarte
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.|Dermatology Center Epidermis, Instituto CUF, Porto, Portugal.
authors.forename: Osvaldo
authors.initials: O
authors.lastname: Correia
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Oksana
authors.initials: O
authors.lastname: Sokhatska
authors.affiliation: Department of Medical Education and Simulation, Faculty of Medicine, University of Porto, Porto, Portugal.|Department of Epidemiology, Predictive Medicine and Public Health, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Milton
authors.initials: M
authors.lastname: Severo
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.|Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Diana
authors.initials: D
authors.lastname: Silva
authors.affiliation: CBQF-Centro de Biotecnologia e Química Fina-Laboratório Associado, Escola Superior de Biotecnologia, Universidade Católica Portuguesa, Porto, Portugal.
authors.forename: Manuela
authors.initials: M
authors.lastname: Pintado
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.
authors.forename: Luis
authors.initials: L
authors.lastname: Delgado
authors.affiliation: Laboratory of Immunology, Basic and Clinical Immunology Unit, Faculty of Medicine, University of Porto, Porto, Portugal.|Immunoallergology Department, Centro Hospitalar São João, Porto, Portugal.
authors.forename: Andre
authors.initials: A
authors.lastname: Moreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D048271:Chitosan / Q000008:administration & dosage / Q000494:pharmacology / Q000627:therapeutic use*; D003020:Clothing; D003876:Dermatitis, Atopic / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D008297:Male; D013210:Staphylococcus / Q000187:drug effects*; D013784:Textiles
chemical_list: D000890:Anti-Infective Agents; D048271:Chitosan