Nanomaterial shows potential for AD treatment

A customized nanotextile garment for wet wrap therapy (WWT) for moderate-to-severe atopic dermatitis (AD) was as effective as viscose yet superior in terms of patient acceptability, a Singapore study has shown.

One of the cornerstones of AD management is the restoration of skin barrier and hydration caused by the increased transepidermal water loss in AD. [Indian J Dermatol 2016;61:649-655] WWT is a widely used adjunctive modality for AD with proven superiority over topical steroid therapy. [Br J Dermatol 2006;154:579‐585; Immunol Allergy Clin North Am 2017;37:123‐139]

“The conventional material used for WWT is viscose. [However,] drawbacks include discomfort, high cost, and poor durability,” said the researchers. While smoother than cotton, viscose fibres are still rough enough to elicit skin irritation. It also easily loses strength, thus requiring cautious handling and washing. [Dermatitis 2009;20:29‐33] “[V]iscose is also a good medium for microorganisms to grow in, which can potentially increase the risk of secondary skin infection,” they added.

“[W]e explored the possibility of using customized nanopolyester [which] is reported to provide good ventilation and has good cooling properties,” said the researchers. Moreover, polymer nanofibres are highly porous, durable, and do not encourage bacterial growth, hence the reduced risk of secondary infection, they noted.

Fifty-three children (mean age 8 years, 41 percent female) from KK Women’s and Children’s Hospital were randomized 1:1 to receive viscose or 100% nanopolyester on top of their regular topical emollients and corticosteroids for AD. The designated WWT garment should be applied daily overnight or 4 hours in the day for 2 weeks. [Pediatr Dermatol 2020;37:52-57]

Disease severity similarly improved with viscose and nanotextile as seen in the reductions in mean SCORAD* index (from 52.3 to 30.7 [viscose] and 57.0 to 34.6 [nanotextile]) and IGA** scores (from 3.17 to 1.82 and 3.29 to 2.10, respectively; mixed model time effect p<0.001 for all) from baseline to day 14.

The mean quality-of-life score also dropped from baseline to day 14 with both viscose (from 13.6 to 8.26; p<0.001) and nanotextile (from 14 to 8.29; p<0.001), further reinforcing the findings signifying improvement in disease severity.

Patient approved

In terms of patient feedback, nanotextile outdid viscose, as reflected by the lower mean scores in terms of discomfort (2.73 vs 5.12; p=0.001), difficulty in wearing (2.78 vs 5.24; p=0.003), hot/stuffiness (2.43 vs 3.96; p=0.033), and limitation in movement (3.36 vs 2.56; p=0.941).

“[These findings suggest that] nanotextile was … more comfortable and breathable, easier to wear, and [more flexible than] viscose. In addition, the insulated cooling effect of nanotextile allows for better temperature control in hot environments,” said the researchers.

They attributed the higher comfort level to the cooling effect and reduced skin irritation generated by the smoother surface of nanotextile. Its durability, pliability, and reusability account for cost-effectiveness and suitability in a tropical country like Singapore, they added. “The temperature and humidity level in Singapore [are] relatively stable throughout the year. [A]s such, there should be minimal changes in climate for the duration of our study.”

Despite the small sample size and short study duration, the findings underscore the potential of nanotextile to provide better care in AD management, especially for patients with suboptimal response to topicals alone, said the researchers.