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In children with moderate to severe atopic eczema, there was no evidence that using silk garments in addition to standard care improved eczema severity.

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Kim S Thomas, Lucy E Bradshaw, Tracey H Sach, Fiona Cowdell, Jonathan M Batchelor, Sandra Lawton, Eleanor F Harrison, Rachel H Haines, Amina Ahmed, Taraneh Dean, Nigel P Burrows, Ian Pollock, Hannah K Buckley, Hywel C Williams, Joanne Llewellyn, Clare Crang, Jane D Grundy, Juliet Guiness, Andrew Gribbin, Eileen V Wake, Eleanor J Mitchell, Sara J Brown & Alan A Montgomery.

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Kim S Thomas ^1,*, Lucy E Bradshaw ², Tracey H Sach ³, Fiona Cowdell ⁴, Jonathan M Batchelor ¹, Sandra Lawton ⁵, Eleanor F Harrison ², Rachel H Haines ², Amina Ahmed ⁶, Taraneh Dean ^7,8, Nigel P Burrows ⁹, Ian Pollock ¹⁰, Hannah K Buckley ¹¹, Hywel C Williams ¹, Joanne Llewellyn ⁵, Clare Crang ⁹, Jane D Grundy ¹², Juliet Guiness ¹⁰, Andrew Gribbin ¹¹, Eileen V Wake ⁴, Eleanor J Mitchell ², Sara J Brown ^13,14, Alan A Montgomery ²

¹ Centre of Evidence Based Dermatology, University of Nottingham, Nottingham, UK
² Nottingham Clinical Trials Unit, University of Nottingham, Queen’s Medical Centre, Nottingham, UK
³ Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, UK
⁴ Faculty of Health Education and Life Sciences, Birmingham City University, Birmingham, UK
⁵ Nottingham University Hospitals NHS Trust, Queen’s Medical Centre, Nottingham, UK
⁶ Patient and public involvement representative, Nottingham, UK
⁷ Faculty of Science, University of Portsmouth, Portsmouth, UK
⁸ Research and Enterprise, University of Brighton, Brighton, UK
⁹ Cambridge University Hospitals NHS Foundation Trust, Addenbrooke’s Hospital, Cambridge, UK
¹⁰ Royal Free London NHS Foundation Trust, Barnet Hospital, Barnet, UK
¹¹ Portsmouth Hospitals NHS Trust, Queen Alexandra Hospital, Cosham, UK
¹² Isle of Wight NHS Trust, St Mary’s Hospital, Newport, UK
¹³ Skin Research Group, University of Dundee, Dundee, UK
¹⁴ Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK
^* Corresponding author Email: kim.thomas@nottingham.ac.uk

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Responses to this report

Response by Professor Kim Thomas on 3 August 2017 at 1:23 PM
Author Response to CLOTHES criticism dated 30/06/2017
Thank you for your comment and interest in our CLOTHES trial. Whilst we acknowledge that seasonality may play a part in exacerbating eczema in some individuals, we do not think that seasonality is likely to have unduly impacted on interpretation of the CLOTHES trial results. A previous UK study, which followed children daily for a 9-month period, found that the most important factors associated with disease worsening were wearing nylon clothing, dust, unfamiliar pets, sweating and shampoos (Langan 2009). Nevertheless, the participants were recruited over an 18 month period, thus spanning all seasons. The children were randomised to the two groups in a ratio of 1:1 throughout this recruitment period, and so any effect of season on clinical response should have affected both groups equally. As a result, we do not think that the season in which the children were recruited is likely to have biased the study results. The CLOTHES trial followed the children for 6 months, which was felt to be sufficient time to capture the chronic relapsing nature of the eczema, and is in fact, considerably longer than the majority of eczema trials published to date (see the GREAT database: www.greatdatabase.org.uk). Thank you for your comments on this study, we hope our response is helpful. Reference: Langan, S.M., Silcocks, P. and Williams, H.C. (2009), What causes flares of eczema in children?. British Journal of Dermatology, 161: 640–646. doi:10.1111/j.1365-2133.2009.09320.x”

Response by Dr Laura Reeves on 3 August 2017 at 1:13 PM
CLOTHES criticism
Dear Editor, With regards to the recent CLOTHES trial undertaken in Nottingham and published in April 2017: during which period of the year was the 6 month observation period of these children carried out? As we know, eczema is an atopic manifestation and can be significantly worse at certain times of the year- specifically at times of high pollen counts over Spring/Summer. We see children all the time in primary care with exacerbations of eczema varying wildly with seasons; remaining quiescent in colder months and becoming active in warmer weather/high pollen counts. If the study was conducted prior to the start of this season (and thus run into it) then this may have affected the severity of some children's eczema more so than others irrespective of their treatment group? Would a year long study be more fitting for the fluctuating nature of atopic dermatitis?