Clothing and Fabrics

Clothing touches a toddler’s skin all day and night, so fabric choice is one of the most common pieces of trigger advice for Atopic Dermatitis. The National Eczema Society (NES) says many people with eczema find that wool and synthetic fabrics such as polyester and nylon cause overheating, sweating and irritation, “which set off the dreaded itch”. Rough seams, fibres, fastenings and threads can also irritate sensitive skin. The British Association of Dermatologists lists woollen clothing among irritants and advises cotton or silk, with no wool next to the skin. Medscape’s paediatric guidance says to wear loose-fitting, open-weave cotton or cotton-blend clothing and avoid wool. The mechanism is physical: coarse fibres rub the skin, and overheating and sweat feed the Itch-Scratch Cycle (see Heat and Sweat). Wool is also the source of Lanolin, a separate contact allergen. Lanolin allergy is unrelated to wool-fibre irritation, and true allergy to wool fibre “probably does not exist” (Cutis 2023).

Clothing and Fabrics [part-of] Environmental Triggers Clothing and Fabrics [triggers] Itch-Scratch Cycle Clothing and Fabrics [relates] Heat and Sweat Lanolin [relates] Clothing and Fabrics

Cotton, bamboo and practical points. Cotton, preferably 100%, is the fabric most often recommended. It is soft and cool, absorbs sweat, washes easily and “allows the skin to breathe” (NES). The NES warns that “cotton rich” blends can contain a large share of polyester, so labels need checking. Bamboo viscose is softer and more absorbent and is promoted for temperature control, but its processing is chemical-intensive. The NES also advises 100% cotton bedding over synthetic sheets and pillowcases. Common practical steps include cutting out labels, choosing flat or outside seams and avoiding tight clothing; these come from guidance and experience rather than trials. Clothing and bedding soaked in emollient can catch fire more easily (Emollient Fire Risk).

Clothing and Fabrics [relates] Emollient Fire Risk

Silk garments: the CLOTHES trial. The CLOTHES Trial (Thomas et al., PLoS Med 2017) tested whether special silk garments help. It randomised 300 UK children aged 1–15 (mean age 5) with moderate to severe eczema to standard care plus silk garments for 6 months, or standard care alone. Nurses who did not know the allocation scored eczema with EASI. The garments were worn on a median 81% of nights but only 34% of days. Geometric mean EASI fell from 9.2 to 5.4 with silk and from 8.4 to 5.4 with standard care. There was no difference between groups (adjusted ratio 0.95, 95% CI 0.85–1.07; p = 0.43), which is equivalent to −1.5 to 0.5 EASI points and not clinically important. Skin infections were similar (25% vs 28%). Even if the small effect were real, silk would cost £56,811 per quality-adjusted life year (QALY), which is not cost-effective for the NHS. The authors concluded that “silk clothing is unlikely to provide additional benefit over standard care”. They noted that an objective primary outcome may have underestimated benefits that parents perceive. A nested qualitative study found that “the hoped-for ‘miracle cure’ did not transpire”.

CLOTHES Trial [contradicts] Clothing and Fabrics CLOTHES Trial [relates] Atopic Dermatitis CLOTHES Trial [relates] EASI

Conflict: [National Eczema Society, n.d.; British Association of Dermatologists, 2025] recommend silk (including close-fitting therapeutic silk garments) as a good option for eczema skin. [Thomas et al., CLOTHES Trial, PLoS Med, 2017] found silk garments added no benefit over standard care for children with moderate to severe eczema. Guidance on everyday fabric comfort and trial evidence on therapeutic effect may be answering different questions. Unresolved — add to open_questions.

Laundry detergents: biological vs non-biological. Many UK parents assume non-biological washing powder is kinder to eczema skin. The evidence does not support this. In a randomised, double-blind crossover trial, 25 people with atopic dermatitis used detergent with or without enzymes for one month each. There was no difference in SCORAD, corticosteroid use or symptoms (Andersen et al., Acta Derm Venereol 1998). A British Journal of Dermatology review (Basketter et al. 2008) concluded that enzyme hazards “do not translate into a risk of skin reactions” at consumer exposures, and called the belief “a consequence of a mythology”. The NES agrees there is “no scientific evidence” that bio enzymes make eczema worse, but notes that many people feel they react and so choose non-bio. Fabric conditioner leaves fragrance and chemical residue in fabrics. The NES suggests a double rinse to remove detergent traces. Fragrance-free products reduce Fragrance Allergy risk. See Laundry Detergents.

Laundry Detergents [relates] Clothing and Fabrics Fragrance Allergy [relates] Laundry Detergents

Conflict: [Andersen et al., Acta Derm Venereol, 1998; Basketter et al., Br J Dermatol, 2008] found enzyme (biological) detergents do not worsen atopic dermatitis. Parent reports (evidence: anecdotal, r/toddlers 2024) describe switching to non-biological detergent as “the massive trigger” fix. The only RCT was small (n = 25), short (1 month) and not in toddlers. Unresolved — add to open_questions.

What parents report (evidence: anecdotal). In r/toddlers, one parent said changing “soaps and sheets and clothing material” had not helped significantly, while another credited non-bio detergent for clothes and bedding. On r/eczema, commenters advise “get rid of any synthetic material like polyester, cotton only” and detergents “aimed at allergies”. Thick footed pyjamas are used to stop night scratching. The CLOTHES qualitative study found that some children felt silk helped a little, but most families did not see a dramatic change.

Connections

• Environmental Triggers — fabrics as irritant triggers, source: NES; NHS
• CLOTHES Trial — silk garments no benefit vs standard care, source: Thomas, PLoS Med 2017
• Laundry Detergents — enzymes not shown to worsen AD, source: Andersen 1998; Basketter 2008
• Heat and Sweat — wool/synthetics cause overheating and sweating, source: NES
• Itch-Scratch Cycle — rough fibres provoke itch, source: Medscape
• Lanolin — wool-derived contact allergen, source: Tam & Yu 2022
• Fragrance Allergy — fragranced detergents and conditioners, source: NES
• Emollient Fire Risk — emollient-soaked fabrics ignite more easily, source: NHS
• EASI — CLOTHES primary outcome, source: Thomas 2017