Introduction textiles skin and infections

Since the phylogenetic loss of fur (Rantala, 2007), Homo sapiens has needed to protect his skin with acquired animal skin or some form of fabric in all but a few climatic zones. Very late in evolution, the technical skills of man reached a level that allowed the production of textiles for many more purposes than just avoiding loss of heat or mechanical injury. While the use of textiles on human skin is overwhelmingly beneficial to the wearer (Elsner, 2003), there are situations when the intimate contact of fabrics (or animal skins) with injured or irritated skin may be harmful (Fenske and Lober, 1990; Bolognia, 1995; Fisher et al., 2002; Romagnani, 2004). Mechanical or chemical properties of textiles may lead to skin affections, e.g. chafe, toxicity or allergy. Fabrics may also contribute to skin infection, especially where skin is already injured or stressed. Tightly woven fabrics may favour bacterial or fungal growth by maintaining a moist and warm environment, and fabrics may themselves harbour bacteria (e.g. Teufel et al.,

2010). Indeed, the three-dimensional structure of textiles with a high proportion of 'empty' and capillary spaces, and the hydrophilic or lipophilic surfaces of the fibres have a tendency to absorb aqueous or fatty liquids or emulsions, as well as particulate dirt. These same properties of textiles can be a blessing or a curse. On the one hand, textiles soaked in medicinal compounds, for example, are helpful in wound care. On the other hand, fabrics soaked in sweat or exudates offer an ideal substrate and nutrients for pathogenic bacteria or fungi. The combination of mechanical irritation, susceptible skin, and 'infectious' textiles is a particularly unfavourable trio. In order to shift the balance towards bless, the fibre surface can be modified in ways that make it one or all of less absorptive, drug eluting, or even germicidal. Such textiles have become commercially available in the last decade. The marketing efforts raise great hopes in those parts of the population who suffer from 'stinking socks' and, of special interest here, who suffer from dermatological conditions such as atopic dermatitis or eczema with bacterial or fungal super infections. Moderately priced functional textiles that can, at the same time, stop and/or prevent infections, add to the quality of life, and reduce the need for medication, are a very attractive prospective for the individual and the healthcare system. Unfortunately, the marketing efforts seem to be disproportionately high compared with the current extent of systematic clinical evidence for the benefit of anti-infectious textiles.

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