The success of blinding in both of the trials conducted by Diepgen and colleagues34,35 is questionable because of the different roughness of the various shirt fibres. The magnitude of effects was not stated in the 1995 paper, and it is possible that small differences in comfort between cotton and polyester fabrics were missed. Both RCTs suggest that the smoothness of the fabric is more important than the type of fabric used. Synthetic fibres that are just as comfortable for people with atopic eczema can be manufactured with smooth fibres using yarns and fabric construction.
From the Seymour et a/.36 study it was unclear if the group with atopic eczema who wore cloth nappies were randomised in the same way as the other two groups and whether statistical comparisons were made with the control population who were not part of the same randomised group. The study, nevertheless, suggests that nappy rash is less severe in atopic infants who wear nappies with absorbent gelling material. There was no evidence to support any benefit of conventional disposable nappies over cloth nappies, although the study may have lacked power to demonstrate small differences. The environmental implications of the different types of nappies were not discussed.
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