Fabric contamination and effective laundering for managing skin conditions: A systematic review

• Washing clothes and bedding is widely assumed to be important in managing skin conditions. • Evidence for fabric contamination and effective laundering methods is strong for Staphylococcus aureus , dermatophytes, and bed bugs. • Laundering may only be important for severe cases of head lice, body lice, scabies, molluscum contagiosum, and Streptococcus pyogenes infection. • Temperature is the most important laundering variable. Hot water washing and/or machine drying ≥60°C for at least 15 min is broadly recommended. • Low temperature protocols and alternative methods suitable across organisms require research attention. Household fabrics, such as clothes, bedding, and towels, are in close contact with the skin and are assumed to play a role in the transmission of skin pathogens/ectoparasites. International public health advice for managing skin conditions therefore usually includes recommendations to wash clothes and bedding. However, such advice is often general and inconsistent between sources. This article synthesises evidence for fabric contamination and effective laundering methods specific to priority skin pathogens ( Staphylococcus aureus, Streptococcus pyogenes , dermatophytes, molluscum contagiosum virus) and ectoparasites (scabies, bed bugs, head lice, and body lice). A total of 635 datapoints were extracted from 141 studies; 86 studies were focused on fabric contamination whilst 55 were focused on fabric decontamination or laundry-relevant survivability. Evidence for fabric contamination and effective laundering methods was strong for S. aureus , dermatophytes, and bed bugs. There was scant evidence for the contamination of fabrics with head lice, body lice, scabies, S. pyogenes and molluscum contagiosum virus, so laundering may only be important for severe cases of infection/infestation. Across all organisms, temperature was the most important laundering variable. Washing and/or machine drying at ≥60°C for at least 15 min is broadly recommended. However, this may be difficult to achieve in some settings; low-temperature protocols, and alternative methods require research attention. This review informs the development of practical laundering guidelines and policy, which are needed to support clinics and communities managing a high burden of skin conditions.