Mud therapy and skin microbiome: a review

Advances in modern Balneology: new evidence-based indications from recent studies

Balneotherapy (BT) is a therapeutic approach that utilizes various forms of water-based treatments to promote health and well-being. BT possesses a rich historical heritage and has garnered recognition from esteemed institutions such as the World Health Organization (WHO). Recent scientific research enables the identification of relevant diseases (obesity, metabolic diseases, sleep disorders, mental health conditions, Long-COVID-19, and cancer rehabilitation) that could potentially benefit from balneo-therapeutic treatments, thereby presenting new avenues of opportunity for SPA ("Salus per Aquam") medicine. These conditions exemplify the potential benefits of BT for ailments beyond the traditional scope of treatment associated with BT (most commonly osteoarthritis, fibromyalgia, rheumatic back pain, and chronic inflammatory respiratory or skin disorders). Overall, the current scientific evidence suggests that BT holds significant potential for enhancing both individual wellbeing and public health. However, further high-quality clinical trials are essential to corroborate these preliminary findings and to provide critical insights into the therapeutic benefits of BT, paving the way for its broader integration into healthcare practices and public health initiatives.

Chemical composition and physicochemical properties of natural therapeutic mud of Kazakhstan salt lakes: a review

In recent years, interest in natural therapeutic mud has been growing all over the world. This natural product has a positive therapeutic effect on the skin and has fewer side effects on the human body. There are more than 40 thousand salt lakes in Kazakhstan. Most of them have natural mud sources, the potential of which has not yet been fully explored. The review presents an analysis of the available information on the physical and chemical properties of the main sources of natural mud from salt lakes in Kazakhstan and Kazakh sanatoriums that use natural mud in the treatment. All available publications, presenting the systematic studies, were used for data analysis. A comparative analysis of the mineralization of water, brine, and silt in one reservoir shows that the mineralization of water is not always the least. The available data indicate a point and partial nature of peloid studies, e.g., inorganic composition of natural muds from Western and Southern Kazakhstan is well described in the literature. In turn, there is a lack of these data from Northern and Eastern Kazakhstan. Studies of peloids in these regions seem to be a promising direction of the future research for both local and world scientists. What is more, there is also a big gap in the analysis of organic matter of muds from the Kazakh lakes. Comparing the state of the art, i.e., the studies from other parts of Asia and Europe, the identification of the organic part of muds is another desirable direction as a potential source of biologically active compounds of natural origin.

Biophysical effects of a natural peloid on normal skin

A protocol study was designed to examine cutaneous behavior after continuous application of a peloid in the dry mineral residue of Lanjarón-Capuchina natural mineral water. This study aims to analyze the biomechanical behavior of normal skin using various non-invasive bioengineering techniques after the application of this peloid. We determine the effects of its application for 3 months on 38 healthy volunteers (41.4 ± 5.9 years, range 32-58) without a previous history of skin diseases by courtmetry, sebumetry, pH-metry, reviscometry, and tewametry. It was shown that the production of cutaneous sebum is significantly reduced by 6%, trans epidermal skin loss (TEWL) by 21%, skin fatigue by 30%, elasticity increased by 19%, firmness by 5%, and a skin redensification by 6% was obtained under these experimental conditions. Disparate and non-significant results were obtained concerning pH and viscoelasticity. Continuous skin care with the Lanjarón-Capuchina natural peloid modifies skin behavior, normalizing sebaceous secretion, favoring the biomechanical properties of the skin and the skin barrier function without modifying skin homeostasis.

The Effects of Lakitelek Thermal Water and Tap Water on Skin Microbiome, a Randomized Control Pilot Study

The beneficial effects of balneotherapy have been proven by numerous clinical studies on locomotor disorders. To date, there is only scant data on changes in the microbiome system of the skin during balneotherapy. The aim of this study was to compare the effects of thermal water and tap water on the skin’s microbiome in healthy volunteers. 30 healthy female volunteers participated in the study. The experimental group (of 15 women) spent 30-min 10 times, in Gabriella Spring’s thermal baths (i.e., mineral water containing sodium hydrogen carbonate).The controlled group (15 women) had the same, but in tap water. The results of this study have proven that there is a difference in the influencing effects of tap water and medicinal water on the microbiome of the skin. After bathing in the thermal water of Lakitelek, Deinococcus increased significantly at the genus level, and the tendency for Rothia mucilaginosa bacteria also increased. At the species level, Rothia mucilaginosa increased significantly, while Paracoccus aminovorans and the tendency for Paracoccus marcusii decreased. When the values of the two trial groups after bathing at the genus level were compared, Rothia bacteria increased significantly, while Haemophilus tended to increase, Pseudomonas tended to decrease, Neisseria tended to increase significantly, and Flavobacterium tended to decrease. At the species level, Geobacillus vulcani decreased significantly, and the tendency for Burkholderia gladioli decreased. The growth of Rothia mucilaginosa and the decrease in the tendency of Paracoccus, Pseudomonas, Flavobacteroium, and Burkholderia gladioli confirm the beneficial effect of balneotherapy. In this study, trends are represented by the uncorrected p value. The main result was that the thermal water changed certain bacteria of the skin, both on the genus and species levels, but there were no significant changes in the tap water used, either at the genus or species level. We first compared the worlds of thermal water and tap water’s microbiome systems. The thermal water decreased the number of certain inflammatory infectious agents and could enhance some of their positive effects, which have been proven at the molecular level. Our results can provide an important clue in the treatment of certain skin diseases. The research of the skin microbiome during balneotherapy can be one of the most intriguing and exciting topics of the future and can bring us closer to understanding the mechanism of action of balneotherapy.

Microbiological analysis, antimicrobial activity, heavy-metals content and physico-chemical properties of Fijian mud pool samples

The hot springs are home to a rich bacterial diversity which could be the source of enzymes, antibiotics and many other commercially important products. Most of the hot springs present in Fiji are unexplored and their analysis of microbial diversity could be of great interest in facilitating various industrial, agricultural and medicinal applications. This study is an attempt to evaluate the heavy metal concentration and to analyze the comprehensive bacterial diversity of two Fijian thermal mud pools, namely Sabeto and Tifajek. The two hot springs have a pH of 7.28 to 7.19 and a temperature of 32.2 to 38.8 °C, respectively. Mean metal concentrations of the studied mud samples ranged from 4.758 to 6.870 mg/kg and followed a decreasing sequence as Fe > Mn > Zn > Na > Ni > Cd > Ca > Cr > Cu. Levels of Fe, Na, Mn, Zn, Ni, Cd, Ca, Cr, Cu in the mud pool samples were within World Health Organisation (WHO) limits, while Cd was above regulatory limits. The heavy metals analysis results showed that both mud pools had high values for Cd, above the WHO limit of 3 mg/kg. In addition, 8 strains of actinomycetes were successfully identified for the first time in the Sabeto mud pool, where most of them showed antibacterial activity. The genetic identification of most isolates was determined in BLASTn analyses of their 16S rRNA sequences. Isolates were identified as that of Streptomyces, Nocardia and Rhodococcus genus. Further, AntiSMASH results of the closest relatives of cultured actinobacteria have shown to produce antibiotics, natural pesticides and other compounds of various usage. This study also found no fecal coliforms and supports existing knowledge and practice of using Fijian thermal mud pools for their therapeutic properties. Overall, the presented work indicated that the studied mud pools have therapeutic properties, harboring wealth of bacteria with antibiotic profiles and were risk free from health-related issues of heavy metals and disease-causing pathogens. It provides great insight into the studied mud pools which serves as a baseline from which further heavy metal monitoring or mitigation programs and microbial researches can be conducted.

[Microbiome of therapeutic muds used in Tatarstan]

Therapeutic muds (peloids), which are widely used for body healing, improve metabolism and have antibacterial, anti-inflammatory and analgesic effects due to enrichment with necessary microelements and biological active substances. However, the microbiological component of these effects is not well studied.

OBJECTIVE

To characterize the microbiome of therapeutic muds, used in the Tatarstan Republic, by identifying spectrum of cultivated microorganisms, using molecular analysis of bacterial communities, and by determining their biodiversity and functional potential based on revealed genetic determinants.

MATERIAL AND METHODS

The study design of 5 peloids samples (local sapropels and peat deposits of swamp; 3 samples of Crimean sulfide muds) included three main techniques: isolation and taxonomic determination of cultivated microorganisms by time-of-flight mass-spectrometry; molecular analysis of peloids bacterial communities by 16S RNA high-throughput sequencing; identification of functional profiles of communities by their genetic determinant using Global Mapper tool on iVikodak platform.

RESULTS

Experimental studies have confirmed the safety of examined peloids, where non-pathogenic cultivated bacteria belonging mainly to Bacillus and Rhodococcus genera were dominant. Metagenomic analysis showed that Firmicutes, Proteobacteria and Actinobacteria were predominant in all samples in different ratios. It has been established, that there is both the internal biodiversity of each sample and difference between them. The functional profile of microbial communities was determined based on the identification of bacterial genes. It has been revealed that all communities have an ability to synthesize antibiotics, as well as to decompose dangerous xenobiotics - polyaromatic hydrocarbons, cyclic compounds, and dioxins.

CONCLUSION

Various microbial communities, which were identified in the therapeutic muds, contribute both to the clearance of toxicants in the peloids and to the antibacterial properties of the latter. The obtained priority results create a fundamental basis for the subsequent study of the role of peloids' microbiome of different origin in their healing action.

Property of mud and its application in cosmetic and medical fields: a review

Mud is a semi-colloidal substance formed by the mixture of inorganic, organic and water under the influence of various physical and chemical factors through geological and biological processes. The chemical composition of mud is complex, rich in Ca²⁺, Zn²⁺, Mg²⁺, Na⁺ and other mineral elements, also contains organic matter such as humic acid, fulvic acid and acetic acid. In cosmetic field, mud can improve the activity of glutathione enzyme and superoxide dismutase in skin, which helps the skin anti-aging. Besides, it also can improve the skin microbial community, due to its distinctively physical properties, mineral ions, microorganisms, etc. In medical field, mud can treat osteoarthritis, especially knee osteoarthritis which has been studied extensively, and it can also increase the chemotaxis of macrophages. On the one hand, the use of clay (a kind of refined mud) can protect the gastrointestinal tract and treat some gastrointestinal diseases. On the other hand, clay is often used as carriers or composites in drug delivery, especially in skin drug delivery, showing very positive results. The purpose of this review is to present an overview of current knowledge about the application of mud in cosmetic and medical fields and to provide ideas for further research in mud.

Clinical efficacy of medical hydrology: an umbrella review

The aim of this research was to summarize available scientific evidence on the efficacy of medical hydrology for the management of any health condition. The search was conducted on 26th March 2021, in the following databases: Medline (via PubMed), EMBASE, Web of Science, Cochrane Library, and Google Scholar. All relevant literature reviews investigating the clinical efficacy of interventions characterized by the use of natural mineral waters and muds were included. The quality of studies was assessed with the "AMSTAR 2" tool. After article screening, 49 reviews were included in this work. Overall, retrieved scientific evidence suggests that spa therapy is beneficial for patients affected by some specific musculoskeletal conditions, with improvements potentially lasting up to 9 months. Moreover, balneotherapy can be an integrative support for the management of chronic venous insufficiency and some inflammatory skin diseases like psoriasis. The role of spa therapy in rehabilitation appears relevant as well. More limited, although interesting evidence exists for inhalation and hydropinic therapies. Globally, retrieved evidence suggests that, besides individual wellbeing, medical hydrology can be useful for public health. In particular, higher-quality studies seem to support the integrative use of spa-related interventions for conditions like osteoarthritis, fibromyalgia, low back pain of rheumatic origin, and chronic venous insufficiency. However, the body of evidence has some limitations and further clinical trials should be designed for each relevant application to consolidate and expand acquired knowledge.

Chemical and mineralogical characteristics of peloids in Turkey

To investigate the physical, chemical, and mineralogical characteristics of peloids, which are being used traditionally and historically across Turkey, and evaluate their suitability and potential for use in peloidotherapy. Five peloid samples were gathered from their places of origin, namely Gölemezli, Dalyan, Köprüköy, Gökçeada, and Dikili. Mineral analysis and physical and chemical analyses including electrical conductivity, density, cations, anions, trace elements, organic matters, and water retention capacity at 105 °C were performed. The peloids contained a combination of clay minerals (mainly montmorillonite, kaolinite, and muscovite) and non-clay minerals (mainly quartz, calcite, dolomite, and albite) except for Gölemezli peloid, which was dominated by calcite. The other minerals (i.e., chloride-serpentine, sphalerite, pyrite, magnesium calcite, cristobalite) were also found in some peloids. Gölemezli, Dalyan, and Köprüköy peloids had high total organic matters, mainly humic substances. The water retention capacity was high in Dalyan, Köprüköy, and Dikili peloids. All peloids had a pH value slightly greater than 7 (range 7.93-8.69). Dalyan, Köprüköy, and Dikili peloids had a high water retention capacity. Dalyan and Gökçeada peloids had a high electrical conductivity, 22.040 and 9.020 μS/cm, respectively. The density of peloids was ranged between 1.240 (Gölemezli) and 1.450 (Gökçeada) g/cm³. Total mineralization of investigated peloids was greater than 1000 mg/L: Köprüköy, 2754.8 mg/L; Gölemezli, 3092.8 mg/L; Dikili, 4044.6 mg/L; Gökçeada, 6576.6 mg/L; and Dalyan, 11782.9 mg/L, mainly sodium, magnesium, calcium, chloride, sulfate, bicarbonate, and metasilicic acid. The levels of trace elements were low (≤ 2.0 mg/L) in all peloids. The peloids contained various amounts of clay minerals (mainly montmorillonite, kaolinite, and muscovite), non-clay minerals (mainly quartz, calcite, dolomite, and albite), organic matters (mainly humic acid), cations (mainly sodium, magnesium, and calcium), anions (mainly chloride, sulfate, and bicarbonate), and insoluble compounds (mainly metasilicic acid). The physical, chemical, and mineralogical properties of peloids suggest their suitability and potential for use in peloidotherapeutic applications.

Bacteriostatic and bactericidal clays: an overview

This article aims to draw an overview on the actual knowledge on bacteriostatic and bactericidal natural clays. Particular emphasis is given to the role of clay itself, the action of reduced metals located either in the structure of clay minerals or external to them as constituents of associate minerals, and the definition of the mechanisms of action based on the achievements found in all available studies being carried out so far. The term bactericidal is herein used when a clay or a clay mineral kill the bacteria, whereas the term bacteriostatic is used when those minerals stop bacteria growth and replication. The second part of this article deals with experimental studies on bactericidal natural clay, experience and perspective for the preparation of bactericidal natural clays, interesting on the authors perspective and experience for the preparation of pathogens safe both therapeutic and cosmetic natural mud/natural peloid, and better yet of both therapeutic 87oooand cosmetic peloid itself and designed and engineered peloid. The authors also show how to convert non-antimicrobial clay into antimicrobial one, opening the way in the field of pelotherapy to the preparation of sanitary safe peloids addressed, for instance, to the treatment of rheumatic disabilities, as well as to the preparation of antimicrobial peloids and, in particular, of dermatological ointments, all able to fight infectious skin disorders.

Sulfurous-arsenical-ferruginous balneotherapy for osteoarthritis of the hand: results from a retrospective observational study

Balneotherapy (BT) is a complementary therapy widely used in several rheumatic conditions, however, the evidence in hand osteoarthritis (HOA) is still scarce. The aim of this preliminary study is to retrospectively evaluate the symptomatic effects of a cycle of mud-bath therapy in HOA patients. Two hundred twelve outpatients with primary bilateral HOA treated with 12 daily local mud packs and generalized thermal baths with a sulfurous-arsenical-ferruginous mineral water added to usual treatment were included in the study. Each patient was examined at baseline and at the end of thermal therapy (2 weeks). Primary outcome measures were global spontaneous hand pain on a Visual Analogue Scale (VAS) and the Functional Index for Hand Osteoarthritis (FIHOA) score; secondary outcomes were handgrip strength, duration of morning stiffness, Health Assessment Questionnaire (HAQ), Short Form Health Survey (SF-12), tolerability and patients' and physicians' global impression of treatment efficacy and tolerability. Our results demonstrated that the efficacy of mud-bath therapy was significant in all the assessed parameters at the end of therapy, except for the physical component score of SF-12. The thermal treatment was well tolerated. The patient's and the physician's global assessments showed a high level of satisfaction in terms of efficacy and safety. In conclusion, our results may suggest a short-term effectiveness of mud-bath therapy in controlling pain and improving functionality in HOA patients, supporting the role of this treatment as a complementary strategy in the management of HOA; however, further randomized controlled trials with a long-term follow-up are needed.

Mud therapy and rehabilitation - scientific relevance in the last six years (2015 – 2020) Systematic literature review and meta-analysis based on the PRISMA paradigm

Abstract Background. Balneotherapy is a stimulation - adaptation treatment method applied in the forms of bathing, drinking, and inhalation cures performed with natural therapeutic factors, a method which is acting in three main ways: thermally, mechanically, and chemically. Mud or peloids are natural therapeutic factors formed by natural processes under the influence of biological and geological phenomena, which in a finely dissolved state and mixed with water (mud) are used in medical practice in the form of baths or local procedures. Objective. This systematic review aims to rigorously select related articles and identify within their content, the main possible uses of therapeutic mud and physiological mechanisms, to see the main region of scientific interest for pelotherapy, and to discuss the value of mud therapy in rehabilitation medicine. Methods. The working method is based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. We searched for open-access articles published in English, between January 2015 and December 2020, from the following databases: Cochrane, Elsevier, NCBI/PubMed, NCBI/PMC, PEDro, and ISI Web of Knowledge/Science (the latter was also used to identify ISI indexed articles). The contextually searched syntax used was ”Pelotherapy/Peloidotherapy/Mud-therapy/ /Fango-therapy AND Rehabilitation”. The selected articles were analyzed in detail regarding pathologies addressed by mud therapy and country scientific relevance for this therapeutic method. The meta-analysis proceeded was designated to estimate the prevalence of various pathologies in the use of mud therapy. Results. Our search identified, first, 394 articles. Based on the successive filtering stages and, respectively, on the classification criteria of the Physiotherapy Evidence Database (PEDro), we finally identified/retained and analyzed 68 articles. Although, in principle, a rigorous method – and we have followed the PRISMA type paradigm – there still might be some missing works of our related article selection. On the other hand, to augment/ consolidate our documentation base, we have used also 40 papers freely found in the literature, and even – aiming, too, at an as exhaustive knowledge underpinning as possible – derogatively, we have also considered some articles which, probably being very new, couldn't yet have reached the PEDro threshold score we have settled. Conclusions. This paper overviews the current state-of-the-art knowledge in the approach of peloidotherapy in rehabilitation, with a focal point on the therapeutic properties of peloids. Keywords: mud-therapy, pelotherapy, peloidotherapy, fango therapy, rehabilitation, balneotherapy, natural therapeutic factors,

To treat or not to treat? Misbeliefs in spa water disinfection

"Spa waters should be left untreated" says the dogmatic approach. Health authorities of European countries having traditional spa culture strictly control hygienic conditions of bathing in thermal/mineral waters. These regulations are based on the assumption that chemical treatment (disinfection) of such waters impacts their healing effects. However, a slow change of paradigm has been observed in studying the mode of action of spa waters that could help overcome recent attitudes. Organic content or the role of microbiome has also been emphasized by some authors recently. The article deals with possible interactions among aquatic microorganisms and the disinfection and health effects of spa waters and tries to explain the new findings in this field.