The influence of mineral water solutions in phototherapy

Quality of life of psoriasis patients before and after balneo -- or balneophototherapy

PURPOSE

An observational prospective study was conducted to study the effects of hypotonic spa-water baths and narrowband ultraviolet B therapy given alone or in combination for treatment of moderate-severe psoriasis.

MATERIALS AND METHODS

TWO TREATMENTS WERE ANALYSED: 2 weeks of balneotherapy followed by ultraviolet-B (UVB) 311-nm phototherapy (BPT) or 2 weeks of daily bath treatments of Comano water alone (BT). One hundred and eleven adult patients with moderate to severe chronic plaque psoriasis were enrolled. Quality of life (QoL) questionnaires {36-item Short Form of the Medical Outcomes Study questionnaire (SF-36) and Skindex-29} were administered at baseline and 2 months from the end of therapy. The self-administered Psoriasis Area Severity Index (SAPASI), and the General Health Questionnaire (GHQ)-12 (to assess clinical severity and psychological distress, respectively) were also recorded at the same time-periods.

RESULTS

SAPASI was significantly reduced from 15.2 to 8.7 in BPT group and 11.6 to 7.8 in BT. A decrease of greater than 50% after therapy in SAPASI_50 score was reached by 42% and 37% of patients in the BPT and BT groups, respectively. At follow-up, both groups had better scores on all SF-36 scales (with statistically significant improvement in social functioning and mental health in the BPT group) and in all Skindex-29 scales. A statistically significant reduction of GHQ-12 positive cases was observed in the BPT group.

CONCLUSION

Comano spa-water alone or in combination with phototherapy had beneficial therapeutic effects on patients with psoriasis. Although our observational study design prevents us from making meaningful comparisons between the 2 interventions, the combination of balneo and phototherapy seems to improve QoL and lessen clinical severity, and reduced the proportion of GHQ-12 positive cases.

Complementary therapy for psoriasis

The authors provide some specifications regarding the correct terminology to be applied in the field of complementary medicine, and review and comment on several complementary treatments for psoriasis. Putative psychotherapeutic equivalents are kept distinct from treatments based on the surreptitious administration of physical or pharmacologic agents. Limits on the application of psychotherapeutic techniques are discussed. Risks inherent to complementary treatments (psychological derangements, moral subjugation, physical damage, economic exploitation) are underscored. The authors plead for the application of adequate scientific criticism in complementary medicine, but warn that any approach to the practice of medicine which is not disinterested and patient oriented--as the academic one should be--will be inappropriate, misleading, or even immoral. In the authors' opinion, this could also apply to the evidence-based medicine movement (often perceived as the archenemy of alternative medicine), should this movement be influenced by economical, political, or other nonmedical factors.

Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water

BACKGROUND

Leopoldine spa water is a hypotonic water rich in sulphate that has been used occasionally for balneological treatments in psoriatics. We evaluated the anti-inflammatory effects of this salso-sulphate water on the skin of subjects with psoriasis.

PATIENTS AND METHODS

We selected 10 volunteer subjects (23-58 years old), who presented symmetrical, bilateral psoriasis involving at least 40% of the body surface. All the subjects were subjected to the following treatment schedule: (i) immersion of both arms in water twice a day [the right arm was immersed in Leopoldine spa water at its natural source temperature (27.2 degrees C) for 30 min, and the left arm was immersed in double-distilled water for 30 min at a constant temperature of 27 degrees C]; (ii) both arms were exposed to the sun for 60 min after each immersion; and (iii) vaseline containing moisturizing creams were applied liberally. The treatment was continued for 4 weeks and was well tolerated by all subjects. Response to treatment was assessed by means of the modified Psoriasis Area and Severity Index (PASI). Six of the 10 subjects volunteered to undergo a cutaneous biopsy of lesional skin both before and 4 weeks after treatment to allow for assessment of modifications of the cutaneous infiltrate in the areas treated.

RESULTS

At the end of 4 weeks the average pretreatment PASI score of the left arms was 5.72 (range 4-9.6) while the right arms had a mean PASI of 5.56 (range of 3.2-9). At the end of the study the average PASI score was 0.78 for the arms treated with Leopoldine spa water and 2.83 for the arms treated with double-distilled water. The mean PASI improvement score for the Leopoldine spa water treated arms was 85.9% while the double-distilled water treated arms showed a PASI improvement score of 50.5%. An immunohistological study showed significant differences between the cutaneous samples taken 4 weeks after treatment and those taken before treatment with Leopoldine spa water. There were significant decreases in the numbers of epidermal CD4+ and CD8+ T lymphocytes and CD1a+ Langerhans cells (microscopic field at x 22 objective), as well as a decrease in the epidermal keratinocyte expression of intercellular adhesion molecule-1 and interleukin-8 and the dermal expression of CD4+ and CD8+ T lymphocytes.

CONCLUSIONS

These data show the potential anti-inflammatory effects of Leopoldine mineral waters on human skin affected by psoriasis.