Alternative treatment of psoriasis with balneotherapy using Leopoldine spa water

Efficacy of hydrotherapy, spa therapy, and balneotherapy for psoriasis and atopic dermatitis: a systematic review

BACKGROUND

Atopic dermatitis (AD) and psoriasis are chronic inflammatory diseases that have significant skin complications.

OBJECTIVE

The purpose of this systematic study was to evaluate the evidence obtained from human studies on the effects of hydrotherapy, spa therapy, and balneotherapy in psoriasis and atopic dermatitis.

METHODS

The present systematic review was conducted according to the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) statements. Also, for this study databases such as Embase, PubMed, Scopus ProQuest, and sciences direct database were searched from the beginning to April 2021.

RESULTS

All human studies that examined the effect of balneotherapy, spa therapy, and hydrotherapy on psoriasis and atopic dermatitis were published in the form of a full article in English. In the end, only 22 of the 424 articles met the criteria for analysis. Most studies have shown that balneotherapy, spa therapy, and hydrotherapy may reduce the effects of the disease by reducing inflammation and improving living conditions. In addition, the results of the Downs and Black score show that seven studies received very good scores, three studies received good scores, nine studies received fair scores, and three studies received poor scores.

CONCLUSIONS

The results of studies also showed that hydrotherapy leads to an improvement in the PASI score index. Nevertheless, more clinical trials are needed to determine the mechanism of action of hydrotherapy on these diseases.

Evaluation of the benefit of thermal spa therapy in plaque psoriasis: the PSOTHERMES randomized clinical trial

Spa therapy is considered an add-on treatment for psoriasis, but without any objective evaluation in the absence of randomized trials. This multicenter, open-label, randomized trial compared immediate spa therapy versus a control group having usual treatments until study assessments at 4.5 months. Spa therapy was proposed in five French spa resorts with standardized programs. Inclusion criteria were adults with plaque psoriasis, Dermatology Life Quality Index (DLQI) > 10, and stable medical treatment in the last 6 months. The main objective was DLQI ≤ 10 at 4.5 months after inclusion. VQ-Dermato and EQ5D-3L also assessed quality of life (QoL), Perceived Stress Scale (PSS) stress, and visual analogue scales (VAS) pain and pruritus. Between January 2015 and November 2018, 128 patients were randomized to either immediate spa therapy (64) (within 34 days, median) or usual treatments (61) until assessment at 4.5 months. Most were first-time spa users (71.2%). Mean DLQI and Psoriasis Area and Severity Index at inclusion were 16.7 and 10.5, respectively. Immediate spa therapy patients achieved the primary objective for 66.1% [95% CI 52.6% > 77.9%] vs 41.4% [95% CI 28.6% > 55.1%] control group patients (p = 0.007). VQ-Dermato scores and pruritus VAS significantly improved. Outcomes at 12-month follow-up of the immediate spa therapy group showed persistent improvement of DLQI, VQ-Dermato, and pruritus. This randomized controlled trial demonstrated that a cure of spa therapy improves QoL and alleviates certain symptoms of psoriasis, in short and long terms. This justifies its integration in the therapeutic strategies for psoriasis. Trial registration number: ClinicalTrials.gov Identifier: NCT02098213.

Anti-inflammatory effects of free and liposome-encapsulated Algerian thermal waters in RAW 264.7 macrophages

The main objectives of this work were to formulate liposomes encapsulating highly mineralized thermal waters (TWs) and to study anti-inflammatory effect of free and encapsulated thermal waters on RAW 264.7 macrophage cells stimulated with lipopolysaccharide (LPS). TWs-loaded conventional and deformable liposomes (TWs-Lip and TWs-DLip) were prepared by sonication and extrusion, respectively. They were considered for their vesicle size, zeta potential, entrapment efficiency, physical stability and in vitro anti-inflammatory effect. Formulated liposome suspensions have a low polydispersity and nanometric size range with zeta potential values close to zero. The vesicle size was stable for 30 days. Entrapment efficiency of TWs was above 90% in conventional liposomes and 70% in deformable liposomes. Pretreatment of LPS-stimulated murine macrophages, with free and liposome-encapsulated TWs, resulted in a significant reduction in nitric oxide (NO) production and modulated tumor necrosis factor-α (TNF-α) production suggesting an anti-inflammatory effect which was even more striking with TWs-Lip and TWs-DLip. Liposome formulations may offer a suitable approach for transdermal delivery of TWs, indicated in inflammatory skin diseases.

Mind-Body Interventions as Alternative and Complementary Therapies for Psoriasis: A Systematic Review of the English Literature

Objective: Conventional therapeutic methods for psoriasis include topical and systemic drugs, phototherapy, and biologic agents. Despite the fact that these treatment methods, and especially biologic agents, are met with a considerable reduction in disease activity, they can sometimes be costly and are nonetheless accompanied by high risks of adverse events, ranging from mild to debilitating. Therefore, complementary and alternative medicine (CAM), especially mind-and-body interventions, such as acupuncture, psychotherapy, climatotherapy, and cupping may provide a cheaper and potentially beneficial outcome for these patients. Methods: We performed a systematic review of articles pertaining to acupuncture, cupping, psychotherapy and meditation, as well climatotherapy and balneotherapy in the management of psoriasis, by using the PubMED, Medline and Google Academic research databases and reference cross-checking. Results: 12 articles on acupuncture, 9 on dry or wet cupping, 27 concerning meditation, hypnosis or psychotherapy, and 34 regarding climate therapy or balneotherapy were found. Discussion and Conclusions: Currently, there is a lack of evidence in the English literature to support acupuncture as an effective alternative therapy for psoriasis, whereas cupping has been described in the majority of instances to result in Koebner phenomenon and clinical worsening. Stress management therapies such as psychotherapy, hypnosis, and meditation have shown promising results as complementary treatment methods. Climatotherapy and balneotherapy have already been proven as effective means of achieving clinical improvement in psoriasis. Further research is still needed to verify the usefulness of the lesser studied treatment methods.

Nitrodi thermal water downregulates protein S‑nitrosylation in RKO cells

Balneotherapy and spa therapy have been used in the treatment of ailments since time immemorial. Moreover, there is evidence to suggest that the beneficial effects of thermal water continue for months following the completion of treatment. The mechanisms through which thermal water exerts its healing effects remain unknown. Both balneological and hydroponic therapy at 'the oldest spa in the world', namely, the Nitrodi spring on the Island of Ischia (Southern Italy) are effective in a number of diseases and conditions. The aim of the present study was to investigate the molecular basis underlying the therapeutic effects of Nitrodi spring water in low-grade inflammation and stress-related conditions. For this purpose, an in vitro model was devised in which RKO colorectal adenocarcinoma cells were treated with phosphate-buffered saline or phosphate-buffered saline prepared with Nitrodi water for 4 h daily, 5 days a week for 6 weeks. The RKO cells were then subjected to the following assays: 3-(4,5- Dimethylthiazol-2-yl)-2,5-diphenyl-2H-tetrazolium bromide assay, Transwell migration assay, western blot analysis, the fluorimetric detection of protein S-nitrosothiols and S-nitrosylation western blot analysis. The results revealed that Nitrodi spring water promoted cell migration and cell viability, and downregulated protein S-nitrosylation, probably also the nitrosylated active form of the cyclooxygenase (COX)-2 protein. These results concur with all the previously reported therapeutic properties of Nitrodi spring water, and thus rein-force the concept that this natural resource is an important complementary therapy to traditional medicine.

Incorporation of Cró thermal water in a dermocosmetic formulation: cytotoxicity effects, characterization and stability studies and efficacy evaluation

OBJECTIVE

Development of cosmetic formulations to provide a controlled release of hydrophilic active compounds from mineral medicinal waters constitutes an attractive challenge. The objective of this study was the development and the characterization of a dermocosmetic gel formulation with Cró thermal water, from Beira Interior of Portugal, as a major functional ingredient.

METHODS

Concentrations of mineral chemical elements of Cró thermal water were previously determined by inductively coupled plasma-optical emission spectrometry or mass spectrometry and cytotoxicity assays using thermal water were carried out on normal human dermal fibroblasts (NHDF) cells. Then, the Cró thermal water was included (more than 90%) in a developed gel formulation that was characterized through rheological and texture analysis and submitted to stability assays during 30 days. The effects on the skin volunteers, namely skin pH, the degree of hydration, transepidermal water loss and skin relief, were evaluated through non-invasive biometric techniques. A gel formulation including purified water was used as a control.

RESULTS

Cró thermal water is rich on several chemical elements in particular sodium, silica, potassium and calcium besides some trace elements, with important functions for the skin. NHDF cells adhered and proliferated in the presence of thermal water confirming the biocompatibility of the major component of the gel formulation. The developed gel formulation based on thermal water resulted in an improvement of textural parameters, comparing with the purified water-based one. Significant improvements in the cutaneous biometric parameters (degree of hydration, transepidermal water loss and skin relief) of volunteers were also registered for the gel formulation containing thermal water.

CONCLUSION

This study demonstrated for the first time the potential benefits of Cró thermal water in a gel formulation to be used in cosmetic and dermatological applications.

Monfortinho Thermal Water-Based Creams: Effects on Skin Hydration, Psoriasis, and Eczema in Adults

The use of mineral water for therapeutic purposes has varied from century to century and from country to country. Its effectiveness depends on the individual experiences of the population and their cultural traditions. Usually, the waters recommended for dermatological treatment are hot springs that contain sulfur or more recently, silicon. The mechanisms by which mineral waters actuate in dermatological disorders are still not clear but it is believed that they involve thermal, mechanical, chemical, immunologic, and anti-oxidant reactions and enzymatic activity. The aim of this study is to characterize the thermal waters of Monfortinho, one of the oldest Portuguese spas, their potential use for the preparation of dermatological formulations (creams), and their effectiveness on the treatment of skin disorders (psoriasis and eczema). To accomplish this, cream formulations with different contents of thermal water were developed. The formulations were characterized in terms of thermal water analysis and physicochemical properties and their effects were studied by skin biometrics in adults (mean age of 54.3 years old) through skin hydration evaluation and evaluated in clinical studies on 22 patients with psoriasis and eczema. The results showed that all the formulations improved the skin hydration and have beneficial effects in relieving the symptoms of psoriasis and other disorders, but no significant differences were observed when thermal water was used (compared to laboratory ultra-pure water).

Sulphate mineral waters: A medical resource in several disorders

Based on their chemical composition, salus per aquam (spa) mineral waters (or medical mineral waters) can be classified as sulphurous, sulphate, bicarbonate etc. Sulphate mineral waters where the predominant element is sulphate anion SO₄²⁻, are frequently used in clinical therapy. In this review, we describe and analyze the current scientific knowledge concerning the therapeutic effect of sulphate mineral waters in the treatment of several disorders.

Moreover, we underline how important is to integrate spa treatments with other therapeutic approaches to meet the various needs that can arise during a specific pathological state.

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Now, there is no systematic Review on Sulphate mineral waters in literature.

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The Review focuses on the importance of spa treatment as complementary therapy.

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The Review highlights the efficacy and tolerability of the spa in several disorders.

Salt water and skin interactions: new lines of evidence

In Health Resort Medicine, both balneotherapy and thalassotherapy, salt waters and their peloids, or mud products are mainly used to treat rheumatic and skin disorders. These therapeutic agents act jointly via numerous mechanical, thermal, and chemical mechanisms. In this review, we examine a new mechanism of action specific to saline waters. When topically administered, this water rich in sodium and chloride penetrates the skin where it is able to modify cellular osmotic pressure and stimulate nerve receptors in the skin via cell membrane ion channels known as "Piezo" proteins. We describe several models of cutaneous adsorption/desorption and penetration of dissolved ions in mineral waters through the skin (osmosis and cell volume mechanisms in keratinocytes) and examine the role of these resources in stimulating cutaneous nerve receptors. The actions of salt mineral waters are mediated by a mechanism conditioned by the concentration and quality of their salts involving cellular osmosis-mediated activation/inhibition of cell apoptotic or necrotic processes. In turn, this osmotic mechanism modulates the recently described mechanosensitive piezoelectric channels.

Impact of Different Spa Waters on Inflammation Parameters in Human Keratinocyte HaCaT Cells

Background

The treatment of different skin conditions with spa waters is a long tradition dating back to at least late Hellenism. Interestingly, independent scientific examinations studying the effect of spa waters are scarce.

Objective

In the present in vitro study, we compared the effect of culture media supplemented with (a) thermal spa waters (La Roche-Posay, Avène) and (b) two natural mineral drinking waters (Heppinger, Adelholzener) on physiological parameters in HaCaT keratinocytes.

Methods

The different medium preparations were investigated with regard to cell proliferation and cell damage. Moreover, the impact on inflammation parameters with and without ultraviolet B (UVB) irradiation was examined.

Results

Two popular thermal spring waters were found to suppress cell proliferation and cell damage. Moreover, these waters reversed the induction of interleukin-6, as measured using enzyme-linked immunosorbent assay and promoter transactivation, and the formation of reactive oxygen species after UVB stimulation. Of note, the two natural mineral waters, which are distributed as drinking waters, had some effect on the above-mentioned parameters but to a lesser extent.

Conclusion

In summary, our results show that spa waters, and particularly those derived from thermal springs, reduce parameters associated with inflammation. It seems likely that trace elements such as selenium and zinc are critical for the observed effects.

Health resort medicine in non-musculoskeletal disorders: is there evidence of its effectiveness?

Health resort medicine (HRM; in German: Kurortmedizin) is a field of medicine with long-lasting tradition in several European countries. A number of systematic reviews have shown the effectiveness of HRM in musculoskeletal conditions. Reviews focusing on the effectiveness of HRM in non-musculoskeletal disorders are rare. This systematic review aims to provide an overview about all types of health resort treatments applied in non-musculoskeletal conditions, to summarize evidence for its effectiveness and to assess the quality of published studies. MEDLINE, Web of Knowledge and Embase were searched for articles published between January 2002 and December 2013. We used a broad search strategy in order to find studies investigating the effects of HRM in non-musculoskeletal disorders. Two authors independently extracted data and assessed quality using the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies (EPHPP-QAT). Forty-one studies (19 of them with control group) from eight countries examining the efficacy of various forms of spa treatment for 12 disease groups were included. The studies are markedly heterogeneous regarding study design, population and treatment. HRM treatment is associated with clinical improvement in diseases of the skin, respiratory, circulatory, digestive and nervous system among others. However, small samples, the lack of control groups and an insufficient follow-up often limit the generated evidence. The scientific literature of the last decade has shown that a number of non-musculoskeletal disorders are treated with different kinds of HRM. The challenge for the future will be to carry out thoroughly designed studies in larger patient populations to corroborate the impact of HRM treatment on non-musculoskeletal disorders.

Bathing Effects of Various Seawaters on Allergic (Atopic) Dermatitis-Like Skin Lesions Induced by 2,4-Dinitrochlorobenzene in Hairless Mice

We evaluated the preventive effects of four types of seawater collected in Republic of Korea on hairless mice with 2,4-dinitrochlorobenzene- (DNCB-) induced allergic/atopic dermatitis (AD). The anti-inflammatory effects were evaluated by measuring tumor necrosis factor- (TNF-) α and interleukins (ILs). Glutathione (GSH), malondialdehyde (MDA), superoxide anion, and inducible nitric oxide synthase (iNOS) were measured to evaluate the antioxidant effects. Caspase-3 and poly (ADP-ribose) polymerase (PARP) were observed to measure the antiapoptotic effects; matrix metalloproteinase- (MMP-) 9 levels were also evaluated. Mice with AD had markedly higher clinical skin severity scores and scratching behaviors; higher TNF-α and ILs (1β, 10, 4, 5, and 13) levels; higher MDA, superoxide anion, caspase-3, PARP, and MMP-9 levels; and greater iNOS activity. However, the severity of AD was significantly decreased by bathing in seawaters, but it did not influence the dermal collagen depositions and skin tissue antioxidant defense systems. These results suggest that bathing in all four seawaters has protective effects against DNCB-induced AD through their favorable systemic and local immunomodulatory effects, active cytoprotective antiapoptotic effects, inhibitory effects of MMP activity and anti-inflammatory and antioxidative effects.

Immunomodulatory effects of balneotherapy with hae-un-dae thermal water on imiquimod-induced psoriasis-like murine model

Background

Balneotherapy, although not a well-established dermatological treatment, is thought to have therapeutic properties for psoriasis and is used as an alternative treatment modality throughout the world.

Objective

To evaluate the mechanism underlying the therapeutic immunologic effects of thermomineral water.

Methods

A murine model of imiquimod-induced psoriasis-like skin inflammation was used for evaluating the therapeutic effects of balneotherapy with Hae-Un-Dae hot spring mineral water. The clinical improvements were evaluated by a dermatologist. Lesional cytokines, including interleukin (IL)-17A, IL-23, and IL-22, were quantitatively measured by real-time reverse transcriptase polymerase chain reaction. Serum levels of interferon-γ, IL-4, IL-5, and IL-17A were measured by enzyme-linked immunosorbent assay. T cell proportions in the spleen were evaluated by flow cytometry, and histopathological evaluation of the skin was also performed.

Results

The mineral water balneotherapy group showed faster improvement in skin erythema and scales than the distilled water bathing group. A substantial reduction was observed in the lesional mRNA levels of IL-17A and IL-23 in the mineral water group. Serum levels of IL-4 and IL-5 were significantly decreased in the mineral water group but not in the distilled water group. Normalized T cell proportions were observed after bathing.

Conclusion

Balneotherapy showed immunomodulatory effects in a psoriasis-like murine model. Balneotherapy suppressed lesional IL-23 and IL-17A, which are important cytokines in the pathogenesis of psoriasis. These results suggest that balneotherapy can be used as an effective and safe treatment for psoriasis.

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.

Climatotherapy of psoriasis

In the era when biological treatments for psoriasis are gaining more and more popularity, climatotherapy represents a safe and efficient alternative to the conventional therapeutic modalities. Climatotherapy comprises alternative treatment methods, which are based on the healing capacities of natural resources. This paper provides the reader with relevant information on the different climatotherapeutic methods, the intimate mechanisms of their action, and the cumulated clinical experience in the treatment of psoriasis. The positive effect of thalassotherapy for psoriasis has been known since ancient times. However, in the past decades a number of controlled studies revealed the efficacy of thalassotherpay in the treatment of psoriasis. Herein, it is exemplified on the experience in the centers at the Dead Sea and the Black Sea coast. Originating from Europe, balneo- and spa therapy are becoming popular alternatives for psoriasis treatment worldwide. A short review on the centers profiled for psoriasis therapy is provided. The unique sites of Blue Lagoon in Iceland and Kangal in Turkey are selected in this paper. Additionally, alternative nature-based treatments for psoriasis such as high mountain climatotherapy and naphtalotherapy are discussed.