Journal of Alternative Complementary & Integrative Medicine Category: Medicine Type: Review Article
A Critical Evaluation of Dead Sea Therapy in the Management of Psoriasis
- Shirley Telles1*, Sachin Kumar Sharma1, Savita Agnihotri1, Acharya Balkrishna1
- 1 Patanjali Research Foundation, Haridwar, Uttarakhand, India
*Corresponding Author:Shirley Telles
Patanjali Research Foundation, Haridwar, Uttarakhand, India
Received Date: Jan 19, 2017 Accepted Date: Jun 23, 2017 Published Date: Jul 10, 2017
Psoriasis is characterized by pronounced proliferation of keratinocytes and vascular inflammatory changes. With conventional treatments having undesirable side-effects there is an interest in other therapies. In particular Dead Sea (DS) balneotherapy and climatotherapy have been useful. The DS is unique in its chemical, climatic and environmental conditions. The combination of chemicals in the DS water, high temperature and other environmental factors appear to induce cell proliferation, reduce inflammation, cause favorable immunomodulation, and selectively protect the patients from harmful Ultraviolet (UV) rays. There may also be psychological benefits of being in proximity to the DS which is historically known to be healing. Despite these benefits it must be noted that DS therapy is contraindicated in certain conditions (e.g., epilepsy) and ineffective in certain types of psoriasis (e.g., pustular). In this article possible mechanisms underlying the benefits and contraindications of Dead Sea balneotherapy and climatotherapy are discussed.
Psoriasis is an inflammatory, autoimmune disease mediated by interleukin (IL)-17 producing Cluster of Differentiation 4 (CD4+) and T helper cells (Th) cells . A pronounced proliferation of keratinocytes and of dermal vascular endothelial cells follows the inflammatory response . Conventional treatments are generally immunosuppressant and their long term use is complicated by toxic effects . With this background there is an attempt to seek non-conventional remedies for psoriasis. In this article possible mechanisms underlying the benefits and contraindications of the (i) balneotherapy (chemical and thermal effects) and (ii) climatotherapy (thermal and phototherapy effects) are discussed.
The benefits of DS therapy in patients with psoriasis were determined from a systematic review of articles cited in Medline under the search words ‘Dead Sea’ (with 360 articles retrieved) . The articles were graded based on the level of evidence . There is evidence based on a single Randomized Controlled Trial (RCT) and a well designed non-randomized controlled trial, that DS water balneotherapy together with DS phototherapy is an effective treatment for psoriasis.
Chemical effects of Balneotherapy on psoriasis
Apart from this Dead Sea water contains high amount of bromide compounds. Bromide compounds are more powerful than their chloride counterparts and potassium bromide has the strongest inhibitory effect even when compared to magnesium . Magnesium bromide and magnesium chloride had inhibitory effects on proliferation of fibroblasts from psoriatic and healthy skin biopsy specimens . Though bromide has beneficial effects the possibility of toxic effects needs to be examined. For example, the application of bromide compounds was associated with contact dermatitis in guinea pigs .
Thermal effects of balneotherapy on psoriasis
Thermal effects of climatotherapy on psoriasis
Heat may have immuno-suppressive effects by which humoral and cell meditated immune responses are reduced. Thermal treatment also results in a concurrent unexplained reduction in serum cortisol levels .
In summary the DS appears to be uniquely suited to treat skin and rheumatic disease; which has been known since ancient times. The therapeutic benefits can be attributed to multiple factors. These include the unique climatic characteristics and natural resources, DS water with its unparalleled salinity and unique composition, DS mineral mud, increased bromide content of the air and a high selenium content of local drinking water.
Effects of phototherapy on psoriasis
Despite the many benefits of climatotherapy adverse effects such as sunburn (5 percent) and photo sensitivity reactions (8.5 percent) have been observed in few patients . Apart from this there are general contraindications for using DS climatotherapy which include severe psychiatric conditions, epilepsy, cardiac dysrhythmias, compromised balance and addiction to mind-altering substances e.g., alcohol . While most kinds of psoriasis respond to the DS therapy, the exceptions are generalized pustular psoriasis and erythoderma .
Diverse mechanisms may explain the benefits of DS therapy [23,24]. These include mechanical, thermal and chemical effects. The chemical effects of DS therapy have been supported by in vivo and in vitrostudies which show increased levels of minerals influencing cell proliferation and differentiation [8,25-27]. Anti-inflammatory and immuno-modulatory effects involve various cell lineages. Also bathing in high concentrated salt solutions can cause the elution of various pro-inflammatory mediators of the skin from patients of psoriasis [28-30]. Another benefit of DS therapy is increased photosensitivity to UV-B irradiation which may contribute to the efficacy of photo-balneotherapy suggesting that the beneficial effect of Dead Sea climatotherapy is greater than balneotherapy alone.
Finally the psychological effect of being in the DS area with its historical significance in healing cannot be overlooked. A major disadvantage of using these reported benefits is that most trials were carried out on animal models with few trials on human patients [3,5,13,26]. The number of well designed RCT is small and hence the findings are open to question . There is also a degree of uncertainty about the treatment protocol in terms of the duration and frequency of sun exposure; and similarly the duration and frequency of bathing in the DS . Also despite the fact that the DS high salt and mineral content make it very safe to swim there have been reports of persons drowning in the DS . This is believed to occur if a person trips, falls and swallows water. Swallowing DS water carries other risks as the high sodium content disrupts the body’s electrolyte balance.
Hence though beneficial, adverse effects of DS therapy cannot be entirely ruled out. The focus of future research should be the long term follow-up of patients undergoing DS therapy for psoriasis. All adverse outcomes should be systematically documented.
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Citation:Telles S, Sharma SK, Agnihotri A, Balkrishna A (2017) A Critical Evaluation of Dead Sea Therapy in the Management of Psoriasis. J Altern Complement Integr Med 3: 033.
Copyright: © 2017 Shirley Telles, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.