The percentage of patients achieving PASI 75 after 1 month and remission time after Climatotherapy at the Dead Sea in Psoriasis patients
Harari M, Novack L, Barth J, David M, Friger M, Moses SW
2007 | INTERNATIONAL JOURNAL OF DERMATOLOGY

Background: The Dead Sea and Arava Research Center has been involved for over a decade in the evaluation of the health effects in a variety of chronic diseases in which exposure to the natural resources available at the Dead Sea has been shown to be therapeutically effective. Among skin diseases, Psoriasis, being the most frequent one of the responding diseases, has been studied in detail.

After having established in previously published studies the optimum duration of climatotherapy (sun exposure), its relative effect to thalassotherapy (immersion in sea water), the nature of the mechanism of action at the cellular and immunological level and after establishing the lack of skin carcinogenesis as a result of prolonged exposure to the Dead Sea sun, the following represents the first study in which psoriasis patients were subsequently followed up on a regular basis for twelve months in their home country.

The data show that the treatment was highly effective and free of side effects, while the duration of the therapeutic effect lasted, in terms of major reappearance lesion, deep into the second half of the first year after exposure.

The price paid per week remission achieved with Dead Sea Climatotherapy to other ones, which have been calculated in another study, compares favorably with most other modes of treatment. These last ones, such as the immunosuppressive and PUVA treatment, can be accompanied by serious side effects while others such as the recently introduced biologicals are presently prohibitively expensive.

The percentage of patients achieving PASI 75 after 1 month and remission time after Climatotherapy at the Dead Sea in Psoriasis patients.

The data provided in the following text are self-explanatory; should you have additional questions the authors named below will gladly respond to e-mails.

The following document represents a resume of a study on the effectiveness and the length of the clinical remission of plaque-type psoriasis patients exposed to Dead Sea climatotherapy. The study was conducted in collaboration between Israeli Physician from the Dead Sea area and German Physicians practicing in the state of Saxony:

This study included 64 German psoriasis patients who were exposed to a 28-day climatological treatment at the Dead Sea, which included a daily sun exposure in the morning and afternoon. The exposure time was calculated according to personal parameters and based on measurements of ambient solar irradiation. Thalassotherapy included a gradual increase of immersion in the Dead Sea water.

The patients underwent a PASI evaluation (a quantitative measure of skin involvement in psoriasis) on arrival and at departure, with a subsequent follow up examination for twelve month in Germany, during which they were reexamined when reporting on the reappearance of new skin lesions. A PASI evaluation was subsequently performed periodically.

Evaluation: The time of reappearance of a skin lesion after total or near total clearance at the end of climatotherapy was defined as “duration of remission time”.

The time elapsed until a 50% relapse of the initial PASI clearance occurred was considered as “duration of the therapeutic effect”.

Results: Climatotherapy effect: The PASI value showed an average decline from 31,7 before to 1,4 at the termination of treatment, representing a 95% improvement.

The median length of remission was 23,1 weeks, and the medium period of the therapeutic effect was 33,6 weeks.

Statistical multivariate analysis of data revealed that a longer period of remission was observed in younger patients.

This study establishes that a four-week course of Dead Sea climatotherapy provides an effective mode of treatment for patients with plaque-type psoriasis. The results compare favorably with other modes of treatment, having the advantage of being practically devoid of side effects and allowing patients to undergo this treatment in a vacation-like atmosphere interacting with vacation seeking hotel guests, which contributes to an improvement of their quality of life as shown in a other studies.

David M. Tsukrov B. Adler B. Hershko K. Pavlotski F. Rozenman D. Hodak E. Paltiel O.
2005 | JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

Dead Sea climatotherapy is highly effective in the treatment of psoriasis. However, its potential side effects, especially the risk of skin cancer, are unclear.

Objectives: We sought to determine the prevalence of solar damage and skin cancer among patients with psoriasis who underwent Dead Sea climatotherapy compared with control patients.

Methods: This Multicenter controlled cross-sectional study was carried out Lit the Dead Sea Solarium Clinic and outpatient clinics of the participating centers. A total of 1198 participants (460 patients with psoriasis and 738 control patients) aged 20 to 70 years were included. A standard questionnaire including demographic parameters and sun exposure habits was administered to all participants. Patients were questioned about previous psoriatic treatments and climatotherapy at the Dead Sea. All participants underwent a structured physical examination of the skin. We compared the prevalence of solar damage for patients with psoriasis and control patients and assessed the extent of photodamage among patients with psoriasis according to exposure time at the Dead Sea in univariate and multivariate analyses.

Results: Elastosis (P < .001), solar lentigines (P = .03), poikiloderma (P < .001), and facial wrinkles (P < .001) were significantly more common among patients with psoriasis compared with control patients and showed a dose response with increased Dead Sea exposure time. Self-reported previous skin cancers were more common in control patients compared with patients with psoriasis (8.2% vs 3.5%, P = .002), however, the prevalence of non-melanoma skin cancer on examination did not differ between the two groups. No cases of malignant melanoma were detected in either group.

Conclusions: Dead Sea climatotherapy is not associated with an increased risk of malignant melanoma or nonmelanoma skin cancer for patients with psoriasis in Israel. However, UV exposure at the Dead Sea may play a role in the development of solar damage.

Hodak E. Gottlieb A.B. Segal T. Politi Y. Maron L. Sulkes J. David M.
2003 | JOURNAL OF THE AMERICAN ACADEMY OF DERMATOLOGY

The beneficial effect of climatotherapy at the Dead Sea (CDS) for psoriasis has been established clinically but there is a striking lack of studies assessing its in vivo effect at the molecular and cellular levels.

Objectives: We sought to study the response of activated immunologic cells and keratinocytes in psoriatic lesions to CDS.

Methods: A total of 27 patients with chronic, stable, plaque-type psoriasis treated with CDS for 28 consecutive days were evaluated with the Psoriasis Area and Severity index score and quantitative histologic measures.

Results: After 4 weeks of treatment, the overall Psoriasis Area and Severity index score decreased by 81.5%. Complete clearance was achieved in 48% of the patients, and moderate to marked improvement in 41%. The average duration of remission was 3.3 months. Histologically, there was an overall reduction in malpighian layer thickness by 63.4%, and keratinocyte hyperplasia, assessed by Ki-67 cell cycle antigen expression, decreased by 78%; residual cell proliferation was confined mainly to the basal layer. These changes were accompanied by normalization of keratin 16 expression in 90% of the patients. T lymphocytes were almost totally eliminated from the epidermis (depletion of >90% of CD3(+) and CD25(+) cells), with only a low number remaining in the dermis (depletion of 69.4% of CD3(+) cells and 77.4% of CD25(+) cells). This reduction in activated T cells was accompanied by a marked reduction in HLA-DR expression by epidermal keratinocytes.

Conclusions: CDS is a highly effective and remittive treatment for moderate to severe plaque-type psoriasis, leading to a reversal of both pathologic epidermal and immunologic activation.

Even-Paz Z. Efron D.
2003 | ISRAEL MEDICAL ASSOCIATION JOURNAL

An increased risk of developing cancer of the skin is the only potentially serious (albeit unproven) long-term side effect of heliotherapy and it is therefore prudent to avoid unnecessary exposure to solar ultraviolet radiation. Traditional heliotherapy for psoriasis at the Dead Sea calls for a sun exposure of 5-6 hours daily for 28 days. Studies have determined that mid-summer exposure for 3 hours is equally effective.

Objectives: To determine the effect of 3 hours sun exposure daily in the heliotherapy of psoriasis at the Dead Sea during the months March to December; and to monitor the associated ambient doses of solar UVB radiation.

Methods: A total of 194 patients with moderate to severe psoriasis was treated in the months of March to December by 3 hours of sun exposure each day. The dose of ambient solar UVB was monitored by a Solar Model 501A UVB- Biometer.

Results: Three hours of sun exposure daily was therapeutically efficacious in all months from March to November, but not in December. The lowest effective cumulative UVB dose was 170 SED (standard erythema dose), recorded in March and November.

Conclusions: Daily sun exposure for the heliotherapy of psoriasis at the Dead Sea can be reduced to at least 3 hours daily, about half the time originally recommended.

Gruner S. Zwirner A. Diezel W. Boonen H. Sonnichsen N.
1990 | DERMATOLOGISCHE MONATSSCHRIFT

In the last years a new therapy of psoriasis was developed, which consists in a treatment with salt solutions, resembling the water of the Dead Sea, and ultraviolet light (Tomesa-therapy).

We studied the influence of the used salt on ATPase positive epidermal Langerhans cells in murine ear skin. An irreversible partial reduction of the Langerhans cell ATPase was found after salt treatment of separated epidermis or of full skin preparations. These results may have implications for the optimization and broader application of this therapy.

Sukenik S. Giryes H. Halevy S. Neumann L. Flusser D. Buskila D.
1994 | JOURNAL OF RHEUMATOLOGY

Objectives: To evaluate the effectiveness of balneotherapy (mud packs and sulfur baths) on patients with psoriasis and psoriatic arthritis (PsA).

Methods: One hundred and sixty-six patients with psoriasis and PsA were treated at the Dead Sea for a period of 3 weeks. The patients were divided into 2 groups. Both groups had the regular regimen of bathing in Dead Sea water and exposure to the sun's ultraviolet rays. The study group, which consisted of 146 patients also was treated with mud packs and sulfur baths. The control group, which had no additional therapy, consisted of 20 patients. The main clinical variables assessed were duration of morning stiffness, grip strength, activities of daily living, subjective patient assessment of disease severity, number of active joints, number of effluent joints, Ritchie index, psoriasis area and severity index score, cervical, thoracic, and lumbar spine pain and limitations of movement.

Results: Statistically significant improvement was found in most variables in both groups. However, better results were observed in the study group. In 2 variables, reduction of spinal pain and range of movement in the lumbar spine, significant improvement (p < 0.001 and p = 0.022, respectively) was observed in the study group only.

Conclusions: Treatment of psoriasis and PsA at the Dead Sea area is very efficacious and the addition of balneotherapy can have additional beneficial effects on patients with PsA. Other controlled studies with longer followup periods are needed to verify our results.