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Dead sea psoriasis: The request could not be satisfied

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Effect of Dead Sea Climatotherapy on Psoriasis; A Prospective Cohort Study

Front Med (Lausanne). 2020; 7: 83.

Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark

Edited by: Peter Wolf, Medical University of Graz, Austria

Reviewed by: Thilo Gambichler, University Hospitals of the Ruhr-University of Bochum, Germany; Franz J. Legat, Medical University of Graz, Austria

This article was submitted to Dermatology, a section of the journal Frontiers in Medicine

Received 2019 Oct 3; Accepted 2020 Mar 2.

Copyright © 2020 Emmanuel, Lybæk, Johansen and Iversen.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

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Abstract

Background: Dead Sea climatotherapy (DSC) is a treatment option for psoriasis in Denmark. However, the response to DSC has not been particularly well studied.

Aim: We sought to determine effectiveness and response duration of DSC on psoriasis-related outcome parameters.

Methods: Eighteen patients participated in a 4-week treatment program in Ein Gedi in Israel. Treatment, consisting of sun exposure and bathing, was individualized.

Results: DSC was associated with a mean 13.0-point reduction (88%) in Psoriasis Area and Severity Index and a mean reduction of 2.3 (76.7%) on the 5-point Investigator’s Global Assessment Scale. Furthermore, patients’ quality of life improved measured by the Dermatology Quality of Life Index and EuroQol 5D index values. The mean time from treatment end to reappearance of visible skin symptoms was 93. 8 days (SD: 62.5, range: 31–219 days).

Conclusions: Our results confirm that DSC has an immediate effect on skin manifestations and improves quality of life, but long-term disease control is not observed.

Keywords: psoriasis, Dead Sea, climatotherapy, heliotherapy, cohort, Ein Gedi

Introduction

Psoriasis is a chronic skin disease affecting ~1–3% of the western population (1). It has a wide range of clinical phenotypic appearances, ranging from pruritic scaly red plaques on the skin to isolated affection of the nails (2). Treatment modalities range from topical treatment and photo therapy to systemic treatment with small molecules and biological therapies (3). Treatment of skin diseases using UV light has been used since 1903 when Niels Ryberg Finsen won the Nobel prize for reporting on the effective treatment of tuberculosis of the skin (4). Phototherapy, i.e., treatment exclusively using light, is usually supplemented with balneotherapy i. e., baths in salt water, collectively termed balneophototherapy (BPT). In addition, a change of humidity and air, and a change in barometric pressure is added and then collectively termed climate therapy or climatotherapy (5). Climatotherapy is a safe treatment option, and beneficial effects on psoriasis have been reported (6, 7). Climatotherapy has also been shown to improve quality of life (QoL) (8). In some countries, it is an alternative to medication for psoriasis with treatment centers located all over the world (9). The proportion of psoriasis patients attending a university hospital dermatology clinic and having used climatotherapy at some time during the course of their treatment varies considerably across the world; from 8% in the Nordic countries to 46% in the Middle East (10). Danish psoriasis patients have mainly received climatotherapy at Ein Gedi at the Dead Sea in Israel located at 31°N, 35°E. With a location ~400 meters below sea level, patients are exposed to salt and minerals and prolonged sun exposure while exposure to cancer-inducing ultraviolet B (UVB) radiation from the sun is minimal (11–13). This combination is unique among treatment centers. Dead Sea climatotherapy (DSC) has a long-standing history, and Denmark was one of the first countries to test it in psoriasis patients (14). DSC is particularly relevant where other therapies are contraindicated or have failed. Patients treated in Israel constitute a subgroup of psoriasis patients that has not previously been much studied.

In the present study, we therefore investigated the effect of DSC on psoriasis by measuring psoriasis-related outcomes before, immediately after, and at first visible signs of psoriasis after completion of DSC.

Materials and Methods

Study Design and Population

Eighteen Danish patients were enrolled in this prospective cohort study. The study size was based on feasibility. The inclusion criteria were referral for DSC. Referral was a shared decision between the treating dermatologist and the patient. The date of enrolment of the first- and last patient was on the 18th of February 2015 and 2nd of September 2015, respectively. All patients referred to climatotherapy for the given enrolment period were given the possibility of being included in this study. The last follow-up visit of the last patient was on the 5th of January 2016. Patients were allowed to use their usual treatments at baseline. No formal exclusion criteria were applied though contraindications for selection for DSC include photo-aggravated systemic diseases or dermatoses, skin malignancies, acute skin infections, non-controlled concomitant diseases, and lack of compliance with instructions regarding sun exposure and bathing.

All patients were sent on a 4-week treatment program at Ein Gedi at the Dead Sea in Israel. Here, they received individualized treatment consisting of 28 days of bathing and escalating doses of UVB exposure according to skin type and UV index. Treatment was supplemented with educational lectures and discussions about psoriasis and QoL, comorbidities, manifestations, and various treatments. A healthy lifestyle consisting of physical activity and a healthy diet was stressed. Group discussions were instituted for sharing ways to manage psoriasis. Individual and group-based education, guidance, and daily training were provided by a nurse and a physiotherapist. Treatment-related costs were fully covered by the Danish Medical Insurance System. The study was an open-label, single-arm cohort study with up to three repeated measures for a maximum of 8 months. Patients were to be assessed by the same dermatologist 1 week before (baseline) and immediately after (visit 1) climatotherapy, and at the first visible sign of psoriasis reappearance (visit X). At these assessments, we obtained data on Psoriasis Area And Severity Index (PASI), 5-point Investigator’s Global Assessment (IGA) Scale, Nail Psoriasis Severity Index (NAPSI), Body Mass Index (BMI), waist circumference, blood pressure, and pulse; and patients answered the following questionnaires: Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Dermatology Quality of Life Index (DLQI), and EuroQol−5 Dimensions−3 Levels (EQ-5D-3L) [consisting of the EQ-5D descriptive system and EQ-VAS (EuroQol—Visual Analog Scale)]. Patients were encouraged to contact the study coordinators as soon as their psoriasis skin symptoms reappeared. They would then be booked for an appointment with the dermatologist.

Statistics

Figure and statistical analysis was performed in SigmaPlot v. 14.0 (Systat Software, Chicago, IL, USA). Normality was tested using the Shapiro-Wilk normality test. For parametric data a one-way repeated measures analysis of variance with Bonferroni post hoc test was used to compare results from different visits. For non-parametric data a Friedman repeated measures analysis of variance on ranks was used. Missing data were not included in the statistical analysis. All P-value calculations were two-sided, and a P-value of <0.05 was considered significant.

Results

All 18 patients completed the planned treatment. shows a flowchart of included patients. In summary, 17 patients were seen at visit 1; of 10 (55.6%) patients achieving complete skin clearance after treatment, eight were seen at visit X. Demographic characteristics at baseline can be seen in . Full individual demographic characteristics can be seen in Table S1. No side effects of treatment were noted. No significant differences in BMI, waist circumference, blood pressure, or pulse were observed between the visits (data not shown). The time from baseline to visit 1 was 46.5 days (SD: 7.8, range: 32–57). The time from baseline to departure was mean 13.6 days (SD: 5.7, range: 2–25). The mean time from end of treatment to visit 1 was 4.4 days (SD: 4.4, range: 0–17). The mean time from visit 1 to visit X was 90.9 days (SD: 63.7, range: 21–216). The mean time from end of treatment to reappearance of skin symptoms was 93.8 days (SD: 62.5, range: 31–219 days). A Kaplan-Meier curve showing time to reappearance of skin symptoms among full responders can be seen on .

Flowchart of included patients.

Table 1

Demographic and clinical characteristics of the cohort at baseline. (n = 18).

Baseline
Sex, n (%)
  Male 12 (67)
  Female 6 (33)
Age, years, mean (SD) [range] 52. 2 (12.2) [25-71]
Body Mass Index (kg/m2), mean (SD) [range] 28.5 (6.8) [19.5–46.1]
Waist circumference (cm), mean (SD) [range] 104.7 (16.3) [81.5–142]
Duration of psoriasis, years, mean (SD) [range] 34.2 (17.8) [8-60]
Treatment duration, days, mean (SD) [range] 28. 8 (3.2) [24-38]
Previous climate therapy, n (%)
  Yes 15 (83)
    Number of climate treatments, mean (SD) [range] 11.2 (7.0) [1-25]
Type of disease, n (%)
  Nail psoriasis 18 (100)
  Psoriatic arthritis 7 (39)
Psoriasis-related comorbidities, n (%)
  Anxiety 2 (11)
  Asthma 1 (6)
  Chronic obstructive pulmonary disease 1 (6)
  Depression 1 (6)
  Diabetes 5 (28)
  Hypercholesterolemia 2 (11)
  Hypertension 6 (33)
  Osteoarthritis 2 (11)
Medication at baseline, n (%) 8 (44)
  Topical steroids 8 (44)
  UVB 2 (11)
  No medication 10 (56)
Treatment for nail psoriasis 12 months prior to or during baseline, n (%) 4 (22)
Family history of psoriasis, n (%) 14 (78)
  No family history 3 (17)
Smoking, n (%) 2 (11)
Alcohol, n (%) 0 (0)
Sick leave due to psoriasis, n (%) 0 (0)
Professional educational requirements, n (%)
  High school 11 (61)
  Post-secondary diploma 4 (22)
  University degree 0 (0)
Prior treatments
  Topical Steroids, n (%) 17 (94)
  Light therapy, n (%) 15 (83)
  Tar, n (%) 7 (39)
  Oral systemic, n (%) 13 (72)
  Biologic, n (%) 4 (22)

Kaplan-Meier curve of the eight full responders showing time from end of treatment until reappearance of visible psoriasis (visit X).

Results from clinical and patient questionnaire scores can be seen on . Full individual data can be seen in Tables S2, S3. From baseline to visit 1, the results were for the most part similar for each clinical and questionnaire measure; mean values improved for all measures, but improvements were significant only for PASI, IGA, DLQI, and EQ-5D index values. All patients had a PASI reduction (mean 13.0, equivalent to 88% reduction). The mean IGA reduction was 2.3 (76.7%), DLQI showed a mean improvement of 11.9 (85.6%) and EQ-5D index values were improved by 0.11 (13.9%).

Table 2

Results from clinical and patient questionnaire scores.

Clinical evaluation Baseline Visit 1 Visit X P-values
PASI, mean (SD), [range], {values} 14. 8 (5.4), [7.3–27], {15} 1.8 (3.1), [0–9.7], {15} 5.8 (3.1), [2.7–9.9], {6} a

0.001
b = 0.120
c
=
0.002
IGA, mean (SD), [range], {values} 3 (0.4), [0–4], {17} 0.7 (1.0), [0–3], {15} 1.9 (0.9), [1-3], {7} a

0.001
b = 0.050
c

0.001
NAPSI Hands + Feet, mean (SD), [range], {values} 58. 1 (54.0), [0–160], {15} 54.6 (47.6), [0–124], {15} 23.2 (38.8), [0–92], {5} NS
NAPSI Hands, mean (SD), [range], {values} 28.8 (24.4), [0–80], {14} 27.1 (22.4), [0–62], {14} 15 (23.4), [0–56], {5} NS
NAPSI Feet, median (interquartile range), {values} 240 (3–73), {13} 16 (2–60), {15} 2 (0–19. 5), {5} NS
Self-reported questionnaires
NAPPA-Global, mean (SD), [range], {values} 1.0 (0.9), [0–3], {18} 0.6 (0.8), [0–2.3], {16} 1.1 (1.0), [0–2.7], {8} NS
NAPPA-Signs, mean (SD), [range], {values} 1.6 (1.2), [0–3.7], {18} 0.9 (1.1), [0–3.3], {16} 0.9 (1.0), [0–2.4], {7} NS
NAPPA-Stigma, mean (SD), [range], {values} 0. 8 (3.0), [0–2.4], {18} 0.6 (0.8), [0–2.4], {16} 0.7 (1.1), [0–2.9], {7} NS
NAPPA-Everyday Life, mean (SD), [range], {values} 0.8 (0.9), [0–2.9], {18} 0.4 (0.6), [0–2.1], {16} 0.9 (1.0), [0–2.4], {7} NS
DLQI, mean (SD), [range], {values} 13.9 (7.6), [2-28], {18} 2.0 (3.5), [0–13], {16} 7. 4 (6.2), [0–16], {7} a

0.001
b
=
0.024
c = 0.114
EQ-5D index values, mean (SD), [range], {values} 0.79 (0.09), [0.63–1.00], {18} 0.90 (0.13), [0.64–1.00], {16} 0.82 (0.10), [0.70–1.00], {6} a
=
0.008
b = 0.134
c = 1.000
EQ-VAS, mean (SD), [range], {values} 61.0 (16.1), [25-95], {17} 76. 0 (23.1), [20-100], {16} 59.6 (14.3), [40–75], {7} NS

Neither NAPSI, NAPPA nor EQ-VAS was significantly improved between baseline and visit 1.

Discussion

DSC has been well established as a treatment option affecting not only physical appearance but also patients’ QoL (8, 15, 16). These effects are, unfortunately, not everlasting. Remission times vary in the literature due to various definitions of remission and relapse (17). In our study, remission time was defined as the skin symptom-free interval. Ten patients achieved complete psoriasis clearance and eight of those had confirmed re-emergence of psoriasis within the study period. Among those patients, the mean symptom-free interval was 93.8 days (13.4 weeks). One study using a German cohort reported remission lasting 24.9 weeks (16). Another study showed complete remission in 74% of the patients after 6 months and a mean remission of 196 days (15). Additionally, one study showed remission lasting 100 days but offered no clear definition of remission (18). In our study, the high mean PASI and IGA scores at visit X of 5.8 (SD: 3.1, range: 2.7–9.9) and 1.9 (SD: 0.9, range: 1–3), respectively, could suggests a delay between first experiencing cutaneous symptoms and then contacting the department. This could lead to an overestimation of the duration of remission. However, the results presented here still suggest that the skin symptom-free interval is comparable to what is reported by others.

We observed a PASI improvement of 88% and complete clearance in 55.6% of patients at visit 1. This is in accordance with previous studies on DSC, which report improvement ranging from 81.5 to 95.5% and complete clearance ranging from 48 to 70% immediately after DSC (7, 16, 18–20). The IGA reduction further substantiates the short-term effectiveness of DSC.

BPT is an effective treatment option for psoriasis and an alternative to DSC. BPT is performed at centers located worldwide, is known to improve QoL and has shown efficacy in randomized clinical trials (21, 22). Dawe et al. (23) conducted a randomized trial on 60 patients on the effect of narrowband-UVB alone and in combination with localized Dead Sea salt soaks. Among patients who achieved complete remission no difference in remission times was found between treatments. However, the psoriasis severity score fell significantly more from baseline to end of treatment sessions when comparing combination to narrowband-UVB alone (23). The study by Klein et al. (24) included 356 patients and investigated the effect of UVB alone and in combination with a whole-body Dead Sea salt bath. A relative PASI reduction of 67.4% was observed in the combination group after the 35th treatment. Clearance, defined as PASI improvement of at least 75% from baseline, was not observed in any of the participants (24). Treatment time for the studies by Dawe et al. (23) and Klein et al. (24) was ~12 and 11 weeks, respectively. A randomized study by Léauté-Labrèze et al. (25) conducted on 71 psoriasis patient compared spa water alone; phototherapy alone and combination. They observed a PASI reduction of 64 and 55% in the phototherapy and combination group at 3 weeks, respectively. However, no significant difference between the two groups was observed (25). Two larger German randomized control trials including 143 and 1,241 patients also investigated the effect of BPT on psoriasis (26, 27). Brockow et al. (26) studied the effect of concentrated saline spa water baths followed by UVB and found a median PASI reduction of 66% after 6 weeks of treatment. Forty-nine percentage had PASI < 5 after intervention and 31% had PASI < 5 after 3 months (26). Schiener et al. found a median PASI improvement of 76% after a maximum of 8 weeks of treatment (27). A retrospective clinical study on 174 patients investigating the effect of BPT on PASI and QoL found an improvement in PASI of 70.9% and QoL of 51.2% after 30 treatments (~6 weeks) (28). We report a faster treatment response than studies conducted on BPT. BPT, however, is often performed in clinics closer to the patient’s home and therefore does not require relocation to more disease favorable locations.

New biological treatments are now being used for treating moderate-to-severe plaque psoriasis. Biologics are a heterogenous group of agents with different molecular targets and efficacy, however in long-term clinical trials and epidemiologic studies, their safety profile and efficacy are acceptable (29–31). Moreover, short-term data on biologics are robust, with up to 70.7% of patients achieving more than 90% reduction in PASI and up to 89.7% achieving a PASI 75 response after 12 weeks of treatment dependent on the specific biologic and dose used (31). Regarding the longer-term effects of biologics, a Swedish study found that switching to biologics was associated with a sustained effect at 10 years with a PASI reduction of 82.8%, a DLQI improvement of 85.7%, and an EQ-5D improvement of 11.0% (32). A study conducted on patients with moderate-to-severe psoriasis comparing the effect of biologics with that of systemic, topical, or light treatment found that biologics resulted in an average mean reduction in DLQI of 6. 6 at week 24 (33). A double blinded randomized study comparing ixekizumab with guselkumab found that 35 out of 520 (7%) of ixekizumab- and 7 out of 507 (1%) of guselkumab treated patients achieved a PASI 100 response after 4 weeks and a median PASI percentage improvement of at least 75% for ixekizumab and 50% for guselkumab (34). We report short term results after 4-weeks of treatment that are faster or comparable with the newest biologics. However, a strength of continuous usage of newer biologics are that their effect lasts longer; moreover, they have a positive effect on psoriasis-related parameters and, unlike DSC, do not require patients to complete a 4-week extensive treatment program.

DSC is known to improve QoL parameters (8, 16). We observed an improvement in DLQI and EQ-5D index values after treatment, further substantiating this observation. Nail psoriasis is a subset of psoriasis that usually responds poorly to conventional therapy. To our knowledge, the present study is the first study to include nail assessments as a separate measure. We found no significant improvement in NAPSI or NAPPA parameters after treatment; but due to the slow growth rate of nails, we would not expect nail parameters to improve until several months after treatment. Interestingly, we observed a non-significant improvement in NAPSI between baseline and visit X, substantiating this expectation of a trend in objective nail improvement.

We report no adverse effects, though it has been shown that the risk of non-melanoma skin cancer is almost increased 5-fold for Danish psoriasis patients compared with the background population (35). Another study using an Israeli cohort found that treatment-related solar damage might give rise to chronic solar damage such as wrinkles and solar lentigines, though no increased risk of non-melanoma skin cancers was found (36). This suggest that patients’ ethnicity and treatment side effects should be taken into consideration when referring patients for DSC.

A strength of this study is the plethora of parameters used to appraise the effect of DSC, giving us a full and comprehensive view of psoriasis morbidity. Additionally, the same dermatologist evaluated all patients throughout the study, thereby eliminating inter-evaluator bias. The limitations of this study include the small number of patients, the small number of data points, and the lack of a control group. However, blinding and randomization are difficult to institute in this kind of intervention. The open-label design used here might therefore contribute to an overestimation of the results. In this study, we cannot conclude whether the positive effect on psoriasis morbidity is sustained beyond visit X. Therefore, future studies should include larger sample sizes, more follow-up points, and longer follow-up times to further elucidate both the short-term and long-term effects of DSC on psoriasis.

In conclusion, this study confirms that DSC can be beneficial in the short term for treatment of both psychological and dermatological aspects of psoriasis, but the effects are not long lasting.

Data Availability Statement

Datasets generated for this study are included either in the article/Supplementary Material or are available on request.

Ethics Statement

All patients signed an individual written informed consent form. The Central Denmark Region Committees on Health Research Ethics committee waived the requirement for ethical approval for this study on human participants due to the study being a quality control study, in accordance with the national legislation and the institutional requirements. Procedures were conducted in accordance with the Helsinki Declaration of 1975 as revised in 2013.

Author Contributions

TE, DL, CJ, and LI participated in the design of the study, monitoring the study, and wrote sections of the manuscript. TE conducted the statistical analysis and wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. (2013) 133:377–85. 10.1038/jid.2012.339 [PubMed] [CrossRef] [Google Scholar]4. Grzybowski A, Pietrzak K. From patient to discoverer-Niels Ryberg Finsen (1860-1904)-the founder of phototherapy in dermatology. Clin Dermatol. (2012) 30:451–5. 10.1016/j.clindermatol.2011.11.019 [PubMed] [CrossRef] [Google Scholar]5. Routh HB, Bhowmik KR.
A glossary of concepts relating to balneology, mineral water, and the spa. Clin Dermatol. (1996) 14:549–50. 10.1016/S0738-081X(96)00082-X [CrossRef] [Google Scholar]6. Snellman E, Lauharanta J, Reunanen A, Jansen CT, Pakkasvirta TJ, Kallio M, et al. . Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6-month follow-up study. Br J Dermatol. (1993) 128:172–7. 10.1111/j.1365-2133.1993.tb15147.x [PubMed] [CrossRef] [Google Scholar]7. Abels DJ, Rose T, Bearman JE. Treatment of psoriasis at a Dead Sea dermatology clinic. Int J Dermatol. (1995) 34:134–7. 10.1111/j.1365-4362.1995.tb03599.x [PubMed] [CrossRef] [Google Scholar]8. Kopel E, Levi A, Harari M, Ruzicka T, Ingber A. Effect of the dead sea climatotherapy for psoriasis on quality of life. Isr Med Assoc J. (2013) 15:99–102. [PubMed] [Google Scholar]9. Kazandjieva J, Grozdev I, Darlenski R, Tsankov N. Climatotherapy of psoriasis. Clin Dermatol. (2008) 26:477–85. 10.1016/j.clindermatol.2008.05.001 [PubMed] [CrossRef] [Google Scholar]10. Svendsen MT, Jeyabalan J, Andersen KE, Andersen F, Johannessen H. Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review. J Dermatolog Treat. (2017) 28:374–83. 10.1080/09546634.2016.1254331 [PubMed] [CrossRef] [Google Scholar]11. Even-Paz Z, Gumon R, Kipnis V, Abels DJ, Efron D.
Dead Sea sun versus Dead Sea water in the treatment of psoriasis. J Dermatolog Treat. (1996) 7:83–6. 10.3109/09546639609089534 [CrossRef] [Google Scholar]12. Halverstam CP, Lebwohl M. Nonstandard and off-label therapies for psoriasis. Clin Dermatol. (2008) 26:546–53. 10.1016/j.clindermatol.2007.10.023 [PubMed] [CrossRef] [Google Scholar]13. Leibovici V, Sagi E, Siladji S, Greiter JC, Greiter F, Holubar K. Seasonal variation of UV Radiation at the Dead Sea. Dermatologica. (1987) 174:290–2. 10.1159/000249201 [PubMed] [CrossRef] [Google Scholar]14. Avrach WW, Niordsen AM. [Treatment of psoriasis at the Dead Sea]. Ugeskr Laeger. (1974) 136:2687–90. [PubMed] [Google Scholar]15. Shani J, Harari M, Hristakieva E, Seidl V, Bar-Giyora J. Dead-Sea climatotherapy versus other modalities of treatment for psoriasis: comparative cost-effectiveness. Int J Dermatol. (1999) 38:252–62. 10.1046/j.1365-4362.1999.00583.x [PubMed] [CrossRef] [Google Scholar]16. Harari M, Novack L, Barth J, David M, Friger M, Moses SW. The percentage of patients achieving PASI 75 after 1 month and remission time after climatotherapy at the Dead Sea. Int J Dermatol. (2007) 46:1087–91. 10.1111/j.1365-4632.2007.03278.x [PubMed] [CrossRef] [Google Scholar]17. Abels D, Harari M. Psoriasis remission time at the Dead Sea. J Am Acad Dermatol. (2000) 43:325. 10.1067/mjd.2000.106364 [PubMed] [CrossRef] [Google Scholar]18. Hodak E, Gottlieb AB, Segal T, Politi Y, Maron L, Sulkes J, et al. . Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: combined effects on epidermal and immunologic activation. J Am Acad Dermatol. (2003) 49:451–7. 10.1067/S0190-9622(03)00916-2 [PubMed] [CrossRef] [Google Scholar]19. Harari M, Shani J. Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea (Israel) DMZ Clinic. Int J Dermatol. (1997) 36:304–8. 10.1046/j.1365-4362.1997.00204.x [PubMed] [CrossRef] [Google Scholar]20. Harari M, Czarnowicki T, Fluss R, Ruzicka T, Ingber A. Patients with early-onset psoriasis achieve better results following Dead Sea climatotherapy. J Eur Acad Dermatology Venereol. (2012) 26:554–9. 10.1111/j.1468-3083.2011.04099.x [PubMed] [CrossRef] [Google Scholar]21. Tabolli S, Calza A, Pietro CD, Sampogna F, Abeni D.
Quality of life of psoriasis patients before and after Balneo – or Balneophototherapy. Yonsei Med J. (2009) 50:215–21. 10.3349/ymj.2009.50.2.215 [PMC free article] [PubMed] [CrossRef] [Google Scholar]22. Gambichler T. Balneophototherapy for psoriasis using saltwater baths and UV-B irradiation, revisited. Arch Dermatol. (2007) 143:647–9. 10.1001/archderm.143.5.647 [PubMed] [CrossRef] [Google Scholar]23. Dawe R, Yule S, Cameron H, Moseley H, Ibbotson SH, Ferguson J. A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol. (2005) 153:613–9. 10.1111/j.1365-2133.2005.06663.x [PubMed] [CrossRef] [Google Scholar]24. Klein A, Schiffner R, Schiffner-Rohe J, Einsele-Krämer B, Heinlin J, Stolz W, et al. . A randomized clinical trial in psoriasis: synchronous balneophototherapy with bathing in Dead Sea salt solution plus narrowband UVB vs. narrowband UVB alone (TOMESA-study group). J Eur Acad Dermatology Venereol. (2010) 25:570. 10.1111/j.1468-3083.2010.03840.x [PubMed] [CrossRef] [Google Scholar]25. Léauté-Labrèze C, Saillour F, Chene G, Cazenave C, Luxey-Bellocq ML, Sanciaume C, et al.
Saline spa water or combined water and UV-B for psoriasis vs conventional UV-B: lessons from the Salies de Béarn randomized study. Arch Dermatol. (2001) 137:1035−9. [PubMed] [Google Scholar]26. Brockow T, Schiener R, Franke A, Resch KL, Peter RU. A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis. J Eur Acad Dermatology Venereol. (2007) 21:1027–37. 10.1111/j.1468-3083.2007.02152.x [PubMed] [CrossRef] [Google Scholar]27. Schiener R, Brockow T, Franke A, Salzer B, Peter RU, Resch KL. Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trial. Arch Dermatol. (2007) 143:586–96. 10.1001/archderm.143.5.586 [PubMed] [CrossRef] [Google Scholar]28. Cattaneo A, Violetti SA, Tavecchio S, Bruni E, Carrera C, Crosti C. Tomesa balneophototherapy in mild to severe psoriasis: a retrospective clinical trial in 174 patients. Photodermatol Photoimmunol Photomed. (2012) 28:169–71. 10.1111/j.1600-0781.2012.00659.x [PubMed] [CrossRef] [Google Scholar]29. Rustin M. Long-term safety of biologics in the treatment of moderate-to-severe plaque psoriasis: review of current data. Br J Dermatol. (2012):167:3–11. 10.1111/j.1365-2133.2012.11208.x [PubMed] [CrossRef] [Google Scholar]30. Egeberg A, Ottosen M, Gniadecki R, Broesby-Olsen S, Dam TN, Bryld LE, et al. . Safety, efficacy, and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol. (2018) 178:509–19. 10.1111/bjd.16288 [PubMed] [CrossRef] [Google Scholar]32. Hjalte F, Carlsson KS, Schmitt-Egenolf M. Sustained psoriasis area and severity index, dermatology life quality index and EuroQol-5D response of biological treatment in psoriasis: 10 years of real-world data in the Swedish National Psoriasis Register. Br J Dermatol. (2018) 178:245–52. 10.1111/bjd.15757 [PubMed] [CrossRef] [Google Scholar]33. Norris D, Photiou L, Tacey M, Dolianitis C, Varigos G, Foley P, et al. . Biologics and dermatology life quality index (DLQI) in the Australasian psoriasis population. J Dermatolog Treat. (2017) 28:731–6. 10.1080/09546634.2017.1329501 [PubMed] [CrossRef] [Google Scholar]34. Blauvelt A, Papp K, Gottlieb A, Jarell A, Reich K, Maari C, et al. . A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 12-week efficacy, safety and speed of response from a randomized, double-blinded trial. Br J Dermatol. (2020). 10.1111/bjd.18851. [Epub ahead of print]. [PMC free article] [PubMed] [CrossRef] [Google Scholar]35. Frentz G, Olsen JH, Avrach WW. Malignant tumours and psoriasis: climatotherapy at the Dead Sea. Br J Dermatol. (1999) 141:1088–91. 10.1046/j.1365-2133.1999.03161.x [PubMed] [CrossRef] [Google Scholar]36. David M, Tsukrov B, Adler B, Hershko K, Pavlotski F, Rozenman D, et al. . Actinic damage among patients with psoriasis treated by climatotherapy at the Dead Sea. J Am Acad Dermatol. (2005) 52(3 Pt 1):445–50. 10.1016/j.jaad.2004.11.019 [PubMed] [CrossRef] [Google Scholar]

Effect of Dead Sea Climatotherapy on Psoriasis; A Prospective Cohort Study

Front Med (Lausanne). 2020; 7: 83.

Department of Dermatology, Aarhus University Hospital, Aarhus, Denmark

Edited by: Peter Wolf, Medical University of Graz, Austria

Reviewed by: Thilo Gambichler, University Hospitals of the Ruhr-University of Bochum, Germany; Franz J. Legat, Medical University of Graz, Austria

This article was submitted to Dermatology, a section of the journal Frontiers in Medicine

Received 2019 Oct 3; Accepted 2020 Mar 2.

Copyright © 2020 Emmanuel, Lybæk, Johansen and Iversen.

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

This article has been cited by other articles in PMC.

Abstract

Background: Dead Sea climatotherapy (DSC) is a treatment option for psoriasis in Denmark. However, the response to DSC has not been particularly well studied.

Aim: We sought to determine effectiveness and response duration of DSC on psoriasis-related outcome parameters.

Methods: Eighteen patients participated in a 4-week treatment program in Ein Gedi in Israel. Treatment, consisting of sun exposure and bathing, was individualized.

Results: DSC was associated with a mean 13.0-point reduction (88%) in Psoriasis Area and Severity Index and a mean reduction of 2.3 (76.7%) on the 5-point Investigator’s Global Assessment Scale. Furthermore, patients’ quality of life improved measured by the Dermatology Quality of Life Index and EuroQol 5D index values. The mean time from treatment end to reappearance of visible skin symptoms was 93.8 days (SD: 62.5, range: 31–219 days).

Conclusions: Our results confirm that DSC has an immediate effect on skin manifestations and improves quality of life, but long-term disease control is not observed.

Keywords: psoriasis, Dead Sea, climatotherapy, heliotherapy, cohort, Ein Gedi

Introduction

Psoriasis is a chronic skin disease affecting ~1–3% of the western population (1). It has a wide range of clinical phenotypic appearances, ranging from pruritic scaly red plaques on the skin to isolated affection of the nails (2). Treatment modalities range from topical treatment and photo therapy to systemic treatment with small molecules and biological therapies (3). Treatment of skin diseases using UV light has been used since 1903 when Niels Ryberg Finsen won the Nobel prize for reporting on the effective treatment of tuberculosis of the skin (4). Phototherapy, i. e., treatment exclusively using light, is usually supplemented with balneotherapy i.e., baths in salt water, collectively termed balneophototherapy (BPT). In addition, a change of humidity and air, and a change in barometric pressure is added and then collectively termed climate therapy or climatotherapy (5). Climatotherapy is a safe treatment option, and beneficial effects on psoriasis have been reported (6, 7). Climatotherapy has also been shown to improve quality of life (QoL) (8). In some countries, it is an alternative to medication for psoriasis with treatment centers located all over the world (9). The proportion of psoriasis patients attending a university hospital dermatology clinic and having used climatotherapy at some time during the course of their treatment varies considerably across the world; from 8% in the Nordic countries to 46% in the Middle East (10). Danish psoriasis patients have mainly received climatotherapy at Ein Gedi at the Dead Sea in Israel located at 31°N, 35°E. With a location ~400 meters below sea level, patients are exposed to salt and minerals and prolonged sun exposure while exposure to cancer-inducing ultraviolet B (UVB) radiation from the sun is minimal (11–13). This combination is unique among treatment centers. Dead Sea climatotherapy (DSC) has a long-standing history, and Denmark was one of the first countries to test it in psoriasis patients (14). DSC is particularly relevant where other therapies are contraindicated or have failed. Patients treated in Israel constitute a subgroup of psoriasis patients that has not previously been much studied.

In the present study, we therefore investigated the effect of DSC on psoriasis by measuring psoriasis-related outcomes before, immediately after, and at first visible signs of psoriasis after completion of DSC.

Materials and Methods

Study Design and Population

Eighteen Danish patients were enrolled in this prospective cohort study. The study size was based on feasibility. The inclusion criteria were referral for DSC. Referral was a shared decision between the treating dermatologist and the patient. The date of enrolment of the first- and last patient was on the 18th of February 2015 and 2nd of September 2015, respectively. All patients referred to climatotherapy for the given enrolment period were given the possibility of being included in this study. The last follow-up visit of the last patient was on the 5th of January 2016. Patients were allowed to use their usual treatments at baseline. No formal exclusion criteria were applied though contraindications for selection for DSC include photo-aggravated systemic diseases or dermatoses, skin malignancies, acute skin infections, non-controlled concomitant diseases, and lack of compliance with instructions regarding sun exposure and bathing.

All patients were sent on a 4-week treatment program at Ein Gedi at the Dead Sea in Israel. Here, they received individualized treatment consisting of 28 days of bathing and escalating doses of UVB exposure according to skin type and UV index. Treatment was supplemented with educational lectures and discussions about psoriasis and QoL, comorbidities, manifestations, and various treatments. A healthy lifestyle consisting of physical activity and a healthy diet was stressed. Group discussions were instituted for sharing ways to manage psoriasis. Individual and group-based education, guidance, and daily training were provided by a nurse and a physiotherapist. Treatment-related costs were fully covered by the Danish Medical Insurance System. The study was an open-label, single-arm cohort study with up to three repeated measures for a maximum of 8 months. Patients were to be assessed by the same dermatologist 1 week before (baseline) and immediately after (visit 1) climatotherapy, and at the first visible sign of psoriasis reappearance (visit X). At these assessments, we obtained data on Psoriasis Area And Severity Index (PASI), 5-point Investigator’s Global Assessment (IGA) Scale, Nail Psoriasis Severity Index (NAPSI), Body Mass Index (BMI), waist circumference, blood pressure, and pulse; and patients answered the following questionnaires: Nail Assessment in Psoriasis and Psoriatic Arthritis (NAPPA), Dermatology Quality of Life Index (DLQI), and EuroQol−5 Dimensions−3 Levels (EQ-5D-3L) [consisting of the EQ-5D descriptive system and EQ-VAS (EuroQol—Visual Analog Scale)]. Patients were encouraged to contact the study coordinators as soon as their psoriasis skin symptoms reappeared. They would then be booked for an appointment with the dermatologist.

Statistics

Figure and statistical analysis was performed in SigmaPlot v. 14.0 (Systat Software, Chicago, IL, USA). Normality was tested using the Shapiro-Wilk normality test. For parametric data a one-way repeated measures analysis of variance with Bonferroni post hoc test was used to compare results from different visits. For non-parametric data a Friedman repeated measures analysis of variance on ranks was used. Missing data were not included in the statistical analysis. All P-value calculations were two-sided, and a P-value of <0.05 was considered significant.

Results

All 18 patients completed the planned treatment. shows a flowchart of included patients. In summary, 17 patients were seen at visit 1; of 10 (55.6%) patients achieving complete skin clearance after treatment, eight were seen at visit X. Demographic characteristics at baseline can be seen in . Full individual demographic characteristics can be seen in Table S1. No side effects of treatment were noted. No significant differences in BMI, waist circumference, blood pressure, or pulse were observed between the visits (data not shown). The time from baseline to visit 1 was 46.5 days (SD: 7.8, range: 32–57). The time from baseline to departure was mean 13.6 days (SD: 5.7, range: 2–25). The mean time from end of treatment to visit 1 was 4.4 days (SD: 4.4, range: 0–17). The mean time from visit 1 to visit X was 90.9 days (SD: 63.7, range: 21–216). The mean time from end of treatment to reappearance of skin symptoms was 93.8 days (SD: 62.5, range: 31–219 days). A Kaplan-Meier curve showing time to reappearance of skin symptoms among full responders can be seen on .

Flowchart of included patients.

Table 1

Demographic and clinical characteristics of the cohort at baseline. (n = 18).

Baseline
Sex, n (%)
  Male 12 (67)
  Female 6 (33)
Age, years, mean (SD) [range] 52. 2 (12.2) [25-71]
Body Mass Index (kg/m2), mean (SD) [range] 28.5 (6.8) [19.5–46.1]
Waist circumference (cm), mean (SD) [range] 104.7 (16.3) [81.5–142]
Duration of psoriasis, years, mean (SD) [range] 34.2 (17.8) [8-60]
Treatment duration, days, mean (SD) [range] 28. 8 (3.2) [24-38]
Previous climate therapy, n (%)
  Yes 15 (83)
    Number of climate treatments, mean (SD) [range] 11.2 (7.0) [1-25]
Type of disease, n (%)
  Nail psoriasis 18 (100)
  Psoriatic arthritis 7 (39)
Psoriasis-related comorbidities, n (%)
  Anxiety 2 (11)
  Asthma 1 (6)
  Chronic obstructive pulmonary disease 1 (6)
  Depression 1 (6)
  Diabetes 5 (28)
  Hypercholesterolemia 2 (11)
  Hypertension 6 (33)
  Osteoarthritis 2 (11)
Medication at baseline, n (%) 8 (44)
  Topical steroids 8 (44)
  UVB 2 (11)
  No medication 10 (56)
Treatment for nail psoriasis 12 months prior to or during baseline, n (%) 4 (22)
Family history of psoriasis, n (%) 14 (78)
  No family history 3 (17)
Smoking, n (%) 2 (11)
Alcohol, n (%) 0 (0)
Sick leave due to psoriasis, n (%) 0 (0)
Professional educational requirements, n (%)
  High school 11 (61)
  Post-secondary diploma 4 (22)
  University degree 0 (0)
Prior treatments
  Topical Steroids, n (%) 17 (94)
  Light therapy, n (%) 15 (83)
  Tar, n (%) 7 (39)
  Oral systemic, n (%) 13 (72)
  Biologic, n (%) 4 (22)

Kaplan-Meier curve of the eight full responders showing time from end of treatment until reappearance of visible psoriasis (visit X).

Results from clinical and patient questionnaire scores can be seen on . Full individual data can be seen in Tables S2, S3. From baseline to visit 1, the results were for the most part similar for each clinical and questionnaire measure; mean values improved for all measures, but improvements were significant only for PASI, IGA, DLQI, and EQ-5D index values. All patients had a PASI reduction (mean 13.0, equivalent to 88% reduction). The mean IGA reduction was 2.3 (76.7%), DLQI showed a mean improvement of 11.9 (85.6%) and EQ-5D index values were improved by 0.11 (13.9%).

Table 2

Results from clinical and patient questionnaire scores.

Clinical evaluation Baseline Visit 1 Visit X P-values
PASI, mean (SD), [range], {values} 14. 8 (5.4), [7.3–27], {15} 1.8 (3.1), [0–9.7], {15} 5.8 (3.1), [2.7–9.9], {6} a

0.001
b = 0.120
c
=
0.002
IGA, mean (SD), [range], {values} 3 (0.4), [0–4], {17} 0.7 (1.0), [0–3], {15} 1.9 (0.9), [1-3], {7} a

0.001
b = 0.050
c

0.001
NAPSI Hands + Feet, mean (SD), [range], {values} 58. 1 (54.0), [0–160], {15} 54.6 (47.6), [0–124], {15} 23.2 (38.8), [0–92], {5} NS
NAPSI Hands, mean (SD), [range], {values} 28.8 (24.4), [0–80], {14} 27.1 (22.4), [0–62], {14} 15 (23.4), [0–56], {5} NS
NAPSI Feet, median (interquartile range), {values} 240 (3–73), {13} 16 (2–60), {15} 2 (0–19.5), {5} NS
Self-reported questionnaires
NAPPA-Global, mean (SD), [range], {values} 1.0 (0.9), [0–3], {18} 0.6 (0.8), [0–2.3], {16} 1.1 (1.0), [0–2.7], {8} NS
NAPPA-Signs, mean (SD), [range], {values} 1.6 (1.2), [0–3.7], {18} 0.9 (1.1), [0–3.3], {16} 0.9 (1.0), [0–2.4], {7} NS
NAPPA-Stigma, mean (SD), [range], {values} 0.8 (3.0), [0–2.4], {18} 0.6 (0.8), [0–2.4], {16} 0.7 (1.1), [0–2.9], {7} NS
NAPPA-Everyday Life, mean (SD), [range], {values} 0.8 (0.9), [0–2.9], {18} 0.4 (0.6), [0–2.1], {16} 0.9 (1.0), [0–2.4], {7} NS
DLQI, mean (SD), [range], {values} 13.9 (7.6), [2-28], {18} 2.0 (3.5), [0–13], {16} 7.4 (6.2), [0–16], {7} a

0.001
b
=
0.024
c = 0.114
EQ-5D index values, mean (SD), [range], {values} 0.79 (0.09), [0.63–1.00], {18} 0.90 (0.13), [0.64–1.00], {16} 0.82 (0.10), [0.70–1.00], {6} a
=
0.008
b = 0.134
c = 1.000
EQ-VAS, mean (SD), [range], {values} 61.0 (16.1), [25-95], {17} 76.0 (23.1), [20-100], {16} 59.6 (14.3), [40–75], {7} NS

Neither NAPSI, NAPPA nor EQ-VAS was significantly improved between baseline and visit 1.

Discussion

DSC has been well established as a treatment option affecting not only physical appearance but also patients’ QoL (8, 15, 16). These effects are, unfortunately, not everlasting. Remission times vary in the literature due to various definitions of remission and relapse (17). In our study, remission time was defined as the skin symptom-free interval. Ten patients achieved complete psoriasis clearance and eight of those had confirmed re-emergence of psoriasis within the study period. Among those patients, the mean symptom-free interval was 93.8 days (13.4 weeks). One study using a German cohort reported remission lasting 24.9 weeks (16). Another study showed complete remission in 74% of the patients after 6 months and a mean remission of 196 days (15). Additionally, one study showed remission lasting 100 days but offered no clear definition of remission (18). In our study, the high mean PASI and IGA scores at visit X of 5.8 (SD: 3.1, range: 2.7–9.9) and 1.9 (SD: 0.9, range: 1–3), respectively, could suggests a delay between first experiencing cutaneous symptoms and then contacting the department. This could lead to an overestimation of the duration of remission. However, the results presented here still suggest that the skin symptom-free interval is comparable to what is reported by others.

We observed a PASI improvement of 88% and complete clearance in 55.6% of patients at visit 1. This is in accordance with previous studies on DSC, which report improvement ranging from 81.5 to 95.5% and complete clearance ranging from 48 to 70% immediately after DSC (7, 16, 18–20). The IGA reduction further substantiates the short-term effectiveness of DSC.

BPT is an effective treatment option for psoriasis and an alternative to DSC. BPT is performed at centers located worldwide, is known to improve QoL and has shown efficacy in randomized clinical trials (21, 22). Dawe et al. (23) conducted a randomized trial on 60 patients on the effect of narrowband-UVB alone and in combination with localized Dead Sea salt soaks. Among patients who achieved complete remission no difference in remission times was found between treatments. However, the psoriasis severity score fell significantly more from baseline to end of treatment sessions when comparing combination to narrowband-UVB alone (23). The study by Klein et al. (24) included 356 patients and investigated the effect of UVB alone and in combination with a whole-body Dead Sea salt bath. A relative PASI reduction of 67.4% was observed in the combination group after the 35th treatment. Clearance, defined as PASI improvement of at least 75% from baseline, was not observed in any of the participants (24). Treatment time for the studies by Dawe et al. (23) and Klein et al. (24) was ~12 and 11 weeks, respectively. A randomized study by Léauté-Labrèze et al. (25) conducted on 71 psoriasis patient compared spa water alone; phototherapy alone and combination. They observed a PASI reduction of 64 and 55% in the phototherapy and combination group at 3 weeks, respectively. However, no significant difference between the two groups was observed (25). Two larger German randomized control trials including 143 and 1,241 patients also investigated the effect of BPT on psoriasis (26, 27). Brockow et al. (26) studied the effect of concentrated saline spa water baths followed by UVB and found a median PASI reduction of 66% after 6 weeks of treatment. Forty-nine percentage had PASI < 5 after intervention and 31% had PASI < 5 after 3 months (26). Schiener et al. found a median PASI improvement of 76% after a maximum of 8 weeks of treatment (27). A retrospective clinical study on 174 patients investigating the effect of BPT on PASI and QoL found an improvement in PASI of 70.9% and QoL of 51.2% after 30 treatments (~6 weeks) (28). We report a faster treatment response than studies conducted on BPT. BPT, however, is often performed in clinics closer to the patient’s home and therefore does not require relocation to more disease favorable locations.

New biological treatments are now being used for treating moderate-to-severe plaque psoriasis. Biologics are a heterogenous group of agents with different molecular targets and efficacy, however in long-term clinical trials and epidemiologic studies, their safety profile and efficacy are acceptable (29–31). Moreover, short-term data on biologics are robust, with up to 70.7% of patients achieving more than 90% reduction in PASI and up to 89.7% achieving a PASI 75 response after 12 weeks of treatment dependent on the specific biologic and dose used (31). Regarding the longer-term effects of biologics, a Swedish study found that switching to biologics was associated with a sustained effect at 10 years with a PASI reduction of 82.8%, a DLQI improvement of 85.7%, and an EQ-5D improvement of 11.0% (32). A study conducted on patients with moderate-to-severe psoriasis comparing the effect of biologics with that of systemic, topical, or light treatment found that biologics resulted in an average mean reduction in DLQI of 6.6 at week 24 (33). A double blinded randomized study comparing ixekizumab with guselkumab found that 35 out of 520 (7%) of ixekizumab- and 7 out of 507 (1%) of guselkumab treated patients achieved a PASI 100 response after 4 weeks and a median PASI percentage improvement of at least 75% for ixekizumab and 50% for guselkumab (34). We report short term results after 4-weeks of treatment that are faster or comparable with the newest biologics. However, a strength of continuous usage of newer biologics are that their effect lasts longer; moreover, they have a positive effect on psoriasis-related parameters and, unlike DSC, do not require patients to complete a 4-week extensive treatment program.

DSC is known to improve QoL parameters (8, 16). We observed an improvement in DLQI and EQ-5D index values after treatment, further substantiating this observation. Nail psoriasis is a subset of psoriasis that usually responds poorly to conventional therapy. To our knowledge, the present study is the first study to include nail assessments as a separate measure. We found no significant improvement in NAPSI or NAPPA parameters after treatment; but due to the slow growth rate of nails, we would not expect nail parameters to improve until several months after treatment. Interestingly, we observed a non-significant improvement in NAPSI between baseline and visit X, substantiating this expectation of a trend in objective nail improvement.

We report no adverse effects, though it has been shown that the risk of non-melanoma skin cancer is almost increased 5-fold for Danish psoriasis patients compared with the background population (35). Another study using an Israeli cohort found that treatment-related solar damage might give rise to chronic solar damage such as wrinkles and solar lentigines, though no increased risk of non-melanoma skin cancers was found (36). This suggest that patients’ ethnicity and treatment side effects should be taken into consideration when referring patients for DSC.

A strength of this study is the plethora of parameters used to appraise the effect of DSC, giving us a full and comprehensive view of psoriasis morbidity. Additionally, the same dermatologist evaluated all patients throughout the study, thereby eliminating inter-evaluator bias. The limitations of this study include the small number of patients, the small number of data points, and the lack of a control group. However, blinding and randomization are difficult to institute in this kind of intervention. The open-label design used here might therefore contribute to an overestimation of the results. In this study, we cannot conclude whether the positive effect on psoriasis morbidity is sustained beyond visit X. Therefore, future studies should include larger sample sizes, more follow-up points, and longer follow-up times to further elucidate both the short-term and long-term effects of DSC on psoriasis.

In conclusion, this study confirms that DSC can be beneficial in the short term for treatment of both psychological and dermatological aspects of psoriasis, but the effects are not long lasting.

Data Availability Statement

Datasets generated for this study are included either in the article/Supplementary Material or are available on request.

Ethics Statement

All patients signed an individual written informed consent form. The Central Denmark Region Committees on Health Research Ethics committee waived the requirement for ethical approval for this study on human participants due to the study being a quality control study, in accordance with the national legislation and the institutional requirements. Procedures were conducted in accordance with the Helsinki Declaration of 1975 as revised in 2013.

Author Contributions

TE, DL, CJ, and LI participated in the design of the study, monitoring the study, and wrote sections of the manuscript. TE conducted the statistical analysis and wrote the first draft of the manuscript. All authors contributed to manuscript revision, read, and approved the submitted version.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

References

1. Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. J Invest Dermatol. (2013) 133:377–85. 10.1038/jid.2012.339 [PubMed] [CrossRef] [Google Scholar]4. Grzybowski A, Pietrzak K. From patient to discoverer-Niels Ryberg Finsen (1860-1904)-the founder of phototherapy in dermatology. Clin Dermatol. (2012) 30:451–5. 10.1016/j.clindermatol.2011.11.019 [PubMed] [CrossRef] [Google Scholar]5. Routh HB, Bhowmik KR.
A glossary of concepts relating to balneology, mineral water, and the spa. Clin Dermatol. (1996) 14:549–50. 10.1016/S0738-081X(96)00082-X [CrossRef] [Google Scholar]6. Snellman E, Lauharanta J, Reunanen A, Jansen CT, Pakkasvirta TJ, Kallio M, et al. . Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6-month follow-up study. Br J Dermatol. (1993) 128:172–7. 10.1111/j.1365-2133.1993.tb15147.x [PubMed] [CrossRef] [Google Scholar]7. Abels DJ, Rose T, Bearman JE. Treatment of psoriasis at a Dead Sea dermatology clinic. Int J Dermatol. (1995) 34:134–7. 10.1111/j.1365-4362.1995.tb03599.x [PubMed] [CrossRef] [Google Scholar]8. Kopel E, Levi A, Harari M, Ruzicka T, Ingber A. Effect of the dead sea climatotherapy for psoriasis on quality of life. Isr Med Assoc J. (2013) 15:99–102. [PubMed] [Google Scholar]9. Kazandjieva J, Grozdev I, Darlenski R, Tsankov N. Climatotherapy of psoriasis. Clin Dermatol. (2008) 26:477–85. 10.1016/j.clindermatol.2008.05.001 [PubMed] [CrossRef] [Google Scholar]10. Svendsen MT, Jeyabalan J, Andersen KE, Andersen F, Johannessen H. Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review. J Dermatolog Treat. (2017) 28:374–83. 10.1080/09546634.2016.1254331 [PubMed] [CrossRef] [Google Scholar]11. Even-Paz Z, Gumon R, Kipnis V, Abels DJ, Efron D.
Dead Sea sun versus Dead Sea water in the treatment of psoriasis. J Dermatolog Treat. (1996) 7:83–6. 10.3109/09546639609089534 [CrossRef] [Google Scholar]12. Halverstam CP, Lebwohl M. Nonstandard and off-label therapies for psoriasis. Clin Dermatol. (2008) 26:546–53. 10.1016/j.clindermatol.2007.10.023 [PubMed] [CrossRef] [Google Scholar]13. Leibovici V, Sagi E, Siladji S, Greiter JC, Greiter F, Holubar K. Seasonal variation of UV Radiation at the Dead Sea. Dermatologica. (1987) 174:290–2. 10.1159/000249201 [PubMed] [CrossRef] [Google Scholar]14. Avrach WW, Niordsen AM. [Treatment of psoriasis at the Dead Sea]. Ugeskr Laeger. (1974) 136:2687–90. [PubMed] [Google Scholar]15. Shani J, Harari M, Hristakieva E, Seidl V, Bar-Giyora J. Dead-Sea climatotherapy versus other modalities of treatment for psoriasis: comparative cost-effectiveness. Int J Dermatol. (1999) 38:252–62. 10.1046/j.1365-4362.1999.00583.x [PubMed] [CrossRef] [Google Scholar]16. Harari M, Novack L, Barth J, David M, Friger M, Moses SW. The percentage of patients achieving PASI 75 after 1 month and remission time after climatotherapy at the Dead Sea. Int J Dermatol. (2007) 46:1087–91. 10.1111/j.1365-4632.2007.03278.x [PubMed] [CrossRef] [Google Scholar]17. Abels D, Harari M. Psoriasis remission time at the Dead Sea. J Am Acad Dermatol. (2000) 43:325. 10.1067/mjd.2000.106364 [PubMed] [CrossRef] [Google Scholar]18. Hodak E, Gottlieb AB, Segal T, Politi Y, Maron L, Sulkes J, et al. . Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: combined effects on epidermal and immunologic activation. J Am Acad Dermatol. (2003) 49:451–7. 10.1067/S0190-9622(03)00916-2 [PubMed] [CrossRef] [Google Scholar]19. Harari M, Shani J. Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea (Israel) DMZ Clinic. Int J Dermatol. (1997) 36:304–8. 10.1046/j.1365-4362.1997.00204.x [PubMed] [CrossRef] [Google Scholar]20. Harari M, Czarnowicki T, Fluss R, Ruzicka T, Ingber A. Patients with early-onset psoriasis achieve better results following Dead Sea climatotherapy. J Eur Acad Dermatology Venereol. (2012) 26:554–9. 10.1111/j.1468-3083.2011.04099.x [PubMed] [CrossRef] [Google Scholar]21. Tabolli S, Calza A, Pietro CD, Sampogna F, Abeni D.
Quality of life of psoriasis patients before and after Balneo – or Balneophototherapy. Yonsei Med J. (2009) 50:215–21. 10.3349/ymj.2009.50.2.215 [PMC free article] [PubMed] [CrossRef] [Google Scholar]22. Gambichler T. Balneophototherapy for psoriasis using saltwater baths and UV-B irradiation, revisited. Arch Dermatol. (2007) 143:647–9. 10.1001/archderm.143.5.647 [PubMed] [CrossRef] [Google Scholar]23. Dawe R, Yule S, Cameron H, Moseley H, Ibbotson SH, Ferguson J. A randomized controlled comparison of the efficacy of Dead Sea salt balneophototherapy vs. narrowband ultraviolet B monotherapy for chronic plaque psoriasis. Br J Dermatol. (2005) 153:613–9. 10.1111/j.1365-2133.2005.06663.x [PubMed] [CrossRef] [Google Scholar]24. Klein A, Schiffner R, Schiffner-Rohe J, Einsele-Krämer B, Heinlin J, Stolz W, et al. . A randomized clinical trial in psoriasis: synchronous balneophototherapy with bathing in Dead Sea salt solution plus narrowband UVB vs. narrowband UVB alone (TOMESA-study group). J Eur Acad Dermatology Venereol. (2010) 25:570. 10.1111/j.1468-3083.2010.03840.x [PubMed] [CrossRef] [Google Scholar]25. Léauté-Labrèze C, Saillour F, Chene G, Cazenave C, Luxey-Bellocq ML, Sanciaume C, et al.
Saline spa water or combined water and UV-B for psoriasis vs conventional UV-B: lessons from the Salies de Béarn randomized study. Arch Dermatol. (2001) 137:1035−9. [PubMed] [Google Scholar]26. Brockow T, Schiener R, Franke A, Resch KL, Peter RU. A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis. J Eur Acad Dermatology Venereol. (2007) 21:1027–37. 10.1111/j.1468-3083.2007.02152.x [PubMed] [CrossRef] [Google Scholar]27. Schiener R, Brockow T, Franke A, Salzer B, Peter RU, Resch KL. Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trial. Arch Dermatol. (2007) 143:586–96. 10.1001/archderm.143.5.586 [PubMed] [CrossRef] [Google Scholar]28. Cattaneo A, Violetti SA, Tavecchio S, Bruni E, Carrera C, Crosti C. Tomesa balneophototherapy in mild to severe psoriasis: a retrospective clinical trial in 174 patients. Photodermatol Photoimmunol Photomed. (2012) 28:169–71. 10.1111/j.1600-0781.2012.00659.x [PubMed] [CrossRef] [Google Scholar]29. Rustin M. Long-term safety of biologics in the treatment of moderate-to-severe plaque psoriasis: review of current data. Br J Dermatol. (2012):167:3–11. 10.1111/j.1365-2133.2012.11208.x [PubMed] [CrossRef] [Google Scholar]30. Egeberg A, Ottosen M, Gniadecki R, Broesby-Olsen S, Dam TN, Bryld LE, et al. . Safety, efficacy, and drug survival of biologics and biosimilars for moderate-to-severe plaque psoriasis. Br J Dermatol. (2018) 178:509–19. 10.1111/bjd.16288 [PubMed] [CrossRef] [Google Scholar]32. Hjalte F, Carlsson KS, Schmitt-Egenolf M. Sustained psoriasis area and severity index, dermatology life quality index and EuroQol-5D response of biological treatment in psoriasis: 10 years of real-world data in the Swedish National Psoriasis Register. Br J Dermatol. (2018) 178:245–52. 10.1111/bjd.15757 [PubMed] [CrossRef] [Google Scholar]33. Norris D, Photiou L, Tacey M, Dolianitis C, Varigos G, Foley P, et al. . Biologics and dermatology life quality index (DLQI) in the Australasian psoriasis population. J Dermatolog Treat. (2017) 28:731–6. 10.1080/09546634.2017.1329501 [PubMed] [CrossRef] [Google Scholar]34. Blauvelt A, Papp K, Gottlieb A, Jarell A, Reich K, Maari C, et al. . A head-to-head comparison of ixekizumab vs. guselkumab in patients with moderate-to-severe plaque psoriasis: 12-week efficacy, safety and speed of response from a randomized, double-blinded trial. Br J Dermatol. (2020). 10.1111/bjd.18851. [Epub ahead of print]. [PMC free article] [PubMed] [CrossRef] [Google Scholar]35. Frentz G, Olsen JH, Avrach WW. Malignant tumours and psoriasis: climatotherapy at the Dead Sea. Br J Dermatol. (1999) 141:1088–91. 10.1046/j.1365-2133.1999.03161.x [PubMed] [CrossRef] [Google Scholar]36. David M, Tsukrov B, Adler B, Hershko K, Pavlotski F, Rozenman D, et al. . Actinic damage among patients with psoriasis treated by climatotherapy at the Dead Sea. J Am Acad Dermatol. (2005) 52(3 Pt 1):445–50. 10.1016/j.jaad.2004.11.019 [PubMed] [CrossRef] [Google Scholar]

Is the Dead Sea an Effective Psoriasis Treatment? — Psoriasis Center — Everyday Health

It has been known for centuries that people with skin conditions, including psoriasis, can benefit from bathing in the Dead Sea in eastern Israel, where the water is 10 times as salty as the ocean.

“It goes back to ancient times,” says Mark Lebwohl, MD, chairman emeritus of the National Psoriasis Foundation Medical Board and professor of dermatology at the Icahn School of Medicine at Mt. Sinai in New York City. “[In the Bible,] people talk about soaking in water for leprosy, and they were probably talking about psoriasis. The Hebrew word for leprosy is tzaarat, which kind of sounds like psoriasis.”

You can buy mineral-rich sea salts to add to your bath water, but can they help relieve pain and itching from psoriasis? “The sea salt products they’re selling might have some slight benefit,” says Dr. Lebwohl. “The best you can say is they might be of limited benefit as a psoriasis treatment.”

On the other hand, Lebwohl says, making a pilgrimage to the Dead Sea and spending at least two weeks there can be a very helpful psoriasis treatment.

“While the minimum is two weeks, people who stay four to six weeks get a tremendous amount of benefit,” Lebwohl adds. “I had a patient with very bad psoriasis who found it cleared for the first time in his life.”

How long the benefits of being at the Dead Sea last will vary from patient to patient.

“I have had patients say to me that on the airplane ride back they felt their psoriasis return. Other patients have had very long remissions,” Lebwohl says. Some patients return to the Dead Sea annually.

Lebwohl and other researchers believe it’s a combination of factors that makes psoriasis treatments at the Dead Sea so effective.

What’s Different About the Dead Sea

“The light at the Dead Sea is very unique. The mineral content of the water is very unique,” Lebwohl says. The evaporating air or thick haze around the Dead Sea contains chloride salts — magnesium, sodium, potassium, calcium — in concentrations that are 20 times greater than anywhere else in the world. According to the National Psoriasis Foundation, the salts help break down thick plaques and allow sunlight to target the inflammation underneath.

The Dead Sea is the lowest point on Earth, more than 400 meters (m) below sea level. The sun’s rays must pass through not only these extra 400 m (about 1,300 feet), but also the haze. The haze helps to filter out the shorter of the sun’s ultraviolet rays, which are the most damaging to the skin.

“It turns out that the rays that are left are the peak effective wavelength of ultraviolet light for treating psoriasis,” Lebwohl explains. Sunbathers still are advised to use caution and wear sunscreen if they will be exposed for a long time.

It’s also a pleasant experience to relax in the thermo-mineral pools while being exposed to the sunlight at the Dead Sea, which can break the well-known link between stress and psoriasis flares. “So there could be a psychological component contributing to the success of the treatments at the Dead Sea as well,” Lebwohl says.

What the Research Shows

Lebwohl says a well-known study done back in 1989 by Israeli dermatologist Zvi Even-Paz, MD, found that the greatest benefit comes from actually visiting the Dead Sea. Dr. Even-Paz compared psoriasis patients who received treatments of light and water at the Dead Sea with those who received similar treatments in Jerusalem, which is at a higher elevation. He also had a group that was treated with the Dead Sea water alone.

Even-Paz found the patients who improved the most were those who received the light and water at the Dead Sea. Those in Jerusalem improved, but not as much as those at the Dead Sea, while only a small percentage of those who were treated with the Dead Sea water alone showed improvement.

“It really does seem like the combination of the two — the light and the water — is ideal, but it is the sunlight at the Dead Sea that causes the overwhelming effect,” Lebwohl says. Over the years, researchers have continued to study the effects of the Dead Sea as a psoriasis cure, and their conclusions have been similar.

Other Psoriasis Treatment Destinations

Besides the Dead Sea, other bodies of mineral-rich water where people travel for a psoriasis cure include Kangal in Turkey and the Blue Lagoon spa in Grindavik, Iceland.

In the United States, there’s Berkeley Springs in West Virginia, which is about two hours from Washington, DC, and has a fountainhead of warm mineral waters, Warm Mineral Springs near Sarasota, Florida, and Soap Lake in eastern Washington, known for its mineral water and creamy black mud.

“There are other places that have clinics for psoriasis where sun exposure is part of the regimen, but there’s not as much published data on them as the Dead Sea, and the light anywhere else is very different,” Lebwohl says.

If you can’t travel for psoriasis treatment, you may get a bit of relief by adding sea salts to your bath. At the very least, a relaxing soak won’t hurt.

How Dead Sea Salt Can Boost Skin Health

If you haven’t tried using Dead Sea salt skin treatments, it may be time to give it a try. Dead Sea salt skin treatments can help you with a number of different skin conditions, such as psoriasis, inflammation, and dryness.

Read on to learn about what Dead Sea Salt is, its benefits, how you can use it, and more.

What Is Dead Sea Salt?

Dead Sea salt is salt from the Dead Sea in Israel, which is the saltiest and deepest lake in the world.

Known for its healing properties since Biblical times, Dead Sea salt has been used to treat various skin conditions, such as psoriasis, due to solar ultraviolet radiation found in the Dead Sea. 

Psoriasis is a skin condition that causes itchy, red, scaly patches that appear on the body. They can appear all over the body, but most commonly appear on your elbows, knees, scalp, and trunk.

Benefits of Dead Sea Salt

Dead Sea Salt is great for your skin—it can boost skin health as well as treat various health conditions, such as rheumatoid arthritis and psoriasis. Rheumatoid arthritis is an autoimmune disease where your body’s immune system attacks your own systems. It can cause inflamed joints and damage to other parts of your body, like your eyes, skin, and heart.

Boost skin health. Research has shown that the magnesium salts in Dead Sea water can boost skin health by treating inflammation.

In one study, participants with dry skin submerged one arm for 15 minutes in bathwater containing 5 percent Dead Sea salt. The second arm was then submerged in tap water to compare the two. 

One to six weeks later, the arms that were submerged in Dead Sea salt solution became smoother. Redness and dryness, which are signs of inflammation, also significantly decreased after the Dead Sea salt treatment.

Treating rheumatological diseases. Dead Sea mud and bathing in Dead Sea salt water can also be used to treat rheumatological diseases, which are inflammatory and autoimmune diseases that cause your immune system to attack your organs, bones, muscles, and joints. 

Rheumatological diseases include psoriatic arthritis, knee osteoarthritis, and rheumatoid arthritis.

Treating psoriasis. Several studies have also shown that Dead Sea salt is particularly good at treating psoriasis.

Symptoms of psoriasis include:

  • Itching, soreness, and burning sensations
  • Stiff and swollen joints
  • Ridged and thick nails
  • Scaly spots, which often happen to children
  • Red patches of skin with silvery, thick scales

A long-term or chronic disease, psoriasis has no cure and usually goes through cycles. It can go away, only to come back a few months later.

Research has shown that Dead Sea salt can alleviate many symptoms of psoriasis. Due to the solar ultraviolet radiation in the Dead Sea, Dead Sea balneotherapy (or bathing) can treat psoriasis.

A 1997 study involving 25 participants with psoriasis vulgaris (chronic or long-term psoriasis) showed that Dead Sea bath salt was more beneficial than common salt. The participants were separated into two groups, with one using Dead Sea bath salt and the other using common salt. Both groups used their respective treatments during their daily 20-minute baths for three weeks.

After the three weeks were over, the participants who used Dead Sea bath salt had a much higher percentage of psoriasis reduction (43.6%) than those treated with common salt (24%).

Is Dead Sea Salt Safe?

Generally, Dead Sea salt is safe to use.

Using Dead Sea salt is safe for your skin — it doesn’t appear to increase your risk for skin cancer.

Lab analysis of Dead Sea mud has also revealed that there aren’t any mineral concentrations that could affect your health.

However, using Dead Sea salt comes with some risks if too much of it is swallowed, including:

  • Disturbances in cardiac or heart rhythm due to abnormalities in electrolyte concentration
  • Too much of it can be toxic

These risks only occur if you’re drowning in the Dead Sea, though. They would not occur if you’re just bathing in Dead Sea salt.

How To Use Dead Sea Salt

Dead Sea salt can be used in several different ways as bath salts or skincare products.

Bath Salts. Dead Sea salt can be used as bath salts, which you can add to your bath and soak in the tub.

You can use Dead Sea bath salts by putting them into bathwater that’s around 95 degrees Fahrenheit or 35 degrees Celsius. You can add one cup of salt to your bathwater, but feel free to adjust as needed.

Skincare products. Dead Sea salt can also be used in skincare products such as facial masks, creams, and soaps. 

In particular, Dead Sea mud, which is mud from the Dead Sea that has a high concentration of Dead Sea salt, is used to create these skincare products.

You can apply these to your face as well as other parts of your body to reduce inflammation, redness, and dryness. However, before deciding to buy or use a product, be sure to read the ingredients and talk to your doctor. Don’t buy or use a product if there’s anything in it that may cause an allergic reaction.

Outcome of “Short-term” Dead Sea Climatotherapy for Psoriasis | HTML

Arnon D. Cohen1,2,3, Jonathan Shapiro4, David Michael4, Emmilia Hodak4, Dina Van-Dijk2, Lechaim Naggan3 and Daniel A. Vardy1,2

1Clalit Health Services, 2Siaal Research Center for Family Medicine and Primary Care, 3Epidemiology and Health Services Evaluation Department, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, and 4Departments of Dermatology, Rabin Medical Center, Petah Tiqva, Israel. E-mail: [email protected]

Accepted May 22, 2007.

Sir,

Climatotherapy at the Dead Sea (CDS) for patients with psoriasis induces a persistent remission in the majority of patients with psoriasis, is associated with minor side-effects and is pleasant for the patients (1–11).

The published literature on CDS describes patients with moderate to severe psoriasis who spend an average period of one month (“long-term”) at the Dead Sea. There are no published data, however, on the effectiveness and characteristics of “short-term” CDS for patients with psoriasis, who spend only 2 weeks at the Dead Sea.

The instruments used previously for assessment of response to CDS in psoriasis patients were not standardized. In the last 10 years, the use of a 75% or 50% decrease in Psoriasis Area and Severity Index (PASI75 and PASI50, respectively; 12, 13) has become the gold standard in evaluating the efficiency of psoriasis treatment. In a literature review, we found no publications that used the PASI75 or PASI50 instruments to assess the response to CDS in patients with psoriasis. In a previous study we have shown the utility of the Beer Sheva Psoriasis Severity Score (BPSS) to assess psoriasis severity and response to treatment (14).

The objective of the current study was to assess the effectiveness of CDS in a series of patients with psoriasis treated for a “short-term” period of 2 weeks, using BPSS and PASI, with particular emphasis on PASI75 and PASI50 end-points.

METHODS

The study was conducted in the southern district of Clalit Health Services, the largest organization of managed care in Israel. In the southern district of Israel, Clalit Health Services serves a population of approximately 470,000 enrollees.

The study group comprised patients with psoriasis vulgaris who received CDS between March 23, 2003 and April 20, 2006. All patients were advised to stop any topical treatment (except emollients) before commencing CDS treatment. A wash-out period of 2–4 weeks of systemic anti-psoriatic drugs was advised before CDS.

Treatment was carried out in the Ein Bokek area, on the shores of the Dead Sea. The treatment protocol for psoriasis at the Dead Sea included sunlight exposure and bathing in Dead Sea water.

The treatment protocol included gradual exposure to the sun for a duration that depended on the skin type, season of the year and time of day. In most cases, sunlight exposure started at 15 min daily and was gradually increased to a maximum of 3 h daily, divided into morning and afternoon sessions. The required time for sun acclimatization was 5 days for skin types III and IV and 6 days for skin type II. Bathing in Dead Sea water for 15 min twice a day was performed before sun exposure. Patients used emollients, such as Vaseline, baby oils and moisturizing creams, freely before and after treatment. The patients were allowed to use salicylic acid (2–5%) ointment.

Clinical assessment of psoriasis severity was performed at baseline and at the end of the treatment period. The severity of psoriasis was measured using the PASI (1). The PASI ranges from 0 to 72. In the current study, response to treatment using the PASI was defined according to the rate of improvement in PASI, as follows: good 75–100%; moderate 50–74%; slight 25–49%; and none, less than 25%.

In addition to the PASI, we used the BPSS. This is a novel tool for the ambulatory assessment of patients with psoriasis, which we have described previously (14). BPSS has 16 items, of which 8 are recorded by the physician and 8 by the patient, using linear 4–10-point visual analogue scales. All scores are summed directly, except for the 7 items of distribution of the disease assessed by the physician (which have 4-point scales, and are multiplied by 2.5). BPSS ranges from 0 to 160. In our previous study, we have shown the utility of the BPSS to assess psoriasis severity and response to treatment (14).

The results of continuous variables are shown as means±SD. Paired t-tests were used to analyse statistically significant differences in continuous parameters before and after treatment. Dichotomous variables were analysed using χ2 tests. Logistic regression was used for multivariate analyses. p-values ≤0.05 were considered statistically significant.

RESULTS

A total of 85 adult patients with psoriasis vulgaris were treated by CDS (47 men, 38 women; mean age 52.5 years, range 22–80 years). There was a positive family history of psoriasis in 28.9% of the patients.

The majority of patients were treated between May and July (55/85 patients, 64.7%). Fourteen patients (16.5%) had less then 3 h a day of sun exposure and 32 patients (37.6%) bathed in the Dead Sea for less than 30 min daily. The mean length of treatment was 14.5 days (standard deviation (SD) 3.9 days) with 57/82 of the patients (69.5%) staying between 12 and 14 days.

There was a 70.9% reduction in PASI, from a mean of 17.5±11.0 before treatment to 4.4±4.6 after treatment (p <0.001). PASI75 was observed in 43/78 patients (55.1%) and PASI50 was observed in 66/78 patients (84.6%).

There was a 50.7% reduction in BPSS, from a mean of 72.1±20.3 before treatment to 35.3±21.3 after treatment (p <0.001). BPSS75 was observed in 17/84 patients (20.2%) and BPSS50 was observed in 44/84 patients (52.4%).

The mean PASI reduction was 77.7% (SD 24.2) in women and 65.2% (SD 31.1) in men (p-value 0.052). The mean BPSS reduction was 53.9% (SD 28.9) in women and 48.1% (SD 23.7) in men (n.s.). Age did not have a significant effect on PASI or BPSS (data not shown). The reduction in PASI and BPSS, stratified according to sun exposure and Dead Sea bathing, is shown in Table I.

Table I. Percentage of patients (n=85) who achieve 75% and 50% reduction in PASI and BPSS, stratified according to length of sun exposure and Dead Sea bathing

PASI75

PASI50

BPSS75

BPSS50

Daily sun exposure (h)

<3

54.5

63.6

30.8

53.8

4–6

57.4

88.9

21.4

53.6

>6

46.2

84.6

7.1

50.0

Total

55.1

84.6

20.2

52.4

Daily Dead Sea water bathing

None

50.0

100.0

66.7

100.0

<30 min

51.7

75.9

24.1

62.1

30–60 min

63.3

90.0

15.2

39.4

1–2 h

50.0

87.5

11.8

47.1

>2 h

  0.0

100.0

50.0

100.0

Total

55.1

84.6

20.2

52.4

PASI: Psoriasis Area and Severity Index; BPSS: Beer Shera Psoriasis Severity Score.

A logistic regression model demonstrated that sun exposure of more then 3 h/day (OR 8.9, 95% confidence interval (CI) 1.5–53.8) and female gender (OR 5.5, 95% CI 0.9–31.6) were significantly associated with PASI50. The length of immersion in Dead Sea water did not have an effect on PASI50.

DISCUSSION

This is the first study to describe the characteristics of “short-term” CDS in patients with psoriasis. The main finding is that only 55% of the patients achieved PASI75, which is in contrast to previous studies on long-term CDS, reporting an almost complete remission after CDS in the majority of the patients (1, 9). For example, in a study conducted by Even-Paz et al. (15), the improvement rate was 87% in patients treated by long-term CDS. The mean length of CDS reported in our study was 14.5 days, with more than two-thirds of patients staying between 12–14 days, compared with an average of one month in previously published studies. In our opinion, the main reason for the observed low response rate to CDS in our study relies on the short length of stay at the Dead Sea.

Previous studies investigated which factor is responsible for the beneficial effect of CDS in patients with psoriasis (4). Exposure to sunlight and Dead Sea water bathing are considered to be most important. In a study by Even-Paz et al. (15), it was observed that the major therapeutic factor is exposure to sunlight, whereas Dead Sea water only enhances the effect of the sun. In the current study, a multivariate analysis demonstrated that an average sun exposure of more than 3 h per day is independently associated with improved outcome; further demonstrating that exposure to Dead Sea sunlight has the main effect on the response rate to CDS.

The recommendations for CDS consist of sunlight exposure at a maximum of 3 h daily in the spring and summer, divided into morning and afternoon sessions (4). In our study, we observed that 83.5% of patients reported sun exposure of more then 3 h per day. As CDS is a phototherapy with known risks for sun damage, we recommend that patients should not be exposed to sunlight for longer than the recommended therapeutic guidelines. As almost two-thirds of Israeli patients perform CDS during a period of 3 months (May–July), we recommend that public health decision-makers and Health Maintenance Organization managers in Israel should organize a public dermatology consultation at the Dead Sea area for patients with psoriasis undergoing CDS, at least during the spring period.

REFERENCES

1. Abels DJ, Rose T, Bearman JE. Treatment of psoriasis at a Dead Sea dermatology clinic. Int J Dermatol 1995; 34: 134–137.

2. Abels DJ, Harari M. Psoriasis remission time at the Dead Sea. J Am Acad Dermatol 2000; 43: 325–326.

3. Azizi E, Kushelevsky AP, Avrach W, Schewach-Millet M. Climate therapy for psoriasis at the Dead Sea, Israel. Isr J Med Sci 1982; 18: 267–270.

4. David M, Efron D, Hodak E, Even-Paz Z. Treatment of psoriasis at the Dead Sea: why, how and when? Isr Med Assoc J 2000; 2: 232–234.

5. Even-Paz Z, Shani J. The Dead Sea and psoriasis. Historical and geographic background. Int J Dermatol 1989; 28: 1–9.

6. Even-Paz Z. Dermatology at the Dead Sea spas. Isr J Med Sci 1996; Suppl 32: S11–S15.

7. Even-Paz Z, Efron D. Determination of solar ultraviolet dose in the Dead Sea treatment of psoriasis. Isr Med Assoc J 2003; 5: 87–88.

8. Halevy S, Giryes H, Friger M, Grossman N, Karpas Z, Sarov B, et al. The role of trace elements in psoriatic patients undergoing balneotherapy with Dead Sea bath salt. Isr Med Assoc J 2001; 3: 828–832.

9. Harari M, Shani J. Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea (Israel) DMZ Clinic. Int J Dermatol 1997; 36: 304–308.

10. Hodak E, Gottlieb AB, Segal T, Politi Y, Maron L, Sulkes J, et al. Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: combined effects on epidermal and immunologic activation. J Am Acad Dermatol 2003; 49: 451–457.

11. Kushelevsky AP, Harari M, Kudish AI, Hristakieva E, Ingber A, Shani J. Safety of solar phototherapy at the Dead Sea. J Am Acad Dermatol 1998; 38: 447–452.

12. Fredriksson T, Pettersson U. Severe psoriasis – oral therapy with a new retinoid. Dermatologica 1978; 157: 238–244.

13. Carlin S, Feldman J, Krueger A, Menter G, Krueger A. 50% reduction in the Psoriasis Area and Severity Index (PASI 50) is a clinically significant endpoint in the assessment of psoriasis. J Am Acad Dermatol 2004, 50: 859–866.

14. Cohen AD, Van Dijk D, Naggan L, Vardy DA. Effectiveness of climatotherapy at the Dead Sea for psoriasis vulgaris: a community-oriented study introducing the “Beer Sheva Psoriasis Severity Score”. J Dermatolog Treat 2005; 16: 308–313.

15. Even-Paz Z, Gurnon R, Kipnis V, Abels DJ, Efron D. Dead Sea sun versus Dead Sea water in the treatment of psoriasis. J Dermatol Treat 1996; 7: 83–86.

Kenkoderm Psoriasis Dead Sea Mineral Salt Soap with Argan Oil & Shea B

Kenkoderm Dead Sea Soaps were created and formulated by a dermatologist whose husband developed serious psoriasis flares. Dead Sea Salt provides your skin with a complete range of nourishing minerals. Key ingredients like Shea Butter, Argan Oil, and Vitamin E soothe and moisturize the skin. Kenkoderm Dead Sea Salt Soap bar gets it rich color from the natural sea salt in the bar. The bars are fragrance-free and color-free. All Kenkoderm products are proudly manufactured and packaged in the USA.

 

Key Product Features:

  • Dead Sea Salt gently nourishes and conditions psoriatic skin
  • Shea Butter soothes and moisturizes the skin
  • Argan Oil produced from the Argan Tree, is high in Vitamin E, is an antioxidant known to moisturize the skin
  • Soap bars are fragrance-free and color-free; rich color from the natural sea mud in the bar
  • Kenkoderm soaps use a Rainforest Alliance Certified™ Palm Oil base

 

Directions:

With warm water, work the bar in a circular motion to lather skin. Gently massage affected areas, rinse thoroughly and pat dry. Follow with moisturizer and/or prescription medication as directed by your doctor.

Alternate daily use with Kenkoderm Dead Sea Mud soap for best results.

 

Ingredients:

Sodium Palmate (Saponified Palm Oil), Sodium Cocoate (Coconut Oil), Sodium Palm Kernelate (Saponified Palm Kernel Oil), Water (Aqua), Glycerin (Vegetable Glycerin), Sodium Chloride (Salt), Butyrospermum Parkii (Shea Butter), Maris Sal (Dead Sea Salt), Argania Spinosa (Argan Oil), Tetrasodium Etidronate, Pentasodium Pentasodium, Tocopherol (Vitamin E)

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Skin-healing powers of the Dead Sea

Nestled between Jordan and Israel, the Dead Sea has about 10 times the salinity of the oceans. People from around the world travel to the Dead Sea to bathe in its water and to cover themselves with its mud to relieve symptoms of skin conditions, including psoriasis and eczema, as well as rheumatoid arthritis, cardiac disease, respiratory illnesses and more.

Of all the diseases, the Dead Sea’s therapeutic effects are most studied in the area of psoriasis, says Jeffrey Altman, M.D., assistant professor at Rush Medical College in the department of dermatology and a practicing dermatologist in Arlington Heights, Ill.

The Dead Sea difference The sea’s water is about 40 percent magnesium chloride salt.

“The water is very pure of contamination because of its isolated location with minimal sources of input,” Dr. Altman says. “We know that bathing in the Dead Sea works for psoriasis, from both modern and ancient experience. It was known in the time of Cleopatra that it had healing properties. And throughout the ages, people with psoriasis knew they could get better from a stay at the Dead Sea.”

Theoretical evidence also suggests that the higher atmospheric pressure in the Dead Sea has almost the effect of hyperbaric oxygen, Dr. Altman says.

“We know that phototherapy has a variety of effects on inhibiting inflammation in the skin and affects the epidermis by minimizing excessive proliferation of the skin that occurs in psoriasis,” he says. “There are a variety of theories about the Dead Sea salt bathing; namely, its inhibitory effects on neutrophils and an immunomodulatory effect on lymphocytes. The high salt concentration of the Dead Sea can also make the skin more photosensitive, so that the phototherapy is more effective.”

Even the UV therapy on the beaches surrounding the Dead Sea has special properties associated with being more than 1,300 feet below sea level.

“The ultraviolet,” Dr. Altman says, “gets ‘tweaked’ through more layers of atmosphere by being well below sea level. The Dead Sea is at the lowest spot on earth. We know that helps to filter some of the shorter UV bands. So you tend to have a more pure spectral array of UV – just about the right mix of UV that’s ideal for psoriasis treatment.

“The beneficial effect of Dead Sea climatotherapy for dermatological diseases, such as psoriasis, eczema, lichen planus and vitiligo has been documented in a multitude of publications and presentations at international meetings over the last 40 years,” says Michael David, M.D., clinical professor, Sackler School of Medicine, Tel Aviv University, and head of the department of dermatology at Rabin Medical Center, Beilinson Campus, in Israel.

“As result of these studies,” he says, “it was established that the solar component is strikingly more important than the immersion into the Dead Sea water in the climatotherapeutic effect on psoriasis.”

Climatotherapy for psoriasis Dr. David has authored several papers supported by the Dead Sea Medical Research Center. In terms of the effect of Dead Sea climatotherapy on the pathogenesis of psoriasis, Dr. David and colleagues published in 2003 (Journal of the American Academy of Dermatology) a study examining the effect of Dead Sea climatotherapy on the pathological changes and immunological activation in psoriatic skin. Twenty-seven patients with psoriasis were treated at the Dead Sea for 28 days. The overall improvement was 81.5 percent. Complete clearance was achieved in 48 percent of the patients, and moderate to marked improvement in 41 percent. There was reversal of both pathological abnormalities and immunological activation, according to Dr. David.

90,000 Features of the treatment of psoriasis at the Dead Sea

The resort of Ein Bokek on the coast of the Dead Sea has a unique microclimate due to the evaporation of salt water and its location – it is the deepest natural depression in the world, located 404 meters below sea level. But the location of the resort is not fundamental in the treatment of psoriasis, the main factor is the impact of the Dead Sea water. This natural reservoir is unique in every sense, the concentration of salt in it is simply off scale, and there are no such sources anywhere in the world.We will tell you more about this amazing natural medicine today.

Water that heals

Calling the water of the Dead Sea “water” in the full sense of the word can be very conditional, because up to 43% solution – minerals. In the composition, you can find most of the elements of the periodic table, it is saturated with many useful trace elements and impurities of medicinal mud.

Potassium, magnesium and bromine have a tremendous healing effect on the skin affected by psoriasis, cleanse it and stimulate cells to regenerate, have a relaxing effect on the muscles, and improve blood circulation.Sea water with high mineralization regulates moisture in the cells of the skin, heals wounds, has anti-stress and antiseptic effects, and prevents possible infections in the foci of psoriatic plaques.

Beach Treatment

You can get treatment on the coast just by swimming in the sea, the water acts as a natural antiseptic. The Israeli resorts of the Dead Sea have a number of specially equipped beaches that work exclusively for patients with psoriasis. There are separate areas for men and women, and patients do not need to be ashamed of their illness.Here, under the supervision of doctors, patients can swim and thus undergo medical procedures.

It is important to correctly apply medicinal waters and bathe in doses. The body, exhausted by psoriasis, relaxes while swimming in the sea, blood circulation is normalized, the skin is renewed, the moisture balance of the skin returns to normal, and metabolic disorders are alleviated.

Procedures with sea water

Also, the water of the Dead Sea for the treatment of psoriasis is used for the preparation of therapeutic baths, rubdowns, lotions, ointments, dressings soaked in a solution of sea salt.Concentrated baths and pools with Dead Sea water have a beneficial effect on the condition of the skin due to the saturation of blood plasma and intercellular fluid with beneficial minerals.

Also, do not forget about the thermal springs located along the coast of the Dead Sea. The main element in the composition of thermal water is sulfur. Hot sulfur baths saturate tissues with oxygen, strengthen the circulatory system, and improve the balance of oxidation and reduction reactions. Mineral pools, which are filled with water from natural hydrogen sulfide sources, increase the supply of oxygen to the body, and the circulatory system is strengthened.

Dead Sea Mud

According to world statistics, Dead Sea mud is the leader in its effectiveness for the treatment of psoriasis of any stage. Local silt sulphide highly mineralized mud is famous all over the world for its truly miraculous properties. Peloid therapy or mud therapy is an important aspect of treatment at the Dead Sea. Mud has a powerful anti-inflammatory and hormonal-normalizing effect, while there are no hormones or antibiotics, only microelements.

Local healing mud contains a lot of bactericidal substances such as iodine, zinc and bromine. Together, these microelements relieve inflammation of the skin, improve its nutrition, cleanse and rejuvenate all layers. The high therapeutic effect of mud therapy for psoriasis is achieved with the application of peloid mud and mud wrap.

The unique composition of mud with a high concentration of minerals, salts and other microelements allows you to effectively fight not only skin manifestations of psoriasis, but is also useful for joints, bones, muscles.Psoriatic arthritis is treated with therapeutic mud baths, applications, wraps, such procedures significantly alleviate the articular manifestations of the disease.

The climate on the Dead Sea coast is a natural immunomodulator

Sunbathing will be an effective addition to swimming in the Dead Sea and mud therapy. To do this, in spa hotels and sanatoriums, special rooftop solariums have been created, but you can sunbathe in doses just on the beach. Thanks to the lake’s vapors, a cap is created in the air of micro-crystals of salts that can reflect the harmful hard ultraviolet light, the sun’s rays are filtered by a kind of salt filter of the Dead Sea vapors.Ultraviolet light loses its aggressiveness and the hard component of the radiation spectrum. Exposure to the sun will not cause burns, but, on the contrary, will have a beneficial effect on psoriatic plaques, they will begin to involution and gradually fade, up to complete disappearance.

On the coast of the Dead Sea, even the air has a healing effect, as it is saturated with oxygen, negative ions, beneficial fumes from the Dead Sea salts, especially bromine. Air baths act as a natural immunomodulator.In addition, the air here is dry, desert, does not contain any allergens, only the beneficial fumes of the Dead Sea salts.

Additional methods of psoriasis treatment

Speaking about the treatment of psoriasis on the coast of the Dead Sea, one cannot fail to mention the physical methods of treatment – this is an integral part of the comprehensive fight against the manifestations of psoriasis.

In the sanatoriums on the Dead Sea coast, a wide range of physiotherapeutic procedures are used, for example, various phototherapy procedures: PUVA therapy, selective phototherapy, ultraviolet disinfection (UFO), narrow-band light therapy.Also effective are laser therapy, ultrasound, magnetotherapy, cryotherapy. The necessary procedures are determined by the attending physician in the sanatorium, based on the general condition of the patient, the degree of damage and the stage of the disease.

Based on the foregoing and our own experience, we can say with confidence that even one course of psoriasis treatment on the Dead Sea coast can achieve a stable remission of the disease for most patients. There is a harmonious combination of unique natural factors that you will not find anywhere else.Their complex effect makes it possible, after undergoing a course of treatment, to significantly improve the quality of life of patients with psoriasis. There are no patients with psoriasis in the world who would not be helped by treatment on the coast of the Dead Sea. Almost everyone feels and, most importantly, sees significant improvements in the condition of the skin after the course of treatment, the manifestations of the disease decrease, and sometimes even completely disappear.

90,000 Dead Sea psoriasis treatment – facts and advice

The Dead Sea is a place with a unique microclimate.It annually attracts many tourists from all over the world for recreation and treatment. Including for the treatment of such a complex disease as psoriasis . It is a complex chronic skin disease with a long and sometimes lifelong course of alternating remissions and exacerbations. So can psoriasis be cured? Of course you can, although this is not an easy process.

A large number of reviews on the positive result of psoriasis treatment at the Dead Sea gives hope to those who have not been spared this disease.The overwhelming majority of patients after treatment at the Dead Sea go into a stable remission. And in some patients, psoriasis is completely healed. Also, you can come here not only for the treatment of psoriasis and prevention. The uniqueness of the treatment of psoriasis at the Dead Sea. What exactly influences the success of psoriasis treatment in this region?

  1. One way to treat psoriasis is sunbathing. The feature of ultraviolet radiation in the Dead Sea allows you to sunbathe for longer, increasing the effectiveness of treatment.What’s the secret? The Dead Sea region has a high solar activity (330 days of sunshine a year) and a minimum amount of hard ultraviolet radiation. The Dead Sea is located 400 meters below sea level. The air here is saturated with oxygen – the oxygen content in the air is 15% higher than in other parts of the world. The constant evaporation of mineral-rich water creates an additional atmospheric layer that weeds out aggressive sun rays. It is here that a special kind of ultraviolet radiation is devoid of harmful effects.Therefore, sunbathing here can be taken longer. Psoriatic plaques under the influence of sunlight disappear or begin to evolve.
  2. Favorable effect on the nervous system. Stress is known to be one of the triggering factors for psoriasis. The air here is saturated with oxygen and bromine. Which soothes the nervous system and cleanses the lungs and bronchi.
  3. The unique climate of the Dead Sea. There are sunny skies and dry warm air all year round.The minimum amount of precipitation. In winter the temperature fluctuates between 20 and 23 ° C, in summer the average temperature is 32 and 39 ° C. There is almost no vegetation. The air of the Dead Sea is completely free of allergens.
  4. The water temperature in the Dead Sea ranges from 20-25 ° C in winter to 28-37 ° C in summer. You can view the temperature of water and air in the Dead Sea in real time HERE.
  5. Unique composition of the Dead Sea water. Dead Sea water has a high salt concentration.The salinity of the water is 8 times higher than the salinity of the Atlantic Ocean, 7 times higher than the Red and Mediterranean Seas, 14.5 times higher than the Black Sea, 40 times higher than the Baltic Sea. In terms of chemical composition, the Dead Sea water is a highly concentrated brine of various salts and trace elements, which are very beneficial for the health of the skin.
  6. Unique mud composition. Dead Sea mud contains an incredible amount of biologically active substances that can restore diseased cells and prolong the life of healthy ones.
Which time of year is ideal for treating psoriasis at the Dead Sea?

If your goal is the treatment of psoriasis, then the best time for you is from spring to late autumn, namely from mid-March to mid-November.
Benefits of staying at the Dead Sea in the summer.

Self-treatment or treatment at a clinic at the Dead Sea?

You can choose for yourself a rest in a hotel and take a sun bath on your own, breathe the air saturated with useful microelements, swim in the healing sea and do mud wraps.This will give its positive effect
But it is safer and much more effective to treat psoriasis under the supervision of doctors. Treatment requires individual adjustments based on the characteristics of the organism. Therefore, the doctor will advise on the correct and beneficial dosages of both solar and water and mud treatments. Prescribe additional cosmetic procedures and medical treatment of the affected skin areas.

If you want to know about other diseases that are treated at the Dead Sea, read about it here – Treatment at the Dead Sea.

When organizing a trip to the Dead Sea, it is very important to take into account the indications and contraindications for treatment at the Dead Sea. And also choose the right hotel to suit you.
We have prepared a list of Dead Sea hotels for you to make your search easier:

Hod HaMidbar 4 * Dead Sea Hotel
Crowne Plaza 5 * Dead Sea
Daniel 5 Hotel * Hotel Dead Sea
David Dead Sea Resort & Spa 5 *
Hotel Herods 5 * Dead Sea Hotel
Hotel Isrotel 5 * Dead Sea
Hotel Isrotel Ganim 4 * Hotel Dead Sea
Hotel Leonardo Club 4 * Dead Sea Hotel
Hotel Leonardo Inn Hotel 3 * Dead Sea
Hotel Leonardo Plaza 4 * (former Privilege) Dead Sea Hotel
Lot Spa Hotel 4 * Dead Sea
Oasis 4 * Hotel Dead Sea
Royal Tower 5 * Hotel Dead Sea
Spa Club 4 * Hotel Dead Sea

If you are interested in organized treatment of psoriasis at the Dead Sea, contact the specialists at the Dead Sea Clinic.The clinic is equipped with the most modern and innovative equipment and apparatus. The unique techniques and developments of the clinic allow for the treatment and rehabilitation of patients at the highest medical level.

Treatment of psoriasis at the Dead Sea

The category of patients with psoriasis remains the largest among all categories of patients who come to the clinic at the Dead Sea for treatment. Dead Sea psoriasis treatment has been proven to be effective. This is confirmed by the positive statistics of patients.The majority of patients treated at the Dead Sea Clinic have excellent results, many years of remission and even complete healing. The life-giving effect of the Dead Sea can fight the disease even at the most advanced stages.

What methods are used to treat psoriasis at the Dead Sea

A whole range of procedures is used to treat psoriasis at the Dead Sea. However, one of the basic means of therapy is taking ultraviolet baths. And it is on the coast of the Dead Sea that there is an opportunity to be under the sun’s rays for as long as possible.A unique natural filter traps ultraviolet light and allows only beneficial rays to pass through.

In the treatment of psoriasis at the Dead Sea, the following are used:

  • dosed balneo-heliotherapy;
  • emollient oils;
  • non-hormonal ointments;
  • preparations based on Dead Sea minerals;
  • thalassotherapy;
  • physiotherapy;
  • mud therapy.

What makes the Dead Sea psoriasis clinic unique Dead Sea Clinic ?

Dead Sea Clinic is one of the leading psoriasis treatment clinics in the Dead Sea .One of the advantages of the Dead Sea Clinic in comparison with other places is the long-term practice. More than 20 years of experience in the resort. As well as a convenient territorial location of the clinic. It is located directly on the shores of the Dead Sea, in the same building with the only specialized beach in the resort for patients with psoriasis “Solarium – 400m”.

This is a beautifully equipped beach specially designated for psoriasis patients. For greater comfort, the beach is divided into zones for men and women.Patients without bathing suits can expose themselves to the sun for hours. This makes it possible to simultaneously bask in the Dead Sea and here, without spending a lot of time on transitions under the hot rays of the sun, to undergo medical procedures in comfortable conditions. And what is especially important, all this is under the constant supervision of the clinic staff.

Israeli Dermatology and Dead Sea Clinic provides its patients with a unique laser for treatment of psoriasis skin and nails, and obtaining a longer remission without the use of drug therapy.

For more information about the Dead Sea psoriasis treatment program and what it includes and how the course of treatment goes, read HERE.

Also read what time of year it is best to come for treatment, facts and advice on psoriasis treatment at the Dead Sea .

And before arriving, be sure to familiarize yourself with the indications and contraindications for treatment at the Dead Sea.

Watch the film made by the program “I’m ashamed of my body”. A unique video of the Dead Sea psoriasis treatment at the Dead Sea Clinic.You will see with your own eyes all stages of treatment. From the advanced stage of psoriasis – to smooth skin and happy eyes of a grateful patient.

Treatment of psoriasis with Yofing Dead Sea cosmetics

The Israeli company Yofing has developed cosmetics with Dead Sea minerals that help in the treatment of psoriasis and psoriatic arthritis. Positive results have been proven laboratory and clinical.

Psoriasis (squamous lichen) is a chronic skin disease that is not transmitted by contact with patients and is difficult to treat.Severe pathology threatens with serious complications, leads to psychological and physical discomfort. What triggers the development of psoriasis, who is at risk and, most importantly, is the Dead Sea cosmetics effective in treating the disease?

Psoriasis: what is it, signs, causes?

Psoriasis is classified as a complex autoimmune pathology – immune cells behave aggressively towards skin cells. As a result, in some areas, the top layer of the skin dies off too quickly, forming specific red plaques that flake off and itch.In the progressive stage, the spots are covered with silvery-white scales.

According to the latest estimates, about 250 million people in the world suffer from the disease. In cold and temperate climates, psoriasis is diagnosed more often than in tropical climates. The problem is mainly faced by girls 16–20 years old, boys 18–22 years old and people 40–55 years old. Symptoms are not without reason manifested at this age, since the disease is associated with hormonal changes. Therefore, pregnancy can also provoke its progression.

The causes of psoriasis can be:

• Immunity disorders;

• stress;

• infectious diseases;

• skin diseases: dermatosis, lichen, fungus, acne, herpes zoster, etc .;

• heredity (children inherit a predisposition, not the disease itself).

Psoriasis is ill for a long time, sometimes for life with periods of remission and exacerbations. Without treatment, the disease can progress and spread to other organs and tissues (for example, nails and joints).

Types of psoriasis

There is no single generally accepted classification of the disease. In 80% of patients, psoriasis ordinary is diagnosed, which spreads throughout the body or is localized on the elbows, knees, scalp, lower back. The inflamed areas turn red, thicken and become covered with scales.

Approximately 5–10% of patients suffer from psoriatic arthritis, which affects the joints of the hands and feet. Pathology is more common in men. This form of the disease leads to edema, swelling, pain, deformation of small joints.

There is also teardrop-shaped psoriasis, which looks like water droplets on the skin. It can manifest itself in children and adolescents after an infectious disease. No less dangerous are exudative psoriasis (formed in the folds of the skin) and pustular (causes white blisters with a red corolla around).

Psoriasis is not a sentence: treatment methods

Patients with psoriasis are prescribed solutions and creams with corticosteroids, phototherapy, vitamin complexes, preparations with tar. Therapy is more aimed at relieving symptoms and maintaining the remission stage, but there have been cases of complete cure.

The spa treatment on the shores of the Dead Sea helps to cope with the disease. The water of the reservoir has pronounced healing properties, and the beneficial mud contains 5-10 times more active substances than in other mud deposits.

Why does Dead Sea mud and salts help psoriasis patients?

On this topic

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Psoriasis is a disease that not only spoils the appearance of the skin, but also causes significant inconvenience.Since psoriasis is a well-known and widespread disease, nowadays there are several methods of treating it and many medicines to combat it.

Ions of bromine, potassium, calcium, magnesium, sodium regulate many biological processes in the body. In the Dead Sea, their concentration is high and human blood has a similar composition of macronutrients.

Salt with mineral components has strong healing properties:

• Potassium – improves the absorption of nutrients into cells.

• Sodium – regulates cellular metabolism.

• Calcium – participates in wound healing, prevents infections, strengthens connective tissue.

• Magnesium – has antihistamine properties and increases the vital activity of cells.

• Bromide – soothes, disinfects.

• Chlorine – maintains water balance.

However, climatotherapy on the coast of the Dead Sea is contraindicated during an exacerbation. And not everyone can afford an expensive vacation in another country.In this case, the Dead Sea cosmetic products, which have a pronounced regenerative effect, will significantly alleviate the condition.

Especially for patients with psoriasis, the Israeli company Yofing has developed the Anti Psoriasis Complex Set with natural ingredients. The series includes Recovery Oil and Pso Calm Cream. The rich herbal oil nourishes, relieves irritation, prepares the skin for the next treatment and enhances its effect. Pso Calm Cream with vitamin E, lavender oil, eucalyptus, bergamot, geranium heals wounds, removes toxins, eliminates psoriasis symptoms.Squalane (unsaturated natural hydrocarbon), which is part of the composition, retains moisture in the skin, protects it from the negative effects of the external environment.

Israeli dermatologists also offer patients with psoriasis a complex of Pain Relief Kit from the universal oil Recovery Oil and Painot Cream. The latter contains minerals, bactericidal and antispasmodic natural ingredients. The cream relieves pain in ligaments, muscles, joints. It relieves pain in joints, relieves inflammation in patients with psoriatic arthritis.Unlike Pso Calm Cream, it cannot be applied to bleeding inflammations.

Yofing cosmetics are not tested on animals, certified and in accordance with EU standards. Unlike many pharmacy ointments, it is free of allergens and hormones. The use of advanced nanotechnology makes it possible to create creams that deliver beneficial substances to the deep layers of the skin. The properties attributed to the products have been confirmed by quality checks in the laboratory. Healing complexes for patients with psoriasis have been approved by dermatologists, toxicologists, and therapists.

The causes of psoriasis are not fully understood and it cannot be assured that the Dead Sea cosmetics will once and for all solve all the patients’ problems. But after a full course of treatment, patients experience peeling, itching, and a stable remission occurs. And after some time, the course will need to be repeated. The best confirmation of the high efficiency of the funds is the reviews of satisfied customers.

Source: yofing.ru

90,000 Treatment of psoriasis in Israel reviews, price

Get prices in the clinic

Treatment of skin diseases in Top Ichilov – guaranteed result in the shortest possible time

Operative treatment of psoriasis in Israel

Drug treatment of psoriasis in Israel

  • Examination by the best highly qualified dermatologists 58
  • The use of the latest drugs and ointments
  • The most modern equipment is used for diagnostics

Drug treatment involves the use of the following drugs:

  1. Coal tar – helping to reduce inflammation;
  2. Steroids – used to treat localized psoriasis;
  3. Vitamin D derivatives;
  4. Use of drugs that suppress the immune system and slow down the production of skin cells;
  5. Biological treatments for psoriasis.

Treatment of psoriasis with light therapy in the Top Ichilov clinic

Used if psoriasis covers most of the body and is not treated with medication. Ultraviolet or light therapy is a treatment with natural sunlight combined with Dead Sea salts, steroid creams, or medications that increase the sensitivity of the skin to sunlight.

Psoriasis recedes at the Dead Sea

Treatment of psoriasis in Israel is also distinguished by the fact that the Dead Sea is an ideal place for the treatment of psoriasis.Geographically, the Dead Sea is the lowest point on earth and has the highest atmospheric pressure. The oxygen level in the air is 15% higher than anywhere else in the world.

The Dead Sea is a place where it is possible to carry out bioclimatic treatment, it is unique in that the patient can combine a pleasant bathing in the water with a healing effect. The Dead Sea Mud is loaded with minerals that can help fight psoriasis. The sun is also important in the treatment of psoriasis, in the Dead Sea its rays do not damage the skin with ultraviolet light, but on the contrary, sunbathing can be taken from morning to evening.

A program for error-free diagnosis of psoriasis in 3-4 days

Psoriasis is a chronic skin disease that, if not treated correctly, leads to joint damage. Therefore, it is very important to get diagnosed by real specialists as soon as possible. Doctors of MC Top Ichilov are specialists of the international level, known all over the world for their brilliant diagnosis and surgical treatment of a wide range of skin diseases. You can find out the prices for treatment in Israeli blades here.

First day – diagnostic plan

On the first day, the patient is provided with a consultation with a specialist dermatologist who analyzes the medical history, performs an initial examination of the patient and develops a plan for diagnostic measures.

Second and third days – diagnostics

On the second day, the patient undergoes basic diagnostics, which includes the following elements: lipids, coagulation, etc.

  • Ultrasound of the abdominal cavity
  • Doppler ultrasonography of the liver vessels
  • Skin biopsy and histopathology to determine the type of psoriasis – this analysis is not shown to everyone, a specialist can refer the patient to it if necessary.
  • Fourth day – treatment plan

    The results of the analyzes are made available to an expert group specially created for each specific case. The group includes leading dermatologists who jointly draw up a treatment plan and monitor its implementation throughout the patient’s stay in Israel.

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    Treatment of psoriasis in Israel

    chronic diseases like psoriasis take a lot of time, effort and money from people. Recovery happens very quickly on the shores of the Dead Sea! It combines cutting edge medical technology and natural health resorts, whose impact on recovery is simply priceless.Each clinic in Israel can offer its own advantages in the treatment of psoriasis to patients. The Israel Clinic Association will help you find the best option.

    Many patients from all over the world choose the treatment of psoriasis in Israel largely due to the climate and the healing waters of the Dead Sea. The country’s doctors use 100% of the natural potential in the treatment of psoriasis. Even from a seemingly simple visit to the beach, patients can sometimes benefit more than from months of treatment in another part of the world.After all, the water and mud of the Dead Sea have a unique composition that heals skin ailments. Also, the condition of patients with psoriasis is well influenced by the bright sun, as well as clean dry air. It is important to note that depression and chronic fatigue very often go hand in hand with psoriasis. Treatment at the Dead Sea can be a wonderful therapy for frayed nerves and a great relaxation. The data of Israeli doctors show that in most patients who underwent treatment at the Dead Sea, the area of ​​skin lesions decreased by 80% -90% or disappeared altogether.Choosing Israel, the Dead Sea, psoriasis treatment can turn into a complete rest!

    The best clinics in Israel

    Methods of treating psoriasis in Israel

    In addition to the beneficial effects of natural health resorts, treatment of psoriasis in Israel provides for a whole range of measures. The task of doctors is not only to eliminate the manifestation of the disease. They want to strengthen the patient’s health, to make sure that there is no next exacerbation or it goes away without complications.Therefore, the treatment of psoriasis in Israel offers:

    Drug treatment . An obligatory item in the treatment of psoriasis is taking effective and non-toxic drugs that will help relieve itching and reduce inflammation. Also, patients are prescribed immunomodulators and vitamins. If necessary, the patient can be assigned:

    Laser treatment . The beneficial light of a laser lamp is directed to the areas of inflamed skin;

    Shockwave therapy .Sick areas are affected by a single acoustic impulse of significant amplitude or shock waves. The procedure is painless, it helps to relieve pain and avoid surgical treatment.

    UV treatment . Like the sun’s rays, ultraviolet lamps act on the skin with uv-rays. This helps to reduce the skin manifestations of psoriasis in a short time, because in one session a person receives the same dose of ultraviolet radiation as in a week in the sun.

    Diet therapy .In psoriasis, the patient’s diet is very important. It is imperative to exclude from the menu everything that is excessively salty, sweet, spicy, fatty, fried.

    Treatment of psoriasis in Israel. Diagnostics

    Usually a dermatologist is able to make a diagnosis already at the first examination of a patient. But the treatment of psoriasis in Israel is carried out only on the basis of the individual indicators of the patient, so the doctor can prescribe the following tests:

    Urine and blood tests. Routine laboratory tests will help assess the general condition of the body and find out how much the immune system is suffering.This information is very important for proper treatment.

    Skin biopsy and histology. This will help determine the type of psoriasis or exclude another skin condition similar to psoriasis.

    X-ray of the joints. It is prescribed in cases where the disease has already affected the patient’s joints. Psoriatic arthritis is also successfully treated by Israeli doctors.

    The Association of Israeli Clinics will help you choose a clinic for the treatment of psoriasis

    How much does psoriasis treatment cost?

    How much does psoriasis treatment cost in Israel? Not more expensive, and sometimes significantly cheaper than therapy in other countries.Any clinic in Israel for the treatment of psoriasis has programs that really help. Choosing the treatment of psoriasis in Israel, the reviews of our patients can be a good guide. After you send a request to Israel, the treatment of psoriasis, prices and other details will be known to you as soon as possible. To do this, simply leave an application on the Association’s website. Our consultants will contact you and answer all your questions. We guarantee you that we honestly and impartially treat the achievements of all clinics, and the treatment of psoriasis in Israel really helps people.Therefore, we are waiting for you on the shores of the Dead Sea!

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    The Living Force of the Dead Sea | Publications

    The lesion in psoriasis is an erythematous plaque with a silvery-white surface. Photo SPL / EAST NEWS

    Case history

    Psoriasis is a skin disease manifested in the formation of red scaly patches covered with silvery-white dead scales ranging in size from a few millimeters to a dozen or more centimeters, and accompanied by itching.Due to the exposure of the inner layers of the skin in the affected area, cracks and suppuration may occur. In most cases, psoriasis begins suddenly, without any external cause, at a young age and then manifests itself more or less acutely throughout life. The disease is not fatal, but it often causes severe discomfort, cosmetic defects and even disability. Most often, psoriatic plaques affect areas of the skin on the head, elbow and knee joints. Although the disease itself has been known for a very long time, the term “psoriasis” (from the Greek.- “characterized by a rash”) in 1841 was introduced into clinical practice by Ferdinand Gebra, a Viennese dermatologist. In the 20th century, scientists established that this disease was caused by a violation of the differentiation of the skin (that is, its ability to form layers correctly), and began to develop treatment methods against flaking and thickening of the skin.

    Sun, air and water

    Despite the ideal natural and climatic conditions for the treatment of psoriasis, the most effective fight against the disease requires not only bathing in salt water and being in the fresh air.Medical supervision and moderate use of drugs in most cases are prerequisites for recovery. Each clinic offers its own treatment regimen, which nevertheless includes several mandatory items: examination, doctor’s consultations, mud wraps, sunbathing, etc.

    The process of cleansing the skin from psoriatic irritation is strictly individual, and before starting treatment , the doctor must find out which of the main problems accompanying the course of the disease is most pronounced in each particular patient.It can be a metabolic disorder, reduced immunity, endocrine dysfunction, an imbalance in redox processes, infections, or nervous stress. Therefore, treatment for psoriasis at the Dead Sea begins with a doctor’s consultation and a medical examination. A specialist doctor will assess the patient’s condition and determine the duration of the course of treatment (usually it is recommended to spend at least 21 days at the resort) and the necessary procedures.

    It is believed that the optimal period for the treatment of psoriasis is from mid-April to mid-June.There are doctors who say April and October are the most appropriate. Well, travel companies usually say that the period from March to November is favorable, although in the height of summer and autumn, the treatment may not be as effective. In summer, on the coast, the air temperature reaches 45 ° C, and the water warms up to 38 ° C – such heat is difficult to endure even if absolutely healthy. In autumn, the temperature regime is more favorable, but after returning from the course of treatment in the autumn cold, a person may not cope with the sharp change in climate and respond with a reduction in the period of remission.However, according to experts, much depends on the general state of health of the patient and on his compliance with the doctor’s recommendations. The standard course of treatment includes several types of procedures for the patient, including special skin peels, mud and cream wraps, special massages (for arthropathic psoriasis affecting the joints), a phytotherapeutic complex, treatment with a laser and Darsonval apparatus. The latter works on the principle of exposure to alternating impulse currents on body parts, they increase vitality, activating blood circulation and metabolic processes, thus enhancing cell regeneration.The laser emits light waves that precisely affect the selected area in a short period of time. The procedure is painless and does not require medication. This method of treatment is used for psoriasis of the scalp, plaques that cannot be treated, and less common forms of psoriasis. The treatment uses emollient oils or ointments containing resins, sulfides or salicylic acid. In psoriatic arthritis, kinesiotherapy (movement therapy) is recommended – the patient performs specially designed complexes of gymnastics and breathing exercises.

    It is believed that certain foods and drinks contribute to the exacerbation of the psoriatic process: alcohol, pepper, vinegar, chocolate and some others. Therefore, many doctors during the course of treatment recommend adhering to a certain diet, which involves the consumption of fat in an amount of no more than 70-75 grams per day, dairy products, fresh vegetables, fruits, berries and juices. It is also recommended to hold kefir, apple or cottage cheese fasting days twice a week.