How natural hot springs and sunshine may alleviate symptoms of psoriasis
In 2007, Matthew Katz was 80 percent covered in psoriasis lesions and looking for a noninvasive treatment to manage his condition. His dermatologist told him there was little he could do for him outside of prescribing pharmaceutical medications but handed him a script for treatment at the Dead Sea, located between Israel and Jordan.
The following summer, Katz traveled to the Dead Sea for a 28-day course of treatment for his psoriasis. Each week, he met with a doctor at DMZ Medical Spa, who recommended the appropriate frequency and duration of sunbathing and Dead Sea soaking treatments for his condition. By day 18, Katz's psoriatic lesions had cleared.
After his return to the U.S., Katz remained free of lesions for about six months before they slowly began returning. Even though his psoriasis flared again, the Dead Sea treatment was worth the travel and expense, he said. He plans to return this summer.
"I was happier, more relaxed, less stressed, and not feeling alone or stigmatized," Katz said.
Mineral water and sunshine
With salinity of 33.7 percent, the Dead Sea is one of the saltiest bodies of water on Earth, and since biblical times, the sea — at 1,300 feet below sea level — has been anecdotally known for its healing properties. A 2012 study published in Seminars in Arthritis and Rheumatism, conducted by a panel of dermatologists and researchers at Maccabi Healthcare Services in Israel, concluded that Dead Sea treatments are beneficial in several rheumatologic diseases. The study found the benefits are the result of both the level of sunshine available at the elevation of the Dead Sea and Dead Sea water's salinity and concentration of thermal springs.
Many people with psoriasis and psoriatic arthritis use balneotherapy — the practice of bathing in hot springs and other naturally mineral-rich waters — to alleviate the symptoms of their disease. Balneophototherapy takes treatment one step further, adding ultraviolet light to the bathing process. The science behind the benefits of balneotherapy and balneophototherapy however, are not clearly understood.
A study published in 2012 in the journal Photodermatol Photoimmunol Photomed noted that while the exact mechanisms that make balneophototherapy helpful are unknown, the concentration and mineral composition of the water appear to enhance the transmission of UV light through psoriasis on the skin, which affects the thickness and hydration of the outer layer of skin. Additionally, the study said that the magnesium-rich waters of the Dead Sea make psoriatic lesions more sensitive to the healing effects of UV light, which can be tolerated for longer periods at the Dead Sea because of the elevation.
Dr. Ben Ehst, assistant professor of dermatology and director of medical dermatology at Oregon Health & Science University, said more rigorous scientific research still needs to be done to determine the effectiveness of balneotherapy.
"It is likely that some patients with severe psoriasis can have great improvement from the therapy, but it is still hard to know when, to whom and in what type of psoriasis to recommend it," he said. "For those patients with mild disease, or with residual disease on another treatment, I don't see harm in trying it."
Treatment in the U.S.
While sites such as the Dead Sea, Blue Lagoon in Iceland and Kangal Hot Springs in Turkey have thrived, locations in the U.S. are less well known. Great Pagosa Hot Springs in Colorado and Warm Mineral Springs in Florida draw people for their reported healing properties, and Mavena Derma Clinics in Chicago has created a medical bathing unit that uses a 15 percent concentration of Dead Sea brine and narrowband UVB phototherapy. General Manager Paul Goldenbeld said patients could see up to "an 85 percent reduction in PASI score, comparable to what is expected with pharmaceutical treatments, including biologics."
For those who don't have the time or money to travel, there are many bath salt companies that sell Dead Sea salts. However, tested Tomesa therapy — a type of balneophototherapy that has published results — requires a 10 percent Dead Sea salt solution, a difficult percentage to recreate at home. Mavena Derma Clinics uses a 15 percent Dead Sea salt brine; to create the same concentration at home would require adding an average of 33 to 44 pounds of salt to a home bathtub, Goldenbeld said.