A Critical Evaluation of Dead Sea Therapy in the Management of Psoriasis

Abstract

Volume 3 • Issue 2 • 100033 Despite the benefits, ingestion of selenium has been associated with toxic effects when taken in excess [16]. Nine patients who presented after the intake of a dietary supplement containing selenium which had a formulation error had symptoms of toxicity [16]. The symptoms manifested within a week of ingestion and included alopecia, dystro-phic fingernail changes, gastrointestinal symptoms and memory difficulties. None of the nine persons required hospitalization and all were managed with supportive care. It is unlikely, but possible that patients with psoriasis receiving DS therapy would ingest sufficient water for selenium toxicity to occur. It is also worth noting that modest increases of selenium levels in the skin may accelerate the growth of incipient tumors in mice [17]. Thermal effects of climatotherapy on psoriasis While the basic pathological condition in psoriasis is increased skin cell proliferation, the inflammatory changes in blood vessels further worsen the condition [1]. Apart from its therapeutic effect the DS is also effective because of its unique environment mainly its high temperature and low humidity [3]. Heat may have immuno-suppressive effects by which humoral and cell meditated immune responses are reduced. Thermal treatment also results in a concurrent unexplained reduction in serum cortisol levels [18]. In summary the DS appears to be uniquely suited to treat skin and rheumatic disease; which has been known since ancient times. The therapeutic benefits can be attributed to multiple factors. These include the unique climatic characteristics and natural resources, DS water with its unparalleled salinity and unique composition, DS mineral mud, increased bromide content of the air and a high selenium content of local drinking water. Effects of phototherapy on psoriasis It is well known that there is a selective therapeutic pattern of the response to the sun's radiation at the DS [19]. UV radiation is attenuated when crossing the extra 420 m of the atmosphere at DS. In the DS there is a significant attenuation of shorter, erythematous, more dele-terious UV-B (280-300 nm), while the larger therapeutic wavelengths (300-320 nm) are mildly attenuated, resulting in an enhancement of the therapeutic to damaging ratio [3]. This decreases the risk of skin damage and skin neoplasia following DS water exposure. Despite the many benefits of climatotherapy adverse effects such as sunburn (5 percent) and photo sensitivity reactions (8.5 percent) have been observed in few patients [20]. Apart from this there are general contraindications for using DS climatotherapy which include severe psychiatric conditions, epilepsy, cardiac dysrhythmias, compromised balance and addiction to mind-altering substances e.g., alcohol [21]. While most kinds of psoriasis respond to the DS therapy, the exceptions are generalized pustular psoriasis and erythoderma [22]. Summary Diverse mechanisms may explain the benefits of DS therapy [23,24]. These include mechanical, thermal and chemical effects. The chemical effects of DS therapy have been supported by in vivo and in vitro studies which show increased levels of minerals influencing cell proliferation and differentiation [8,25-27]. Anti-inflammatory and immuno-modulatory effects involve various cell lineages. Also bathing in high concentrated salt solutions can cause the elution of various pro-inflammatory mediators of the skin from patients of psoriasis [28-30]. Another benefit of DS therapy is increased photo-sensitivity to UV-B irradiation which may contribute to the efficacy of photo-balneotherapy suggesting that the beneficial effect of Dead Sea climatotherapy is greater than balneotherapy alone. Finally the psychological effect of being in the DS area with its historical significance in healing cannot be overlooked. A major disadvantage of using these reported benefits is that most trials were carried out on animal models with few trials on human patients [3,5,13,26]. The number of well designed RCT is small and hence the findings are open to question [3]. There is also a degree of uncertainty about the treatment protocol in terms of the duration and frequency of sun exposure ; and similarly the duration and frequency of bathing in the DS [31]. Also despite the fact that the DS high salt and mineral content make it very safe to swim there have been reports of persons drowning in the DS [32]. This is believed to occur if a person trips, falls and swallows water. Swallowing DS water carries other risks as the high sodium content disrupts the body's electrolyte balance. Future Directions Hence though beneficial, adverse effects of DS therapy cannot be entirely ruled out. 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