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    Ancient 'cure' finds believers in the 'burbs

    Psoriasis sufferers gain relief bathing in water from the Dead Sea

    Dr. Altman
    Maui, Hawaii - For thousands of years, people have flocked to the Dead Sea searching for relief for their itchy skin. Now, Chicago-area psoriasis and atopic dermatitis sufferers are bathing in reconstituted Dead Sea water at a suburban clinic.

    Studies suggest that the Dead Sea water can truly relieve symptoms of these diseases, both in the sea itself - located between Jordan, Israel and Palestinian Authority land - and in reconstituted form, according to dermatologist Jeffrey S. Altman, M.D. "It's an incredibly safe therapy," he said. "And it provides a lot of relief."

    For two years, Dr. Altman has served as medical director of the Mavena Derma Center, which offers Dead Sea baths in Des Plaines, Ill. He described his experience there and the research on balneophototherapy at the Noah Worcester Dermatological Society annual meeting.

    Based in Switzerland, Mavena operates a number of clinics in Germany in addition to the Des Plaines clinic it opened three years ago. Balneotherapy - bathing as a medical therapy - is more widely practiced in Europe than in the United States. It has come under increasing scientific study in recent decades.

    Among several studies suggesting that bathing in the Dead Sea can ease psoriasis symptoms was one published in 1996 in the Journal of Dermatological Treatment (7:83-86). Eighty-one psoriasis patients were divided into three groups: sunbathing only, Dead Sea water-bathing only, and combined water and sunbathing. After four weeks, the water patients experienced a 28-percent mean improvement in their PASI scores. The sun patients experienced a 73-percent improvement. Those who bathed in both sun and water experienced an 83-percent improvement.

    The results of this study suggest that phototherapy is the most important aspect of the Dead Sea treatment, but Dr. Altman believes that patients also benefit from the minerals in the water. "After reading all this and studying it, I think the salt does have an effect," he said. The Dead Sea water is 30 percent salt, primarily magnesium chloride, but also including calcium, sodium and potassium chlorides, sulfates, magnesium oxide, iron, trace amounts of heavy metals, and cadmium.

    Minerals increase hydration Citing a 2003 article in the Journal of the American Academy of Dermatology (49(3):451-457), Dr. Altman said the minerals increase hydration in the stratum corneum, decrease the proliferation of T-cells in the dermis and epidermis, decrease proliferation of keratinocytes, potentiate the effects of phototherapy, and may cause elution and decreased production of proinflammatory prostaglandins and leukocytes elastase.

    For the Mavena baths, actual Dead Sea salts are imported and mixed with local water. Psoriasis patients soak for 15 minutes in a solution of 15 percent Dead Sea salt at a temperature of 34C to 36C. (Atopic dermatitis patients soak in a solution of 1 percent to 5 percent salt.) Afterward, the psoriasis patients undergo narrow-band UVB phototherapy.

    The clinic charges about $135 per treatment and Dr. Altman usually prescribes 10 to 25 treatments, three per week, with one or two treatments per week as maintenance. Most insurers have paid for the treatments.

    There are some aspects of the Dead Sea climatotherapy that are not duplicated in the clinic, Dr. Altman acknowledged. First, Dead Sea bathers are often exposed to the sun and water simultaneously instead of sequentially. Second, the Dead Sea is 400 meters below sea level, so atmospheric pressure is unusually high. It is unknown whether these differences matter, said Dr. Altman, but the Mavena treatment "is about as close as you can get in a clinical setting. And the clinical response rate is similar."

    In an unpublished study of this therapy in 328 patients carried out at Mavena's clinic in Magdeberg, Germany, investigators reported an 87.4-percent mean improvement in PASI scores.

    Dr. Altman described several case studies from his own practice in which patients at the Des Plaines clinic experienced dramatic improvement in their PASI scores. "I think balneotherapy reduces redness and scaling more than anything else," he said.