Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: combined effects on epidermal and immunologic activation.

Abstract

BACKGROUND:

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

OBJECTIVE:

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

METHODS:

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

RESULTS:

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

CONCLUSIONS:

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

• Authors: Emmilia Hodak, Alice B Gottlieb, Tsvi Segal, Yael Politi, Lea Maron, Jaqueline Sulkes, Michael David
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 49 Issue 3 Pg. 451-7 (Sep 2003) ISSN: 0190-9622 [Print] United States
• PMID: 12963909 (Publication Type: Comparative Study, Journal Article, Research Support, Non-U.S. Gov't)

Chemical References

• HLA-DR Antigens

Topics

• Adult
• Aged
• Balneology
• Biopsy, Needle
• Combined Modality Therapy
• Female
• Follow-Up Studies
• HLA-DR Antigens (immunology)
• Heliotherapy
• Humans
• Immunohistochemistry
• Israel
• Male
• Middle Aged
• Probability
• Prospective Studies
• Psoriasis (immunology, pathology, therapy)
• Risk Factors
• Sampling Studies
• Seawater
• Severity of Illness Index
• Statistics, Nonparametric
• Treatment Outcome