The Dead Sea and Psoriasis

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The Dead Sea

Situated in the heart of the Great Syrian Africa rift valley that stretches throughout Israel and beyond, the Dead Sea is the lowest point on Earth at 400 metres or 1320 feet below sea level.

  • The waters of the Dead Sea contain 21 minerals, 12 of which are not found in other oceans.
  • The Dead Sea contains ten times more salt and minerals than the Mediterranean Sea.
  • There are several thermo-mineral springs along the Dead Sea shores an natural mineral spring waters flow form the Judean Hills
  • The Dead Sea is the only place on earth where sunbathing for long hours is possible with little or no sunburn because the ultraviolet rays are filtered through three layers; an atmospheric layer, an evaporation layer that exist above the Dead Sea and a thick ozone layer. Recommendations are that visitors still observe safe and progressive exposure to the sun.
  • The air is dry, unpolluted and pollen free with low humidity.
  • The Dead Sea also has a ‘signature’ black mud which is a homogenous mix of minerals, organic elements from the shore line as well as earth/soil.


The Dead Sea and psoriasis

There have been many visitors who have praised the therapeutic benefits of the Dead Sea and its benefits for people with psoriasis. Much of this has been anecdotal in nature and although, regular visitors to the area say that the cure is not permanent and that the psoriasis always returns following a good remission period. However, without exception, all often agree that the benefits of the Dead Sea are accumulative in that the remission periods get longer each year, although the psoriasis returns, it is always less severe than the time before.

Scientific research

A number of studies have suggested that Dead Sea Climatotherapy (DSC) may be an effective intervention for psoriasis. However, the quality of the studies is highly variable, most often due to lack of control groups and inadequate follow-up. However, some more recent studies have been of better quality and do suggest benefit.

Knudsen et al studies 192 patients from Copenhagen with psoriasis, all of whom were sent to the Dead Sea between 1975-1993, for a four-week treatment of sun-exposure and bathing (ref 1). Total or almost total remission was obtained in 73% and significant improvements in 20%. The length of remission of disease was one to three months for 55% of patients.

Hodak et al studied the impact of DSC at the cellular and molecular levels (ref 2). A total of 27 patients with chronic, stable plaque-type psoriasis were evaluated using the Psoriasis Area and Severity Index (PASI) score and quantitative histologic measures. After 4-weeks treatment the PASI score decreased by 81.5%. Complete clearance was achieved in 48% of patients and moderate to marked improvement in 41%. The average duration of remission was 3.3 months. These benefits were mediated by cellular changes, especially T lymphoctes.

Cohen et al (ref 3) used the PASI score together with a new severity index called the Beer Sheva Psoriasis Severity Score (BPSS) in a study of 70 patients (40 men and 30 women) undergoing DSC. Following treatment there was a 76% reduction in mean PASI score and a 58% reduction in the BPSS. The authors conclude that DSC is an effective therapy for patients with psoriasis as judged by both PASI scores and BPSS.

Halevy et al (ref 4) studied the possible role of trace elements as mediators of the beneficial effects of DSC in 23 patients with psoriasis vulgaris. The authors concluded that increased levels of manganese and lithium may be partly responsible for the beneficial effects of DSC.

The issue of the remission time following DSC has been the subject of intense debate and – it must be said – a conspicuous lack of good evidence. What data we have suggests that remission time varies between 5½ to 7 months (ref 5 & 6).

Travelling to the Dead Sea

There are a number of specialist travel agents who organise trips to The Dead Sea. In the United Kingdom check with The Foreign and Commonwealth Office www. fco. gov.uk before booking to seek any current advice about travelling to Israel.

The Israel Government Tourist information can be obtained from
http:// london. mfa.gov.il

Conclusion

Although data are relatively sparse, the better constructed studies do suggest that Dead Sea treatment can be effective in alleviating psoriatic symptoms for periods of up to 7 months.

References

(1) Knudsen EA, Worm AM. Psoriasis treatment at the Dead Sea.
Ugeskr Laeger 1996; 15, 6440-3
(2) Hodak E, 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: 451-3
(3) Cohen AD, et al. Effectiveness of climatotherapy at the Dead Sea for psoriasis vulgaris; community orientated study.
J Dermatolog Treat 2005; 16: 308-13
(4) Halevy S, et al. The role of trace elements in psoriatic patients undergoing balneotherapy with Dead Sea bath salt. Isr Med Assoc J; 2001: 3: 828-32
(5) Abels DJ, Harari M. Psoriasis remission time at the Dead Sea.
J Am Acad Dermatol 2000; 43: 325-6
(6) Shani J, Harari M et al. Dead Sea climatotherapy versus other modalities of treatment for psoriasis: comparative cost effectiveness.
Int J Dermatol 1999; 38: 252-62

Dr David Ashton November 2007