Transcript Climatherapy

Clime- and Heliotherapy
1
Introduction
Therapeutic usable Clime (Healing Clime) is the
result of special dose of temporary and local
changing atmospheric factors controlled by
physicians. The dose can be contrary to the
personally comfort feeling of patients in
according to the indications.
“The doctor is the creator of the cure clime”
(Pfleiderer)
Klim 2
Themes
 Climetherapy
• Definitions
• Clime regions
• Clime factors
• Dose factors
• Effects
• Indications and contraindications
• Cure types and structures
 Heliotherapy
• Radiation sources
• Effect of environment to the
global radiation
• Radiation and skin
• Photochemical and -biological
effects
• Therapeutic and toxic effects
• Photo-Brine-Therapy
• Indications, contra-indications
and risks
Klim 3
Definitions I
Climetherapy is a part of Health Resort Medicine. It is
applied as a complex measure together with other
global adjusted therapeutic measures in the cure
systems. Climetherapy belongs on a treatment concept
of many different effective factors.
In Heliotherapy one important factor of Climetherapy
will be used.
Klim 4
Definition II
 Climetherapy is the special treatment of sick patients by
modification their exposition in the free atmosphere
(Schmidt-Kessen).
 Photo therapy or Light therapy is the therapeutic use of
photon radiation in ultra violet, visible and infrared range.
 Heliotherapy is the Photo therapy by Sunshine.
 Thalasso therapy is the therapy by use of the remedies of
the sea.
Klim 5
Definition III
 Climetherapy
• Cure treatment by use of active and strong elements
of clime
• Sea-clime
• High-altitude clime
 Climecure (cure in the clime)
• Cure treatment in areas without strong elements of
clime by physiotherapy.
• Areas in woods and medium altitudes (Dirnagl)
Klim 6
Definitions III
 Weather is the result of circulation in the atmosphere
 Clime is the long time mean value of the local weather
elements.
 Bio-clime is the clime, which contact the body surface
and has biological effects.
(Schmidt-Kessen)
Klim 7
Clime regions
Sea-clime
• moist, cool, windy
• Aerosol, low pollution
Clime of medium altitudes
• Wood air, not windy
Clime of high altitudes (1200 –2000 m)
• dry, cool, high part of UV
• Decrease of max. O2-uptake about 2%/per 1000m
• up to 1800 m no house-dust-mite can live
Klim 8
General principle of Climetherapy
In-door-clime
(save clime)
Out-door-clime
(stress clime)
Coddling situation
Adaptation to natural
environment factors
Air pollution at home
Careful situation in
health resort
Klim 9
Mechanical factors
Air pressure
Wind pressure
Gravitation
Klim 10
Thermal factors
Air temperature
Radiation temperature
Humidity
Air movement (wind, draw-winch)
Klim 11
Limits of sultry or oppressive
feeling air
Temperature
°C
30
28
26
24
22
Relative Humidity
%
45
50
65
70
75
Klim 12
Actinic factors
UV-B
UV-A
UV-A1 (artificial)
Visible Light
near infrared radiation
(280-315 nm)
(315-400 nm)
(350-400 nm)
(380-780 nm)
(760-2500 nm)
Klim 13
Chemical factors
 Ozone
• Natural concentration: 0,01 - 0,06 ppm
• Maximal working level: 0,1 ppm
• Exhausted by reaction with the earth surface 4 mg/d/m2
 Volatile oils
 Aerosols
 Radon
 Missing air pollution
Klim 14
Electric factors I
 Ions of air
• 102 - 103 ions/ cm3 of 1019 air molecules/cm3
• about 4 ions/cm2 per breath have contact to the lung
surface
 Electrical DC fields
• Field of fine weather : 100 V/m
• Field of low-pressure front: >1 kV/m
• Field of the skin surface by movement: >1 kV/m
Klim 15
Electric factors II
 Electric AC field
(by atmospheric impulse radiation, Sferics)
• 10-Hz-Field
 Magnetic DC field
• 0,5 Gauss
 Magnetic AC field
• by 10-Hz-Field: 10-8 - 10-10 Gauss
• by 50-Hz-AC in houses: 1-5 Gauss
Klim 16
Dose factors of the weather
 cold - hot
 shadow - sunshine
 calm - windy
 dry - moist
 fog - rain
 clean air – air pollution
Klim 17
Dose factors by activity of the
patient
Resting
Sitting
Going
Jogging
Sporting
Klim 18
Dose factors by shielding the
patient
Warm dresses
Wind-tight dresses
Water-tight dresses
Klim 19
Weather-phases in Bioclimatology
1 Fine weather (cool to moderate warm) East part of high pressure
2 Active fine weather (warm and dry) Middle part of high pressure
3 Over loaded fine weather (very hot and dry) West part high
pressure
4 Beginning change of weather (warm and moist) frontal side of
low pressure
5 Changed weather (cold and moist)
6z Active cold air (cold to cool, rain, windy) backside of low pressure
6 Weather normalisation (cold and dry)
Klim 20
Weather and sickness
Weather phase 4 (frontal side of low pressure):
• inflammation in any case
• asthma-attacks,
• disorders by hypotension
• acute disorders of the heart
• thromboses
Weather phase 5 (changed weather)
• fast normalisation of the disorders
Klim 21
Weather and sickness
Weather phase 6z (backside of low pressure)
• acute and spastic disorders
• bile-bladder colic
• cardiac pain
• cardiac-attacks
• disturbance by hypertension
Klim 22
Weather and sickness
Weather phase 6 (Weather normalisation)
• headache
• migraine
• sleep disturbances
• depressions
Klim 23
Which factors of weather are maximal
effective in weather feeling ?
Change of
•hot and dry (phase 3)
to
•cold and moist (phase 5)
Klim 24
Hypothesis of increasing pain in
rheumatoid arthritis
1.
2.
3.
4.
5.
6.
Decrease of air temperature
Decrease of join temperature
Decrease of synovial temperature
Increase of synovial viscosity
Decrease of join mobility
Increase of pain
Klim 25
What is the main reason in
weather sickness?
Disturbance in
peripheral temperature regulation.
Cause?
Lack in training
Problems in civilisation.
Klim 26
Complaints in connection with
weather changes
1.
Weariness
9.
Unbroken sleep disturbance
2.
Bad mood
10.
Increased making mistakes
3.
Unpleasure to work
11.
Increased forgetfulness
4.
Head pressure, headache
12.
Flicker of eyes
5.
Restless sleep
13.
Attack of vertigo
6.
Initial insomnia and
concentrating disturbance
14.
Heart sensations
15.
Pain in postoperative scar
16.
Depressive mood
7.
Nervosity
8.
Pain in points of bone-fractures
Klim 27
Follow up of non-adaptation and
disability in temperature regulation
1. Vasoconstriction of peripheral blood vessels
2. Blood flow from peripheral vessels into the
systemic circulation
3. Hypertension
Klim 28
Main therapeutic clime effects
Improvement of the thermoregulation
Increase of the physical efficiency
Inurity and decrease in susceptibility of infection
Improvement of the skin state
Vitamin D3-formation
Relief of the respiratory tract
Klim 29
Coldness adaptation
Decrease in coldness sensitivity
Pain threshold moves to lower temperature
Initial increase of blood pressure decrease
More increase of heart rate after adaptation
Increase of reactive heat by metabolism
Klim 30
Indications in
Health Resorts with healthy clime
Situation after deficiency of training
• Therapy: Terrain cure by cool conditions
Respiratory tract diseases
• Therapy: Terrain cure and respiratory exercise
Osteoporosis
• Therapy: Terrain cure and Heliotherapy
Skin diseases (Psoriasis, Neurodermitis)
• Therapy: Terrain cure and Heliotherapy
Klim 31
Structures of Health Resorts with healthy
clime in high altitude
Net of terrain ways minimum 30 km
(5 to 15 % ascent)
Clime pavilion
Rest- and gymnastic-field
Equipment in hydrotherapy
Bike travel ways
Patient-consultation and -leading
Klim 32
Cure forms
Out-patient clime cure
Clime compact cure
Klim 33
Treatment by low coldness
stimulation
Regimen refrigerants
Training en repos
Klim 34
Change of aerobic metabolism by
adaptation to coldness
Physical endurance performance increase
• by terrain cure in cold conditions,
• by rest cure in fresh air.
Klim 35
Change of lactate concentration in blood during
ergometric control by rest cure in fresh air
Before
treatment
3 weeks later
By A. Schuh 1995
Klim 36
Change of lactate concentration in blood during
ergometric control by terrain cure in cool
conditions
Before
treatment
3 weeks later
By A. Schuh 1995
Klim 37
Other expositions and indications
 Rest cure in fresh air (1-3times daily 2 hrs.)
• convalescence of bedridden patients
 Sleep treatment in fresh air (cool breathing air)
• weather sickness
• disorders of circulatory and sleep regulations
 Air bath (use of bathing dress, kinesitherapy in cold air)
• hypotonic circulatory regulation disorders
• adipose
• fibromyalgia
Klim 38
Indication in Sea Health Resorts
Chronic diseases of respiratory tract
• Rhinitis, sinusitis paranasalis (in Summer time),
pharyngitis, laryngitis
• Hay rhinitis (on islands), rhinitis vasomotorica
• Chronic relapsing bronchitis
• Asthma-syndrome, allergic asthma (on islands)
• Situation post pneumonia and pleurisy
Klim 39
Indication in Sea Health Resorts
Heart- and circulation diseases
•
•
•
•
Functional circulation disorders, hypo-tension
Early stage of arteriosclerosis
Well compensated essential hypertension
In-patient rehabilitation after cardiac infarction,
cardiac- and vascular operations
• Symptom-complex of varicose
Klim 40
Indication in Sea Health Resorts
Skin diseases
• Eczematous diseases, keratosis, urticaria chronica
• Erythemato-squamous and papular dermatosis,
Psoriasis vulgaris (May to July)
• Dermatosis with blusters
• Pyodermia, acne vulgaris
• Phlebopathy
Klim 41
Indication in Sea Health Resorts
Chronic diseases of locomotoric system
(treatment with mud or other peloides)
• Arthrosis, spondylitis and osteochondrosis
• Post-treatment after accident- and war-lesions
and post operations
Klim 42
Indication in Sea Health Resorts
Women’s diseases
• Chronic inflammation processes of the genitals
(treatment by use of slime)
• Concrescence complaints (treatment by use of slime)
• Cycles disorders, Ovarian insufficiency (treatment
by use of slime)
• Vegetative-endocrine syndrome
• Postmenopausal syndrome
Klim 43
Indication in Sea Health Resorts
Diseases of children
• Chronic relapsing diseases of the upper and lower
respiratory tract.
• Infantile asthma syndrome, allergic asthma (on
islands)
• Hypotonic circulation disorders
• Skin diseases
• Disorders of development
Klim 44
Indication in Sea Health Resorts
General weakness situations
• convalescence
• Dystonia, autonomic nervous
disorders
Klim 45
Indications in Thalassotherapy
of the respiratory tract
Months: I
II III IV V VI VII VIII IX X XI XII
without Decompensation
Diseases
of the respiratory tract
With moderate Decompensation
Sinusitides and Otitides
Cardiac-circulation diseases
with weather sensitivity
Nervous excitability
Delivate, extremely susceptible
patients and infants
Babies, ill infants,
old humans
Klim 46
Indications in Thalassotherapy
of the skin
Months: I
II III IV V VI VII VIII IX X XI XII
for children and adults, and occupational eczema
Neurodermitis
By strong asthenia or dystonia autonomic nervous disorders
Urticaria, Strophulosis,
Furunculosis
Dyshidrotic Eczema
Acne vulgaris and Acne juvenilis
Ichthyosis vulgaris und Psoriasis vulgaris
Prurigo
Klim 47
Stimulus dosage
during cure treatment
4 - 8 days spar,
After this time in low steps as strong as possible
increase,
Individual dosage.
Klim 48
Water temperature
and bath permanence
Cure to inure
Hypotension
Circulation disturbance
Sports Swimming
Without healthy use
Underwater gymnastics and
kinesitherapy
Rheuma-patients
Temperature
Permanence
°C
minutes
16 - 18
18 - 20
20 - 22
21 - 23
23 - 26
27 - 29
5 - 15
5 - 15
10 - 20
15 - 25
15 - 25
20 - 25
30 - 36
20 - 30
Klim 49
Permanence of the first sun-bath
by start of exposition May 1st
min
180
150
Skin Type
IV III
II I
120
90
60
30
06
8
10
12
14
Daytime
16
18
h
Klim 50
Permanence of the first sun-bath
by start of exposition July 1st
min
180
150
Skin Type
120
IV
90
III
II
60
I
30
0
6
8
10
12
14
Daytime
16
18
h
Klim 51
Heliotherapy
•
•
•
•
•
•
•
Radiation sources
Effect of environment to the global radiation
Radiation and skin
Photochemical and -biological effects
Therapeutic and toxic effects
Photo-Brine-Therapy
Indications, contra-indications and risks
Klim 52
Radiation in Heliotherapy
Heliotherapy
Licht
Strahlungsbereich
Wellenlänge
-4
-1
10 bis 10 nm
Gammastrahlung
-2
10 bis 10 nm
Röntgenstrahlung
10 bis 200 nm
Vakuum-Ultraviolett
200 bis 280 nm
UV-C-Strahlung
280 bis 320 nm
UV-B-Strahlung
320 bis 400 nm
UV-A-Strahlung
400 bis 780 nm
Licht
780 bis 1.000.000 nm
Infrarot-Strahlung
1.000.000 bis 1.000.000.000 nm
Mikrowelle
Klim 53
Radiation sources in Phototherapy
Temperature radiators
• Sun >300 nm
Gas-discharge radiators
• Hg 254, 313, 366
• Low pressure, high pressure, highest pressure
LASER
• He/Ne 632 nm
Klim 54
Recovery
Spectrum of an
UV-lamp
Skin protection
against to much
sun radiation
Care of health
Vitamin D3
UVB
UVA
LIGHT
Klim 55
Global radiation of the sun
Equator
Germany
Visible Light
Klim 56
UVradiation
of the sun
UV-C
UV-B
UV-A
Ozon
Klim 57
Change of altitude
and the part of sun-irradiation
UV-B:
15%/1000 m
• Important in high altitudes
UV-A:
2-5%/1000 m
• Important at Dead Sea level
(400 m under sea-level)
Klim 58
Effect of clouds
to the radiation parts of sunshine
UV:
Visible:
Transmission 50%
Transmission 25%
Klim 59
Reflection of UV-B
Snow
Gras
Sand
Shoal mud
moist ground
85%
26%
10-15%
9-10%
3%
Klim 60
Reflection of white pigments
(by Luckiesh 1946)
Material
% Reflexion
254 nm
297 nm 365 nm Sichtbar
MgO
93
93
94
95-97
Weißer Putz
46
65
76
90
TiO2
6
6
31
94
ZnO
2,5
2,5
4
88
5
5
5
6
18-31
21-40
33-50
55-75
Klim 61
Schwarze Lackschicht
Wellpappe
Effective erythema dose
(nach Diffey et al. 1982)
Part of the absorbed environmental dose
Sun bath at the beach
0,75
Sitting in Swimming-pool
0,40
Skying
0,22
Walking
0,17
Sailing
0,14
Klim 62
Penetration of UV-A- and
UV-B-rays into the skin
Visible
51,8%
UV-B 0,4%
Infrarot
43,9%
Stratum corneum
Stratum spinosum
Cutis
UV-A 3,9%
Subcutis
Klim 63
Penetration into the skin
Light
UV-C
UV-B
UV-A
green
red
NIR
IR

nm
250
300
350
550
700
1230
2200
Depth to
find
1 % of
surface
dose
mm
0,2
0,5
1,0
1,2
1,4
2,3
1,1
relative Dose in
Stratum basale in % of
surface dose
White
1,5
18
45
65
75
95
75
Negro
8
40
60
Klim 64
Transmission of skin layers in %
(nach Bachem und Reed 1930; modifiziert von Daniels 1969)
Hautschicht
Dicke
in mm
Wellenlänge in nm
200
250
280
300
400
550
750
Hornschicht
0,03
0
19
15
34
80
87
78
+ native
Epidermis
+ Dermis
0,05
0
11
9
16
57
77
65
2,0
0
0
0
0
0
5
21
Klim 65
Action-spectres
Pigmentation
Erythema
Conjunctivitis
C
A
B
Klim 66
Definitions
Radiation power
• Quotient between radiation flow and the
affected area (unit: W/m2)
Radiation dose
• Product of radiation power and radiation time.
(unit: Ws /m2 or J/m2)
Klim 67
Radiation instruction
for different lamp-types
Kromeyer-Lampe
Typischer
Typische
BetrahlungsAbstand Bestrahlungs
stärke bei
-zeit
diesem
Abstand
2
Kontakt
2s
240 W/m
2
UV-B-Strahler
0,5 m
3 min
7 W/m
UV-A-Strahler
0,5 m
5 – 30 min
0,4 W/m
2
Klim 68
Radiation power
and biological effectiveness
UV-spectrum
Relative biologic
1
effectiveness
and radiation power in
W/m2/nm
biologic
Sensitivity
0,01
effective
UV-spectrum
0,0001
0,000001
300
UV-B
325
350
375
UV-A
400
Wavelength
___________
nm
Klim 69
Rules of Photochemistry
 Photochemical reactions take place only by absorbed radiation
(Grothus-Draper).
 The photochemical effect is proportional to the product of intensity
and performance (Bunsen-Roscoe).
 The absorbed part of light by a substance depends not on the
intensity of light and increase only by their concentration (LambertBeer).
 Radiation follows in quantum units and not in a continuum (Planck).
 By each absorbed quantum will be formed one activated molecule
(Stark-Einstein).
Klim 70
Photochemical reactions
Photochemical activation: A + h  A*
Following reactions:
Energy change: A*  A + heat, light
Energy transfer: A* + B  A + B*
Splitting: A*  a1 + a2
Synthesis: A* + B  AB
Klim 71
Photochemical radiation effects
 UV-B and C
• Dimerisation of thymidine-bricks
• Cracking of amino acids: forming of vasoactive
substances
• Inactivation most of enzymes
• Forming of steroid hydro-peroxides on the skin
(cancerogenic)
Klim 72
UV-Spectrum
20
40
Ergosterine
Vitamin D
20
10
UV-B
220
260
300
Extinktionscoefficient Vitamin D
Extinkionscoefficient Ergosterine
of vitamin D und ergosterine
mµ
Klim 73
Vitamin D3 development
 255-320 nm
• Change of 7-Dehydro-cholesterine to vitamin D3
• Requirement of D3 is produced by a 2 times weekly Sunradiation without erythema to an area like face and arms.
7-Dehydrocholesterine
Vitamin D3
1,25-Dihydroxycholecalciferole
Activation of intestinal Ca- and phosphate absorption
Activation of the renal phosphate reabsorption
Activation of the intraerythrocytal glycolysis
Increase of 2,3-Diphosphoglycerate in the erythrocytes
Increase of the dissociation of oxyhemoglobine
Increase of the O2-supply of cells
Klim 74
Increase of vitamin D3-reaction products
after 4 hrs. UV-B-radiation
(Humpler 1982)
30%
n = 16
Ery
20%
Ery
Ery
PFK
PK
9,25
U/gHb
0,59
U/gHb
Plasma
Ca
10%
Plasma
DPG
PO4
Ery
P50
0%
2,45
mmol/l
1,28
mmol/l
13.95
µmol/l
25,5
mmHg
Klim 75
Primary target-cells of
UV-radiation
Corneocytes (UV-C)
Keratinocytes (UV-B)
Melanocytes (UV-B and UV-A)
Langerhans cells (UV-B)
Endothelial cells (UV-A)
Inocytes (UV-A)
Klim 76
Photobiological radiation effect
by UV-B
Erythema: max. 297 nm
• Latency: 1-4 hrs.
• Maximum: 6-9 hrs.
• MED: 36-50 mJ/cm2
Klim 77
Change of Amino acid concentration in the horny
layer by iterative UV-radiation
Klim 78
Keratinocyte reactions
Intra- and intercellular oedema
Cytolysis
Forming of sunburn cells
Klim 79
Keratinocyte reactions
by lipid peroxidation of membranes
Odland-Granules move into the intercellular space
Lysosomes are resolved
Lysosomal enzymes are released
Mitochondria will be destroyed
Klim 80
Keratinocyte reactions
The reaction of keratinocytes by UV-C, UV-B,
UV-A or phototoxic substances is qualitative
equivalent and is already released by suberythemal doses.
Klim 81
Photochemical radiation effects
by UV-B
Indirect pigmentation: Dose <50 mJ/cm2
• Metabolism of dopaoxidase to tyrosinase
• Oxidation of DOPA to melanin in melanocytes
Klim 82
Melanocyte-reaction
(Melanogenesis)
Minimal Dose UV-B: about 23 mJ/cm2
Minimal Dose UV-A: 17,7 ± 8 J/cm2
Latency time: 1-14 days
Permanency: some months
Forming of black or brown Eumelanin and yellow
or red Pheomelanin
UV-protection depended on localisation
Klim 83
Melanin-synthesis
L-Tyrosin
slowly
Dopaoxydase
L-Dopa
Protein (Cu++)2
fast
Tyrosinase
Protein (Cu+)2
Activation
Dopachinon
spontan
Dopachrom
Deletion of the SH-Inhibition
by
UV-radiation 280-310 nm
X-radiation
temperature increase
inflammation process
SH-blocker: As, Fe, Bi, Au, Ag, Hg
Polym.
Melanin
Klim 84
Photobiologic reactions by
UV-B-radiation
Inhibition of the basal cell mitoses rate
Forming of sunburn cells suprabasal (max. 30 hrs.)
Inhibition of Langerhans cell
Liberation of interleucin 1 (max. 2 hrs.)
Reactive hyper-epidermopoesis (latency 24 hrs.;
permanency 3 weeks)
Akanthosis by following hyper-keratosis
(Miescher’sche Lichtschwiele)
Klim 85
Langerhans cell-reaction
Inhibition of the immune answer
Blocking of T-helper cells
Stimulation of T-Suppressor cells
Klim 86
Photochemical radiation effect
by UV-A
 Direct pigmentation:
Dose >25 J/cm2
• Intracellular peroxide forming
• Stimulation of the pigment movement in the
melanocytes
Klim 87
The melanin-unit
1 Melanocyt by
36 Keratinocytes
Phagocytosis
of Melanosomes
Melanosomes
with Melanin
Melanocyt
Stratum basale
Klim 88
Endothel cell-reaction
Vasodilatation
Increased vasopermeability
Klim 89
Reaction by
UV-A -overdosage
Fever
Leucocytosis
Increase of CRP and immunoglobulin
Increase of phagocytosal effectiveness in
leukocytes
Klim 90
Photochemical radiation effect
by visible light
Blue light 400-480 nm
• Bilirubin will be changed by new-born to a
renal eliminated substance.
Klim 91
Jaundice of newborn
by continual radiation 450-460 nm, 34 µW/cm2/nm
Serum Bilirubin Concentration
mg/100ml
Control
Treatment group
16
14
12
10
8
6
4
2
0
0,24
24
48
72
96
120
144
168
Age in hrs.
Klim 92
Action spectrum to destroy of
bilirubin
Abbau von Serum-Bilirubin
%
25
20
15
10
5
0
400
450
500
550
600
650
nm
Klim 93
Skin types
 Type I: Sunburn without
pigmentation
 Type II: Erythema with
low pigmentation
 Type III: Seldom sunburn
and distinct pigmentation
 Type IV: Never sunburn
and over average
pigmentation
 Type V: South European
and Indian
 Type VI: Negroid Race
Klim 94
Skin types
incidence
skin color
mamilla
lentigo
Sunburn risk
Pigmentation
Protection time
Typ I
Typ II
Typ III
Typ IV
keltic Type
light-skin
dark-skin
mediterrian
European
European
Type
12 %
light
light
often
nearly
always
moderate
10-20 min
78 %
Light brown
pigmentated
hardly
seldom
8%
darkbrown
dark
never
never
always
20-30 min
always
30-40 min
2%
Very light
stricking light
many
always
hardly
5-10 min
Klim 95
Representative Exposition special Persons
(nach Challoner 1976 und Leach 1978)
Group
Gardener
Sunexposition on the
balkony
Labor- and office worker
Bedridden long term
patients
Part of absorbed
environment dose
0,1
0,1
0,03
0,001
Klim 96
Persons with higher UV-sensitivity
New-born and infants
Children more than adult
Bloated children
Men are 20% more sensitive than women
Old human are lesser sensitive
Klim 97
Relative UV sensitivity of different body areas
Back of the hand, lower leg
Forehead, neck, leg
Arms
Breast, abdomen, back
25 %
25 - 50 %
50 - 75 %
75 - 100 %
Klim 98
Minimal erythema dose (MED)
Light-steps by 20-30-40-50-60-70 mJ/cm2
Back, buttocks (representative), forearms
Control after 24 hrs.
Heliotherapy will be used by tables
Klim 99
MED and UV-A
The MED for UV-B will be decrease by
UV-A-irradiation.
(Photoaddition or Photoaugmentation ?)
Klim 100
Erythema stage
 Suberythema: no visible erythema (sedative Dose)
 Stage I: hardly visible erythema (MED), subside after 1-2 days.
 Stage II: low reddening (5times MED), after 3 days subside by easy
little desquamation.
 Stage III: intensive reddening, about 1 week persistent, defurfuration.
Inflammation dose for small areas by treatment of acne vulgaris and
painful situations like Lumbalgo.
 Stage IV: very intensive reddening after 2 hrs. (9times MED),
vesication.
Klim 101
Treatment of
Dermatitis solaris
 Cooling packs
 mild shaking mixture like Lotio alba, 0,5% VioformLotio
 Prescription of corticosteroids containing lotions or
Crèmes
 In very strong forms injection of Calcium and antihistaminica, if necessary also corticosteroides, oral or
possible i.v.
Klim 102
Photo-Pigmentation-Index (PPI)
Quotient by erythema and Pigmentation
stage. It is to control after 72 and 120 hrs. in
4 half-quantitative stages by various points.
Good pigmentation: PPI < 1
deficient pigmentation: PPI >1
Klim 103
Rules of Phototherapy
To use the lowest therapeutic dose
To avoid erythema
By skin diseases to irradiate till free of symptoms,
than decrease radiation dose slowly step by step.
By repeated radiation to use low single doses.
Klim 104
Indications in UV-therapy
 Psoriasis vulgaris
 Pemphigus vulgaris
 Urticaria
 Herpes simplex o. solaris
 Neurodermitis
 Seborrhoic Eczema
 Ichthyosis
 Acne vulgaris
 Ulcus cruris
 Alopecia
 Pityriasis versicolor
 Mycosis fungoides
 Rachitis-prophylaxis
 Secondary Anaemia
 Hyperthyreosis
 Hypertension
Klim 105
Effects and indications
Habituation and
exertion of
influence the
pruritus
 Lichen ruber planus
 Pityriasis lichenoides
 Erythrodermie pityriasique en
plaques disséminées
 Dermatitis herpetiformis
(Pemphigus vulgaris, Urticaria)
 Lighturticaria
 Herpes simplex
 Seborrhoic eczema
 Ichthyosis
Klim 106
Effects and indications
 Inurity
 cytostatic effect
 Repigmentation
 Peeling
 Psoriasis vulgaris
 Psoriasis vulgaris
 Reticules and reticular
Hyperplasia
 Vitiligo
 Pityriasis versicolor
 Pityriasis rosea
Klim 107
Effects and indications
 Activation of the metabolism
 Vitamin-D-activation
 Acne vulgaris et
conglobata
 Alopecia areata et diffusa
 Mycosis fungoides
Klim 108
Indications in the Heliotherapy
by supportive treatment









Non active rheumatoid arthritis
General tendo-periostosis
Hypertension
Osteomalacia
Osteoporosis
Respiratory tract diseases
Non active Tbc
Cardiac rehabilitation
Depressions
Klim 109
Use of Heliotherapy in Prevention
Light-adaptation in winter and spring time in case
of light-urticaria and other photodermatoses
Rickets prophylaxis in childhood
Infect prophylaxis and increase of the immune
resistance
Increase of the mental learning possibility
Klim 110
Application of the Heliotherapy
Daily or two-daily irradiation by suberythemal
doses
6 applications
Increase till erythema first stage
To avoid overheating
Klim 111
Progression of the Dose of
Sunbathes
30 % Increase
8. Tag
1. Tag
2. Tag
3. Tag
4. Tag
5. Tag
6. Tag
7. Tag
8. Tag
9. Tag
10. Tag
34 Minuten
44 Minuten
58 Minuten
75 Minuten
97 Minuten
126 Minuten
164 Minuten
213 Minuten
277 Minuten
361 Minuten
Klim 112
The sedative cure
Behandlung
Intervall Tage
1.
Täglich oder jeden 2. Tag
Dosierung
0,5
2.
0,7
3.
0,9
4.
1,1
5.
1,3
6.
1,5
Reaktion
Bemerkungen
Suberythem
Die sehr leichte Reaktion soll
nach jeder Behandlung
wieder auftreten.
Ansteigende Dosen bis
höchstens zum Auftreten des
Erythems ersten Grades.
Klim 113
The tonic cure
Behandlung
Intervall Tage
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
2—3 Tage zwischen den
einzelnen Behandlungen
Dosierung
1
1,3
1,6
2
2,3
2,6
3
3,3
3,6
4
4,3
4,6
5
5,3
5,6
Reaktion
Bemerkungen
Erythem
ersten
Grades
Das Ziel ist, nach jeder
Behandlung das Erythem
ersten Grades zu erzeugen.
Bei jeder Behandlung werden
Rücken und Brustseite des
Körpers bestrahlt. Beim
Auftreten von Pigmentation
3-4 Wochen aussetzen und
von vorne beginnen..
Klim 114
The therapeutic cure
Behandlung
Intervall Tage
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
12.
2—3 Tage, die Reaktion
auf die vorhergehende
Bestrahlung muß
verschwunden sein.
Dosierung
1
1,5
2,25
3,5
5
7,5
16
16
24
27
30
30
Reaktion
Bemerkungen
Erster, später
zweiter Grad
des
Erythems.
Pigmentation
von der 6.
Behandlung
ab.
Nach jeder Bestrahlung soll
ein ausgesprochenes Erythem
festgestellt werden können.
Nach 12 Sitzungen 3-4
Wochen Pause.
Klim 115
Sunbathes in flat country altitude till 500 m
in minutes
Monat
März
April
Mai
Juni/Juli
August
Septem.
Tageszeit
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
wolkenlos
teilweise bewölkt
1. Bad
3. Bad
5. Bad
1. Bad
3. Bad
5. Bad
70
60
90
40
35
55
30
25
40
35
30
45
40
35
55
60
50
75
90
90
90
60
70
90
55
45
70
60
50
75
70
60
90
90
90
90
90
90
90
90
90
90
90
75
90
90
90
90
90
90
90
90
90
90
90
75
90
50
45
70
40
30
50
45
40
60
50
45
70
75
60
90
90
90
90
90
75
90
70
55
90
75
70
90
90
75
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
90
Klim 116
Sunbathes in high altitudes 1300 to 1700
m
in minutes
Monat
März
Schnee
April
Schnee
April
kein
Schnee
Mai
Juni
Juli
August
Septem.
Tageszeit
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
Vormittags
11-14 Uhr
Nachmittags
wolkenlos
teilweise bewölkt
1. Bad
3. Bad
5. Bad
1. Bad
3. Bad
5. Bad
50
40
60
25
20
30
35
30
45
25
20
30
30
25
40
25
20
30
35
30
45
90
70
90
45
35
55
60
50
75
45
35
55
55
45
70
45
35
50
60
55
75
90
90
90
75
60
90
90
90
90
75
60
90
90
75
90
75
60
90
90
90
90
60
50
75
30
25
40
45
40
60
30
25
40
40
30
50
30
25
40
45
40
60
90
90
90
55
45
70
75
70
90
55
45
70
70
55
90
50
45
70
75
70
90
90
90
90
90
75
90
90
90
90
90
75
90
90
90
90
90
75
90
90
90
90
Klim 117
Relative MED and geographic latitude
nach Piazena
Columbia
Klim 118
Indications in Heliotherapy
by supportive treatment of skin diseases
Pruritic dermatoses
Chronic relapsed urticaria
Atopic constitutional neurodermitis
Psoriasis arthropatica
Vitiligo
Klim 119
Effects of visible light
Dynamisation
Increase of performance
Mood improvement
Klim 120
Photo-Sole-Therapy I
 Indications
• Psoriasis
• Ichthyosis
 10-15 minutes bath in high concentrated brine or sea
water
 Irradiation by suberythemale dose daily
• SUP-radiator (300-320 nm) (UV-B)
• Sun
Klim 121
Photo-Sole-Therapy II
 Indications
• Atopic constitutional neurodermitis
 10-15 minutes bath first in 1% brine or more if tolerable
 Irradiation daily by
• High performance-UV-A-radiator
• Sun
Klim 122
Indications
in red-light- or Infrared-therapy








Moisten eczema
Dermatitides
Sinusitides
Hordeolum (sty)
Furuncle
chronic-inflammatory rheumatic diseases in non-acute stage
degenerative diseases of the spine and extremity
Soft tissue rheumatic diseases
Klim 123
Contraindications in case of
overheating
 Disturbance of sensibility
 Congestive cardiac insufficiency
 Strong disturbance of cardiac rhythm
 Acute situation post myocardial infarct
 Hormonal disorders in diabetes mellitus, hyperthyroidism,
adrenal cortex insufficiency
 Advanced vascular disturbance
Klim 124
Light protection
 Most of light protection agents absorb mainly UV-B.
 In this case by use of light protection agents the result is a stronger
irradiation by UV-A, because no warning erythema is developed.
 Endogenous light protection is mainly resulted by increase of horny
layer thickness. A small part of endogenous light protection is related to
the amino acids and urocanic acid in the horny layer. Melanin is
protecting, if it is deposit in the horny layer of some races or skin types.
 Light adaptation by protract and fractionated irradiation lower than the
MED can be recommended.
Klim 125
Light protection factor
Protection time =
Endogenous protection time x Light protection factor
Light callosity:
Pigmentation:
Adaptation:
light protection factor 4
light protection factor 10
till light protection factor 40
Klim 126
Photo-allergy
Sulphonamide
Psychopharmaca
Antihistaminica
Antimycotica
Phenothiazine
Desodorantia
Optic clearing agents in
laundry
Sweetening agents
Photo-allergic reaction
latency of 7-21 days.
Klim 127
Photo-toxicity
Contamination in
Vaseline and face
cosmetics
Acridine dyes
Trypaflavin
Eosin in lip sticks
Gras-dermatitis
Bergamot oil (eau de
cologne) Berloquedermatitis
Photo-toxic reactions no latency.
Klim 128
relative Empfindlichkeit
Light sensitivity in Porphyry
300
400
500
600
nm
Klim 129
Contraindications of
Phototherapy
Light-dermatosis (photo-toxic, photo-allergic,
photosensitization, photo-anaphylactic, photobiotrophic reactions)
Exsudative or open Tbc
Hyperthyreosis
Ulcus ventriculi and duodeni
Klim 130
Unsuitable is the
UV-irradiation by
Decompensation situation of the
circulation system
Acute nephritis
Cachexia
Haemophilia
Strong menstrual bleeding
X-ray-dermatitis
Klim 131
Risks in case of exacerbation
Psoriasis in stadium of outbreak
Lichen ruber planus
Pityriasis rosea
Porphyry
Klim 132
Risks
Oncological risk in therapeutic use is insignificant.
Change in connective tissue, development of folds and
basaloma in radiated skin areas are the result of excessive
and unnecessary use of solaria in cosmetic interest or sun
exposition during long life of special occupation groups.
Melanoma are to find up to 75% as late lesion on not
irradiated areas especially as follow up of strong light
inflammations during the childhood.
Mortality in Germany is 0,2 cases per 10000 inhabitants.
Klim 133
Benefit and Disadvantage of the
UV-radiation
 Disadvantage
Deficiency disease by underdosage
 Benefit
Dietetic use by normal dosage
Preventive use in actual deficiency diseases
Stimulation by short overdosage
Use in therapeutic treatment by special dosage (skin diseases)
 Disadvantage
Toxic skin reactions by overdosage
Klim 134
“Sunbalance” by Greiter
Benefits
Essential Photosynthesis (Vegetation and oxygen)
Seeing and hormonal control
Vitamin D-synthesis and development of a functional skeleton and protection against
rickets
Killing of bacteria
Heat
Healing of diseases
Activation of the human organism
Improved performance economy
Improved protection of the organism by increased melanin synthesis and increased
thickness of the horny layer.
Klim 135
“Sunbalance” by Greiter
Disadvantage
Sunburn
Premature skin ageing
Skin cancer
Phototoxic or photoallergic effects
Klim 136
Conclusion
Clime- and Heliotherapy are stimulation treatments.
Result is the reactivation of already present selfhealing power.
Patients could be independent by use of pharmaca.
Clime- and Heliotherapy are typical naturopathic
treatments.
Klim 137
Literature
 Phototherapie von S. Chlebarov und H.G. Pratzel im “Lehrbuch der
Physikalischen Medizin und Rehabilitation”. Hrsg. von K.L.Schmidt,
H. Drexel, K.-A.Jochheim im G. Fischer Verlag, Heidelberg, 1995
(ISBN 3-437-00797-1)
 Klimatherapie: ebenda Artikel von W. Schmidt-Kessen und mehrere
Artikel versch. Autoren in “Heilbad und Kurort. 48. Jahrgang, Heft 3
1996.”
 Elektroklima: P. Kröling: Übersichtsartikel in “Die Heilkunst 7/92, S.
241-250”
Klim 138