Transcript The Benefit of Dead Sea Elements in the Treatment of Psoriasis

The Benefit of Dead Sea
Elements in the Treatment of
Psoriasis
Jamal Dabbas M.D.
Walid Y. Farah M.D.
Amman - Jordan
Dead Sea
 Fed by the holly river ( Jordan River )
 Bounded on the west by the West Bank and
Israel and on the east by Jordan.
 The surface of the Dead Sea, 408 m (1,340 ft)
below sea level, it is the lowest water surface on
earth.
 55 km long by 17.5 km.
 Moab mountains on the east and Palestinean –
Israeli mountains on the west.
History
 Historical figures and beauty seekers like
Cleopatra and king Herod recognized the
natural secret of using the dead sea as the most
potent natural skin remedy for the skin.
 The modern era for treating skin diseases at the
Dead Sea began in 1959 with psoriasis being
the principal dermatological disease treated
 The Dead Sea is a vehicle of minerals and
chemicals including Sulfur, Chlorine, Potassium,
Sodium, Calcium, Magnesium and Bromine.
 Over millions of years, the hot dry air and high
evaporation rate have contributed to the high salt
concentration present in the Dead Sea, making it
one of the saltiest lakes in the world.
 The water, ten times saltier than the
Mediterranean Sea, has such a high specific
weight that one can float effortlessly with no fear of
drowning.
Physical Properties
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Temperature 27°C -39°C.
Humidity 34%
Rainfall 50mm per year.
Very high barometeric pressure – 10%
richer in oxygen
 Atomosphere pollen free and contains a
high concentration of Bromide.
Physical Properties contd.
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UV light
UVA > UVB
Aerosol haze
High degree of buoyancy
Dead Sea Salts
Differ from regular sea salt in 3 important ways :
1.Contain 10 times more minerals than sea salt.
2. Absorb essential oils with ease, which enables
them to be released into the bath water as they
dissolve.
3. Concentration of divalent cations ( Mg & Ca ) is
very high compared with monovalent cations
(Na & K )
Comparison of Salt Concentration
mg/Liter
Dead Sea
Water
Mediteranian
Water
Ocean
Water
Chloride
224.000
22.900
19.000
Magnesium
44.000
1.490
1.350
Sodium
40.100
12.700
10.500
Calcium
17.200
470
400
Potassium
7.650
470
390
Bromide
5.300
76
65
 In recent years there is much interest in
dead sea therapy of variety of
dermatological and systemic diseases and
has been used in Jordan .
 Health resort area, providing Dead Sea
therapy, is located a long the eastern shore
of the dead sea at the southern end of the
Jordan river
 Studies curried out at the Dead Sea have
showed positive results in lengthening the
duration of remission and has been
recommended as an alternative treatment
for psoriasis. The studies have included
both exposure to the environment and
subdue UV rays at Dead Sea itself together
with application of Dead Sea mud and
soaking in mineral paths.
Dead Sea Mud in the Treatment of
Psoriasis
Dr. Jamal Dabbas
Dr. Jalal Zubi
Dr. Jeries Daoud
Dr. Walid Farah
Introduction
 Psoriasis represent the largest group of skin
disease patients treated at the Dead Sea
which have been investigated.
 In our study therapy used at home and not
at the Dead Sea.
Methods and Materials
 March – August 1998.
 Patients treated in dermatology clinics
outside the Dead Sea above the sea level in
Jordan.
 120 patients of psoriasis.
 Two groups 60 patients each.
 First group assigned to use Dead Sea Mud.
 Second group to use wash out mud ( False
mud).
Comparison of major ingredients of
true mud and washed out mud
Ingredients
True mud (mg/L) False mud (mg/L)
Ca
23556
64.5
Na
31727
81.2
K
6841
56.3
Cl
190000
1100
Mg
32493
105.1
Total Scaling
284598
1397.0
Methods and Materials
 Age 14 – 61 years.
 All in good health apart from psoriasis.
 2 pts in true mud group and 4 pts in false
mud group lost follow up .. Daily activities.
 There were no significant difference in
demographic and epidemiological variables
for the 2 groups
Demographic Data
Parameter
Age (years)
Sex
Race
Mean
True mud
(n=58)
34
False mud
(n=56)
31
Range
16 - 61
14 – 58
Male
34
33
Female
24
23
White
54
53
Black
4
3
Target Area
Target Area
Chest
True mud
(n=58)
0
False mud
(n=56)
0
Abdomen
2
2
Buttocks
3
4
Back
4
3
Upper limbs
12
7
Lower limbs
20
21
Elbow
14
12
Knee
3
7
Disease status and duration
Disease
status at
entry
Disease
duration
(yrs)
True mud
(n=58)
False mud
(n=56)
Stable
38
35
Worsening
20
21
Mean
6.3
7.1
Materials and Methods
 Three signs of psoriasis
Erythema
Induration
Scaling
 Four sign scores for disease severity
0 = none
1 = slight
2 = moderate
3 = severe
Excluded individuals
 Systemic steroids within 28 days
 Antimetabolites within 28 days
 Topical therapies for psoriasis within 14
days
 Any investigational drugs within 1 month
Application
Apply the mud to treatment areas
twice daily for 1 hour each for a
total of three weeks , occlusive
dressing may be used when
appropriate.
Follow Up
Patients returned for evaluation of
their response to treatment after 3
, 7 , 14 and 21 days of drug
application ( study days 4 , 8 , 15
and 22 )
Criteria for Evaluation
 Cleared = 100% clearance of signs
(except for residual discoloration)
 Marked improvement = 75 – 99%
clearance of signs.
 Moderate improvement = 50 - < 74%
clearance of signs.
 Mild improvement = < 50% clearance of
signs
 No change = no detectable improvement
 Exacerbation = flare of sites monitored
Patients Self evaluation
 1 = Excellent
 2 = Good
 3 = Fair
 4 = Poor
 5 = No response
 6 = Exacerbation
Efficacy of Treatement
Based on individual and total
disease sign scores, the percent
improvement in sign scores, the
global evaluation of change in
disease status and the patient self
– evaluation of their response to
treatment .
Safety of Treatment
Assessed by examination of
patients at each visit for
local side effects if any.
Visit
Rx
Pts #
0
M
P
M
P
M
P
M
P
M
P
58
56
58
56
58
56
58
56
58
56
Day
4
Day
8
Day
15
Day
21
Mean sign scores MTSS
Eryth Scal. Indur.
1.9
2.1
1.9
5.9
1.85 2.15
1.8
5.8
2.0
2.0
1.9
5.9
1.9
2.1
1.8
5.8
1.7
1.7
1.8
5.2
1.9
2.1
1.9
5.9
1.6
1.3
1.6
4.5
1.8
2.0
2.1
5.9
1.6
1.1
1.3
4.0
1.6
2.0
2.1
5.7
Mean Pt. Self Evaluation ( Mean Score )
Visit
Day 4
True Mud
( n=58 )
4.05
False Mud
( n=56 )
4.0
Day 8
3.0
3.95
Day 15
2.95
3.95
Day 22
3.05
4.0
Conclusion
 Dead Sea mud applied twice daily for 3
weeks was efficacious in the treatment of
psoriasis of variable severity.
 Much more effective than placebo.
 Rapid onset of action as 1 week of therapy.
 Exact mechanisms deserve further efforts…
Mechanical ? Thermal ? Chemical ????
Conclusion
Within the limitations of this study, Dead Sea
mud when applied over a 3 weeks treatment
period, may be be described
SAFE
RAPID
FAIRLY EFFICACIOUS
In the treatment of psoriasis.