Effects of Rusanda Spa Balneotherapy Combined with Calcipotriol on Plaque Psoriasis

Zoran Golušin; Marina Jovanović; Nataša Magda; Slobodan Stojanović; Milan Matić; Aleksandra Petrović

doi:10.2298/4407

Zoran Golušin Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia
Marina Jovanović Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia
Nataša Magda Special Hospital for Physical Medicine and Rehabilitation ''Rusanda'', Melenci, Serbia
Slobodan Stojanović Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia
Milan Matić Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia
Aleksandra Petrović Clinical Center of Vojvodina, Clinic of Dermatovenereology Diseases, Novi Sad, Serbia

DOI: https://doi.org/10.2298/4407

Abstract

Introduction: Treatment of psoriasis is very complex and universally or uniquely effective treatment modalities are still being explored. Apart from conventional treatment, which includes topical calcipotriol (vitamin D3 analogue), balneotherapy is receiving increased attention worldwide. Being part of climatotherapy, balneotherapy is defined as the use of natural environmental factors in the treatment of health conditions, whereas in the treatment of psoriasis it means use of mineral baths and peloids.

Aim: The aim of this study was to examine therapeutic efficacy of mineral waters and peloids of the Rusanda Spa on plaque psoriasis in patients also treated with calcipotriol.

Methods: The study included 60 patients divided into two groups. The first group included patients treated with mineral waters, peloids and calcipotriol in the Rusanda Spa, while the second group included outpatients treated only with calcipotriol. The study lasted 21 days, and each patient was followed up for at least one month after ending the treatment. The treatment efficacy was measured by PASI scores on days 0, 7, 14, 21 and on 30^th day after the end of therapy.

Results: After thee weeks of treatment in the Rusanda Spa, the first group showed a decrease in PASI score by 59.45%, whereas in the group of outpatients treated by calcipotriol it was 39.34%. On the 30^th day following treatment, the first group presented with a PASI score reduction of 58.44%, and the second group of 34.78%. The therapeutic efficacy of mineral waters and peloids combined with calcipotriol showed to be significantly higher in regard to monotherapy with calcipotriol (p<0,05). In regard to clinical symptoms, the best results were obtained in reduction of desquamation (p<0,001).

Conclusion: The results of our study show that balneotherapy in the Rusanda Spa combined with calcipotriol is a safe and effective therapeutic modality in the treatment of plaque psoriasis.

References

Grozev I, Kazandjeva J, Tsankov N. Alternative treatment of psoriasis - is rifampicin a mild immunosupressor. Serb J Dermatol Venereol 2010;2(1):5-12.

Karadaglić Dj, Brkić S. Palmoplantar pustulosis – is there any progress in the treatment. Serb J Dermatol Venereol 2011;3 (3) : in press

Morimoto S, Kumahara Y. Patient with psoriasis cured by 1 alpha-hydroxyvitamin D3. Med J Osaka Univ 1985; 35: 51-4.

Reichrath J, Muller SM, Kerber A, Baum HP, Bahmer FA. Biologic effects of topical calcipotriol (MC 903) treatment in psoriatic skin. J Am Acad Dermatol 1997; 36: 19-28.

J.M. Carrascosa, F. Vanacloch, L. Borrego, E. Fernández-López, A. Fuertes, L. Rodríguez-Fernández-Freire et al. Update of the Topical Treatment of psoriasis. Actas Dermosifiliogr 2009;100:190-200

Dučić-Ugrinović D, Dostanić I, Karadaglić Đ. Psorijaza. U: Karadaglić Đ. Dermatologija. Beograd: Vojnoizdavački zavod; 2000. pp. 391-420.

Kazandjieva J, Grozdev I, Darlenski R, Tsankov N. Climatotherapy of psoriasis. Clinics in Dermatol 2008; 26: 477-85.

Merial-Kieny C, Mengual X, Guerrero D, Sibaud V. Cical efficacy of Avene hydrotherapy measured in a large cohort of more than 10,000 atopic or psoriatic patients. J Eur Acad Dermatol Venereol 2011; 25(1): 30-4.

Ghersetich I, Freedman D, Lotti T. Balneology today. Eur J Dermatol 2000; 14: 426-8.

Ubogui J, Stengel FM, Kien MC, Sevinsky L, Rodriguez-Lupo L. Thermalism in Argentina. Arch Dermatol 1998; 134(11): 1411-2.

Abels DJ, Rose T, Bearman JE. Treatment of psoriasis at the Dead Sea dermatological clinic. Int J Dermatol 1995; 34: 134-7.

Fredriksson T, Pettersson U. Severe psoriasis—oral therapy with a new retinoid. Dermatologica 1978;157:238-44.

Puzenat E, Bronsard V, Prey S, Gourraud PA, Aractingi S, Bagot M, et al. What are the best outcome measures for assessing plaque psoriasis severity? A systematic review of the literature. J Eur Acad Dermatol Venereol 2010;24(l):10-6.

Naldi L. Scoring and monitoring the severity of psoriasis. What is the preferred method? What is the ideal method? Is PASI passé? facts and controversies Clin Dermatol 2010;28(1):67-72

Joly F, Charveron M, Aries MF, Bidault J, Kahhak L, Beauvais F. Effect of Avene spring water on the activation of rat mast cell by substance P or antigen. Skin Pharamacol 1998;11:111-6.

Merial-Kieny C, Castex-Rizzi N, Selas B, Mery S, Guerrero D. Avene Thermal Spring Water: an active component with specific properties. J Eur Acad Dermatol Venereol 2011; 25(1): 2-5.

Paravina M, Stepanović M, Racić G. Balneotherapy effectively acts on symptoms of psoriasis vulgaris. Central Eastern Europian Dermato Venereological Association (CEDVA) Bulletin. 2002;4:70-2.

Tsankov NK, Kamarashev J. Spa therapy in Bulgaria. Clinics in Dermatol 1996;14:675-8.

Shani J, Harari M, Hristakieva E, Seidl V, Bar-Giyora J. Dead-Sea climatotherapy versus other modalities of treatment for psoriasi:comparative cost-effectiveness. Int J Dermatol 1999;38:252-62.

Schiffner R, Schiffner-Rohe J, Wolfl G, Landthaler M, Glabl A, Walther TH et al. Evaluation of a multicentre study of synchronous application of narrawband ultraviolet B phototherapy (TL-01) and bathing in Dead Sea salt solution for psoriasis vulgaris. Br J Dermatol 2000;142:740-7.

Kiriakova N, Etugov D, Popov J, Kazandjieva J. Thaalassotherapy of psoriatic patients in Bulgaria. Central Eastern Europian Dermato Venereological Association (CEDVA) Bulletin. 2002;4:67-9.

Gambichler T, Terras S, Skrygan M. TGFβ/Smad signalling in psoriatic epidermis models exposed to salt water soaks and narrowband ultraviolet B radiation. Cytokine 2013;64(1):35-8.

Brockow T, Schiener R, Franke A, Resch KL, Peter RU. A pragmatic randomized controlled trial on the effectiveness of low concentrated saline spa water baths followed by ultraviolet B (UVB) compared to UVB only in moderate to severe psoriasis. J Eur Acad Dermatol Venereol 2007;21(8):1027-37.

Brockow T1, Schiener R, Franke A, Resch KL, Peter RU. A pragmatic randomized controlled trial on the effectiveness of highly concentrated saline spa water baths followed by UVB compared to UVB only in moderate to severe psoriasis. J Altern Complement Med 2007;13(7):725-32.

Gambichler T, Rapp S, Senger E, Altmeyer P, Hoffmann K. Balneophototherapy of psoriasis: highly concentrated salt water versus tap water--a randomized, one-blind, right/left comparative study. Photodermatol Photoimmunol Photomed. 2001;17(1):22-5.

Schiener R, Brockow T, Franke A, Salzer B, Peter RU, Resch KL. Bath PUVA and saltwater baths followed by UV-B phototherapy as treatments for psoriasis: a randomized controlled trial. Arch Dermatol 2007;143(5):586-96.

Gambichler T, Terras S, Skrygan M. Cyclooxygenase 2 expression and apoptosis in normal and psoriatic epidermis models exposed to salt water soaks and narrowband ultraviolet B radiation. J Eur Acad Dermatol Venereol. 2013;Dec 16. doi: 10.1111/jdv.12345. (Epub ahead of print)

Reichrath J, Muller SM, Kerber A, Baum HP, Bahmer FA. Biologic effects of topical calcipotriol (MC 903) treatment in psoriatic skin. J Am Acad Dermatol 1997;36:19-28.

van Rossum MM, van Erp PEJ, van de Kerkhof PCM. Treatment of psoriasis with a new combination of calcipotriol and betamethasone dipropionate: a flow cytometric study. Dermatology 2001;203(2):148-52.

Highton A, Quell J. Calcipotriene ointment 0,005% for psoriasis: A safety and efficacy study. J Am Acad Dermatol 1995;32:67-72.

Tham SN, Lun KC, Cheong WK. A comparative study of calcipotriol ointment and tar in chronic plaque psoriasis. Br J Dermatol 1994;131:673-7.

Papp KA, Guenther L, Boyden B, Larsen FG, Harvima R, Guilhou J et al. Early onset of action and efficacy of a combination of calcipotriene and betamethasone dipropionate in the treatment of psoriasis. J Am Acad Dermatol 2003;48:48-54.

Sharma V, Kaur I, Kumar B. Calcipotriol versus coal tar:a prospective randomized study in stable plaque psoriasis. Int J Dermatol 2003;42:834-8.

Lebwohl M, Menter A, Koo J, Feldman SR. Combination therapy to treat moderate to severe psoriasis. J Am Acad Dermatol 2004;50:416-30.

Kragballe K, Noerrelund KL, Lui H, Ortonne P, Wozel G, Uurasmaa T et al. Efficacy of once daily treatment regimens with calcipotriol/betamethasone dipropionate ointment and calcipotriol ointment in psoriasis vulgaris. Br J Dermatol 2004;150:1167-73.

Kaufmann R, Bibby AJ, Bissonnette R. A new calcipotriol/betamethasone diprpionate formulation (Daivobet) is an effective once daily treatment for psoriasis vulgaris. Dermatology 2002;205(4):389-93.

Guenther L, Cambazard F, van de Kerkhof PC. Efficacy and safety of a new combination of calcipotriol and betamethasone dipropionate (once or twice daily) compared to calciotriol (twice daily) in the treatment of psoriasis vulgaris: a randomized, double-blind, vehicle-controlled clinical trial. Br J Dermatol 200;:147(2):316-23.