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Thermalism in Argentina
Alternative or Complementary Dermatologic Therapy
Javier Ubogui, MD;
Fernando M. Stengel, MD;
María C. Kien, MD;
Luis Sevinsky, MD;
Liliana Rodríguez Lupo, MD
Arch Dermatol. 1998;134:1411-1412.
ABSTRACT
Our study took place in the region of the Copahue Volcano in the Andes Mountain range, 1900 m above sea level. Fifty-five patients who came to the Copahue Thermal Basin Complex (Neuquén, Argentina) for treatment of psoriasis vulgaris were clinically evaluated for participation in this study. Thermal products—waters, mud, and/or algae—were the only therapeutic agents used, except for bland emollients for xerosis. Treatment for brief periods (10 ± 3 days) resulted in notable improvement.
INTRODUCTION
Dermatologic thermalism—the therapeutic use of hot-water springs and their products (muds and algae)—offers an effective, natural, multifactorial, complementary, and nontoxic alternative to traditional treatment of psoriasis. Good results have also been described when thermalism was used as a single or adjuvant therapy for eczema, acne, and chronic skin ulcers.1-2
PATIENTS AND METHODS
Fifty-five (31 men, 24 women) of 236 patients with psoriasis who spontaneously visited the Copahue Thermal Basin Complex (Neuquén, Argentina) during the 1987-1988 to 1990-1991 summer seasons (November through April) were evaluated for inclusion in our study. Inclusion criteria for subjects comprised moderate or severe lesions and an intention to stay at the complex for at least 7 days (average, 10 ± 3 days); all subjects accepted the therapeutic protocol and the 3 control visits; and no subject had had topical and/or systemic therapy for psoriasis in the 6 previous weeks.
The study protocol included 3 objective medical assessments—at day 0, at day 5, and on the day of discharge (day 10 ± 3 days)—and 1 subjective assessment, ie, patient opinion at discharge. Objective criteria were scaling, erythema, and thickness; designations for evaluation of these criteria were worse, no change, mild improvement, improvement, and marked improvement. Surface extension was not evaluated because no change was expected with such a short course of treatment.
Thermal therapy comprised 2 daily baths, one with thermal water (algae-rich "Green Lagoon" with volcanic water) (Table 1) and the other with mud and/or algae from the sulfurous lagoons. Sunbathing in Copahue was curtailed because of weather conditions; protocol patients did not sunbathe. In 23 patients, pretherapy and posttherapy punch biopsies were performed.
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Copahue Volcano Water Chemical Analysis*
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The antimicrobial properties of the Copahue volcanic water were investigated with 64 nosocomial strains. In the control Petri dish, pure medium was used (trypticase soy broth agar). Three other Petri dishes were prepared with 20% unmodified volcanic water, 20% alkalized (NaOH 3N) volcanic water, and 20% acidified (HCl 0,01N) distilled water (pH 1), respectively.
RESULTS
On day 5, all subjects showed improvement in scaling and worsening in erythema. On day 10, there was marked improvement in erythema, xerosis, and scaling. Two subjects developed new guttate lesions, and 8 exhibited a few residual macules.
Results of the objective assessments of the subjects at 10 ± 3 days revealed marked improvement in 11 subjects, improvement in 29, and mild improvement in 15. In the subjective assessments, 20 subjects felt there was marked improvement; 21, improvement; and 14, mild improvement.
In the results of 10 of the 23 biopsies, the following histological changes were noted: (1) marked decrease of the parakeratotic corneal layer associated with orthokeratotic hyperkeratosis, increase of the granular layer, and epidermal thinning with irregularity of the rete ridges; (2) minimal reduction in the size and diameter of the dermal vessels; and (3) slight decrease of the dermal infiltrate.
The Petri dish with 20% volcanic water showed no bacterial growth. The other 3 dishes yielded positive results for organisms. Thus, the pH factor was not responsible for the antibacterial effects.
COMMENT
According to most authors, effective thermal treatments must last 3 to 4 weeks, and in Argentina, high costs can prevent such lengthy stays. Nonetheless, the use of mineral waters and associated products from their natural environment for the treatment of skin diseases, popularized by the Dead Sea experience,3-5 dates back in dermatologic reports from Copahue to 1938.6-7 The mode of action of thermalism still requires investigation, but its principle depends on the integrated actionof 2 natural systems: the microecosystem, ie, thermal products per se (water, muds, algae), and the macroecosystem, ie, the natural volcanic environment (scenery, climate, calmness).
The various minerals (salts) and trace elements present in the sulfur-rich waters and mud found at Copahue give to them strongly keratolytic, moderately antimicrobial, and mildly anti-inflammatory and immunomodulatory properties. Different types of algae release active antimicrobials and natural healing components such as calcium alginate and steroidal compounds.1, 8-9 If microorganisms play a role in psoriasis, these components may play a substantial role in healing, acting either directly on the skin microflora or on eventual upper airway–polluting foci.10 Work from Pescara, Italy, suggests that in immune-mediated conditions, sulfur products may have anti-inflammatory effects on the epithelium.11
CONCLUSIONS
In patients with psoriasis vulgaris, brief thermal treatments led to improvement. In thermalism, dose implies time, number of exposures, and frequency, and when therapy is extended (4 weeks), our own as-yet unpublished observations indicate that better results can be expected.
Thermalism expands the therapeutic armamentarium and complements or potentiates the action of other therapies for psoriasis (eg, mud baths plus psoralen–UV-A). It is an effective, natural, multifactorial, complementary, and nontoxic alternative to traditional management of psoriasis, and it deserves a place in dermatologic therapy and research.
AUTHOR INFORMATION
Accepted for publication September 3, 1998.
Corresponding author: Javier Ubogui, MD, Bulnes 1937, 3° A, 1425 Buenos Aires, Argentina (phone/fax (54-1) 823-8755).
From Hospital Diego Thompson and Academia Nacional de Medicina (Dr Ubogui), Hospital CEMIC (Dr Stengel), Hospital Argerich (Dr Kien), Hospital Jose de San Martin, Buenos Aires University (Dr Sevinsky), Buenos Aires, Argentina, and Hospital Neuquén (Dr Lupo), Neuquén, Argentina.
REFERENCES
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1. Ubogui J, Ficoseco H. Ulceras por decúbito e hidroterapia en las termas de Copahue. Arch Argent Dermatol. 1990;40:393-399.
2. Ubogui J, Rodríguez Lupo L, Ficoseco H, Kien C, Sevinsky L, Stengel F. Terapéutica no convencional de la psoriasis en las termas de Copahue (Neuquén, Argentina): experiencia preliminar. Arch Argent Dermatol. 1991; 41:25-39.
3. Abels DJ, Byron J. Psoriasis treatment at the Dead Sea: a natural selective ultraviolet therapy. J Am Acad Dermatol. 1985;12:639-643.
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4. Abels DJ, Rose T, Bearman JE. Treatment of psoriasis at a Dead Sea dermatology clinic. Int J Dermatol. 1985;34:134-137.
5. Harari M, Shani J. Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea. Int J Dermatol. 1997;36:304-308.
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6. Alvarez G. Contribución al estudio de las termas de Copahue (Neuquén), en sus aplicaciones dermatológicas. Bol Asoc Med Argent. 1938;4:220.
7. Gunche F, Castillo M. Balneoterapia Preparada y Aguas Minerales Argentinas en Dermatología. Buenos Aires, Argentina: Ed Sophos; 1960.
8. Accorinti J, Squadrone M, Wenzel M, Perez A. Valoración de las propiedades antimicrobianas del agua del volcán Copahue (Neuquén, Argentina). Arch Argent Dermatol. 1991;41:229-237.
9. Squadrone M. Acción del agua del volcán Copahue (Neuquén, Argentina) sobre las micobacterias. Arch Argent Dermatol. 1992;42:97-108.
10. Noah WP. The role of microorganisms in psoriasis. Semin Dermatol. 1990;9:269-276.
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11. Valitutti S, Castellino F, Musiano P. Effect of sulfurous (thermal) water on T lymphocyte proliferative response. Ann Allergy. 1990;65:463-467.
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