Marco Harari

Safety of solar phototherapy at the Dead Sea

BACKGROUND Climatotherapy at the Dead Sea is effective for patients with psoriasis, atopic dermatitis, vitiligo, and other diseases. Although impressive improvement has been reported for patients with psoriasis, with a clearance rate of more than 80% after a 4-week stay, questions regarding the safety of this treatment have arisen. OBJECTIVE AND METHODS We compare the mean UVB radiation intensities absorbed by psoriatic patients undergoing a 4-week climatotherapy under supervision at the DMZ Rehabilitation Clinic of Ein-Bokek (The Dead Sea, Israel), with similar climatotherapy studies in Sweden and Switzerland. We also compare the climatotherapy radiation dosages with the UVB intensities absorbed by psoriatic patients in radiation cabins at seven university clinics. RESULTS According to our individually computerized DMZ protocol, a psoriasis patient with skin type IV is exposed during a 4-week climatotherapy to a mean 3.11 J/cm2 (148 MED) of UVB, similar to that in Sweden and Switzerland. The range of the in-clinic annual phototherapy in the seven medical centers studied varied from 1.17 to 37.80 J/cm2 (56 to 1800 MED). CONCLUSION When all relevant factors are taken into account, the mean UVB exposure dose at the Dead Sea is one of the lowest reported for clearance of psoriatic plaques.

Ultraviolet radiation properties as applied to photoclimatherapy at the Dead Sea

Background The Dead Sea basin, the lowest terrestrial point on earth, is recognized as a natural treatment center for patients with various cutaneous and rheumatic diseases. Psoriasis is the major skin disease treated at the Dead Sea with excellent improvement to complete clearance exceeding 85% after 4 weeks of treatment. These results were postulated to be associated with a unique spectrum of ultraviolet radiation present in the Dead Sea area.

Demographic evaluation of successful antipsoriatic climatotherapy at the Dead Sea (Israel) DMZ Clinic

Background Natural balneologic properties, thermomineral springs and unequivocal success in improving psoriasis, attract an ever‐growing number of psoriatlcs to the DMZ Clinic on the shores of the Dead Sea in Israel.

Clinical evaluation of a more rapid and sensitive Psoriasis Assessment Severity Score (PASS), and its comparison with the classic method of Psoriasis Area and Severity Index (PASI), before and after climatotherapy at the Dead-Sea

Abstract

Climatotherapy of atopic dermatitis at the Dead Sea : demographic evaluation and cost-effectiveness

Background About 21% of the patients coming yearly to the DMZ Clinic at the Dead Sea for climatotherapy suffer from atopic dermatitis. This is a common, chronic, and relapsing disease which necessitates drug treatment (topical corticosteroids, antimicrobials, antihistamines, or immunomodulators), phototherapy, or climatotherapy.

Climatotherapy at the Dead Sea: an effective treatment modality for atopic dermatitis with significant positive impact on quality of life.

BackgroundAtopic dermatitis (AD) has an appreciable effect on quality of life. Improving the quality of life of AD patients is a priority. ObjectiveThis study aimed to evaluate the impact of Dead Sea climatotherapy (DSC) as a treatment of AD and its influence on the quality of life of these patients. MethodsForty-nine adult patients with AD treated during the years 2009–2010 at the Deutsches Medizinisches Zentrum Medical Center participated in this prospective study. Climatotherapy was administered in accordance with a computer-designed protocol and included gradually increased sun exposure after a sea bath. Severity of AD was evaluated using the Scoring Atopic Dermatitis (SCORAD) index. Patient quality of life was evaluated using Skindex-29. Statistical analysis was performed using a paired t test and Wilcoxon and Mann-Whitney U tests. ResultsAfter treatment, the mean SCORAD value improved by 39 points (P < 0.001). The overall Skindex-29 score improved by a mean value of 33 points (P < 0.001). The pretreatment SCORAD, duration of AD, and maximal daily sun exposure predicted the posttreatment SCORAD values. Pretreatment Skindex-29 and patient age predicted the posttreatment Skindex-29 in a multiple linear regression model. ConclusionsDead Sea climatotherapy provides an effective treatment modality for AD by improving the patient’s skin condition and quality of life.

Sustained decrease of blood pressure in psoriatic patients during treatment at the Dead Sea

The diastolic and systolic blood pressure of 1366 psoriatic patients, treated at the Dead Sea for a period of 4 weeks, was monitored from the day following their arrival. The patients were divided into three categories: (a) psoriatics on antihypertensive medication; (b) psoriatics not receiving antihypertensive medication, but whose initial diastolic blood pressure equaled or exceeded 90 mmHg, and (c) psoriatics with normal blood pressure (diastolic pressure lower than 90 mmHg). A paired t-test revealed that the systolic blood pressure of the two hypertensive groups (a and b) dropped by an average of 22 mmHg, and the diastolic blood pressure dropped by 11 and 16 mmHg, respectively. The drop was evident 2 days after their arrival, and leveled off only after 2 weeks. A similar drop in systolic blood pressure was observed in normotensive psoriatics. On the basis of this study it may be concluded that high blood pressure is not a contraindication for the treatment of psoriasis at the Dead Sea.

The measurement and analysis of normal incidence solar UVB radiation and its application to the photoclimatherapy protocol for psoriasis at the Dead Sea, Israel.

The broad‐band normal incidence UVB beam radiation has been measured at Neve Zohar, Dead Sea basin, using a prototype tracking instrument composed of a Model 501A UV‐Biometer mounted on an Eppley Solar Tracker Model St‐1. The diffuse and beam fraction of the solar global UVB radiation have been determined using the concurrently measured solar global UVB radiation. The diffuse fraction was observed to exceed 80% throughout the year. The application of the results of these measurements to the possible revision of the photoclimatherapy protocol for psoriasis patients at the Dead Sea medical spas is now under investigation. The suggested revision would enable the sun‐exposure treatment protocol to take advantage of the very high diffuse fraction by allowing the patient to receive the daily dose of UVB radiation without direct exposure to the sun, viz. receive the diffuse UVB radiation under a sunshade. This would require an increase in sun‐exposure time intervals, as the UVB radiation intensity beneath a sunshade is less than that on an exposed surface.

The solar ultraviolet B radiation protection provided by shading devices with regard to its diffuse component

Background: The composition of the incident solar global ultraviolet B (UVB) radiation with regard to its beam and diffuse radiation fractions is highly relevant with regard to outdoor sun protection. This is especially true with respect to sun protection during leisure‐time outdoor sun exposure at the shore and pools, where people tend to escape the sun under shade trees or different types of shading devices, e.g., umbrellas, overhangs, etc., believing they offer protection from the erythemal solar radiation. The degree of sun protection offered by such devices is directly related to the composition of the solar global UVB radiation, i.e., its beam and diffuse fractions.

Dead Sea ultraviolet climatotherapy for children with atopic dermatitis.

Atopic dermatitis (AD) is a common, chronic, and relapsing inflammatory skin disorder. Moderate to severe cases represent an extremely disabling disease, for both children and their parents. Dead Sea climatotherapy (DSC), recognized as a natural treatment for patients with skin diseases, takes advantage of the selectively scattered ultraviolet irradiation (UV) present at the lowest terrestrial site on the earth.