Balneotherapy using thermal mineral water baths and dermatological diseases: a systematic review.

Balneotherapy includes practices and methods using medically and legally recognized mineral-medicinal waters, muds and natural gases from natural springs for therapeutic purposes. One of the most widely used method in balneotherapy is bathing with thermal mineral water. In the course of the years, scientific community has produced an increasing number of evidences that this practice is an effective method for treating signs and symptoms of several pathologies such as rheumatic, cardiovascular and dermatological diseases. This systematic review is aimed at evaluating the effect of balneotherapy with thermal water baths as a treatment to manage signs and symptoms of patients affected by all types of dermatological diseases. The systematic review was conducted according to the PRISMA Statement, and its protocol was registered on PROSPERO platform (CRD42022295913). The research was performed on the databases Pubmed, Scopus, Web of Science and Cochrane. We included clinical trials evaluating the effects of balneotherapy using thermal mineral water baths for managing dermatological diseases in humans, published in English and Italian language. Eight studies were included, seven of them enrolled adults affected by psoriasis and one studied atopic dermatitis patients. The common result of all the articles included was a clear improvement of signs and symptoms of psoriasis and eczematous diseases after use of thermal mineral water baths. These effects seem to be strictly related to physical and chemical properties of thermal water used for balneotherapy. However, studies in this field are still limited to support robust evidence of the effectiveness of balneotherapy using thermal mineral water baths and often their quality is low. Thus, new clinical studies need to be carried out, using more correct methods for conducting the studies and for processing statistical data.

Efficacy of balneotherapy on pain, function, and sleep quality in patients with chronic low-back pain: a prospective observational study.

The aim of this prospective observational study was to evaluate the efficacy of a cycle of sulfate-arsenical-ferruginous mud bath therapy on pain, function, and sleep quality in patients with chronic low-back pain (CLBP). One hundred twenty-three patients treated at Levico Spa Center (Italy) with 12 daily local mud packs and generalized thermal baths were included in this experience. General medical assessments were performed before starting the therapy, at the end of the treatment, and 3 months later. Pain intensity and stiffness were measured by a 0 to 10 cm visual analogue scale (VAS); the range of mobility of the lumbar spine was evaluated using the Schober test and functional disability by the Roland-Morris Disability Questionnaire (RMDI). The Pittsburgh Sleep Quality Index (PSQI) was used to assess the sleep quality. The VAS score for pain and stiffness showed a significant reduction (p < 0.0001) at the end of the treatment persisting for 3 months of follow-up. Similarly, a significant improvement was found for the Schober test and RMDQ. Finally, we showed a significant decrease of PSQI score at the end of the cycle of mud bath and at 3 months of follow-up. The Spearman analysis showed a significant positive correlation between the score of PSQI and VAS pain, VAS stiffness, and RMDQ. In conclusion, this preliminary study confirms the beneficial and long-term efficacy of balneotherapy on pain and function and, for the first one, shows the positive effect on quality of sleep in patients with CLBP treated with a cycle of mud bath therapy.

Spa therapy and peripheral serotonin and dopamine function: a systematic review.

Spa therapy consists of multiple techniques based on the healing effects of water, including hydrotherapy, balneotherapy, and mud therapy, often combined with therapeutic exercises, massage, or physical therapy. Balneotherapy is a clinically effective complementary approach in the treatment of low-grade inflammation- and stress-related pathologies, especially rheumatic conditions due to its anti-inflammatory properties. The main objective of this investigation was to conduct a systematic review analyzing the available evidence on the effect of spa therapy on serotonin and dopamine function. The databases PubMed, Web of Science, Scopus, and Cochrane Central Register of Controlled Trials (CENTRAL) were used from June to July 2023. Exclusion criteria were (1) articles not written in English, (2) full text not available, (3) article not related to the objective of the review. JADAD scale was used for methodological quality evaluation. Four studies were included in the systematic review. Two studies were related to serotonin in healthy individuals, one to serotonin in fibromyalgia, and one to dopamine in healthy individuals. One of the studies evaluated hydrotherapy, another one balneotherapy and mud-bath therapy, and the other two assessed balneotherapy interventions. Studies were very heterogeneous, and their methodological quality was low, making it difficult to draw clear conclusions regarding the effect of spa therapy on peripheral serotonin and dopamine function. The findings of this review highlight the lack of studies evaluating these neurotransmitters and hormones in the context of spa therapy. Further research is needed to evaluate the potential effects of these therapies on serotonin or dopamine function.

Social Networks in French Balneotherapy: A Focus on Spa Doctors.

Spa therapy is a medical treatment based on the use of natural mineral water. In France, spa therapy is delivered in spa care facilities (SCF) involving the intervention of several actors (stakeholders). Spa doctors are key stakeholders as they prescribe the treatments, follow spa patients and assess spa therapy with scientific studies. This study aimed to analyze the spa doctors' relationships in order to highlight their role in transferring information to other stakeholders, particularly to spa managers. For that purpose, we used the social network analysis (SNA) method by means of snowball data collection. We sent a questionnaire to all the spa therapy categories of actors. In total, 80 persons answered and declared 397 relationships. Our results, based on the categorization of respondents and of their relationships and on quantitative indicators (density, response rate), show that spa doctors demonstrate a very acceptable density of relations with spa managers and elected local authorities. However, they appear to be poorly involved in relations concerning the strategy and management of SCF, although they are essential actors in ensuring the medical relevance and sustainability of spa therapy. This research is of interest to patients' care as it recommends deeper involvement of spa doctors in the management of SCF in order to optimize access to informational resources, specifically regarding the evolution of treatments in accordance with scientific progress. Our data are of international scope because the organizational model of balneotherapy, based on the cooperation between spa doctors and SCF, is universal.

Thermal Therapy Modulation of the Psoriasis-Associated Skin and Gut Microbiome.

INTRODUCTION: Psoriasis is a systemic immune-mediated disease primarily manifesting as skin redness and inflammation. Balneotherapy proved to be a successful non-pharmacological option to reduce the skin areas affected by the disease, but the specific mechanisms underlying this effect have not been elucidated yet. Here we test the hypothesis that the effect of thermal treatments on psoriatic lesions could be partially mediated by changes in the resident microbial population, i.e., the microbiome. METHODS: In this study, we enrolled patients with psoriasis and monitored changes in their skin and gut microbiome after a 12-bath balneotherapy course with a combination of 16S rRNA amplicon sequencing and metagenomics. Changes in the resident microbiome were then correlated with thermal therapy outcomes evaluated as changes in Psoriasis Area and Severity Index (PASI) and Body Surface Area index (BSA). RESULTS: The amplicon sequencing analysis of the skin microbiome showed that after thermal treatment the microbiome composition of affected areas improved to approach that typical of unaffected skin. We moreover identified some low-abundance bacterial biomarkers indicative of disease status and treatment efficacy, and we showed via metagenomic sequencing that thermal treatments and thermal water drinking affect the fecal microbiome to host more species associated with favorable metabolic health. CONCLUSIONS: Changes in lower-abundance microbial taxa presence and abundance could be the basis for the positive effect of thermal water treatment and drinking on the cutaneous and systemic symptomatology of psoriasis.

Psoriasis is an immune-mediated disease primarily manifesting as skin redness and inflammation that affects 2­3% of the world's population. No cure is currently available for this condition, and patients are offered pharmacological and non-pharmacological options to alleviate the discomfort. Previous studies and clinical practice have shown that thermal water treatment can be a non-pharmacological option to reduce the areas affected by the disease. However, the specific mechanisms causing this reduction have not been clarified yet. Given that neither the chemical nor the physical composition of thermal water can explain this beneficial effect, recent studies have suggested that it might be due to the effect of thermal water on the microbial communities living on the skin (i.e., the skin microbiome). In this work carried out at Terme di Comano, Northern Italy, we describe the effect of thermal water treatment on the skin microbiome of patients with psoriasis and we highlight the potentially beneficial effect of thermal water drinking on the microbial communities living in the gut, namely the gut microbiome. Specifically, we show that after balneotherapy the areas affected by psoriasis have a higher diversity of microbes usually present on healthy skin, potentially explaining the reduction in disease severity after treatment, and we describe how the gut microbiome of patients who drank thermal water changes to host more species linked with favorable metabolic health. These findings highlight that thermal water treatment and drinking could reduce both the skin and systemic symptomatology of psoriasis by affecting the skin and gut microbiome.

[Comparison of balneotherapy and balneotherapy combined with magnetic-laser therapy at a sanatorium-resort stage of treatment of patients with eczema]. / Sravnenie bal'neoterapii i bal'neoterapii v sochetanii s magnitolazernoi terapiei na sanatorno-kurortnom etape lecheniya bol'nykh s istinnoi ekzemoi.

The search for new rational ways to improve the effectiveness of treatment and rehabilitation measures of patients with true eczema continues to be one of the pressing issues in modern clinical dermatology. OBJECTIVE: The comparative analysis of influence of different variants of SCL: balneotherapy and balneotherapy combined with magnetic laser therapy on the dermatological status, IL-4 and IL-13 level, psycho-emotional state and QOL evaluation in patients with true eczema. MATERIAL AND METHODS: The study involved 112 patients with true eczema undergoing spa treatment (SCR) (54 in the balneotherapy group and 58 in the balneotherapy group combined with magnetic laser therapy. The effectiveness of SCR was assessed using the EASI, HARS and MADRS scales, and the DLQI questionnaire. The dynamics of IL-4 and IL-13 plasma levels were studied. The duration of the study was 6 months and 14 days. RESULTS: After 14 days of SCR, a statistically significant reduction of the EASI index was more pronounced in the balneotherapy group in combination with MLT compared to the balneotherapy group (p=0.041). Balneotherapy combined with MLT contributed to a statistically significant reduction in the HARS and HDRS scores. The decrease in IL-4 and IL-13 levels was statistically more significant in the balneotherapy group in combination with MLT. The combined use of balneotherapy and MLT in comparison with the balneotherapy group was accompanied by a more pronounced improvement in QOL. The combined use of balneotherapy and MLT in the follow-up phase showed a long-term positive effect: 6 months after completing SCR, the number of patients who had clinical remission was statistically significantly higher than that of the balneotherapy group (87.4% vs 22.5%). CONCLUSION: The combined use of balneotherapy and MLT compared with balneotherapy in patients with true eczema on SCR was shown to be advantageous. The complex application of balneotherapy and MLT decreases inflammatory biomarker scores, improves dermatological and psychoemotional status, QOL parameters and is well tolerated.

The Benefits of Water from Nitrodi's Spring: The In Vitro Studies Leading the Potential Clinical Applications.

Natural products (water, plants, and minerals) have been studied for diverse applications in health and disease. Since there has been a growing interest in the introduction of thermal water as a clinical complementary approach in the treatment of low-grade inflammation and stress-related conditions, this review focuses on the oldest spa in the world: Nitrodi's spring. Substantial studies in the 1960s showed that both the internal and external use of Nitrodi's water yielded several benefits in physiological processes and in treating certain disorders, mainly allergic and autoimmune inflammatory conditions. More recently, a novel interest in Nitrodi's water has prompted researchers to further explore the effects of this water and shed light on the molecular mechanisms sustaining its therapeutic efficacy. In different epithelial cell models, Nitrodi's water had strong promotional effects on proliferation, cell migration, cell viability, and fibroblast to myofibroblast transition, all of which essential for wound healing and tissue remodeling. Moreover, Nitrodi's water exhibited anti-oxidant and anti-inflammatory properties through the inhibition of ROS production and protein S-nitrosylation. Here, we have collected the clinical and basic data on Nitrodi's water and reviewed articles that have discussed its use as a potential treatment for several inflammatory and autoimmune diseases and age-related skin deterioration.

The Potential Role of Spa Therapy in Managing Frailty in Rheumatic Patients: A Scoping Review.

Frailty is not limited to the elderly, as patients with rheumatic diseases can also experience this condition. The present scoping review aimed to investigate the possibility of using the health resort setting as an alternative location for managing rheumatic patients with frailty. The research resulted in finding several in vitro, in vivo, and clinical studies, resulting in evidence supporting the effectiveness of spa treatments in reducing pain, improving function, and managing comorbidity in rheumatic diseases. Additionally, spa treatments were demonstrated to modulate the MAPK/ERK pathway and the NF-kB pathway's activation and to reduce proinflammatory molecules' secretion in rheumatic diseases, thus suggesting their potential effective role in the regulation of inflammaging in frailty. Moreover, the health resort setting may offer potential resources to reduce risk factors, such as drug consumption, inactivity, and disease severity, and may serve as a setting for developing prevention protocols for frailty. Future research should explore innovative approaches, such as exercise training and early diagnostics, for the overall management of frailty in rheumatic patients in the spa setting.

Effect of hydrotherapy, balneotherapy, and spa therapy on blood pressure: a mini-review.

Hypertension (high blood pressure) is one of the most common health conditions. When your blood pressure is high for a long term, it can cause health problems, such as heart disease. In addition to the main methods of treatment, there are various methods of adjuvant therapy, one of the most common of which is hydrotherapy. In this review study, we examined the effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure. We searched the PubMed/MEDLINE, Web of Science, Scopus, and Science Direct databases until April 2022 using related keywords. In summary, the current study shows that different hydrotherapy methods may improve blood pressure. Hydrotherapy as one of the adjunctive therapy methods can be effective in lowering blood pressure. Blood circulation is smoothed by the warmth of the water. This improvement may be achieved by regulating heart rate, releasing hormones that control blood pressure, or regulating the activity of baroreceptors or chemoreceptors. In addition to using medications, hypertension patients also use non-pharmacological approaches in their care, including hydrotherapy, balneotherapy, and warm water foot soaks performed at home. Although several lines of evidence show the potential effects of hydrotherapy, balneotherapy, and spa therapy on blood pressure, many clinical trials are needed.

Exploring the potential role of health resort medicine in the management of breast cancer-related lymphedema: a viable alternative for innovative rehabilitation opportunities?

Lymphedema is a chronic and progressive disorder of the lymphatic system that impairs the return of lymphatic fluid. Breast cancer treatment can cause breast cancer-related lymphedema (BCRL), with axillary lymph node dissection and regional lymph node radiation being established risk factors. BCRL can cause severe morbidity, disability, and reduced quality of life. Early detection and treatment are essential to prevent the disease from progressing and causing complications. According to the International Society of Lymphology, complex decongestive therapy (CDT) is the most effective conservative treatment for lymphedema. Aquatic exercise is a safe and effective form of therapeutic CDT exercise that can improve joint range of motion, reduce pain, and positively impact limb volume. Additionally, health resort medicine and thermal mineral-rich waters may provide synergistic benefits for therapeutic exercise programs. Therefore, we believe that consideration should be given to whether the spa setting could represent a viable alternative for the rehabilitation of BCRL patients.

A Novel Approach to Assess Balneotherapy Effects on Musculoskeletal Diseases-An Open Interventional Trial Combining Physiological Indicators, Biomarkers, and Patients' Health Perception.

The present study aimed to evaluate whether a 14-day period of balneotherapy influences the inflammatory status, health-related quality of life (QoL) and quality of sleep, underlying overall health state, and clinically relevant benefits of patients with musculoskeletal diseases (MD). The health-related QoL was evaluated using the following instruments: 5Q-5D-5L, EQ-VAS, EUROHIS-QOL, B-IPQ, and HAQ-DI. The quality of sleep was evaluated by a BaSIQS instrument. Circulating levels of IL-6 and C-reactive protein (CRP) were measured by ELISA and chemiluminescent microparticle immunoassay, respectively. The smartband, Xiaomi MI Band 4, was used for real-time sensing of physical activity and sleep quality. MD patients improved the health-related QoL measured by 5Q-5D-5L (p < 0.001), EQ-VAS (p < 0.001), EUROHIS-QOL (p = 0.017), B-IPQ (p < 0.001), and HAQ-DI (p = 0.019) after balneotherapy; the sleep quality was also improved (BaSIQS, p = 0.019). Serum concentrations of IL-6 were markedly decreased after the 14-day balneotherapy (p < 0.001). No statistically significant differences were observed regarding the physical activity and sleep quality data recorded by the smartband. Balneotherapy may be an effective alternative treatment in managing the health status of MD patients, with a decrease in inflammatory states, along with positive effects on pain reduction, patient's functionality, QoL, quality of sleep, and disability perception status.

Effect of Balneotherapy on Skin Lesion at Hot Springs in Southern Ethiopia: A Single-Arm Prospective Cohort Study.

Background: Balneotherapy is the use of mineral water for the treatment of a wide range of diseases including skin lesions. Even though Ethiopia has a large number of places with natural hot springs, their therapeutic value has not been thoroughly studied. The aim of this study was to determine the effect of balneotherapy among patients with skin lesions at hot springs in southern Ethiopia. Methods: A single-arm prospective cohort study design was used to assess patient's progress from their skin lesion complaint after using the hot water for at least three consecutive days or more. An individual visiting the hot springs site and staying there for at least three days or more was included in the study. From four hot springs sites in Southern Ethiopia, 1320 study participants who were 18 years of age or older were enrolled. The data were gathered using a standardized questionnaire and a physical examination. A descriptive analysis was made. Results: Of the total, 142 (10.8%) of them had various skin lesions. Flexural lesions accounted 87 (61.3%), non-specific skin conditions 51 (35.9%), co-lesions at the scalp, external ear canal, trunk, and various locations, and psoriatic lesions comprised 4.8%. There were 72 (82.8%) typical eczematous lesions among the total number of flexural lesions. After using balneotherapy for 3-7 days once daily, 69 (95.2%) cases of eczematous dermatitis and 30 (58.8%) cases of non-specific skin issues showed improvement from the lesion. Additionally, after 30 days of bathing once daily, the PASI score of more than 90% of the psoriatic cases dropped to a score of one. Conclusion: Patients with skin lesions benefit significantly from balneotherapy when it lasts for three or more days. In order to improve skin lesions, proper application for at least a week or longer is highly beneficial.

The Effects of Lakitelek Thermal Water and Tap Water on Skin Microbiome, a Randomized Control Pilot Study.

The beneficial effects of balneotherapy have been proven by numerous clinical studies on locomotor disorders. To date, there is only scant data on changes in the microbiome system of the skin during balneotherapy. The aim of this study was to compare the effects of thermal water and tap water on the skin's microbiome in healthy volunteers. 30 healthy female volunteers participated in the study. The experimental group (of 15 women) spent 30-min 10 times, in Gabriella Spring's thermal baths (i.e., mineral water containing sodium hydrogen carbonate).The controlled group (15 women) had the same, but in tap water. The results of this study have proven that there is a difference in the influencing effects of tap water and medicinal water on the microbiome of the skin. After bathing in the thermal water of Lakitelek, Deinococcus increased significantly at the genus level, and the tendency for Rothia mucilaginosa bacteria also increased. At the species level, Rothia mucilaginosa increased significantly, while Paracoccus aminovorans and the tendency for Paracoccus marcusii decreased. When the values of the two trial groups after bathing at the genus level were compared, Rothia bacteria increased significantly, while Haemophilus tended to increase, Pseudomonas tended to decrease, Neisseria tended to increase significantly, and Flavobacterium tended to decrease. At the species level, Geobacillus vulcani decreased significantly, and the tendency for Burkholderia gladioli decreased. The growth of Rothia mucilaginosa and the decrease in the tendency of Paracoccus, Pseudomonas, Flavobacteroium, and Burkholderia gladioli confirm the beneficial effect of balneotherapy. In this study, trends are represented by the uncorrected p value. The main result was that the thermal water changed certain bacteria of the skin, both on the genus and species levels, but there were no significant changes in the tap water used, either at the genus or species level. We first compared the worlds of thermal water and tap water's microbiome systems. The thermal water decreased the number of certain inflammatory infectious agents and could enhance some of their positive effects, which have been proven at the molecular level. Our results can provide an important clue in the treatment of certain skin diseases. The research of the skin microbiome during balneotherapy can be one of the most intriguing and exciting topics of the future and can bring us closer to understanding the mechanism of action of balneotherapy.

Cardiovascular physiological effects of balneotherapy: focused on seasonal differences.

Hot water bathing has been demonstrated to be an effective way to improve people's cardiovascular health in many studies. This study focused on seasonal physiological changes to provide suggestions on bathing methods based on season for hot spring bathing. Volunteers were recruited to the program of hot spring bathing at 38-40 °C in New Taipei City. Cardiovascular function, blood oxygen, and ear temperature were observed. There were five assessments for each participant during the study process: baseline, bathing for 20 min and 2 cycles *20 (2*20) min, resting for 20 min and 2*20 min after bathing, respectively. Lower blood pressure (p < 0.001), pulse pressure (p < 0.001), left ventricular dP/dt Max (p < 0.001), and cardiac output (p < 0.05) were identified after bathing then rested for 2*20 min in four seasons, compared to baseline by paired T test. However, in multivariate linear regression model, potential risk for bathing in summer was assumed by higher heart rate (+28.4%, p < 0.001), cardiac output (+54.9%, p < 0.001) and left ventricular dP/dt Max (+27.6%, p < 0.05) during bathing at 2*20 min in summer. Potential risk for bathing in winter was postulated by blood pressure lowering (cSBP -10.0%; cDBP -22.1%, p < 0.001) during bathing at 2*20 min in winter. Hot spring bathing is shown to potentially improve cardiovascular function via reducing cardiac workload and vasodilation effects. Prolonged hot spring bathing in summer is not suggested due to significantly increased cardiac stress. In winter, prominent drop of blood pressure should be concerned. We demonstrated the study enrollment, the hot-spring contents and location, and physiological changes of general trends or seasonal variations, which may indicate potential benefits and risks during and after bathing. (Abbreviations: BP, blood pressure; PP, pulse pressure; LV, left ventricular; CO, cardiac output; HR, heart rate; cSBP, central systolic blood pressure; cDBP, central diastolic blood pressure).

Comparative analysis of balneotherapy in European public health systems: Spain, France, Italy, and Portugal.

Balneotherapy comprises the use of natural mineral waters for health and/or well-being purposes. When balneotherapy is offered by the public health system, some countries with Latin-based languages call it social thermalism. The aim of this study is to compare balneotherapy in health systems of Spain, France, Italy, and Portugal. The study involves a qualitative systematic review of the literature using the systematic search flow method. Twenty-two documents, from 2000 to 2022, were included and its findings were described in seven categories: the first outlines the historical characterization of social thermalism in the systems analyzed and the others outline the components of the health systems: coverage/access, health financing, workforce, inputs and techniques, organization and regulation, and network provision of services. The models of insurance and social security that cover part of the thermal treatment are highlighted. Doctors with competence in medical hydrology constitute the majority of the workforce. Similarities regarding inputs and techniques are observed, with variation in the number of days of the balneotherapy treatment cycle. In the regulation of services, the Ministry of Health of each country is prominent. The provision of services is mainly performed in specialized care in accredited balneotherapy establishments. Despite the limitations of the method, the comparisons made may serve to support public policies for balneotherapy.

Evaluation of the effects of Lake Hévíz sulfur thermal water on skin microbiome in plaque psoriasis: An open label, pilot study.

Psoriasis is a chronic inflammatory skin disease. It is associated with changes in skin microbiome. The aim of this study was to evaluate how Lake Hévíz sulfur thermal water influences the composition of microbial communities that colonizes skin in patients with psoriasis. Our secondary objective was to investigate the effects of balneotherapy on disease activity. In this open label study, participants with plaque psoriasis underwent 30-min therapy sessions in Lake Hévíz, at a temperature of 36 °C, five times a week for 3 weeks. The skin microbiome samples were collected by swabbing method from two different areas (lesional skin-psoriatic plaque and non-lesional skin). From 16 patients, 64 samples were processed for a 16S rRNA sequence-based microbiome analysis. Outcome measures were alpha-diversity (Shannon, Simpson, and Chao1 indexes), beta-diversity (Bray-Curtis metric), differences in genus level abundances, and Psoriasis Area and Severity Index (PASI). Skin microbiome samples were collected at baseline, and immediately after treatment. Based on the visual examination of the employed alpha- and beta-diversity measures, no systematic difference based on sampling timepoint or sample location could be revealed in these regards. Balneotherapy in the unaffected area significantly increased the level of Leptolyngbya genus, and significantly decreased the level of Flavobacterium genus. A similar trend was revealed by the results of the psoriasis samples, but the differences were not statistically significant. In patients with mild psoriasis, a significant improvement was observed in PASI scores.

Is Balneotherapy Protective Against Oxidative Stress? A Pilot Study.

BACKGROUND/AIM: This study aimed to research the effects of Harkány healing water on oxidative stress. The study was performed in a randomized, placebo-controlled, double-blind setup. PATIENTS AND METHODS: Twenty patients with psoriasis who underwent a 3-week-long inward balneotherapy-based rehabilitation were enrolled. Psoriasis Area and Severity Index (PASI) score and Malondialdehyde (MDA) - a marker of oxidative stress - were determined, on admission and before discharge. Patients were treated with dithranol. RESULTS: The mean PASI score - determined on admission and before discharge - decreased significantly after the 3-week-long rehabilitation 8.17 vs. 3.51 (p<0.001). The baseline MDA value of patients with psoriasis was significantly higher compared to controls (3.0±3.5 vs. 8.4±7.4) (p=0.018). MDA levels of patients receiving placebo water increased significantly compared to MDA levels of patients receiving healing water (p=0.049). CONCLUSION: The effectiveness of dithranol resides in the formation of reactive oxygen species. No increased oxidative stress was found in the patients treated with healing water, thus healing water seems to be protective against oxidative stress. However, further research is needed to confirm these preliminary results.

Study on nondrug intervention of 7 days of balneotherapy combined with various sleep-promoting measures on people with sleep disorders: preliminary and pilot study.

To preliminarily explore a nondrug intervention method and evaluate its effects (sleep quality, physical examination indicators, and general physical symptoms) on people with sleep disorders. The intervention was based on regular balneotherapy, coupled with targeted health education, appropriate exercise, diet management, and other sleep-promoting measures. It was the combined effects that we evaluated. We recruited 31 volunteers with sleep disorders to receive a 7-day sleep-promoting experience in Tianxing International Hot Spring City, Nanchuan District, Chongqing. The intervention adopted a plan that combined balneotherapy with various sleep-promoting measures. Persisting baths in hot springs 1-2 times per day targeted health lectures about 1 h every morning, appropriate exercise every day (sleep-aid yoga, forest hiking, morning exercises, etc.), and diet management (the principle is to control oil, salt, and sugar, diversify food, keep meat and vegetable balanced, and control total calories. The dinner is light and easy to digest). During the intervention period, all participants followed the above intervention plan, and they lived in the spa resort to accept unified arrangement. This study adopted a self-contrast method by comparing the changes in sleep quality, physical examination indicators, and general physical symptoms before and after the intervention through physical examinations and questionnaire surveys. After the intervention, the subjects' total score of Insomnia Severity Index (ISI) decreased significantly (P = 0.006), and all seven dimensions showed a decrease, four of which included early morning awakening, sleep dissatisfaction, noticeability of sleep problems by others, and distress caused by sleep problems decreased significantly (all P < 0.05). The subjects' body mass index, waist circumference, fasting blood glucose, and triglycerides decreased significantly (all P < 0.05), and systolic blood pressure increased significantly (P = 0.006). Total cholesterol, high-density lipoprotein, low-density lipoprotein, and diastolic blood pressure did not change significantly (all P > 0.05). To some extent, all general health problems were improved than before the intervention (the improvement rate was up to 70% or more). The non-pharmacological intervention of balneotherapy combined with various sleep-promoting measures showed positive effects on sleep quality, general physical symptoms, and some physical examination indicators of sleep disorders. This comprehensive intervention may be an effective way to improve people's health with sleep disorders.

The effects of immersion in 42℃ radon, natrium, calcium, bicarbonate content thermal-mineral water on chronic low back pain. Controlled, follow-up study.

In our minimized follow-up trial with 137 participants with chronic low back pain, one group of participants received regular outpatient care, and the other group received balneotherapy by immersion in 42℃ thermal-mineral water in addition to regular outpatient care on 15 occasions for 3 weeks. Pain on movement and at rest on the 0-100 mm visual analogue scale (VAS), Oswestry index, the number of participants evaluating the symptoms clinically acceptable (Patient Acceptable Symptom State, PASS) and the EuroQol-5D-5L (EQ-5D-5L) quality of life questionnaire were assessed at basal time (at week 0) and after balneotherapy (at weeks 3 and 12). The VAS pain scores, the Oswestry index, the EQ-5D-5L index and the EQ-VAS significantly improved in the balneotherapy group after treatment at week 3 (p < 0.001) and week 12 (p < 0.001) compared to baseline, with a significant between group difference at week 3 (p < 0.001) and week 12 (p < 0.001). The pain VAS score on movement was 66.82 ± 11.48, 26.69 ± 21.49, and 20.09 ± 23.29 in the balneotherapy group, and 63.67 ± 14.77, 67.35 ± 15.44, and 70.23 ± 18.26 in the control group at the consecutive visits. The PASS increased in both groups at week 3 and week 12 compared to the baseline, with a significant between-group difference at week 3 and week 12 for the balneotherapy group. Our results suggest the therapeutic efficacy of immersion in 42℃ thermal mineral water on chronic low back pain.ClinicalTrials.gov Identifier: NCT05342051.

Rationale and current evidence of aquatic exercise therapy in venous disease: A narrative review.

Chronic venous disorders (CVD) of the lower limbs can be treated with different strategies. Typically, conservative management is based on compression therapy, anticoagulants and venoactive drugs. Endovenous treatments remain the gold standard to treat saphenous insufficiency, with sclerotherapy and surgery maintaining a role in selected cases. In addition, several 'unconventional' approaches have been proposed to prevent CVD progression and complications, minimize symptoms and improve the quality of life and postoperative outcomes. Among these, balneotherapy and aquatic exercises are proving as valid and effective supporting treatments, as mentioned in a growing number of scientific publications. Moreover, aquatic protocols have been studied for both venous and lymphatic insufficiency. For these reasons, they were mentioned in the last CVD guidelines provided by the European Society for Vascular Surgery. The aim of this narrative review is to overview and summarize current literature evidences on the role and effectiveness of aquatic rehabilitative protocols in CVD, reviewing old and current literature. Furthermore, the physical basis of the effects of water immersion on lower limb venous and tissues modifications are also described.