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Psoriasis treatment: faster and long-standing results after bathing in geothermal seawater. A randomized trial of three UVB phototherapy regimens

Authors

  • Jenna Huld Eysteinsdóttir,

    Corresponding author
    1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
    2. Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden
    3. Department of Dermatology, Landspitali University Hospital, Reykjavík, Iceland
    4. Department of Immunology, Landspitali University Hospital, Reykjavík, Iceland
    • Correspondence:

      Dr Jenna Huld Eysteinsdóttir, M.D., Department of Dermatology, Sahlgrenska University Hospital, Gröna Stråket 16, Göteborg 413 45, Sweden.

      Tel: +031 342 10 00

      Fax: +031 821871

      e-mail: jennahuld@gmail.com

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  • Jón Hjaltalín Ólafsson,

    1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
    2. Department of Dermatology, Landspitali University Hospital, Reykjavík, Iceland
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  • Bjarni A. Agnarsson,

    1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
    2. Department of Pathology, Landspitali University Hospital, Reykjavík, Iceland
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  • Björn Rúnar Lúðvíksson,

    1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
    2. Department of Immunology, Landspitali University Hospital, Reykjavík, Iceland
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  • Bárður Sigurgeirsson

    1. Faculty of Medicine, University of Iceland, Reykjavík, Iceland
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  • Conflicts of interest:
  • This study was primarily sponsored by the Icelandic Technology Development Fund and the Landspitali University Hospital Research Fund. The Blue Lagoon Ltd. offered the treatment and the ensuing expenses free of charge.

Summary

Background

The combination of seawater baths and narrowband ultraviolet B (NB-UVB) is a known treatment for psoriasis. This study evaluates two treatment regimens that combine bathing in geothermal seawater and NB-UVB therapy in comparison with NB-UVB monotherapy.

Methods

Sixty-eight psoriasis patients were randomly assigned to outpatient bathing in geothermal seawater combined with NB-UVB therapy three times a week, intensive daily treatment involving bathing in geothermal seawater combined with NB-UVB therapy, or NB-UVB therapy alone three times a week; treatment period was 6 weeks. Disease severity [Psoriasis Area Severity Index (PASI) and Lattice System Physician's Global Assessment scores], quality of life (Dermatology Life Quality Index) and histological changes were evaluated before, during and after treatment. The primary end point was the proportion of patients who achieved PASI 75 at 6 weeks.

Results

At 6 weeks, the percentage of patients who achieved PASI 75 and PASI 90 was significantly greater for both regimens, bathing in geothermal seawater three times a week (68.1% and 18.2%, respectively) and intensive treatment with geothermal seawater (73.1% and 42.3%, respectively) than for NB-UVB monotherapy (16.7% and 0%, respectively) (P < 0.05 in all comparisons). Clinical improvement was paralleled by improvement in quality of life and histological score and a reduction in NB-UVB doses.

Conclusion

Bathing in geothermal seawater combined with NB-UVB therapy in psoriasis induces faster clinical and histological improvement, produces longer remission time and permits lower NB-UVB doses than UVB therapy alone.

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