Onderzoek Dr. J. Lidaj, inzake psoriasis (artritis)

Natural Health Spa Smrdáky
Possibilities of Psoriasis vulgaris et generalisata Treatment

Based on recent scientific knowledge, empirical experience of mankind in the balneotherapy with sulphur and hydrogen sulphide waters was highlighted on concrete effects not only on the whole human organism but also on individual structures. Skin, as a borderline organ, provides considerable possibilities of either macroscopic monitoring and by means of immunoreactions and a total adaptibility of organism in connection with the sulphur and hydrogen sulphide influences on deep structures, muscles and joints.

Psoriasis is referred to as keratoderma disorder affecting about 2-3% of the population. More over about 10% of psoriatic patients have also arthritis symptoms. The joints involvement ratio as per sex is approximately equal. The skin or nails psoriasis mostly precedes the psoriatis arthritis by 10 and more years, it only sporadic appears simultaneously with it and yet more sporadic follows it.

The cause of the disease (psoriasis) not known as far. Genetic factors (an increased occurrence of psoriasis and psoriatis arthritis was found out in the families) including an increased occurrence in uniovular twins are under consideration. Immunogenetic analyses in psoriasis and psoriatic arthritis demonstrate the presence of genetic factors. The external factors (injury, bacterial or viral infection, psychic trauma) also influence the development of psoriasis (vulgaris, generalisata, arthritis) and may be a trigger in genetic predisposed persons.

In the treatment of psoriasis are used various internal antiifnlamatory, antimetabolic or immunomodulatory drugs (corticoids, retinoids, methotrexate, cyclosporin A ),  or external therapy (ointments, creams, liquids, shampoos with salicyl acid, urea, coal tar, vitamin D3. Used are also phototherapy (natural sun, arteficial UV light), thalassotherapy (sea) and balneotherapy or balneophototherapy (natural, health spa, Tomesa).The treatment with methotrexate, cyclosporin A and retinoides is effective in severer forms of psoriasis. Due to potential undesirable effects an exact dosage and a continuous monitoring of a patient are unavoidable.

Just in the Natural Health Spa’s (PLK) Smrdáky conditions the complex balneotherapy for psoriasis (bath in mineral hydrogen sulphide water, phototherapy (natural sun, arteficial UV light), and for psoriatic arthritis mud application, massages, electrotherapy procedures, rehabilitation) is advantageously utilized.

Two sources of hydrogen sulphide water called Jozef I. and Jozef II. are used in the spa Smrdáky at present, having following balneological characteristics: - natural, curative slightly mineralized, hydrocarbonate, chloride-carbonate, sodium, sulphuric water with an increased content of boric acid, cold (temperature 13°C), hypotonic, alkaline with hydrogen sulphide content of approximately 600 mg/1 of water.

The penetration of hydrogen sulphide (H2S) through the skin into the entire organism was evidenced by the isotope method. The optimum therapeutic effect thereof is reached in the full bath with the concentration of 50 – 100 mg H2S/1 liter of water, bath temperature between 37-38°C and duration 15-20 minutes according to the status and properties of epidermis (greater penetration of hydrogen sulphide in the points of an impaired epidermal barrier in psoriasis or dermatitis).

 The concentration of hydrogen sulphide in the partial bath (hands, feet, capillaritis – hairy part of a head), can be increased to 200-250 mg H2S/ 1 liter of water.

In the process of application of natural sulphurous mud enriched with minerals on the joints is used above all the transfer of its thermal capacity into the organism’s depth. The mud temperature is 45°C, application duration 20 minutes. A thin liquid layer occurs on the skin at the same time enabling the infiltration of active substances into the skin and at the same time an uniform heat transfer between a so-called peloide covering layer adhering to the skin and deeper subcutaneous structures and joints. In the mud bath much more heat is transferred into the nucleus of an organism than from a water bath having the same temperature.

 
Application of mud pack
The resorbed hydrogen sulphide from a bath influences not only the skin but has the afinity to glucosamineglucans and amino acides containing sulphid as well. The simultaneous deep effect of the mud is the explanation for following reparative processes in articular cartilages  and connective tissue by means of hyaluron degradation and chondroitin sulphate inhibition or leucocytic elastase taking part in the connective tissue degradation. The advantage of mud application is also the deep hyperaemic effect on the surrounding joints musculature.


Different effect of tresholdpain on press at upper extremity (in %) in the end of isothermal, 20 minutes bath and after 20 minutes rest a hydrogenium sulphide water bath (upper green curve - strong analgetic effect) and normal drinking water bath (low blue curve).

To the additional parts of a complex balneotherapy belong hand massages, underwater treatment, whirlpool bath and Scotch douches (influencing blood vessels and lymphatic sinuses with a following improvement of the metabolism and reflexive effect on the deeper structures and joints), Endomed (interferential currents with deep analgesic effect), ultrasound (micromassage and transformation of high-frequency oscillations to the heat), for the diathermy of tissues infrared heating lamp (Solux) and paraffin pack, passive and active kinesitherapy.
Such a complex balneotherapy results in the remission of the dermal or articular findings for approximately six months to one year depending on a patient’s regimen. Dr. Lidaj

Treatment guidelines for diagnosis:
Psoriasis vulgaris, Psoriasis generalisata
Contraindications: Psoriasis pustulosa generalisata Zumbusch
Period of treatment: 4 (four weeks)

A.Enter
   - medical admitance examination  1 x
   - control medical examination (visit) 2-3 x
   - final examination 1 x

B. Therapy
     1.  whole body bath in hydrogenium sulfide mineral water with
          concentration 25 – 50 – 100 mg H2S daily, Monday - Saturday             partial – daily – Monday to Saturday -
     2. partial bath in hydrogenium sulfide mineral water with
         concentration 150 – 250 mg H2S (mineral dish for scalp, face,
         hands, foots) –  daily or each second day
     3. phototherapy (whole body - natural sun, arteficial UVB light,
         Selective Ultraphototherapy 315 nm, partial – comb, pencil
         311 nm for scalp, hands, foots) – daily or each second day
         – daily or each second day
         – daily natural sun, arteficial UV light Monday-Friday

C. Backbone and joint problems (cases with Arthritis psoriatica)
     1. mud packing – up 45 °C, 20 minutes, joints, back bone
         – two times for week
     2. hand massage (back, or upper or low extremities)
         – two or three times for week
     3. underwater massage, whirpool (whole body, low extremities)
         – daily or each other day for week
     4. electrotherapy – diadynamic streams, Endomed (pains,
         muscular backbone spasm) – two or three times for week

D. External topical treatment
    - for body skin: 5% salicyl acid ointment, 5-8 % lig. carb.  
      detergensointment, 2-6% tar ointment,  0,2 - 0,5 % cignolin
      ointment
    - for scalp – 6% salicyl acid oil, cignolin tincture, liquor carbonis
      detergens shampoo


Medical warning:
Concentration of hydrogenium sulphide in bath, a number and type of other procedures depends from stadium of skin or joint disease and general health conditions of patient (contraindications of bath treatment, complicated heart disease, high blood pressure etc).


Full whole body bath in hydrogenium
sulphide mineral water with concentration of
50 - 100 mg H2 S per liter


Sulphur erythema (red skin) after
application hand bath with
concentration of 250 mg H2S/liter.

 
Due to the hydrogen sulphide effect occur not only the skin hyperaemia influencing the trophic of all skin components and reflexively also deeper tissues (analgetic effect), but at the same time the hypalgesia of any kind and skin pruritus feeling are reduced. The balneotherapeutic influence of hydrogen sulphide bath is though, not limited only to the skin and superficial vasal or neural structures, the overall influence thereof is explained by the activity on a cellular level and by the influence upon the immunity system by means of a primary immunosuppressive effect on the Langerhans cells (blocking resp. modulation of receptors on their surface), reduction of binding of the epidermal growth factor, by the influence on the pathomechanism of pathological processes by means of cytokines, mainly interleukin 8 secreted by various cells (e.g. monocytes, lymphocytes, endotheliums, fibroblasts, keratinocytes, melanocytes). On the receptor level involved are the effects comparable with the use of cyclosporin, dithranol or UV-B. Substantial influence on the currative effect has also the magnesium content in a bath and following phototherapy by the UV-lamps with spectrum between UV-A and UV-B, 315 nm,  so-called SUP (selective ultraphotothe rapy) or local therapy with 311 n.


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