Balneophototherapy (synonym: brine phototherapy) is a treatment method in which substance-containing baths (e.g., with high salt concentrations) are used together with phototherapeutic measures (UV light). This form of therapy is mainly used in the field of dermatology (the study of skin diseases) and is considered a successful treatment for atopic eczema (neurodermatitis) and especially psoriasis (psoriasis). The so-called psoriasis vulgaris is a chronic inflammatory disease of the skin, which runs in phases and is based on a genetic disposition. The disease can be triggered by physical, chemical, mechanical and inflammatory irritations of the skin as well as by infections, HIV disease, pregnancy, medication or stress. Externally, itchy, reddened, sharply demarcated, scaly papules appear, which are caused by an excessive formation of the epidermis (top layer of skin). The human epidermis consists of seven layers, whose cells are characterized by different stages of maturation. During a period of approximately 28 days, the cells migrate from the basal layer up to the corneal layer, changing their morphology (shape) before detaching as skin scales. In psoriasis vulgaris, this process occurs within 4 days and leads to the symptoms described. This occurs preferentially on the following areas of the body:
- Stretch sides of the arms and legs (e.g., knees or elbows).
- Hand and foot insides
- Lumbar region
- Hairy head area
The following article provides an overview of the method of balneophototherapy and deals with the associated theoretical background.
Indications (areas of application)
- Atopic eczema (neurodermatitis).
- Ichthyosis vulgaris (fish skin disease).
- Psoriasis (psoriasis)
- Prurigo, pruritus (itching)
- Parapsoriasis en plaques – a chronic skin disease whose cause is unclear, but similar to psoriasis.
- Vitiligo (white spot disease)
Contraindications
- Cardiovascular disease (cardiovascular disease).
- Hypertension (high blood pressure)
- Severe infectious diseases
- Wounds and/or rhagades (fissures; narrow, cleft-shaped tear that cuts through all layers of the epidermis (cuticle)).
The procedure
The principle of balneophototherapy is based on the imitation of a therapeutic bath in the Dead Sea. The so-called Dead Sea therapy consists of two main components: The seawater has a salt concentration of about 40% and, in combination with natural irradiation by sunlight, unfolds its healing effect on the diseased skin. Less elaborate hypertonic salt baths or brine baths with subsequent UV irradiation are used in specialized practices and centers in Germany. A distinction is made between synchronous and asynchronous balneotherapy. In synchronous balneotherapy, the application of UV light takes place during the bath, while in asynchronous balneotherapy the irradiation follows the bath. The bath usually lasts about 20 minutes, and the subsequent radiation is either pure UVB light or a combination of UVA and UVB light. The effect of balneophototherapy is due, among other things, to the release of pro-inflammatory substances from the skin. A special variant of balneophototherapy is bath PUVA therapy, which is also called photochemotherapy. This term stands for the combined use of UVA light and psoralen. Psoralen are substances that have a photosensitizing (increase in light sensitivity) effect on the skin, so that the effectiveness of the UVA light is increased. In Germany, the substance 8-methoxypsoralen (8-MOP) is used. This substance can be applied via oral tablet administration (oral PUVA therapy/oral Puva), but today bath PUVA treatment and cream PUVA treatment are available. In Germany, balneophototherapy (asynchronous balneotherapy and bath PUVA therapy) has so far only been paid for by the health insurance fund for psoriasis patients.Since 2020, balneophototherapy as photosol therapy, which combines a salt bath with UV-B rays, has also been reimbursed by health insurance for patients with moderate and severe atopic dermatitis.
Benefits
Balneophototherapy and especially bath PUVA therapy have a positive effect on chronic inflammatory skin conditions such as psoriasis or atopic dermatitis. With outpatient balneotherapy, therapeutic treatment with brine baths and UV light is now feasible for patients in Germany without traveling to the Dead Sea.
