The effect of balneophototherapy in the Blue Lagoon in Iceland on psoriasis compared with phototherapy alone

• Main Author: Eysteinsdóttir, Jenna Huld
• Other Authors: Jón Hjaltalín Ólafsson, Læknadeild (HÍ), Faculty of Medicine (UI), Heilbrigðisvísindasvið (HÍ), School of Health Sciences (UI), Háskóli Íslands, University of Iceland
• Format: Doctoral or Postdoctoral Thesis
• Language: English
• Published: University of Iceland, School of Health Sciences, Faculty of Medicine 2017
• Subjects: Psoriasis; Blue Lagoon; Balneophototherapy; IL-17; Quality of life; Trozak histological score; IL-22; Outcome measure; Sóríasis; Bláa lónið; Baðlækningar; Sjúkdómar; Doktorsritgerðir; Iceland
• Online Access: https://hdl.handle.net/20.500.11815/522

Abstract Psoriasis is a chronic immune-mediated inflammatory skin disease with profound effects on psychosocial wellbeing. Narrowband UVB phototherapy is a known effective treatment for chronic plaque psoriasis and previous studies suggest an additional beneficial effect of balneophototherapy (BPT) at the Blue Lagoon (BL) (bathing in geothermal seawater followed by UVB therapy), but the scientific rationale for this empirical observation remaines elusive. The aim of the study was to evaluate the clinical, psychosocial, histological, and immunological effects of BPT at the BL has on plaque psoriasis compared with UVB phototherapy alone. Initially, a pilot study was conducted where 12 psoriasis patients were enrolled to evaluate the potential immunological effect of inpatient BPT at the BL. This was compared with UVB phototherapy was explored, as well as validating methods to use in the prospective randomized controlled trial. Secondly, a prospective randomized controlled trial was conducted where 68 psoriasis patients were enrolled into three different treatment groups to evaluate the clinical, histological, psychosocial of BPT at the BL compared with UVB phototherapy. These groups were as follows: 1) outpatient BPT at the BL (GSW group), 2) Inpatient BPT at the BL (IT-GSW group), and 3) UVB monotherapy (UVB group). All treatments were given for 6 weeks. Thirdly, the histological score of Trozak used as an additional secondary outcome in this thesis was evaluated by comparing it with other psoriasis outcome measures. Circulating skin homing (CLA) T cells expressing skin homing markers were significantly reduced with BPT at the BL in the pilot study. The reduction was 68% for CCR4 (p<0.001), 74% for CD103 (p<0.001), 65% for CCR10 (p<0.001), 80% for skin homing T cells co-expressing CCR4/CCR10 (p<0.001), to no detection (100%) for skin hominig T cells co-expressing CD103/CCR4 (p<0.001) after 3 weeks of treatment. In the randomized controlled trial, the percentage of patients who achieved PASI 75 and ...