Balneologically Activated Skin Functions and their Clinical Evidence.

Prof. Dr. Dr. Helmut G. Pratzel
Institute for Medical Balneology and Climatology,
University of Munich, Germany

Each effect of a bath is naturally imparted via the skin, which can act as the gateway for bath components and heat. It is known that the skin can respond to this as either a reflex organ with its differentiated sensorium, a metabolic organ, or an immune organ.

In this case the bath can cause within the organism a peripheral impairment of functional sequences which are normally homeostatically controlled. These skin responses can affect the total organism by transmitter substances activating helping functions. The efficiency of medical baths can be rationally explained on the basis of these functional sequences, although there still exists an open field for basic research in this area.

Permeation through, but not the entry into, the stratum corneum is impeded. The stratum corneum is the barrier of the integument used against the penetration of substances into the body and against the elimination of substances from the body. The blood levels of the topical application components are hardly significant. Primary effects of bath components take place not via the blood levels, but in the skin.

The epidermis is a strategically located buffer zone with the ability to reactively defend against penetrated external aggressors through the use of immunological defences, the lowering of pain perception, the improvement of haemodynamics, and thermal regulation. Stress hormones, such as ACTH, MSH, epinephrine, and endorphin, are produced directly by the skin. The use of serial cellular stress reactions to activate self-healing powers in the organism for the treatment of systemic chronical diseases in typical of the balneotherapy and the natural methods in medicine.

With baths, significantly higher concentrations of minerals and medicaments can be reached in thee epidermis than with systemic flooding via the vascular system. It is not possible to achieve the same reactions in the skin with the use of other application forms of these substances.

By double-blind research experiments, the efficiency of sodium chloride baths and baths using Dead Sea salt of the same osmotic concentration for the treatment of patients with rheumatoid arthritis, no effect was found with the use of sodium chloride but significant effects were produced when using Dead Sea salts.

The improvements of the rheological properties of the blood in the treatment of patients with arteriosclerosis can only be explained by chemical reactions in the skin. There is no measurably significant difference of COČ concentration outside the skin from bathing.

The property of the hydrogen sulfide to act as a radical trap for oxygen radicals is also an indication of its involvement in the inflammation suppression. However, hydrogen sulfide can have these effects only in the epidermis, where it is completely oxidized into insignificant sulfates. That means sulphur is not a specific agent, rather the reaction comes from the reduction effect of sulphur on epidermal cells. Hydrogen sulphide baths inhibit, depending on their does, the epidermal Langerhans cells, which as precursors of the cellular peripheral immunological system, play the role in the immune presentation. One one hand, it is known that the number of Langerhans cells increases in some inflammatory tissues. This is the result of activated immune response. On the other hand, it is strategically suggestive that a decrease of the needable number of Langerhans cells in the epidermis of integument may work insufficiently.

All of our clinical double blind studies with sulphurated baths which have been performed have shown a significant cure effect due to a relevant pain alleviation with non-articular rheumatism and degenerative complaints. This analgetic effect goes beyond the placebo effect with concomitant physical treatment.

From "The Journal Of Japanese Association of Physical Medicine Balneology and Climatology". Volume 57, No.1 November 1993.