Fancy a dip in the Dead Sea?

Why is it called the Dead Sea? It is referred to as the Dead Sea because no aquatic organisms such as fish or water plants live in it due to its high salinity, which increases with depth.

With more than 300 sunny days per year, the Dead Sea is attracting an ever growing number of patients suffering from a variety of diseases yearly. According to Wolf et al (2003), the Dead Sea and the whole region around its shores are bursting with life, and the leading powers of its waters, especially in treating rheumatic and skin diseases, have been recognised from ancient times. The natural elements and minerals in the sea, in addition to the mud present on the shores, give the water their curative powers. Climatological and balneological therapies recognised as spa treatments by patients, physicians and dermatologists have led to the use of artificial-light parlours for ultraviolet A (UVA), UVB and photochemotherapy (PUVA) [1-3].

Climatotherapy
Climatotherapy is the treatment of a disease by means of residence in a suitable climate. At the Dead Sea, Climatotherapy is a natural approach to the treatment of psoriasis and other skin diseases, and has been successfully used for more than 25 years in the treatment of moderate to severe psoriasis [3, 4].

So what makes the Dead Sea and Climatotherapy so attractive one might ask? Well, putting aside the sheer pleasure of taking time off to pamper oneself under the guise of treating a skin disease, this treatment does work due to the natural curative factors at the Dead Sea area [2, 3].

Sunlight/UV radiation
The highly successful treatment of diseases at the Dead Sea does not involve the use of drugs; it however comes from the naturally filtered ultraviolet radiation, with minimal phototoxicity, permitting prolonged exposure to sunlight. Its relatively safe UV radiation is due to the thick atmospheric layer over the Dead Sea, with its vapour and haze, and to the great amount of ozone, which is minimally depleted compared to other areas, as well as to the low humidity and warm climate. Due to deletion of UV radiation, longer exposure to ambient UV radiation is possible and as such some patients who cannot tolerate lengthy sun exposure at sea-level can do so at the Dead Sea [1, 2].

Climate
The temperature of the area surrounding the Dead Sea is high all year round, with an annual average of 30.4°C. Humidity is low, so is rainfall [2].

The thick haze overhanging the Dead Sea is rich in minerals, particularly bromine. The high atmospheric bromine level hanging over the Dead Sea is as a result of bromine-containing aerosols derived from the sea. It is thought that inhalation of bromides improves the condition of psoriatics, particularly those with stress-related psoriasis, as they have a relaxing and sedative effect. The atmosphere over the Dead Sea is also oxygen rich. This high level of oxygen is useful for breathing and extrametabolic activity [1, 2].

High mineral content
The high mineral content of the Dead Sea has also been considered a major factor in treating a variety of diseases. The sea contains about 320 g/L salts with KCl, MgCl2, CaCl2, and NaCl being the major components. Compared to the ocean, the Dead Sea is richer in its proportion of calcium, magnesium, potassium and bromide, and lower in its proportion of sodium, sulphate and carbonate. Of major importance from this list of elements and salts is magnesium, which has a concentration in the Dead Sea 30-times higher than that in the ocean. It is an important element in certain epidermal processes and an imbalance in these processes can result in excessive cellular proliferation, which is a major part of the psoriatic state. Hence a deep in the Dead Sea may be useful in regulating magnesium levels necessary in such epidermal processes. Magnesium also has an anticarcinogenic effect, such that tissues which have high concentrations of magnesium have lower cancer incidence compared with tissues with low concentrations of magnesium [1].

'Black mud'
Another mineral-rich constituent of the Dead Sea is its 'black mud' also known as 'bituminous tar'. The therapeutic effect of this processed mud is due to its high mineral content and its ability to retain heat for many hours, thereby stimulating the blood circulation and clearing the skin of dead epidermal cells. Bituminous tar is historically known to have been used medically in the treatment of various rheumatological diseases, including psoriatic arthritis [1].

In addition...
The Dead Sea area is relatively clear of elements of pollution such as industrial wastes, heavy traffic or intensive vegetation, making it ideal for the relief of respiratory ailments. The growth of house dust mite is inhibited in the Dead Sea climate and as such makes it a pollution free as well as allergen-poor environment [1].

Finally...
The type of treatment to be administered is individually determined for each patient after complete examination and evaluation of the disease extension. Factors to be taken into consideration include percentage of skin involvement, skin type, presence of other skin diseases, previous treatment, and previous visits to the Dead Sea [5].

Other dermatological diseases, which can be treated by Climatotherapy at the Dead Sea, include eczema, vitiligo and atopic dermatitis [5].

Treatment Centers are available at the Dead Sea. The Dead Sea Spa Treatment Centers in Israel were established many years ago and have attracted thousands of patients from a number of countries including the UK, France and USA to mention a few [2]. The Dead Sea Spa Treatment Village in Jordan was opened in July 1991 and has received thousands of patients affected with psoriasis since then [2].

Additional benefits
Visiting the Dead Sea region is also an ideal way to tour Israel. Travel distances are short, with Jerusalem only an hour's drive, and Tel-Aviv (30 minute flight time).

The Dead Sea region offers fascinating biblical, archeological and historical sites: such as the mountain fortress of Masada; Qumran, where the famous Dead Sea Scrolls were found in ancient pottery jars; Ein Gedi, where David found refuge from King Saul; and the first monasteries of the Christian monks in the Judean Desert. Natural sites include the caves and eases of Ein Gedi; the canyons of the Judean Desert; Mount Sdom, an 11 mile long mountain range made of pure salt; and the spectacular Flour Cave, so-called due to its powder-like interior.

For the adventurous there is rappelling, rock climbing, and rental of All Terrain Vehicles for exploring otherwise inaccessible desert areas [6].

Medical conditions exempt from climatotherapy
Although Climatotherapy is a natural treatment, beneficial for both the healthy and the sick, certain medical conditions may be exempt from the treatment. Patients with such diseases would therefore need to consult their physician before commencing a stay at the Dead Sea [1]. These include,
1. Photoaggravated dermatoses
2. Certain skin malignancies (melanoma malignum, malignant epithelial tumours)
3. Epidermolyses - This is characterised by blisters, vesicles, and scarring, which prevents patients from being exposed to the sun and waters with high salinity due to the strong burning sensation and the danger of secondary infections.
4. Idiopathic photodermatoses
5. Acute skin infections (bacterial or viral) - Patients suffering from this are particularly excluded due to the fact that viral infections are provoked by sunlight and local infected wounds tend to expand after bathing at the Dead Sea. Such patients would need to be treated with antibiotics and/or antiseptics before their visit to the Dead Sea.
6. Concomitant diseases such as acute internal infections, visceral malignancies, and other internal diseases. These require immediate attention and intensive hospital treatment.

Certain risk groups are also contraindicated including,
1. Severe psychiatric patients
2. Acute alcoholics
These groups are at risk because they may lose control of themselves in non-hospital environments. Patients with immunodeficient diseases, for example AIDS are also contraindicated at the Dead Sea due to the immunosuppressive effect of UV irradiation, which increases the risk of infection [1].

Precautions
Certain drugs can cause discomfort on exposure to sunlight, causing aggravation of the skin to an eruptive stage. Substances associated with light-induced drug eruptions include tetracyclines, amiodarone, sulphonamides, to mention a few. Another situation, which needs to be treated with caution at the Dead Sea, is drug-induced heat emergency, which occurs when the body is unable to dissipate heat adequately. Usually, when environmental temperature rises above 35°C (as it typically happens at the Dead Sea), virtually all body heat is lost to evaporation. A number of drugs affect thermoregulation adversely. These include amphetamine and cocaine, which increase muscle activity and heat production, as well as antidepressants and phenothiazines, which block the impulses that mediate sweating. Older patients (particularly those who are 65 years and older) have a 12-13 times greater incidence of heat stroke than the rest of the population and as such must be cautious in taking drugs, which alter thermoregulation before treatment at the Dead Sea [1].

Proposed side effects at the Dead Sea
There are almost no side effects during and after Climatotherapy treatment at the Dead Sea, and there is a very low risk of potential damage to general health. According to Shani et al (1997) few comments have been published on the side-effects of Climatotherapy at the Dead Sea. In a long term study carried out between 1988 and 1994, the most frequent side effects were sunburn, sun allergy, common cold, oedema, and gastroenteritis, to mention a few. The incidence of these side effects was fairly minimal and most of the effects were not related to the climatologic treatment; also in most cases, these side effects disappeared within a few days after ambulatory treatment [1].

Other Climatotherapy sites
Apart from the Dead Sea, other sites where climatotherapy is available exist. These locations are also such that the environment and natural elements are said to be therapeutic particularly for psoriasis. These sites include,
1. The Red Sea in Egypt where the water contains unique properties, which are said to help certain diseases. Its climate is similar to that at the Dead Sea.
2. The Canary Islands, where there is a psoriasis treatment center.
3. The Blue Lagoon, located in Iceland. It has a unique mineral content and contains salts, silica and blue green algae.
4. France and Canada also have sites where patients can go to treat a number of diseases.

Last Words...
By making use of available curative factors at the Dead Sea, climatotherapy has shown encouraging results mainly for patients with psoriasis. The treatment is a natural, safe (suitable for children, the elderly and pregnant women), and gentle therapy, and patient compliance (following strict medical supervision) may be just a matter of the ability to make the time and cover the expenses for travel and accommodation [2, 3].


The question remains....Would you fancy a deep in the Dead Sea??


Useful links
Living: The Dead Sea
http://www.deadsea.co.il/index.php?page_id=1&lang_action=change_lang&to_lang=en&geo_action=done

The Dead Sea Research Center
http://www.deadsea-health.org/

National Psoriasis Foundation. Other climatotherapy sites
http://www.psoriasis.org/treatment/psoriasis/sun/other_sites.php

Dead Sea Guide
http://www.dead-sea.net/f-healing.htm

References
1. Shani J. et al. Indications, contraindications and possible side-effects of Climatotherapy at the Dead Sea. Int J Dermatol 1997; 36: 481-492.
2. Oumeish OY. Climatotherapy at the Dead Sea in Jordan. Clin Dermatol 1996; 14: 659-664.
3. Wolf R, Orion E, Matz H. Climatotherapy: There is Life in the Dead Sea. IMAJ 2003; 5: 124-125.
4. Hodak E. et al. Climatotherapy at the Dead Sea is a remittive therapy for psoriasis: Combined effects on epidermal and immunologic activation. J Am Acad Dermatol 2003; 49 (3): 451-457.
5. Hristakieva E. Climatotherapy in Dermatology: Why, How and When? Trakia J Sci 2005; 3(4): 27-31.
6. Israel Physician's Guide. Dead Sea Guide. Available from: http://www.dead-sea.net/f-healing.htm. Accessed on: 26 July 2007.



Disclaimer
This article is only for informative purposes. It is not intended to be a medical advice and is not a substitute for professional medical advice. Please consult your doctor for all your medical concerns. Kindly follow any information given in this article only after consulting your doctor or qualified medical professional. The author is not liable for any outcome or damage resulting from any information obtained from this article.