title: A pragmatic randomized controlled trial on the effectiveness of highly concentrated saline spa water baths followed by UVB compared to UVB only in moderate to severe psoriasis.
abstract: BACKGROUND
  There is a lack of sufficiently large randomized trials evaluating the effectiveness of saline spa balneophototherapy compared to ultraviolet B (UVB) only.
  
  
  OBJECTIVE
  The study aimed to evaluate whether highly concentrated saline spa water baths followed by UVB (HC-SSW-UVB) are superior to UVB only in moderate to severe psoriasis.
  
  
  METHODS
  One hundred and sixty (160) adults with a Psoriasis Area and Severity Index (PASI) of >10 from 4 German spa centers were randomly allocated to HC-SSW-UVB (local sodium chloride concentration between 25% and 27%) or UVB only 3 a week until remission (PASI < 5) or for a maximum of 6 weeks. Reduction of PASI > or = 50% (PASI-50) at the end of the intervention period was defined as primary outcome. Only persons receiving at least 1 intervention were included into the primary analysis.
  
  
  RESULTS
  Participants allocated to HC-SSW-UVB attained to a statistically significantly higher rate of PASI-50 than patients allocated to UVB only (68/79 [86%] versus 38/71 [54%]; p < 0.001; number needed to treat, 3.1; 95% confidence interval, 2.1-6.0). Postintervention analysis did not yield a clear hint of a persisting effect.
  
  
  CONCLUSIONS
  The study indicates that HC-SSW-UVB are superior to routine UVB at the end of a 6-week treatment course.
authors.affiliation: Spa Medicine Research Institute, Bad Elster, Germany. thomas.brockow@d-i-g.org
authors.forename: Thomas
authors.initials: T
authors.lastname: Brockow
authors.forename: Ralf
authors.initials: R
authors.lastname: Schiener
authors.forename: Annegret
authors.initials: A
authors.lastname: Franke
authors.forename: Karl Ludwig
authors.initials: KL
authors.lastname: Resch
authors.forename: Ralf Uwe
authors.initials: RU
authors.lastname: Peter
mesh_terms: D000328:Adult; D001452:Balneology / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011565:Psoriasis / Q000628:therapy*; D012720:Severity of Illness Index; D012965:Sodium Chloride / Q000008:administration & dosage*; D016896:Treatment Outcome; D014467:Ultraviolet Therapy / Q000379:methods*
chemical_list: D012965:Sodium Chloride