title: Psoriasis treatment: faster and long-standing results after bathing in geothermal seawater. A randomized trial of three UVB phototherapy regimens.
abstract: BACKGROUND
  The combination of seawater baths and narrowband ultraviolet B (NB-UVB) is a known treatment for psoriasis. This study evaluates two treatment regimens that combine bathing in geothermal seawater and NB-UVB therapy in comparison with NB-UVB monotherapy.
  
  
  METHODS
  Sixty-eight psoriasis patients were randomly assigned to outpatient bathing in geothermal seawater combined with NB-UVB therapy three times a week, intensive daily treatment involving bathing in geothermal seawater combined with NB-UVB therapy, or NB-UVB therapy alone three times a week; treatment period was 6 weeks. Disease severity [Psoriasis Area Severity Index (PASI) and Lattice System Physician's Global Assessment scores], quality of life (Dermatology Life Quality Index) and histological changes were evaluated before, during and after treatment. The primary end point was the proportion of patients who achieved PASI 75 at 6 weeks.
  
  
  RESULTS
  At 6 weeks, the percentage of patients who achieved PASI 75 and PASI 90 was significantly greater for both regimens, bathing in geothermal seawater three times a week (68.1% and 18.2%, respectively) and intensive treatment with geothermal seawater (73.1% and 42.3%, respectively) than for NB-UVB monotherapy (16.7% and 0%, respectively) (P < 0.05 in all comparisons). Clinical improvement was paralleled by improvement in quality of life and histological score and a reduction in NB-UVB doses.
  
  
  CONCLUSIONS
  Bathing in geothermal seawater combined with NB-UVB therapy in psoriasis induces faster clinical and histological improvement, produces longer remission time and permits lower NB-UVB doses than UVB therapy alone.
authors.affiliation: Faculty of Medicine, University of Iceland, Reykjavík, Iceland; Department of Dermatology, Sahlgrenska University Hospital, Gothenburg, Sweden; Department of Dermatology, Landspitali University Hospital, Reykjavík, Iceland; Department of Immunology, Landspitali University Hospital, Reykjavík, Iceland.
authors.forename: Jenna Huld
authors.initials: JH
authors.lastname: Eysteinsdóttir
authors.forename: Jón Hjaltalín
authors.initials: JH
authors.lastname: Ólafsson
authors.forename: Bjarni A
authors.initials: BA
authors.lastname: Agnarsson
authors.forename: Björn Rúnar
authors.initials: BR
authors.lastname: Lúðvíksson
authors.forename: Bárður
authors.initials: B
authors.lastname: Sigurgeirsson
mesh_terms: D000328:Adult; D001452:Balneology; D003131:Combined Modality Therapy; D005260:Female; D045482:Hot Springs; D006801:Humans; D008297:Male; D008875:Middle Aged; D010789:Phototherapy; D011565:Psoriasis / Q000628:therapy*; D012623:Seawater
keywords: Blue Lagoon; balneotherapy; geothermal seawater; histological score; psoriasis; quality of life