Balneotherapy Continued: A Future in US Dermatology?

Dr. Peter Lio (00:04):

Hello, I'm Dr. Peter Lio, and this is the Type 2 Inflammation Journal Club. Welcome. Today I'm here with Dr. Karan Lal. Dr. Lal, thank you so much for joining us.

Dr. Karan Lal (00:13):

Thanks for having me.

Dr. Peter Lio (00:14):

One of the most exciting things about the literature here, and we could pick knits here if we want to say the quality of the evidence isn't always the highest, but in general, it's quite positive. I mean, they're really showing across different diseases and particularly psoriasis. They really showed beautiful improvement for these patients, of course, atopic dermatitis as well. And one of the nice things they often show is that not only do the patients improve while they're there, which we can imagine, there's so many things that are positive happening at that moment, but they actually stay better for quite some time afterwards. So there's a bit of a remit effect or a residual effect, I should say, of this approach. I think there are some methodological issues that limit these studies. I mean, because you're in a different environment. You're on vacation. You have people tending to you.

(00:55):

So I think if we did a perfect controlled study and just replaced the magical spring water with plain old tap water, it might be hard to tell. But as you say, the water is pretty special, and each center has their own set of things that they talk about. Some really talk about the mineral content. Others talk about the bacteriological content, the probiotics and bacterial breakdown products that seem to be soothing. So I do think there's something to it. And of course, I think a big part of it is all the TLC that the patients get when they're there.

(01:21):

I would ask you if you could bring that to the US in centers. This is one of my visions for the future. Do you think there is a role for something, maybe a regional center where we could approximate that, maybe on an American scale, shorter timeframe, but a day treatment type center for patients with severe atopic dermatitis, psoriasis, maybe one step above doing it at home, but maybe a couple steps below having to go overseas. Do you think there could be a way to do that?

Dr. Karan Lal (01:47):

I think definitely. I mean, like you said, there's so many benefits to the treatment. I mean, it's just like when people go ... I have a lot of patients that, for example, that have pediatric patients that have other neurological disorders, and when they go to group therapy and they do day activities, you notice how much improvement there is. So the TLC that you talk about is huge. Outside of the TLC, there's different things like for psoriasis, the pressures of the water that are mechanically exfoliative. Right? I think it's one of the best diseases for those types of therapies. And in fact, when we were there, we had talked to, I think, one of the pharmacists that runs the center who said that, "They've shown in studies that the water at that center showed that there was a decrease in leaky gut." The gut was leaking less than people who were drinking the water.

(02:28):

So I think when you talk about it to people, it's a great concept. And I think people here already pay for other ancillary services, whether it's hyperbaric oxygen therapy, red light therapy, people are doing infusions. So I don't see why people, if they had access, financial access, whether it's through an HSA program where it would convince people to put money into an HSA or FSA. I think it's definitely doable, but I think getting coverage is not going to happen. But people who are desperate and people who are looking for ancillary services and alternative treatments seek that care from us or not from us. And they'll get it. And a lot of people do bad things. People will get started on experimental peptides or on things like that that we have no idea about. So this is something that they've been doing for hundreds of years and is pretty safe. So I would love to see that. I would love to be a part of your vision.

Dr. Peter Lio (03:18):

Well, you know I'll be calling you as soon as we make some moves on this, because I would love to have you part of it. And I really think that that sums it up beautifully, that this is a very old approach. This is nothing new. This isn't newfangled. And in some ways it's less alternative than many of the other things we're talking about because this has been here before most of the more conventional treatments. So we know this is a very, very powerful treatment for many patients.

(03:39):

It can have a profound effect. It's certainly not going to replace anything. This is, I think, as you're using it in yourself and in your patients, it's something that's adjunctive and supportive, but it really does sound like there's potentially more room to expand this because at the very least, all the other aspects that go along with it, just being supported by other people, having someone help you put those wet wraps on, there really is a powerful role for that, especially for families who are exhausted and burned out from treating their atopic dermatitis.

Dr. Karan Lal (04:05):

And it's also not as simple as, I guess we're making it seem, like people ... And I went there and I was thinking like, "Oh, people just bathe in this water." Again, you don't understand. So we tried the different ... There's the Vichy shower, which has a good amount of pressure, and the temperature is different. Then you're in the bathtub where the temperature is different, and there's bubbles. And then there's even pressurized therapy, which I don't think we did because it looked ... It's not painless, by the way. There's definitely some force to this pressurized water that they use for some patients. They even have oral treatments that they're treating people with stomatitis from chemo where they have these pressurized things in their mouths or sores. So I agree, it's alternative to us, but there it is not an alternative treatment. It is another conventional treatment.

Dr. Peter Lio (04:46):

I love it. I'll end with one of my favorite quotes from Carl Sagan who said this great quote, he said, "Extraordinary claims require extraordinary evidence." Right? We think about this a lot and sometimes people, naysayers might say, "Well, this is extraordinary. You're telling me water heals people? What the heck?" It's going to need some extraordinary evidence. But my counterpoint to that is that it really depends on your point of view because for millions of people, this is not extraordinary at all. This is the normal thing that they do. And what sounds extraordinary is putting on some kind of a synthetic cream or injecting something into your body to make you better. So I really think that is so important, and I think that's a great place for us to wrap up. Thank you so much for joining me here. This has been such a fun discussion as always, and I really look forward to future adventures thinking about balneotherapy, hydrotherapy, and helping our patients in any way that we can find.

Dr. Karan Lal (05:35):

Thanks for having me. And for everybody that doesn't know about it, you should really look into it because it is very interesting. And if you have patients that are interested, like I said, it's a great option for people, and I've never seen anyone unhappy.

Dr. Peter Lio (05:46):

Thanks, everybody.