The Benefits of Balneotherapy for Atopic Dermatitis

Dr. Peter Lio (00:04):

Hello, I'm Dr. Peter Lio, and this is the Type Two 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):

It is a pleasure. Tonight, we are going to talk about something really interesting and something near and dear to both of our hearts. We're going to be talking about balneotherapy, or using spa treatments or water treatments for dermatologic diseases. And we're going to be focusing on a paper, and this paper is called Balneotherapy Using Thermal Mineral Water Baths and Dermatological Diseases: A Systematic Review. It's by Protano et al. And it was actually published in a journal I'd never heard of until I found this paper, and that's what I was searching for specifically, but it's the International Journal of Biometeorology. And this actually came out in 2024.

(00:51):

So I want to jump right in, because you and I have had a very special experience with balneotherapy, or sometimes called hydrotherapy, which to define it first really is using water and either drinking it, spraying it on there, wrapping with it to help with these skin diseases. And I'll start by asking you a little bit about your patients and if they've ever brought this up or your experiences thus far, maybe you could tell the story of our journey in France.

Dr. Karan Lal (01:18):

Yeah. We were very fortunate last year, we had the opportunity to go visit a thermal spring center where patients were treated, and we were able to experience some of these treatments ourselves, drink the water, be a part of the whole experience, see patients that came from the United States to try this treatment, meet patients in France. It's not just in France. Actually, in multiple European countries, they have their own form of hydrotherapy centers and these spa-like centers. And it's interesting because I talk to people in Europe when I go to these meetings, and there is actually a lower prevalence of these certain inflammatory skin diseases there than we have here. Not to say that that's one of the reasons, but it's an interesting thing to think about.

(01:59):

And it was so fascinating. I have very bad atopic derm, by the way. I'm on a biologic, I use topical JAK inhibitors, oral JAK inhibitors, I take the whole milieu, and I do use my version of a bridged hydrotherapy, which we can talk about. So I talk about it all the time, but it's a service that is not really available to people here. But we actually can send patients from the US to these centers where they can get treatment, I think that's covered. Patients just have to pay for the expenses of getting there and staying there. I actually just talked about it with a patient this week who has topical steroid withdrawal, who it's going to take time to build this therapeutic alliance, but bringing alternative therapies, I think, is a great place to start.

Dr. Peter Lio (02:41):

I love that. Yes, I feel like it's usually obviously the more severe patients, because if they're more on the mild side, we have a lot of good treatments to help our mild and moderate patients. But as they get more refractory or severe, we have to start digging deeper, and especially some patients are willing to do biologics or JAK inhibitors, some are not, and some are on them, but it's not enough. So it's when we don't have the right tools for the job, this is something that I'll bring up a lot, and it's been really formative for me. I've been lucky enough to go to several centers in France, and it's neat to see there, as you said, it's part of their government program for medicine. If you have bad psoriasis, bad atopic dermatitis, chemotherapy-induced rashes, certain genodermatoses, you actually can get three weeks a year to go to the center.

(03:24):

Now, it's a day center. And I often think, I think when we say spa in the US, we picture it, everybody's walking around with hors d'oeuvres and champagne. It's not quite like that. It's more like a hospital feeling or a treatment center, but it is very luxurious. And of course, you're in... France is pretty beautiful. You're often in the countryside and you're drinking this water and you've changed the rhythms of your life. So it was so cool, I've gotten to bring patients over the years, and I can tell you, all of them have benefited from it.

(03:49):

And the one story I tell a lot is a little girl who used to come in from Michigan to see me, and I threw everything but the kitchen sink at her eczema, I just couldn't do it. And it just so happened that Synchronicity, they messaged me and said, "If you have a patient that's really severe, we'll pay for them to come." I said, "Oh my gosh, I sure do." And I sent her, and this is a few years ago, I didn't go along with her, but she went and came back a new person, it changed everything. So I'd love to pick your brain, what do you bring home? We can't always send patients there, but you said you do some and maybe you do it for yourself, but also for your patients. I'd love to hear how you bring it to the US or bring it to the patient.

Dr. Karan Lal (04:24):

Well, we talk about this and I think it's really interesting. I think Avene in particular has done a really good job about creating... They had a patient in the US that had gone and they created this whole little protocol with doing wet wraps. So it's a modified wet wrap therapy, where we have the cans of the thermal spring water, which has some of the great low mineral content, some of the postbiotics and some of the things that make the water unique and special. Of course, it's probably not the same as what you get when you're in France, but it's the best that we have. And they've shown this water, even during fires and things like that, had therapeutic benefit here.

(04:58):

So what I do is I use it on my skin all the time, almost every morning and every night on my inflamed skin, even with my topicals that I'm using, my topical non-steroidals, and it really just makes my skin feel good. I talk about it to people. It is something you have to dedicate time to, and it's something that you can integrate and learn to do for those hotspot areas.