Ann Dermatol.  2014 Apr;26(2):221-230. 10.5021/ad.2014.26.2.221.

Immunomodulatory Effects of Balneotherapy with Hae-Un-Dae Thermal Water on Imiquimod-Induced Psoriasis-Like Murine Model

• Lee YB
• Lee JY
• Lee HJ
• Yun ST
• Lee JT
• Kim HJ
• Yu DS
• Woo SY
• Kim JW

• KMID: 2171659
• DOI: http://doi.org/10.5021/ad.2014.26.2.221

Abstract

BACKGROUND
Balneotherapy, although not a well-established dermatological treatment, is thought to have therapeutic properties for psoriasis and is used as an alternative treatment modality throughout the world.
OBJECTIVE
To evaluate the mechanism underlying the therapeutic immunologic effects of thermomineral water.
METHODS
A murine model of imiquimod-induced psoriasis-like skin inflammation was used for evaluating the therapeutic effects of balneotherapy with Hae-Un-Dae hot spring mineral water. The clinical improvements were evaluated by a dermatologist. Lesional cytokines, including interleukin (IL)-17A, IL-23, and IL-22, were quantitatively measured by real-time reverse transcriptase polymerase chain reaction. Serum levels of interferon-gamma, IL-4, IL-5, and IL-17A were measured by enzyme-linked immunosorbent assay. T cell proportions in the spleen were evaluated by flow cytometry, and histopathological evaluation of the skin was also performed.
RESULTS
The mineral water balneotherapy group showed faster improvement in skin erythema and scales than the distilled water bathing group. A substantial reduction was observed in the lesional mRNA levels of IL-17A and IL-23 in the mineral water group. Serum levels of IL-4 and IL-5 were significantly decreased in the mineral water group but not in the distilled water group. Normalized T cell proportions were observed after bathing.
CONCLUSION
Balneotherapy showed immunomodulatory effects in a psoriasis-like murine model. Balneotherapy suppressed lesional IL-23 and IL-17A, which are important cytokines in the pathogenesis of psoriasis. These results suggest that balneotherapy can be used as an effective and safe treatment for psoriasis.

Keyword

Bath; Immunomodulation; Mineral waters; Psoriasis

MeSH Terms

Balneology*
Baths
Cytokines
Enzyme-Linked Immunosorbent Assay
Erythema
Flow Cytometry
Hot Springs
Immunomodulation
Inflammation
Interferon-gamma
Interleukin-17
Interleukin-23
Interleukin-4
Interleukin-5
Interleukins
Mineral Waters
Psoriasis
Reverse Transcriptase Polymerase Chain Reaction
RNA, Messenger
Skin
Spleen
Water*
Weights and Measures
Cytokines
Interferon-gamma
Interleukin-17
Interleukin-23
Interleukin-4
Interleukin-5
Interleukins
Mineral Waters
RNA, Messenger
Water

Figure

• 

  Fig. 1 Clinical improvement of imiquimod-induced psoriasis-like skin lesions during 2 weeks of balneotherapy with distilled water or Hae-Un-Dae hot spring mineral water. IMQ: imiquimod, DW: distilled water, MW: mineral water.

• 

  Fig. 2 Clinical improvement scores for skin erythema (A) and scales (B). IMQ: imiquimod, DW: distilled water, MW: mineral water.

• 

  Fig. 3 Expressions of IL-17A, IL-23, and IL-22 mRNA in the skin. IMQ: imiquimod, DW: distilled water, MW: mineral water, IL: interleukin.

• 

  Fig. 4 Serum levels of IFN-γ (A), IL-4 (B), IL-5 (C), and IL-17A (D). IMQ: imiquimod, DW: distilled water, MW: mineral water, INF: interferon, IL: interleukin. *p<0.05; bar: standard error.

• 

  Fig. 5 Fluorescence-activated Cell Sorter analysis of splenic T cell profiles. Th1, Th2, Th17, and Foxp3+ Treg. IMQ: imiquimod, DW: distilled water, MW: mineral water. *p<0.05; bar: standard error.

• 

  Fig. 6 Histological evaluation and comparison of epidermal thickness (H&E, ×100). (A) Imiquimod-induced skin lesion, (B) group treated with distilled water, (C) group treated with mineral water, and (D) negative control group treated with vaseline.

• 

  Fig. 7 Comparison of epidermal thickness. IMQ: imiquimod, DW: distilled water, MW: mineral water. *p<0.05; bar: standard error.

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