Prospective clinical study to assess the efficacy of the topical use of mineral water from the spring of Las Salinas on plaque psoriasis.

Abstract

To the editor: Psoriasis is an inflammatory disease that affects approximately 60 million people worldwide. Plaque psoriasis, or psoriasis vulgaris, is the most common form of psoriasis. It is characterized by well-demarcated erithematous colored lesions with a white scaly layer. In general, patients with less than 3%–5% of their body surface affected are candidates to receive topical treatment. These treatments include emollient creams, corticosteroids, vitamin D analogs, calcineurin inhibitors, keratolytic agents, or combinations. However, the efficacy of these agents is limited and adherence to treatment is low. Therefore, the development of new topical agents that are easy to apply and have limited side effects is an important line of investigation in the management of plaque psoriasis. The medicinal properties of mineral and thermal waters have been known for centuries. Several prospective studies and two randomized clinical trials have demonstrated a significant improvement of psoriasis using mineral waters as a single agent or in combination with other treatments.1-5 The waters from the spring of Las Salinas, located in Villamanrique de Tajo (Madrid, Spain), were declared mineral-medicinal waters for therapeutic purposes on April 13, 2016 by the Community of Madrid Department of Economy, Employment and Finance. The composition of the mineral-medicine waters is provided in Table 1.6 We designed a prospective study to evaluate the efficacy of the topical use of mineral water from the spring of Las Salinas in patients with plaque psoriasis. Between October 7 and December 22, 2021, 20 patients were included in the study (Demographic characteristics in Table 2). Nine were females and 11 males, with a median age of 52.5 years (range 16–85). The median number of lesions treated in each case was 4 (range 1–10), and only 2 patients maintained systemic treatment (methotrexate and adalimumab) during the study period. In both cases, the systemic treatment had been initiated a year prior to their inclusion in this study. With regards to the “severity” parameter, measured using the PASI score, patients presented a mean baseline level of 4 (1–8). After treatment, the mean score was 3 (0–10; Figure 1A). Comparing both figures, there was a 1.1 point mean difference (decreased with treatment) with a standard deviation of 2.29 and a two-tailed p value of 0.04. The plaque moisture, measured with a corneometer, had a mean value of 15.85 (10.3–27), which increased to a level of 18 (10.3–35.2) after treatment (Figure 1B). There was a mean difference of 4 points with a standard deviation of 7.7, and a two-tailed p value of 0.03. Finally, regarding the “plaque sebum”, measured by means of a Sebumeter, the mean baseline value was 8.4 (4.6–42), and it was 14.6 after treatment (4.2–43; Figure 1C). The mean difference was 1 point (increased after treatment), with a standard deviation of 4.3 and a two-tailed p value of 0.29. A paired sample student t-test was used to analyze all three parameters. No adverse events that could be related to the study treatment were reported in any case. In conclusion, topical treatment with thermal waters from the spring of Las Salinas improved psoriasis plaques in patients included in this study. These results are similar to previous studies, indicating that mineral-medicinal waters could be considered a therapeutic option in psoriasis patients. Virginia Sanchez: Study design, data record, data analysis, and manuscript writing, manuscript review and approval. Elena Gallo, Diana Camacho, Federico Feltes and Mar Martin: Data record, manuscript writing, and manuscript review and approval. Aroa García and Consuelo Pumar: Data record, and manuscript review and approval. The study was approved by the ethics commitee of HM Hospital Sanchinarro. All patients provided written consent form before entering the study. The data that support the findings of this study are available from the corresponding author upon reasonable request.