From Probiotic to Prebiotic Using Thermal Spring Water openaccess articles

June 2018 | Volume 17 | Issue 6 | Original Article | 657 | Copyright © 2018

Joshua Zeichner MDa and Sophie Seite PhDb

aMount Sinai Hospital, New York, NY bLa Roche-Posay Dermatological Laboratories, Levallois-Perret, France

figure5biomass of non-pathogenic Gram-negative bacteria such as Vitreoscilla filiformis (LRP-VFB).13 Improvements were observed inthe microbiome of the skin of AD patients with an increase in microbial diversity.Psoriasis VulgarisThe skin microbiome has been evaluated in patients with moderate to severe psoriasis vulgaris at the LRP thermal care center. Similar to studies performed in AD, bacterial swabs were taken from affected and nearby unaffected skin before and after three weeks of TSW balneotherapy.14 While balneotherapy resulted in significant improvements in clinical signs, as measured by Psoriasis Area and Severity Index (PASI) scores, no significant change in the Shannon diversity index was observed. The average taxonomic composition of skin bacterial communities associated with the unaffected and affected skin of psoriatic patients post-balneotherapy showed a significant increase in the level of Xanthomonas genus and, to a lesser extent, Corynebacterium genus.14 The Xanthomonas genus belongs to the main Xanthomonadaceae family found in LRPTSW and also, at a low concentration, on the naturally healthy skin.14 This is associated with a decrease in Staphylococcus genus. Additionally, in this patient group after balneotherapy, there was a significant increase of skin surface Gram-negative bacteria and a significant decrease of Gram-positive bacteria observed (Figure 6). Two studies have been performed specifically to evaluate the therapeutic benefits of balneotherapy in treating psoriasis. In 1995, 92 patients with moderate plaque psoriasis were treated with balneotherapy. After treatment, there was a mean reduction in PASI scores of 47% (from 5.5±0.5 to 2.9±0.3, P less than 0.001), 8% of patients were completely clear and 48% improved by more than 50%. While the clinical significance is unknown, an increase in the mean Se plasma level (from 77.1±2.1 to 90.4±2.7 μg/L, P less than equal to 0.01) was noted after treatment and correlated with the reduction of PASI (rs=0.31, P less than 0.01).3In 2012, 199 patients with severe plaque psoriasis (74.4%) or guttate psoriasis (12.1%) were treated with balneotherapy. Aftertreatment, mean PASI scores were reduced by 57% (from 17.6±0.9 to 7.8±0.5, P less than equal to 0.0001), 96% of patients showed some degree of improvement in PASI scores, 26% achieved a PASI 75, and 64% of patients achieved a PASI 50 response, 78% of patients experienced improvement in DLQI (from 5.9±0.2 to 3.4±0.15, P less than equal to 0.0001). Among these patients, 75% had previously received balneotherapy with an average of 8±9 treatments (max=57 - min=1). Patients reported that balneotherapy continued to improve their quality of life for 7±3 months and gave a sustained remission of psoriasis for an average of 6±3 months following treatment.


Healthy human skin normally consists of a mix of Gram-positive and Gram-negative bacteria of at least 19 phyla. Actinobacteria, Firmicutes, Proteobacteria, and Bacteroides are the predominant bacterial phyla in the human skin, regardless of body site.9,10 Within these phyla, the 3 most abundant genera are: Propionibacterium, Corynebacterium, and Staphylococcus.9,10A variety of inflammatory skin diseases are associated with abnormalities in the microbiota with a loss of diversity.7 There is anoverrepresentation of Firmicute organisms, like Staphylococcisp. and an underrepresentation of Actinobacteria, Proteobacteria, and Cyanobacteria.12 Treatment of AD with LRP-TSW has been associated with improvements in diversity of the microbiota in patients with AD as well as clinically meaningful improvements in signs of the disease itself.12-14

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