1 clime- and heliotherapy. klim 2 introductionintroduction therapeutic usable clime (healing clime)...

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Clime- and HeliotherapyClime- and HeliotherapyClime- and HeliotherapyClime- and Heliotherapy

Klim 2

IntroductionIntroduction

Therapeutic usable Clime (Healing Clime) is the Therapeutic usable Clime (Healing Clime) is the result of special dose of temporary and local result of special dose of temporary and local changing atmospheric factors controlled by changing atmospheric factors controlled by physicians. The dose can be contrary to the physicians. The dose can be contrary to the personally comfort feeling of patients in personally comfort feeling of patients in according to the indications.according to the indications.

““The doctor is the creator of the cure clime” The doctor is the creator of the cure clime” (Pfleiderer)(Pfleiderer)

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ThemesThemes

ClimetherapyClimetherapy

• DefinitionsDefinitions

• Clime regionsClime regions

• Clime factorsClime factors

• Dose factorsDose factors

• EffectsEffects

• Indications and contra-Indications and contra-indicationsindications

• Cure types and structuresCure types and structures

HeliotherapyHeliotherapy

• Radiation sourcesRadiation sources

• Effect of environment to the Effect of environment to the global radiationglobal radiation

• Radiation and skinRadiation and skin

• Photochemical and -biological Photochemical and -biological effectseffects

• Therapeutic and toxic effectsTherapeutic and toxic effects

• Photo-Brine-TherapyPhoto-Brine-Therapy

• Indications, contra-indications Indications, contra-indications and risksand risks

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Definitions IDefinitions I

ClimetherapyClimetherapy is a part of Health Resort Medicine. It is is a part of Health Resort Medicine. It is applied as a complex measure together with other applied as a complex measure together with other global adjusted therapeutic measures in the cure global adjusted therapeutic measures in the cure systems. Climetherapy belongs on a treatment concept systems. Climetherapy belongs on a treatment concept of many different effective factors.of many different effective factors.

InIn Heliotherapy Heliotherapy one important factor of Climetherapy one important factor of Climetherapy will be used.will be used.

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Definition IIDefinition II

ClimetherapyClimetherapy is the special treatment of sick patients by is the special treatment of sick patients by modification their exposition in the free atmosphere modification their exposition in the free atmosphere ((Schmidt-KessenSchmidt-Kessen).).

Photo therapyPhoto therapy or Light therapy is the therapeutic use of or Light therapy is the therapeutic use of photon radiation in ultra violet, visible and infrared range.photon radiation in ultra violet, visible and infrared range.

HeliotherapyHeliotherapy is the Photo therapy by Sunshine. is the Photo therapy by Sunshine. Thalasso therapyThalasso therapy is the therapy by use of the remedies of is the therapy by use of the remedies of

the sea.the sea.

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Definition IIIDefinition III

ClimetherapyClimetherapy• Cure treatment by use of active and strong elements Cure treatment by use of active and strong elements

of climeof clime• Sea-clime Sea-clime • High-altitude climeHigh-altitude clime

ClimecureClimecure (cure in the clime) (cure in the clime)• Cure treatment in areas without strong elements of Cure treatment in areas without strong elements of

clime by physiotherapy.clime by physiotherapy.• Areas in woods and medium altitudesAreas in woods and medium altitudes (Dirnagl)

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Definitions IIIDefinitions III

WeatherWeather is the result of circulation in the atmosphere is the result of circulation in the atmosphere ClimeClime is the long time mean value of the local weather is the long time mean value of the local weather

elements.elements. Bio-climeBio-clime is the clime, which contact the body surface is the clime, which contact the body surface

and has biological effects. and has biological effects.

(Schmidt-Kessen)

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Clime regionsClime regions

Sea-climeSea-clime• moist, cool, windymoist, cool, windy• Aerosol, low pollutionAerosol, low pollution

Clime of medium altitudesClime of medium altitudes• Wood air, not windyWood air, not windy

Clime of high altitudes (1200 –2000 m)Clime of high altitudes (1200 –2000 m)• dry, cool, high part of UVdry, cool, high part of UV• Decrease of max. ODecrease of max. O22-uptake about 2%/per 1000m-uptake about 2%/per 1000m• up to 1800 m no house-dust-mite can liveup to 1800 m no house-dust-mite can live

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General principle of ClimetherapyGeneral principle of Climetherapy

In-door-clime (save clime)

Out-door-clime (stress clime)

Adaptation to natural Adaptation to natural environment factorsenvironment factors

Adaptation to natural Adaptation to natural environment factorsenvironment factorsCoddling situationCoddling situationCoddling situationCoddling situation

Air pollution at homeAir pollution at homeAir pollution at homeAir pollution at home Careful situation in Careful situation in health resorthealth resort

Careful situation in Careful situation in health resorthealth resort

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Mechanical factorsMechanical factors

Air pressureAir pressureWind pressureWind pressureGravitationGravitation

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Thermal factorsThermal factors

Air temperatureAir temperatureRadiation temperatureRadiation temperatureHumidityHumidityAir movement (wind, draw-winch)Air movement (wind, draw-winch)

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Limits of sultry or oppressive Limits of sultry or oppressive feeling airfeeling air

Limits of sultry or oppressive Limits of sultry or oppressive feeling airfeeling air

TemperatureTemperature

°C°C3030 2828 2626 2424 2222

Relative HumidityRelative Humidity

%%4545 5050 6565 7070 7575

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Actinic factorsActinic factors

UV-B UV-B (280-315 nm)(280-315 nm)UV-A UV-A (315-400 nm)(315-400 nm)UV-A1 UV-A1 (artificial)(artificial) (350-400 nm)(350-400 nm)Visible Light Visible Light (380-780 nm)(380-780 nm)near infrared radiation near infrared radiation (760-2500 nm)(760-2500 nm)

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Chemical factorsChemical factors

OzoneOzone• Natural concentration: 0,01 - 0,06 ppmNatural concentration: 0,01 - 0,06 ppm• Maximal working level: 0,1 ppmMaximal working level: 0,1 ppm• Exhausted by reaction with the earth surface 4 mg/d/mExhausted by reaction with the earth surface 4 mg/d/m22

Volatile oilsVolatile oils AerosolsAerosols RadonRadon Missing air pollutionMissing air pollution

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Electric factors IElectric factors I

Ions of airIons of air• 101022 - 10 - 1033 ions/ cm ions/ cm3 3 of 10 of 101919 air molecules/cm air molecules/cm33

• about 4 ions/cmabout 4 ions/cm22 per breath have contact to the lung per breath have contact to the lung surfacesurface

Electrical DC fieldsElectrical DC fields• Field of fine weather : 100 V/mField of fine weather : 100 V/m• Field of low-pressure front: >1 kV/mField of low-pressure front: >1 kV/m• Field of the skin surface by movement: >1 kV/mField of the skin surface by movement: >1 kV/m

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Electric factors II Electric factors II

Electric AC fieldElectric AC field(by atmospheric impulse radiation, Sferics)(by atmospheric impulse radiation, Sferics)• 10-Hz-Field10-Hz-Field

Magnetic DC fieldMagnetic DC field• 0,5 Gauss0,5 Gauss

Magnetic AC fieldMagnetic AC field• by 10-Hz-Field: 10by 10-Hz-Field: 10-8-8 - 10 - 10-10-10 Gauss Gauss• by 50-Hz-AC in houses: 1-5 Gaussby 50-Hz-AC in houses: 1-5 Gauss

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Dose factors of the weatherDose factors of the weather

cold - hotcold - hot shadow - sunshineshadow - sunshine calm - windycalm - windy dry - moistdry - moist fog - rainfog - rain clean air – air pollutionclean air – air pollution

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Dose factors by activity of the Dose factors by activity of the patientpatient

RestingRestingSittingSittingGoingGoingJoggingJoggingSportingSporting

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Dose factors by shielding the Dose factors by shielding the patientpatient

Warm dressesWarm dressesWind-tight dressesWind-tight dressesWater-tight dressesWater-tight dresses

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Weather-phases in BioclimatologyWeather-phases in BioclimatologyWeather-phases in BioclimatologyWeather-phases in Bioclimatology

11 Fine weather Fine weather (cool to moderate warm)(cool to moderate warm) East part of high pressure East part of high pressure22 Active fine weather Active fine weather (warm and dry)(warm and dry) Middle part of high pressure Middle part of high pressure33 Over loaded fine weather Over loaded fine weather (very hot and dry)(very hot and dry) West part high West part high

pressurepressure44 Beginning change of weather Beginning change of weather (warm and moist)(warm and moist) frontal side of frontal side of

low pressurelow pressure55 Changed weather Changed weather (cold and moist)(cold and moist)6z6z Active cold air Active cold air (cold to cool, rain, windy)(cold to cool, rain, windy) backside of low pressure backside of low pressure66 Weather normalisation Weather normalisation (cold and dry)(cold and dry)

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Weather and sicknessWeather and sicknessWeather and sicknessWeather and sickness

Weather phase Weather phase 44 (frontal side of low pressure): (frontal side of low pressure):

• inflammation in any case inflammation in any case

• asthma-attacks, asthma-attacks,

• disorders by hypotensiondisorders by hypotension

• acute disorders of the heart acute disorders of the heart

• thrombosesthrombosesWeather phase Weather phase 55 (changed weather) (changed weather)

• fast normalisation of the disordersfast normalisation of the disorders

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Weather phase Weather phase 6z6z (backside of low pressure) (backside of low pressure)

• acute and spastic disordersacute and spastic disorders

• bile-bladder colicbile-bladder colic

• cardiac paincardiac pain

• cardiac-attackscardiac-attacks

• disturbance by hypertensiondisturbance by hypertension

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Weather phase Weather phase 66 (Weather normalisation) (Weather normalisation)

• headacheheadache

• migrainemigraine

• sleep disturbancessleep disturbances

• depressionsdepressions

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Which factors of weather are maximal Which factors of weather are maximal effective in weather feeling ?effective in weather feeling ?

Which factors of weather are maximal Which factors of weather are maximal effective in weather feeling ?effective in weather feeling ?

Change ofChange of

•hot and dry (phase 3)hot and dry (phase 3)

to to

•cold and moist (phase 5)cold and moist (phase 5)

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Hypothesis of increasing pain in Hypothesis of increasing pain in rheumatoid arthritisrheumatoid arthritis

Hypothesis of increasing pain in Hypothesis of increasing pain in rheumatoid arthritisrheumatoid arthritis

Decrease of air temperatureDecrease of air temperature Decrease of join temperatureDecrease of join temperature Decrease of synovial temperatureDecrease of synovial temperature Increase of synovial viscosityIncrease of synovial viscosity Decrease of join mobilityDecrease of join mobility Increase of painIncrease of pain

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What is the main reason in What is the main reason in weather sickness?weather sickness?

What is the main reason in What is the main reason in weather sickness?weather sickness?

Disturbance in Disturbance in peripheral temperature regulation.peripheral temperature regulation.

Cause?Cause?Lack in trainingLack in training

Problems in civilisation.Problems in civilisation.

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Complaints in connection with Complaints in connection with weather changesweather changes

Complaints in connection with Complaints in connection with weather changesweather changes

1.1. WearinessWeariness

2.2. Bad moodBad mood

3.3. Unpleasure to workUnpleasure to work

4.4. Head pressure, headacheHead pressure, headache

5.5. Restless sleepRestless sleep

6.6. Initial insomnia and Initial insomnia and concentrating disturbanceconcentrating disturbance

7.7. NervosityNervosity

8.8. Pain in points of bone-fracturesPain in points of bone-fractures

1.1. WearinessWeariness

2.2. Bad moodBad mood

3.3. Unpleasure to workUnpleasure to work

4.4. Head pressure, headacheHead pressure, headache

5.5. Restless sleepRestless sleep

6.6. Initial insomnia and Initial insomnia and concentrating disturbanceconcentrating disturbance

7.7. NervosityNervosity

8.8. Pain in points of bone-fracturesPain in points of bone-fractures

9.9. Unbroken sleep disturbanceUnbroken sleep disturbance

10.10. Increased making mistakesIncreased making mistakes

11.11. Increased forgetfulnessIncreased forgetfulness

12.12. Flicker of eyesFlicker of eyes

13.13. Attack of vertigoAttack of vertigo

14.14. Heart sensationsHeart sensations

15.15. Pain in postoperative scarPain in postoperative scar

16.16. Depressive moodDepressive mood

9.9. Unbroken sleep disturbanceUnbroken sleep disturbance

10.10. Increased making mistakesIncreased making mistakes

11.11. Increased forgetfulnessIncreased forgetfulness

12.12. Flicker of eyesFlicker of eyes

13.13. Attack of vertigoAttack of vertigo

14.14. Heart sensationsHeart sensations

15.15. Pain in postoperative scarPain in postoperative scar

16.16. Depressive moodDepressive mood

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Follow up of non-adaptation and Follow up of non-adaptation and disability in temperature regulationdisability in temperature regulationFollow up of non-adaptation and Follow up of non-adaptation and

disability in temperature regulationdisability in temperature regulation

Vasoconstriction of peripheral blood vesselsVasoconstriction of peripheral blood vessels Blood flow from peripheral vessels into the Blood flow from peripheral vessels into the

systemic circulationsystemic circulation HypertensionHypertension

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Main therapeutic clime effects Main therapeutic clime effects

Improvement of the thermoregulationImprovement of the thermoregulationIncrease of the physical efficiencyIncrease of the physical efficiencyInurity and decrease in susceptibility of infectionInurity and decrease in susceptibility of infectionImprovement of the skin stateImprovement of the skin stateVitamin DVitamin D33-formation-formationRelief of the respiratory tractRelief of the respiratory tract

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Coldness adaptationColdness adaptationColdness adaptationColdness adaptation

Decrease in coldness sensitivityDecrease in coldness sensitivityPain threshold moves to lower temperaturePain threshold moves to lower temperatureInitial increase of blood pressure decreaseInitial increase of blood pressure decreaseMore increase of heart rate after adaptationMore increase of heart rate after adaptationIncrease of reactive heat by metabolismIncrease of reactive heat by metabolism

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Indications inIndications inHealth Resorts with healthy climeHealth Resorts with healthy clime

Situation after deficiency of trainingSituation after deficiency of training• Therapy: Terrain cure by cool conditionsTherapy: Terrain cure by cool conditions

Respiratory tract diseasesRespiratory tract diseases• Therapy: Terrain cure and respiratory exerciseTherapy: Terrain cure and respiratory exercise

OsteoporosisOsteoporosis• Therapy: Terrain cure and Heliotherapy Therapy: Terrain cure and Heliotherapy

Skin diseases (Skin diseases (Psoriasis, Neurodermitis)Psoriasis, Neurodermitis)

• Therapy: Terrain cure and HeliotherapyTherapy: Terrain cure and Heliotherapy

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Structures of Health Resorts with healthy Structures of Health Resorts with healthy clime in high altitudeclime in high altitude

Net of terrain ways minimum 30 km Net of terrain ways minimum 30 km (5 to 15 % ascent)(5 to 15 % ascent)

Clime pavilionClime pavilionRest- and gymnastic-fieldRest- and gymnastic-fieldEquipment in hydrotherapyEquipment in hydrotherapyBike travel waysBike travel waysPatient-consultation and -leadingPatient-consultation and -leading

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Cure formsCure forms

Out-patient clime cureOut-patient clime cureClime compact cureClime compact cure

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Treatment by low coldness Treatment by low coldness stimulationstimulation

Treatment by low coldness Treatment by low coldness stimulationstimulation

Regimen refrigerantsRegimen refrigerantsTraining en reposTraining en repos

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Change of aerobic metabolism by Change of aerobic metabolism by adaptation to coldnessadaptation to coldness

Change of aerobic metabolism by Change of aerobic metabolism by adaptation to coldnessadaptation to coldness

Physical endurance performance increasePhysical endurance performance increase

• by terrain cure in cold conditions,by terrain cure in cold conditions,

• by rest cure in fresh air. by rest cure in fresh air.

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Change of lactate concentration in blood during Change of lactate concentration in blood during ergometric control by rest cure in fresh airergometric control by rest cure in fresh air

Change of lactate concentration in blood during Change of lactate concentration in blood during ergometric control by rest cure in fresh airergometric control by rest cure in fresh air

Before Before treatmenttreatment

3 weeks later3 weeks later

By A. Schuh 1995By A. Schuh 1995By A. Schuh 1995By A. Schuh 1995

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Change of lactate concentration in blood during Change of lactate concentration in blood during ergometric control by terrain cure in cool ergometric control by terrain cure in cool

conditionsconditions

Change of lactate concentration in blood during Change of lactate concentration in blood during ergometric control by terrain cure in cool ergometric control by terrain cure in cool

conditionsconditions

By A. Schuh 1995By A. Schuh 1995By A. Schuh 1995By A. Schuh 1995

Before Before treatmenttreatment

3 weeks later3 weeks later

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Other expositions and indicationsOther expositions and indications

Rest cure in fresh air (1-3times daily 2 hrs.)Rest cure in fresh air (1-3times daily 2 hrs.)• convalescence of bedridden patientsconvalescence of bedridden patients

Sleep treatment in fresh air (cool breathing air)Sleep treatment in fresh air (cool breathing air)• weather sicknessweather sickness• disorders of circulatory and sleep regulationsdisorders of circulatory and sleep regulations

Air bath (use of bathing dress, kinesitherapy in cold air)Air bath (use of bathing dress, kinesitherapy in cold air)• hypotonic circulatory regulation disordershypotonic circulatory regulation disorders• adiposeadipose• fibromyalgiafibromyalgia

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Indication in Sea Health ResortsIndication in Sea Health ResortsIndication in Sea Health ResortsIndication in Sea Health Resorts

Chronic diseases of respiratory tractChronic diseases of respiratory tract• Rhinitis, sinusitis paranasalis (in Summer time), Rhinitis, sinusitis paranasalis (in Summer time),

pharyngitis, laryngitispharyngitis, laryngitis

• Hay rhinitis (on islands), rhinitis vasomotoricaHay rhinitis (on islands), rhinitis vasomotorica

• Chronic relapsing bronchitisChronic relapsing bronchitis

• Asthma-syndrome, allergic asthma (on islands)Asthma-syndrome, allergic asthma (on islands)

• Situation post pneumonia and pleurisySituation post pneumonia and pleurisy

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Heart- and circulation diseasesHeart- and circulation diseases• Functional circulation disorders, hypo-tensionFunctional circulation disorders, hypo-tension

• Early stage of arteriosclerosisEarly stage of arteriosclerosis

• Well compensated essential hypertension Well compensated essential hypertension

• In-patient rehabilitation after cardiac infarction, In-patient rehabilitation after cardiac infarction, cardiac- and vascular operationscardiac- and vascular operations

• Symptom-complex of varicoseSymptom-complex of varicose

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Skin diseasesSkin diseases

• Eczematous diseases, keratosis, urticaria chronicaEczematous diseases, keratosis, urticaria chronica

• Erythemato-squamous and papular dermatosis, Erythemato-squamous and papular dermatosis, Psoriasis vulgaris (May to July)Psoriasis vulgaris (May to July)

• Dermatosis with blusters Dermatosis with blusters

• Pyodermia, acne vulgarisPyodermia, acne vulgaris

• Phlebopathy Phlebopathy

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Chronic diseases of locomotoric system Chronic diseases of locomotoric system (treatment with mud or other peloides)(treatment with mud or other peloides)

• Arthrosis, spondylitis and osteochondrosisArthrosis, spondylitis and osteochondrosis

• Post-treatment after accident- and war-lesions Post-treatment after accident- and war-lesions and post operationsand post operations

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Women’s diseasesWomen’s diseases• Chronic inflammation processes of the genitals Chronic inflammation processes of the genitals

(treatment by use of slime)(treatment by use of slime)• Concrescence complaints (treatment by use of slime)Concrescence complaints (treatment by use of slime)• Cycles disorders, Ovarian insufficiency (treatment Cycles disorders, Ovarian insufficiency (treatment

by use of slime)by use of slime)• Vegetative-endocrine syndromeVegetative-endocrine syndrome• Postmenopausal syndromePostmenopausal syndrome

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Diseases of childrenDiseases of children• Chronic relapsing diseases of the upper and lower Chronic relapsing diseases of the upper and lower

respiratory tract.respiratory tract.• Infantile asthma syndrome, allergic asthma (on Infantile asthma syndrome, allergic asthma (on

islands)islands)• Hypotonic circulation disordersHypotonic circulation disorders• Skin diseasesSkin diseases• Disorders of developmentDisorders of development

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General weakness situationsGeneral weakness situations

• convalescenceconvalescence

• Dystonia, autonomic nervous Dystonia, autonomic nervous disordersdisorders

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Indications in Indications in Thalassotherapy Thalassotherapy of the respiratory tractof the respiratory tract

Indications in Indications in Thalassotherapy Thalassotherapy of the respiratory tractof the respiratory tract

I II III IV V VI VII VIII IX X XI XIIwithout Decompensation

With moderate DecompensationDiseases

of the respiratory tract

Babies, ill infants, old humans

Delivate, extremely susceptible patients and infants

Nervous excitability

Cardiac-circulation diseases with weather sensitivity

Sinusitides and Otitides

Months:

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Indications in TIndications in Thalassotherapyhalassotherapy of the skin of the skin

Indications in TIndications in Thalassotherapyhalassotherapy of the skin of the skin

I II III IV V VI VII VIII IX X XI XIIfor children and adults, and occupational eczema

By strong asthenia or dystonia autonomic nervous disordersNeurodermitis

Dyshidrotic Eczema

Urticaria, Strophulosis, Furunculosis

Months:

Prurigo

Ichthyosis vulgaris und Psoriasis vulgaris

Acne vulgaris and Acne juvenilis

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Stimulus dosage Stimulus dosage during cure treatmentduring cure treatment

Stimulus dosage Stimulus dosage during cure treatmentduring cure treatment

4 - 8 days spar,4 - 8 days spar,After this time in low steps as strong as possible After this time in low steps as strong as possible

increase,increase,Individual dosage.Individual dosage.

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Water temperature Water temperature and bath permanenceand bath permanenceWater temperature Water temperature

and bath permanenceand bath permanence Temperature

°C

Permanence

minutes

Cure to inure 16 - 18 5 - 15

Hypotension 18 - 20 5 - 15

Circulation disturbance 20 - 22 10 - 20

Sports Swimming 21 - 23 15 - 25

Without healthy use 23 - 26 15 - 25

Underwater gymnastics and kinesitherapy

27 - 29 20 - 25

Rheuma-patients 30 - 36 20 - 30

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Permanence of the first sun-bathPermanence of the first sun-bathby start of exposition May 1by start of exposition May 1stst

Permanence of the first sun-bathPermanence of the first sun-bathby start of exposition May 1by start of exposition May 1stst

180

0

30

60

90

120

150

min

6 8 10 12 14 16 18 h

IIIIIIIV

Daytime

Skin Type

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Permanence of the first sun-bathPermanence of the first sun-bathby start of exposition July 1by start of exposition July 1stst

Permanence of the first sun-bathPermanence of the first sun-bathby start of exposition July 1by start of exposition July 1stst

180

0

30

60

90

120

150

min

6 8 10 12 14 16 18 h

III

III

IV

Daytime

Skin Type

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HeliotherapyHeliotherapy

• Radiation sourcesRadiation sources

• Effect of environment to the global radiationEffect of environment to the global radiation

• Radiation and skinRadiation and skin

• Photochemical and -biological effectsPhotochemical and -biological effects

• Therapeutic and toxic effectsTherapeutic and toxic effects

• Photo-Brine-TherapyPhoto-Brine-Therapy

• Indications, contra-indications and risksIndications, contra-indications and risks

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Radiation in HeliotherapyRadiation in HeliotherapyRadiation in HeliotherapyRadiation in Heliotherapy

Strahlungsbereich WellenlängeGammastrahlung 10-4 bis 10-1 nmRöntgenstrahlung 10-2 bis 10 nm

Vakuum-Ultraviolett 10 bis 200 nmUV-C-Strahlung 200 bis 280 nmUV-B-Strahlung 280 bis 320 nmUV-A-Strahlung 320 bis 400 nm

Licht 400 bis 780 nmInfrarot-Strahlung 780 bis 1.000.000 nm

Mikrowelle 1.000.000 bis 1.000.000.000 nmLicht

HeliotherapyHeliotherapyHeliotherapyHeliotherapy

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Radiation sources in PhototherapyRadiation sources in Phototherapy

Temperature radiatorsTemperature radiators• Sun >300 nmSun >300 nm

Gas-discharge radiatorsGas-discharge radiators• Hg 254, 313, 366Hg 254, 313, 366• Low pressure, high pressure, highest pressureLow pressure, high pressure, highest pressure

LASERLASER• He/Ne 632 nmHe/Ne 632 nm

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Spectrum of an Spectrum of an UV-lampUV-lamp

Recovery

Skin protection against to much sun radiation

Care of health

Vitamin D3

UVB LIGHTUVA

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Global radiation of the sunGlobal radiation of the sun

Equator

Germany

Visible Light

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UV-UV-radiation radiation

of the sunof the sun

UV-C UV-B UV-A

Ozon

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Change of altitudeChange of altitude and the part of sun-irradiation and the part of sun-irradiation

UV-B: UV-B: 15%/1000 m15%/1000 m• Important in high altitudesImportant in high altitudes

UV-A: UV-A: 2-5%/1000 m2-5%/1000 m• Important at Dead Sea level Important at Dead Sea level

(400 m under sea-level)(400 m under sea-level)

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Effect of clouds Effect of clouds to the radiation parts of sunshineto the radiation parts of sunshine

UV: UV: Transmission 50%Transmission 50%Visible: Visible: Transmission 25%Transmission 25%

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Reflection of UV-BReflection of UV-B

Snow Snow 85%85%Gras Gras 26%26%Sand Sand 10-15%10-15%Shoal mud Shoal mud 9-10%9-10%moist ground moist ground 3%3%

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Reflection of white pigmentsReflection of white pigments (by Luckiesh 1946)(by Luckiesh 1946)

Reflection of white pigmentsReflection of white pigments (by Luckiesh 1946)(by Luckiesh 1946)

% ReflexionMaterial

254 nm 297 nm 365 nm Sichtbar

MgO 93 93 94 95-97

Weißer Putz 46 65 76 90

TiO2 6 6 31 94

ZnO 2,5 2,5 4 88

Schwarze Lackschicht 5 5 5 6

Wellpappe 18-31 21-40 33-50 55-75

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Effective erythema dose Effective erythema dose (nach Diffey et al. 1982)(nach Diffey et al. 1982)

Effective erythema dose Effective erythema dose (nach Diffey et al. 1982)(nach Diffey et al. 1982)

Part of the absorbed environmental dose

Sun bath at the beach 0,75

Sitting in Swimming-pool 0,40

Skying 0,22

Walking 0,17

Sailing 0,14

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Penetration of UV-A- andPenetration of UV-A- andUV-B-rays into the skinUV-B-rays into the skin

UV-B 0,4%

UV-A 3,9%

Visible51,8%

Infrarot43,9%

Stratum corneum

Cutis

Subcutis

Stratum spinosum

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Penetration into the skinPenetration into the skin

Light

Depth to find

1 % of surface

dose

relative Dose in Stratum basale in % of

surface dose

nm mm White Negro UV-C 250 0,2 1,5 UV-B 300 0,5 18 UV-A 350 1,0 45 8 green 550 1,2 65 40 red 700 1,4 75 60 NIR 1230 2,3 95 IR 2200 1,1 75

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Transmission of skin layers in %Transmission of skin layers in % (nach Bachem und Reed 1930; modifiziert von Daniels 1969)(nach Bachem und Reed 1930; modifiziert von Daniels 1969)

Transmission of skin layers in %Transmission of skin layers in % (nach Bachem und Reed 1930; modifiziert von Daniels 1969)(nach Bachem und Reed 1930; modifiziert von Daniels 1969)

Hautschicht Dickein mm

Wellenlänge in nm

200 250 280 300 400 550 750

Hornschicht 0,03 0 19 15 34 80 87 78

+ nativeEpidermis

0,05 0 11 9 16 57 77 65

+ Dermis 2,0 0 0 0 0 0 5 21

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Action-spectresAction-spectres

Pigmentation

ErythemaConjunctivitis AAAA

BBBBCCCC

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DefinitionsDefinitionsDefinitionsDefinitions

Radiation powerRadiation power

• Quotient between radiation flow and the Quotient between radiation flow and the affected area (unit: W/maffected area (unit: W/m22))

Radiation doseRadiation dose

• Product of radiation power and radiation time. Product of radiation power and radiation time. (unit: Ws /m(unit: Ws /m2 2 or J/mor J/m22))

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Radiation instruction Radiation instruction for different lamp-typesfor different lamp-typesRadiation instruction Radiation instruction

for different lamp-typesfor different lamp-types

TypischerAbstand

TypischeBestrahlungs

-zeit

Betrahlungs-stärke bei

diesemAbstand

Kromeyer-Lampe Kontakt 2 s 240 W/m2

UV-B-Strahler 0,5 m 3 min 7 W/m2

UV-A-Strahler 0,5 m 5 – 30 min 0,4 W/m2

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Radiation power Radiation power and biological effectivenessand biological effectiveness

UV-B UV-A

1

0,01

0,0001

0,000001

300 325 350 375 400

UV-spectrum

biologic Sensitivity

effectiveUV-spectrum

Wavelength___________

nm

Relative biologic effectivenessand radiation power in W/m2/nm

Klim 70

Rules of PhotochemistryRules of PhotochemistryRules of PhotochemistryRules of Photochemistry

Photochemical reactions take place only by absorbed radiation Photochemical reactions take place only by absorbed radiation (Grothus-Draper).(Grothus-Draper).

The photochemical effect is proportional to the product of intensity The photochemical effect is proportional to the product of intensity and performance and performance (Bunsen-Roscoe).(Bunsen-Roscoe).

The absorbed part of light by a substance depends not on the The absorbed part of light by a substance depends not on the intensity of light and increase only by their concentration intensity of light and increase only by their concentration (Lambert-(Lambert-Beer).Beer).

Radiation follows in quantum units and not in a continuum Radiation follows in quantum units and not in a continuum (Planck).(Planck).

By each absorbed quantum will be formed one activated molecule By each absorbed quantum will be formed one activated molecule (Stark-Einstein).(Stark-Einstein).

Klim 71

Photochemical reactionsPhotochemical reactionsPhotochemical reactionsPhotochemical reactions

Photochemical activation: A + hPhotochemical activation: A + h A* A*

Following reactions:Following reactions:Energy change: A* Energy change: A* A + heat, light A + heat, lightEnergy transfer: A* + B Energy transfer: A* + B A + B* A + B*Splitting: A* Splitting: A* a a11 + a + a22

Synthesis: A* + B Synthesis: A* + B AB AB

Klim 72

Photochemical radiation effectsPhotochemical radiation effects

UV-B and CUV-B and C• Dimerisation of thymidine-bricksDimerisation of thymidine-bricks• Cracking of amino acids: forming of vasoactive substancesCracking of amino acids: forming of vasoactive substances• Inactivation most of enzymesInactivation most of enzymes• Forming of steroid hydro-peroxides on the skin (cancerogenic)Forming of steroid hydro-peroxides on the skin (cancerogenic)

Klim 73

UV-Spectrum UV-Spectrum of vitamin D und ergosterineof vitamin D und ergosterine

Vitamin DErgosterine

20

10

220 260 300

40

20

mµ

Ext

inki

on

sco

effi

cien

t E

rgo

ste

rin

e

Ext

inkt

ion

sco

effi

cien

t V

itam

in D

UV-BUV-B

Klim 74

Vitamin DVitamin D33 development development

255-320 nm255-320 nm

• Change of 7-Dehydro-cholesterine to vitamin DChange of 7-Dehydro-cholesterine to vitamin D33

• Requirement of DRequirement of D33 is produced by a 2 times weekly Sun- is produced by a 2 times weekly Sun-

radiation without erythema to an area like face and arms.radiation without erythema to an area like face and arms.

7-Dehydrocholesterine7-Dehydrocholesterine Vitamin DVitamin D33 1,25-Dihydroxycholecalciferole1,25-Dihydroxycholecalciferole

Activation of intestinal Ca- and phosphate absorptionActivation of the renal phosphate reabsorption

Activation of the intraerythrocytal glycolysisIncrease of 2,3-Diphosphoglycerate in the erythrocytes

Increase of the dissociation of oxyhemoglobineIncrease of the O2-supply of cells

Klim 75

Increase of vitamin DIncrease of vitamin D33-reaction products -reaction products

after 4 hrs. UV-B-radiationafter 4 hrs. UV-B-radiation((Humpler 1982Humpler 1982))

0%

10%

20%

30%

2,45mmol/l

1,28mmol/l

13.95µmol/l

25,5mmHg

9,25U/gHb

0,59U/gHb

Ca

PO4

DPG

P50

PFK PK

Plasma

Plasma

Ery

Ery

EryEryn = 16

Klim 76

Primary target-cells ofPrimary target-cells of UV-radiation UV-radiation

Primary target-cells ofPrimary target-cells of UV-radiation UV-radiation

Corneocytes (UV-C)Corneocytes (UV-C)Keratinocytes (UV-B)Keratinocytes (UV-B)Melanocytes (UV-B and UV-A)Melanocytes (UV-B and UV-A)Langerhans cells (UV-B)Langerhans cells (UV-B)Endothelial cells (UV-A)Endothelial cells (UV-A)Inocytes (UV-A)Inocytes (UV-A)

Klim 77

Photobiological radiation effect Photobiological radiation effect by UV-Bby UV-B

Erythema: max. 297 nmErythema: max. 297 nm• Latency: 1-4 hrs.Latency: 1-4 hrs.• Maximum: 6-9 hrs.Maximum: 6-9 hrs.• MED: 36-50 mJ/cmMED: 36-50 mJ/cm22

Klim 78

Change of Amino acid concentration in the horny Change of Amino acid concentration in the horny layer by iterative UV-radiationlayer by iterative UV-radiation

Klim 79

Keratinocyte reactionsKeratinocyte reactionsKeratinocyte reactionsKeratinocyte reactions

Intra- and intercellular oedemaIntra- and intercellular oedemaCytolysisCytolysisForming of sunburn cellsForming of sunburn cells

Klim 80

Keratinocyte reactionsKeratinocyte reactionsby lipid peroxidation of membranesby lipid peroxidation of membranes

Keratinocyte reactionsKeratinocyte reactionsby lipid peroxidation of membranesby lipid peroxidation of membranes

Odland-Granules move into the intercellular Odland-Granules move into the intercellular spacespace

Lysosomes are resolvedLysosomes are resolvedLysosomal enzymes are releasedLysosomal enzymes are releasedMitochondria will be destroyedMitochondria will be destroyed

Klim 81

Keratinocyte reactionsKeratinocyte reactionsKeratinocyte reactionsKeratinocyte reactions

The reaction of keratinocytes by UV-C, UV-B, The reaction of keratinocytes by UV-C, UV-B, UV-A or phototoxic substances is qualitative UV-A or phototoxic substances is qualitative equivalent and is already released by sub-equivalent and is already released by sub-erythemal doses.erythemal doses.

Klim 82

Photochemical radiation effectsPhotochemical radiation effects by UV-B by UV-B

Indirect pigmentation: Dose <50 mJ/cmIndirect pigmentation: Dose <50 mJ/cm22

• Metabolism of dopaoxidase to tyrosinaseMetabolism of dopaoxidase to tyrosinase

• Oxidation of DOPA to melanin in melanocytesOxidation of DOPA to melanin in melanocytes

Klim 83

Melanocyte-reaction Melanocyte-reaction (Melanogenesis)(Melanogenesis)

Melanocyte-reaction Melanocyte-reaction (Melanogenesis)(Melanogenesis)

Minimal Dose UV-B: about 23 mJ/cmMinimal Dose UV-B: about 23 mJ/cm22

Minimal Dose UV-A: 17,7 ± 8 J/cmMinimal Dose UV-A: 17,7 ± 8 J/cm22

Latency time: 1-14 daysLatency time: 1-14 daysPermanency: some monthsPermanency: some monthsForming of black or brown Eumelanin and yellow Forming of black or brown Eumelanin and yellow

or red Pheomelaninor red PheomelaninUV-protection depended on localisationUV-protection depended on localisation

Klim 84

Melanin-synthesisMelanin-synthesis

L-Tyrosin L-Dopa Dopachinon

Dopachrom

slowly fast

spontan

DopaoxydaseDopaoxydaseProtein (Cu++)2

ActivationActivationDeletion of the SH-Inhibition

TyrosinaseTyrosinaseProtein (Cu+)2

UV-radiation 280-310 nmX-radiation

temperature increaseinflammation process

SH-blocker: As, Fe, Bi, Au, Ag, Hg

by

MelaninMelanin

Polym.

Klim 85

Photobiologic reactions byPhotobiologic reactions byUV-B-radiationUV-B-radiation

Inhibition of the basal cell mitoses rateInhibition of the basal cell mitoses rateForming of sunburn cells suprabasal (max. 30 hrs.)Forming of sunburn cells suprabasal (max. 30 hrs.)Inhibition of Langerhans cellInhibition of Langerhans cellLiberation of interleucin 1 (max. 2 hrs.)Liberation of interleucin 1 (max. 2 hrs.)Reactive hyper-epidermopoesis (latency 24 hrs.; Reactive hyper-epidermopoesis (latency 24 hrs.;

permanency 3 weeks)permanency 3 weeks)Akanthosis by following hyper-keratosis Akanthosis by following hyper-keratosis

(Miescher’sche Lichtschwiele)(Miescher’sche Lichtschwiele)

Klim 86

Langerhans cell-reactionLangerhans cell-reactionLangerhans cell-reactionLangerhans cell-reaction

Inhibition of the immune answerInhibition of the immune answerBlocking of T-helper cellsBlocking of T-helper cellsStimulation of T-Suppressor cellsStimulation of T-Suppressor cells

Klim 87

Photochemical radiation effect Photochemical radiation effect by UV-Aby UV-A

Direct pigmentation: Direct pigmentation: Dose >25 J/cmDose >25 J/cm22

• Intracellular peroxide formingIntracellular peroxide forming• Stimulation of the pigment movement in the melanocytesStimulation of the pigment movement in the melanocytes

Klim 88

The melanin-unitThe melanin-unit

1 Melanocyt by 36 Keratinocytes

Melanocyt

Melanosomeswith Melanin

Phagocytosis of Melanosomes

Stratum basaleStratum basale

Klim 89

Endothel cell-reactionEndothel cell-reactionEndothel cell-reactionEndothel cell-reaction

VasodilatationVasodilatationIncreased vasopermeabilityIncreased vasopermeability

Klim 90

Reaction by Reaction by UV-A -overdosageUV-A -overdosage

FeverFeverLeucocytosisLeucocytosisIncrease of CRP and immunoglobulinIncrease of CRP and immunoglobulinIncrease of phagocytosal effectiveness in Increase of phagocytosal effectiveness in

leukocytesleukocytes

Klim 91

Photochemical radiation effect Photochemical radiation effect by visible lightby visible light

Blue light 400-480 nmBlue light 400-480 nm

• Bilirubin will be changed by new-born to a Bilirubin will be changed by new-born to a renal eliminated substance.renal eliminated substance.

Klim 92

Jaundice of newbornby continual radiation 450-460 nm, 34 µW/cm2/nm

Control

Treatment group16

14

12

10

8

6

4

2

0

Serum Bilirubin Concentrationmg/100ml

0,24 24 48 72 96 120 144 168 Age in hrs.

Klim 93

Action spectrum to destroy of Action spectrum to destroy of bilirubinbilirubin

400400 450450 500500 550550 600600 650650 nmnm

2525

2020

1515

1010

55

00

Ab

bau

vo

n S

eru

m-B

iliru

bin

Ab

bau

vo

n S

eru

m-B

iliru

bin

%%

Klim 94

Skin typesSkin types

Type IType I:: Sunburn without Sunburn without pigmentationpigmentation

Type IIType II:: Erythema with Erythema with low pigmentationlow pigmentation

Type IIIType III:: Seldom sunburn Seldom sunburn and distinct pigmentationand distinct pigmentation

Type IVType IV:: Never sunburn Never sunburn and over average and over average pigmentationpigmentation

Type VType V:: South European South European and Indianand Indian

Type VIType VI:: Negroid Race Negroid Race

Klim 95

Skin typesSkin typesSkin typesSkin types

Typ I

keltic Type

Typ II

light-skin

European

Typ III

dark-skin

European

Typ IV

mediterrian

Type

incidence 2 % 12 % 78 % 8 % skin color Very light light Light brown darkbrown mamilla stricking light light pigmentated dark lentigo many often hardly never Sunburn risk always nearly

always seldom never

Pigmentation hardly moderate always always Protection time 5-10 min 10-20 min 20-30 min 30-40 min

Klim 96

Representative Exposition special PersonsRepresentative Exposition special Persons (nach Challoner 1976 und Leach 1978)(nach Challoner 1976 und Leach 1978)

Representative Exposition special PersonsRepresentative Exposition special Persons (nach Challoner 1976 und Leach 1978)(nach Challoner 1976 und Leach 1978)

Group Part of absorbed environment dose

Gardener 0,1

Sunexposition on the balkony

0,1

Labor- and office worker 0,03

Bedridden long term patients

0,001

Klim 97

Persons with higher UV-sensitivityPersons with higher UV-sensitivityPersons with higher UV-sensitivityPersons with higher UV-sensitivity

New-born and infantsNew-born and infantsChildren more than adultChildren more than adultBloated childrenBloated childrenMen are 20% more sensitive than womenMen are 20% more sensitive than womenOld human are lesser sensitiveOld human are lesser sensitive

Klim 98

Relative UV sensitivity of different body areasRelative UV sensitivity of different body areasRelative UV sensitivity of different body areasRelative UV sensitivity of different body areas

Back of the hand, lower leg Back of the hand, lower leg 25 %25 %Forehead, neck, leg Forehead, neck, leg 25 - 50 %25 - 50 %Arms Arms 50 - 75 %50 - 75 %Breast, abdomen, back Breast, abdomen, back 75 - 100 75 - 100

%%

Klim 99

Minimal erythema dose (MED)Minimal erythema dose (MED)

Light-steps by 20-30-40-50-60-70 mJ/cmLight-steps by 20-30-40-50-60-70 mJ/cm22

Back, buttocks (representative), forearmsBack, buttocks (representative), forearmsControl after 24 hrs.Control after 24 hrs.Heliotherapy will be used by tablesHeliotherapy will be used by tables

Klim 100

MED and UV-AMED and UV-AMED and UV-AMED and UV-A

The MED for UV-B will be decrease by The MED for UV-B will be decrease by UV-A-irradiation. UV-A-irradiation. (Photoaddition or Photoaugmentation ?)(Photoaddition or Photoaugmentation ?)

Klim 101

Erythema stageErythema stage

SuberythemaSuberythema:: no visible erythema (sedative Dose) no visible erythema (sedative Dose) Stage IStage I:: hardly visible erythema (MED), subside after 1-2 days. hardly visible erythema (MED), subside after 1-2 days. Stage IIStage II:: low reddening (5times MED), after 3 days subside by easy low reddening (5times MED), after 3 days subside by easy

little desquamation.little desquamation. Stage IIIStage III:: intensive reddening, about 1 week persistent, defurfuration. intensive reddening, about 1 week persistent, defurfuration.

Inflammation dose for small areas by treatment of acne vulgaris and Inflammation dose for small areas by treatment of acne vulgaris and painful situations like Lumbalgo.painful situations like Lumbalgo.

Stage IVStage IV:: very intensive reddening after 2 hrs. (9times MED), very intensive reddening after 2 hrs. (9times MED), vesication.vesication.

Klim 102

Treatment of Treatment of Dermatitis solarisDermatitis solaris

Cooling packsCooling packs mild shaking mixture like Lotio alba, 0,5% Vioform-mild shaking mixture like Lotio alba, 0,5% Vioform-

LotioLotio Prescription of corticosteroids containing lotions or Prescription of corticosteroids containing lotions or

CrèmesCrèmes In very strong forms injection of Calcium and anti-In very strong forms injection of Calcium and anti-

histaminica, if necessary also corticosteroides, oral or histaminica, if necessary also corticosteroides, oral or possible i.v.possible i.v.

Klim 103

Photo-Pigmentation-Index (PPI)Photo-Pigmentation-Index (PPI)

Quotient by erythema and Pigmentation Quotient by erythema and Pigmentation stage. It is to control after 72 and 120 hrs. in stage. It is to control after 72 and 120 hrs. in 4 half-quantitative stages by various points.4 half-quantitative stages by various points.

Good pigmentation: PPI < 1Good pigmentation: PPI < 1deficient pigmentation: PPI >1deficient pigmentation: PPI >1

Klim 104

Rules of PhototherapyRules of Phototherapy

To use the lowest therapeutic doseTo use the lowest therapeutic doseTo avoid erythemaTo avoid erythemaBy skin diseases to irradiate till free of symptoms, By skin diseases to irradiate till free of symptoms,

than decrease radiation dose slowly step by step.than decrease radiation dose slowly step by step.By repeated radiation to use low single doses.By repeated radiation to use low single doses.

Klim 105

Indications in UV-therapyIndications in UV-therapyIndications in UV-therapyIndications in UV-therapy

Psoriasis vulgarisPsoriasis vulgaris Pemphigus vulgarisPemphigus vulgaris UrticariaUrticaria Herpes simplex o. solarisHerpes simplex o. solaris NeurodermitisNeurodermitis Seborrhoic EczemaSeborrhoic Eczema IchthyosisIchthyosis Acne vulgaris Acne vulgaris

Ulcus crurisUlcus cruris AlopeciaAlopecia Pityriasis versicolorPityriasis versicolor Mycosis fungoidesMycosis fungoides Rachitis-prophylaxisRachitis-prophylaxis Secondary AnaemiaSecondary Anaemia HyperthyreosisHyperthyreosis HypertensionHypertension

Klim 106

Effects and indicationsEffects and indicationsEffects and indicationsEffects and indications

Habituation and Habituation and exertion of exertion of influence the influence the prurituspruritus

Lichen ruber planusLichen ruber planus Pityriasis lichenoidesPityriasis lichenoides Erythrodermie pityriasique en Erythrodermie pityriasique en

plaques disséminéesplaques disséminées Dermatitis herpetiformis Dermatitis herpetiformis

(Pemphigus vulgaris, Urticaria)(Pemphigus vulgaris, Urticaria) LighturticariaLighturticaria Herpes simplexHerpes simplex Seborrhoic eczemaSeborrhoic eczema IchthyosisIchthyosis

Klim 107


InurityInurity cytostatic effectcytostatic effect

RepigmentationRepigmentation PeelingPeeling

Psoriasis vulgarisPsoriasis vulgaris Psoriasis vulgarisPsoriasis vulgaris Reticules and reticular Reticules and reticular

HyperplasiaHyperplasia VitiligoVitiligo Pityriasis versicolorPityriasis versicolor Pityriasis roseaPityriasis rosea

Klim 108


Activation of the metabolismActivation of the metabolism

Vitamin-D-activationVitamin-D-activation

Acne vulgaris et Acne vulgaris et conglobataconglobata

Alopecia areata et diffusaAlopecia areata et diffusa Mycosis fungoidesMycosis fungoides

Klim 109

Indications in the Heliotherapy Indications in the Heliotherapy by supportive treatmentby supportive treatment

Non active rheumatoid arthritisNon active rheumatoid arthritis General tendo-periostosisGeneral tendo-periostosis HypertensionHypertension OsteomalaciaOsteomalacia OsteoporosisOsteoporosis Respiratory tract diseasesRespiratory tract diseases Non active TbcNon active Tbc Cardiac rehabilitationCardiac rehabilitation DepressionsDepressions

Klim 110

Use of Heliotherapy in PreventionUse of Heliotherapy in Prevention

Light-adaptation in winter and spring time in case Light-adaptation in winter and spring time in case of light-urticaria and other photodermatosesof light-urticaria and other photodermatoses

Rickets prophylaxis in childhoodRickets prophylaxis in childhoodInfect prophylaxis and increase of the immune Infect prophylaxis and increase of the immune

resistanceresistanceIncrease of the mental learning possibilityIncrease of the mental learning possibility

Klim 111

Application of the HeliotherapyApplication of the Heliotherapy

Daily or two-daily irradiation by suberythemal Daily or two-daily irradiation by suberythemal dosesdoses

6 applications6 applicationsIncrease till erythema first stageIncrease till erythema first stageTo avoid overheatingTo avoid overheating

Klim 112

Progression of the Dose of Progression of the Dose of SunbathesSunbathes

Progression of the Dose of Progression of the Dose of SunbathesSunbathes

1. Tag 34 Minuten2. Tag 44 Minuten3. Tag 58 Minuten4. Tag 75 Minuten5. Tag 97 Minuten6. Tag 126 Minuten7. Tag 164 Minuten8. Tag 213 Minuten9. Tag 277 Minuten10. Tag 361 Minuten

8. Tag

30 % Increase

Klim 113

The sedative cureThe sedative cureThe sedative cureThe sedative cure

Behandlung Intervall Tage Dosierung Reaktion Bemerkungen

1. 0,5

2. 0,7

3. 0,9

4. 1,1

5. 1,3

6.

Täglich oder jeden 2. Tag

1,5

Suberythem Die sehr leichte Reaktion sollnach jeder Behandlungwieder auftreten.Ansteigende Dosen bishöchstens zum Auftreten desErythems ersten Grades.

Klim 114

The tonic cureThe tonic cureThe tonic cureThe tonic cure


1. 12. 1,33. 1,64. 25. 2,36. 2,67. 38. 3,39. 3,610. 411. 4,312. 4,613. 514. 5,315.

2—3 Tage zwischen deneinzelnen Behandlungen

5,6

ErythemerstenGrades

Das Ziel ist, nach jederBehandlung das Erythemersten Grades zu erzeugen.Bei jeder Behandlung werdenRücken und Brustseite desKörpers bestrahlt. BeimAuftreten von Pigmentation3-4 Wochen aussetzen undvon vorne beginnen..

Klim 115

The therapeutic cureThe therapeutic cureThe therapeutic cureThe therapeutic cure


1. 12. 1,53. 2,254. 3,55. 56. 7,57. 168. 169. 2410. 2711. 3012.

2—3 Tage, die Reaktionauf die vorhergehendeBestrahlung mußverschwunden sein.

30

Erster, späterzweiter GraddesErythems.Pigmentationvon der 6.Behandlungab.

Nach jeder Bestrahlung sollein ausgesprochenes Erythemfestgestellt werden können.Nach 12 Sitzungen 3-4Wochen Pause.

Klim 116

Sunbathes in flat country altitude till 500 mSunbathes in flat country altitude till 500 m in minutes in minutes

Monat Tageszeit wolkenlos teilweise bewölkt

1. Bad 3. Bad 5. Bad 1. Bad 3. Bad 5. Bad

März Vormittags11-14 UhrNachmittags

706090

909090

909090

907590

909090

909090

April Vormittags11-14 UhrNachmittags

403555

607090

909090

504570

907590

909090

Mai Vormittags11-14 UhrNachmittags

302540

554570

907590

403050

705590

909090

Juni/Juli Vormittags11-14 UhrNachmittags

353045

605075

909090

454060

757090

909090

August Vormittags11-14 UhrNachmittags

403555

706090

909090

504570

907590

909090

Septem. Vormittags11-14 UhrNachmittags

605075

909090

909090

756090

909090

909090

Klim 117

Sunbathes in high altitudes 1300 to 1700 Sunbathes in high altitudes 1300 to 1700 mm

in minutes in minutes Monat Tageszeit wolkenlos teilweise bewölkt

1. Bad 3. Bad 5. Bad 1. Bad 3. Bad 5. Bad

MärzSchnee

Vormittags11-14 UhrNachmittags

504060

907090

909090

605075

909090

909090

AprilSchnee


252030

453555

756090

302540

554570

907590

AprilkeinSchnee


353045

605075

909090

454060

757090

909090

Mai Vormittags11-14 UhrNachmittags

252030

453555

756090

302540

554570

907590

Juni Vormittags11-14 UhrNachmittags

302540

554570

907590

403050

705590

909090

JuliAugust


252030

453550

756090

302540

504570

907590

Septem. Vormittags11-14 UhrNachmittags

353045

605575

909090

454060

757090

909090

Klim 118

Relative MED and geographic latitudeRelative MED and geographic latitudeRelative MED and geographic latitudeRelative MED and geographic latitude

Columbia

nach Piazena

Klim 119

Indications in HeliotherapyIndications in Heliotherapy

by supportive treatmentby supportive treatment of skin diseasesof skin diseases

Pruritic dermatosesPruritic dermatosesChronic relapsed urticariaChronic relapsed urticariaAtopic constitutional neurodermitisAtopic constitutional neurodermitisPsoriasis arthropaticaPsoriasis arthropaticaVitiligoVitiligo

Klim 120

Effects of visible lightEffects of visible lightEffects of visible lightEffects of visible light

DynamisationIncrease of performanceMood improvement

Klim 121

Photo-Sole-Therapy IPhoto-Sole-Therapy I

Indications Indications • PsoriasisPsoriasis• Ichthyosis Ichthyosis

10-15 minutes bath in high concentrated brine or sea 10-15 minutes bath in high concentrated brine or sea waterwater

Irradiation by suberythemale dose dailyIrradiation by suberythemale dose daily• SUP-radiator (300-320 nm) (SUP-radiator (300-320 nm) (UV-BUV-B))• SunSun

Klim 122

Photo-Sole-Therapy IIPhoto-Sole-Therapy II

Indications Indications • Atopic constitutional neurodermitis Atopic constitutional neurodermitis

10-15 minutes bath first in 1% brine or more if tolerable10-15 minutes bath first in 1% brine or more if tolerable Irradiation daily byIrradiation daily by

• High performance-High performance-UV-AUV-A-radiator-radiator• SunSun

Klim 123

Indications Indications in red-light- or Infrared-therapyin red-light- or Infrared-therapy

Moisten eczemaMoisten eczema DermatitidesDermatitides SinusitidesSinusitides Hordeolum (sty)Hordeolum (sty) FuruncleFuruncle chronic-inflammatory rheumatic diseases in non-acute stagechronic-inflammatory rheumatic diseases in non-acute stage degenerative diseases of the spine and extremitydegenerative diseases of the spine and extremity Soft tissue rheumatic diseasesSoft tissue rheumatic diseases

Klim 124

Contraindications in case of Contraindications in case of overheatingoverheating

Disturbance of sensibilityDisturbance of sensibility Congestive cardiac insufficiencyCongestive cardiac insufficiency Strong disturbance of cardiac rhythmStrong disturbance of cardiac rhythm Acute situation post myocardial infarctAcute situation post myocardial infarct Hormonal disorders in diabetes mellitus, Hormonal disorders in diabetes mellitus,

hyperthyroidism, adrenal cortex insufficiencyhyperthyroidism, adrenal cortex insufficiency Advanced vascular disturbanceAdvanced vascular disturbance

Klim 125

Light protectionLight protection

Most of light protection agents absorb mainly UV-B.Most of light protection agents absorb mainly UV-B. In this case by use of light protection agents the result is a stronger In this case by use of light protection agents the result is a stronger

irradiation by UV-A, because no warning erythema is developed. irradiation by UV-A, because no warning erythema is developed. Endogenous light protection is mainly resulted by increase of horny Endogenous light protection is mainly resulted by increase of horny

layer thickness. A small part of endogenous light protection is related to layer thickness. A small part of endogenous light protection is related to the amino acids and urocanic acid in the horny layer. Melanin is the amino acids and urocanic acid in the horny layer. Melanin is protecting, if it is deposit in the horny layer of some races or skin types. protecting, if it is deposit in the horny layer of some races or skin types.

Light adaptation by protract and fractionated irradiation lower than the Light adaptation by protract and fractionated irradiation lower than the MED can be recommended.MED can be recommended.

Klim 126

Light protection factorLight protection factorLight protection factorLight protection factor

Protection time = Protection time = Endogenous protection time x Light protection factorEndogenous protection time x Light protection factor

Light callosity: Light callosity: light protection factor 4 light protection factor 4Pigmentation: Pigmentation: light protection factor 10 light protection factor 10Adaptation: Adaptation: till light protection factor 40 till light protection factor 40

Klim 127

Photo-allergyPhoto-allergy

SulphonamideSulphonamidePsychopharmacaPsychopharmacaAntihistaminicaAntihistaminicaAntimycoticaAntimycotica

PhenothiazinePhenothiazineDesodorantiaDesodorantiaOptic clearing agents in Optic clearing agents in

laundrylaundrySweetening agentsSweetening agents

Photo-allergic reaction latency of 7-21 days.

Klim 128

Photo-toxicityPhoto-toxicity

Contamination in Contamination in Vaseline and face Vaseline and face cosmeticscosmetics

Acridine dyesAcridine dyesTrypaflavinTrypaflavin

Eosin in lip sticksEosin in lip sticksGras-dermatitisGras-dermatitisBergamot oil (eau de Bergamot oil (eau de

cologne) Berloque-cologne) Berloque-dermatitisdermatitis

Photo-toxic reactions no latency.

Klim 129

Light sensitivity in PorphyryLight sensitivity in Porphyry

300 400 500 600 nm

rela

tive

Em

pfi

nd

lic

hke

it

Klim 130

Contraindications of Contraindications of PhototherapyPhototherapy

Light-dermatosis (photo-toxic, photo-allergic, Light-dermatosis (photo-toxic, photo-allergic, photosensitization, photo-anaphylactic, photo-photosensitization, photo-anaphylactic, photo-biotrophic reactions)biotrophic reactions)

Exsudative or open TbcExsudative or open TbcHyperthyreosisHyperthyreosisUlcus ventriculi and duodeniUlcus ventriculi and duodeni

Klim 131

Unsuitable is the Unsuitable is the UV-irradiation by UV-irradiation by

Decompensation situation of the Decompensation situation of the circulation systemcirculation system

Acute nephritisAcute nephritisCachexiaCachexiaHaemophiliaHaemophiliaStrong menstrual bleedingStrong menstrual bleedingX-ray-dermatitisX-ray-dermatitis

Klim 132

Risks in case of exacerbationRisks in case of exacerbation

Psoriasis in stadium of outbreakPsoriasis in stadium of outbreakLichen ruber planusLichen ruber planusPityriasis roseaPityriasis roseaPorphyryPorphyry

Klim 133

RisksRisks

Oncological risk in therapeutic use is insignificant.Oncological risk in therapeutic use is insignificant.Change in connective tissue, development of folds and Change in connective tissue, development of folds and

basaloma in radiated skin areas are the result of excessive basaloma in radiated skin areas are the result of excessive and unnecessary use of solaria in cosmetic interest or sun and unnecessary use of solaria in cosmetic interest or sun exposition during long life of special occupation groups.exposition during long life of special occupation groups.

Melanoma are to find up to 75% as late lesion on not Melanoma are to find up to 75% as late lesion on not irradiated areas especially as follow up of strong light irradiated areas especially as follow up of strong light inflammations during the childhood. inflammations during the childhood.

Mortality in Germany is 0,2 cases per 10000 inhabitants.Mortality in Germany is 0,2 cases per 10000 inhabitants.

Klim 134

Benefit and Disadvantage of the Benefit and Disadvantage of the UV-radiationUV-radiation

DisadvantageDisadvantageDeficiency disease by underdosageDeficiency disease by underdosage

BenefitBenefitDietetic use by normal dosageDietetic use by normal dosagePreventive use in actual deficiency diseases Preventive use in actual deficiency diseases Stimulation by short overdosageStimulation by short overdosageUse in therapeutic treatment by special dosage (skin diseases)Use in therapeutic treatment by special dosage (skin diseases)

DisadvantageDisadvantageToxic skin reactions by overdosageToxic skin reactions by overdosage

Klim 135

““Sunbalance” by GreiterSunbalance” by Greiter

BenefitsBenefits Essential Photosynthesis (Vegetation and oxygen)Essential Photosynthesis (Vegetation and oxygen) Seeing and hormonal controlSeeing and hormonal control Vitamin D-synthesis and development of a functional skeleton and protection against Vitamin D-synthesis and development of a functional skeleton and protection against

ricketsrickets Killing of bacteriaKilling of bacteria HeatHeat Healing of diseasesHealing of diseases Activation of the human organismActivation of the human organism Improved performance economyImproved performance economy Improved protection of the organism by increased melanin synthesis and increased Improved protection of the organism by increased melanin synthesis and increased

thickness of the horny layer.thickness of the horny layer.

Klim 136

““Sunbalance” by GreiterSunbalance” by Greiter

DisadvantageDisadvantageSunburnSunburnPremature skin ageingPremature skin ageingSkin cancerSkin cancerPhototoxic or photoallergic effectsPhototoxic or photoallergic effects

Klim 137

ConclusionConclusion

Clime- and Heliotherapy are stimulation treatments.Clime- and Heliotherapy are stimulation treatments.Result is the reactivation of already present self- Result is the reactivation of already present self-

healing power.healing power.Patients could be independent by use of pharmaca.Patients could be independent by use of pharmaca.Clime- and Heliotherapy are typical naturopathic Clime- and Heliotherapy are typical naturopathic

treatments.treatments.

Klim 138

LiteratureLiterature

Phototherapie von S. Chlebarov und H.G. Pratzel im “Lehrbuch der Phototherapie von S. Chlebarov und H.G. Pratzel im “Lehrbuch der Physikalischen Medizin und Rehabilitation”. Hrsg. von K.L.Schmidt, Physikalischen Medizin und Rehabilitation”. Hrsg. von K.L.Schmidt, H. Drexel, K.-A.Jochheim im G. Fischer Verlag, Heidelberg, 1995 H. Drexel, K.-A.Jochheim im G. Fischer Verlag, Heidelberg, 1995 (ISBN 3-437-00797-1)(ISBN 3-437-00797-1)

Klimatherapie: ebenda Artikel von W. Schmidt-Kessen und mehrere Klimatherapie: ebenda Artikel von W. Schmidt-Kessen und mehrere Artikel versch. Autoren in “Heilbad und Kurort. 48. Jahrgang, Heft 3 Artikel versch. Autoren in “Heilbad und Kurort. 48. Jahrgang, Heft 3 1996.”1996.”

Elektroklima: P. Kröling: Übersichtsartikel in “Die Heilkunst 7/92, S. Elektroklima: P. Kröling: Übersichtsartikel in “Die Heilkunst 7/92, S. 241-250”241-250”

1 clime- and heliotherapy. klim 2 introductionintroduction therapeutic usable clime (healing clime)...

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