dead sea mud in the treatment of psoriasis _ dr jamalal dabbas medics index member contribution may...

8/9/2019 Dead Sea Mud in the Treatment of Psoriasis _ Dr JamalAl Dabbas Medics Index Member Contribution May 2010

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Dead Sea Mud in theDead Sea Mud in the

Treatment of PsoriasisTreatment of Psoriasis

Dr. Walid FarahDr. Walid Farah

Dr. Jamal DabbasDr. Jamal Dabbas

Dr. Jalal ZubiDr. Jalal Zubi

Dr. Jeries DaoudDr. Jeries Daoud

Amman - JordanAmman - Jordan
http://www.medicsindex.com/http://www.medicsindex.com/


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IntroductionIntroduction

Psoriasis represent the largest group of skinPsoriasis represent the largest group of skin

disease patients treated at the Dead Sea whichdisease patients treated at the Dead Sea which

have been investigated.have been investigated.

In our study therapy used at home and not atIn our study therapy used at home and not at

the Dead Sea.the Dead Sea.
http://www.medicsindex.com/


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Methods and MaterialsMethods and Materials

March August 1998.March August 1998.

Patients treated in dermatology clinics outsidePatients treated in dermatology clinics outside

the Dead Sea above the sea level in Jordan.the Dead Sea above the sea level in Jordan. 120 patients of psoriasis.120 patients of psoriasis.

Two groups 60 patients each.Two groups 60 patients each.

First group assigned to use Dead Sea Mud.First group assigned to use Dead Sea Mud. Second group to use wash out mud ( FalseSecond group to use wash out mud ( False

mud).mud).


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Comparison of major ingredients ofComparison of major ingredients of

true mud and washed out mudtrue mud and washed out mud

Ingredients True mud (mg/L) False mud (mg/L)

Ca 23556 64.5

Na 31727 81.2

K 6841 56.3

Cl 190000 1100

Mg 32493 105.1

Total Scaling 284598 1397.0


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Methods and MaterialsMethods and Materials

Age 14 61 years.Age 14 61 years.

All in good health apart from psoriasis.All in good health apart from psoriasis.

2 pts in true mud group and 4 pts in false mud2 pts in true mud group and 4 pts in false mudgroup lost follow up .. Daily activities.group lost follow up .. Daily activities.

There were no significant difference inThere were no significant difference in

demographic and epidemiological variables fordemographic and epidemiological variables forthe 2 groupsthe 2 groups


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Target AreaTarget AreaTarget Area True mud

(n=58)

False mud

(n=56)

Chest 0 0

Abdomen 2 2

Buttocks 3 4

Back 4 3

Upper limbs 12 7

Lower limbs 20 21

Elbow 14 12

Knee 3 7


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Disease status and durationDisease status and duration

True mud

(n=58)

False mud

(n=56)

Disease statusat entry

Stable 38 35

Worsening 20 21

Diseaseduration (yrs)

Mean 6.3 7.1


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Materials and MethodsMaterials and Methods

Three signs of psoriasisThree signs of psoriasis

ErythemaErythema

IndurationInduration

ScalingScaling

Four sign scores for disease severityFour sign scores for disease severity

0 = none0 = none

1 = slight1 = slight2 = moderate2 = moderate

3 = severe3 = severe


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Excluded individualsExcluded individuals

Systemic steroids within 28 daysSystemic steroids within 28 days

Antimetabolites within 28 daysAntimetabolites within 28 days

Topical therapies for psoriasis within 14 daysTopical therapies for psoriasis within 14 days Any investigational drugs within 1 monthAny investigational drugs within 1 month


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ApplicationApplication

Apply the mud to treatment areasApply the mud to treatment areas

twice daily for 1 hour each for atwice daily for 1 hour each for atotal of three weeks , occlusivetotal of three weeks , occlusive

dressing may be used whendressing may be used when

appropriate.appropriate.


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Follow UpFollow Up

Patients returned for evaluation ofPatients returned for evaluation of

their response to treatment after 3 ,their response to treatment after 3 ,7 , 14 and 21 days of drug7 , 14 and 21 days of drug

application ( study days 4 , 8 , 15application ( study days 4 , 8 , 15and 22 )and 22 )


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Criteria for EvaluationCriteria for Evaluation

Cleared = 100% clearance of signs ( except forCleared = 100% clearance of signs ( except forresidual discoloration)residual discoloration)

Marked improvement = 75 99% clearance ofMarked improvement = 75 99% clearance ofsigns.signs.

Moderate improvement = 50 - < 74% clearanceModerate improvement = 50 - < 74% clearanceof signs.of signs.

Mild improvement = < 50% clearance of signsMild improvement = < 50% clearance of signs No change = no detectable improvementNo change = no detectable improvement Exacerbation = flare of sites monitoredExacerbation = flare of sites monitored


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Patients Self evaluationPatients Self evaluation

1 = Excellent1 = Excellent 2 = Good2 = Good

3 = Fair3 = Fair 4 = Poor4 = Poor 5 = No response5 = No response

6 = Exacerbation6 = Exacerbation


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Efficacy of TreatementEfficacy of Treatement

Based on individual and total diseaseBased on individual and total disease

sign scores, the percent improvementsign scores, the percent improvement

in sign scores, the global evaluationin sign scores, the global evaluationof change in disease status and theof change in disease status and the

patient self evaluation of theirpatient self evaluation of their

response to treatment .response to treatment .


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Safety of TreatmentSafety of Treatment

Assessed by examination ofAssessed by examination of

patients at each visit for localpatients at each visit for local

side effects if any.side effects if any.


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Visit Rx Pts # Mean sign scores MTSS

Eryth Scal. Indur.

0 M 58 1.9 2.1 1.9 5.9P 56 1.85 2.15 1.8 5.8

Day

4

M 58 2.0 2.0 1.9 5.9

P 56 1.9 2.1 1.8 5.8Day

8

M 58 1.7 1.7 1.8 5.2

P 56 1.9 2.1 1.9 5.9

Day

15

M 58 1.6 1.3 1.6 4.5

P 56 1.8 2.0 2.1 5.9

Day

21

M 58 1.6 1.1 1.3 4.0

P 56 1.6 2.0 2.1 5.7


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Mean Pt. Self Evaluation ( Mean Score )Mean Pt. Self Evaluation ( Mean Score )

Visit True Mud

( n=58 )

False Mud

( n=56 )

Day 4 4.05 4.0

Day 8 3.0 3.95

Day 15 2.95 3.95

Day 22 3.05 4.0


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ConclusionConclusion

Dead Sea mud applied twice daily for 3 weeksDead Sea mud applied twice daily for 3 weeks

was efficacious in the treatment of psoriasis ofwas efficacious in the treatment of psoriasis of

variable severity.variable severity.

Much more effective than placebo.Much more effective than placebo.

Rapid onset of action as 1 week of therapy.Rapid onset of action as 1 week of therapy.

Exact mechanisms deserve further effortsExact mechanisms deserve further effortsMechanical ? Thermal ? Chemical ????Mechanical ? Thermal ? Chemical ????


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ConclusionConclusion

Within the limitations of this study, Dead SeaWithin the limitations of this study, Dead Seamud when applied over a 3 weeks treatmentmud when applied over a 3 weeks treatmentperiod, may be be describedperiod, may be be described

SAFESAFE

RAPIDRAPID

FAIRLY EFFICACIOUSFAIRLY EFFICACIOUSIn the treatment of psoriasis.In the treatment of psoriasis.


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Dr. Jamal DabbasDr. Jamal Dabbas

Medics Index Member ContributionMedics Index Member Contribution

MAY 2010MAY 2010

For Full Profile and Contact DetailsFor Full Profile and Contact Details

please visit :please visit :

www.medicsindex.comwww.medicsindex.com
http://www.medicsindex.com/http://www.medicsindex.com/http://www.medicsindex.com/http://www.medicsindex.com/

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