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Alternative Treatment in Dermatology

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					ALTERNATIVE TREATMENTS
    IN DERMATOLOGY


   Mohammad Jafferany, MD
         INTRDUCTION

   WHAT IS ALTERNATIVE TREATMENT
   THERAPIES NOT TAUGHT AT
    MEDICAL SCHOOL
   CRITICAL REVIEW   - EXCEPT
    CLIMATOTHERAPY
   WHY PTS. LOOK FOR
ALTERNATIVE TREATMENT

   CONCEPTUAL FRAMEWORK
   NEW TECHNOLOGICAL ADVANCES
   UNDUE ANXIETIES
   SOCIO-ECONOMIC FRONT
       VARIOUS FORMS OF
         TREATMENT
   PLACEBO THERAPY
   AUTOGENIC TRAINING
   BEHAVIOUR THERAPY
   BIOFEEDBACK
   HYPNOSIS
   HERBALISM
    VARIOUS FORMS (CONT…)
   ACUPUNCTURE
   HIKMAT
   SPIRITUAL THERAPY
   COLOR THERAPY
   HOMEOPATHY
   CLIMATOTHERAPY
       PLACEBO THERAPY
   DOCTOR AS A DRUG

   COMPLEX MECHANISM : OPIATE
    RECEPTORS, ENDORPHINS AND
    ENKEPHALINS

   ACNE AND PSORIASIS
     AUTOGENIC TRAINING

   TO RELAX THE PATIENT AS
    EFFECTIVELY AS POSSIBLE

   FRENCH PHARMACIST, 1901

   ACNE
    BIOFEEDBACK THERAPY
   INFORMATIONS ON VARIABLES IS
    FED BACK TO PATIENTS

   THE PATIENT IS TAUGHT TO GAIN
    CONTROL OF THE MONITERED
    FUNCTION
   HYPERHIDROSIS
     BEHAVIOUR THERAPY
   USES THE PRINCIPLES OF
    LEARNING FOR CHANGING THE
    UNADOPTIVE BEHAVIOUR

   THE AIM IS TOWEAKEN THIS
    BEHAVIOUR & STRENGTHEN
    ADOPTIVE HABITS
     TYPES OF BEHAVIOUR
          THERAPY

   SYSTEMIC DESENSITISATION
   AVERSION THERAPY
   OPERANT TECHNIQUE
   ASSERTIVE TRAINING
    SYST. DESENSITISATION
   APPLICABLE WHERE ANXIETY IS A
    FEATURE.
   A STATE INHIBITORY OF ANXIETY IS
    PRODUCED AND…..WEAKER
    STIMULI…..REPEATED…..UNTIL THE
    STIMULI LOSE TO EVOKE ANXIETY.
   COLD URTICARIA
      AVERSION THERAPY
   PERSISTENT BEHAVIOUR
    DISORDERS

   GIVEN UNPLEASANT STIMULUS,
    WHENEVER UNADOPTIVE HABIT IS
    DEMONSTRATED
   TRICHOTILLOMANIA, L.S.Chr
      OPERANT TECHNIQUE

   TO MODIFY COMPULSIVE HABITS

   REWARDS AND PUNISHMENTS

   USEFUL IN CHILDREN
      ASSERTIVE TRAINING

   TO ALLOW SUBJECTS TO EXPRESS
    THEMSELVES MORE FULLY

   WHO ARE AFRAID OF EXPRESSING
    THEIR EMOTIONS AND WITH
    SOCIAL FEAR
   HYPERHIDROSIS, STDs
           HERBALISM
   RENEWED INTEREST IN HERBAL
    MEDICINE

   AGENTS DERIVED FROM PLANTS

   PUVA, OIL OF EVENING PRIMROSE
    ETC.
            HYPNOSIS
   ALTERED STATE OF AWARENESS

   PHYSICAL,NEUROPHYSIOLOGICAL
    AND PSYCHOLOGICAL DISTORTION
    OF EMOTIONS,SENSATIONS,IMAGE
    AND TIME
   WARTS,TYPE I HYPERSENSITIVITY
         ACUPUNCTURE

   INSERTION OF FINE METALLIC
    NEEDLES
   DIS-EQUILIBRIUM B/W YING AND
    YANG
   CH.URTICARIA,ACNE,H.ZOSTER,AA,
    PSORIASIS,VITILIGO AND ECZEMAS
             HIKMAT
   GREEK AND ARABIC MEDICINE

   BILE, BLOOD, PUS AND WATER

   MAY CONTAIN POTENTIALLY TOXIC
    SUBSTANCES
      SPIRITUAL THERAPY
   BASED ON RELIGION & BELIEFS

   PURITY/IMPURITY OF SOUL OR
    SPIRIT
   VERSES FROM HOLY BOOK ,WATER
    AND OBJECTS
         HOMEOPATHY
   SAMUEL HAHNEMANN, LATE 18TH
    CENTURY
   AGENTS PRODUCING SYMPTOMS,
    CAN CURE THOSE SYMPTOMS IN A
    MUCH SMALLER DOSE
   HEAVY METALS, PLANTS ETC.
   PSORIASIS,ECZEMA AND CHRONIC
    DERMATOSES
        COLOR THERAPY
   COLORS DISPERSE IN HUMAN
    BODY AND SUSTAIN LIFE
   IMBALANCE LEADS TO DISEASE
   COLORS - SPECIFIC CHARACTERS
   THE METHOD OF TREATMENT
   CHRONIC SKIN CONDITIONS
       CLIMATOTHERAPY
   THERAPEUTIC EFFECTS BASED ON
    SCIENTIFIC BASIS.
   DEAD SEA , COMMON PLACE TO
    VISIT FOR THIS THERAPY.
   DERMATOLOGICAL & NON
    DERMATOLOGICAL DISORDERS.
        GEOGRAPHY



         Syria
              Iraq      Iran

Egypt

               Saudi Arabia
PHYSICAL CHARACTERS

   LOWEST INHABITED PLACE ON
    EARTH.
   400 m BELOW SEA LEVEL
   THE MOST SALINE LAKE IN WORLD
    (32%) SALT.
   MEAN TEMPERATURE 32 C (19-40)
   RELATIVE HUMIDITY 27%(SUMMER)
    & 38% (WINTER)
          THERAPEUTIC
          CHARACTERS
   NO INVOLVEMENT OF DRUGS
   MINERAL CONTENT OF THE SEA
   THICK HAZE HANGING OVER IT
   FILTERED U/V RADIATION
   PSYCHOLOGICAL FACTORS
   ECOLOGICAL FACTORS
      MINERAL CONTENTS
   A MAJOR FACTOR IN TREATMENT
   320 G/L OF SALTS ( KCL,MgCl,CaCl
    NaCl)
   RICHER IN PROPORTION OF Ca, Mg,
    K & Br.
   THERAPEUTIC EFFICACY :
    THERMAL, MECHANICAL &
    CHEMICAL STIMULATION
     MINERAL…. THERMAL
        STIMULATION

   VASODILATATION
   ENHANCES BLOOD CIRCULATION
   DECREASES BLOOD PRESSURE
   INCREASES BODY TEMPERATURE
    MINERAL….MECHANICAL
        STIMULATION

   BODY RESISTS FLOATATION FORCE
   THE OUTPUT & RYTHEM OF HEART
    INCREASES
   BREATHING BECOME DEEPER
     MINERAL….CHEMICAL
        STIMULATION
   DIRECTLY RELATED TO INDIVIDUAL
    MINERAL
   MAGNESIUM
   BITUMINOUS TAR( BLACK MUD,
    RICH IN ORGANIC SUBSTANCES).
      ROLE OF MAGNESIUM
   REQUIRED FOR ACTIVATION OF
    EPIDERMAL ADENYLATE CYCLASE
    ……….. CYCLIC AMP
   IMBALANCE OF CYCLIC AMP (<) AND
    CYCLIC GMP (>) …….. EXCESSIVE
    CELLULAR PROLIFERATION
   Mg INNHIBITS THE SYNTHESIS OF
    SOME POLYAMINES
        BITUMINOUS TAR
   HIGH CONTENT OF MINERALS
   THERMOPEXIA(ABILITY TO RETAIN
    HEAT),THUS STIMULATING THE
    BLOOD CIRCULATION AND
    CLEARING THE SKIN OF DEAD
    CELLS
           THICK HAZE
   RICH IN MINERALS
   SERUM BROMINE LEVELS - 3 TIMES
   IMPROVEMENT IN CLINICAL &
    PSYCHIC CONDITION, SPECIALLY IF
    THE DISEASE IS STRESS RELATED
          UV RADIATION
   PARTIALLY FILTERED
   EXTRA 400 m OF ATMOSPHERE,
    HAZE OF WATER VAPOUR, AND
    AEROSOLS OVERHANGING THE
    LAKE
   TREATMENT PROTOCOL…...
    EXPOSURE, SKIN TYPE, SEASON,
    TIME OF DAY AND DIAGNOSIS.
PSYCHOLOGICAL FACTORS
   HIGHER SIGNIFICANCE THAN
    ANTICIPATED.
   MUCH SOCIALIZATION
   MUTUAL ENCOURAGEMENT
   AN OPEN ATTITUDE TOWARDS
    DISEASE
     ECOLOGICAL FACTORS
   POLLUTION FREE & ALLERGEN-
    POOR ENVIRONMENT
   EXTRAORDINARILY LOW HUMIDITY,
    HOT & DRY CLIMATE, HIGH RATE
    OF EVAPORATION.
   CAUSING INCREASE IN METABOLIC
    ACTIVITY & IMPROVE OVERALL
    PERFORMANCE.
          INDICATIONS
   ERYTHEMAT-SQUAMOUS
    DERMATOSES
    1. PSORIASIS
    2. LICHEN PLANUS
    3. PARA-PSORIASIS
    4. PRP
   DERMATITIS/ECZEMA
    1. ATOPIC DERMATITIS
    2. DYSHIDROTIC ECZEMA
    INDICATIONS….(CONT…)
 KERATOSES
  1. ICHTHYOSES
  2. PALMO-PLANTER KERATOSES
  3. LICHEN PILARIS
 PRURIGO
 1. P.NODULARIS
 2. P.SIMPLEX
     INDICATIONS…(CONT…)
    MISCELLANEOUS
    1. VITILIGO
    2. ACNE
    3. URTICARIA PIGM. ADULTORUM
    4. NECROBIOSIS LIPOIDICA
    5. MORPHOEA
          PSORIASIS
 THE MOST FREQUENT DISEASE
  TREATED
 DOSTROVSKY & SAGHER (1959)
 SUBSEQUENT STUDIES :
 AVRACH (1976), MONTGOMERY
  (1979),   SCHNIDMAN (1984)
  80-90% SIGNIFICANT IMPROVEMENT
Psoriasis (Recurrence)
            Goeckeman
              19.0%
                               Climatotherapy
                                   18.6%


Dithranol
 22.4%




                    Steroids
                     40.1%
   PSORIASIS
(MORPHOLOGICAL)
 Type of Psoriasis    Response



 Acute Guttate        Quick



 Nummiular & Plaque   Slow



 Erythrodermic &      More slow
 Generalized
PSORIASIS (MECHANISM OF
        ACTION)

SHANI ET AL (1991)
  SEM & XRF STUDIES
SHANI ET AL (1993)
 QCM METHOD STUDY
      OTHER ERYTHEMATO-
     SQUAMOUS DISORDERS

   LICHEN PLANUS, PARA-PSORIASIS
    & PRP.
   VARIOUS STUDIES SHOW
    CONSIDERABLE IMPROVEMENTS IN
    4-6 WEEKS.
       ATOPIC DERMATITIS
   THE SECOND LARGEST GROUP.
   90% COMPLETELY CURED WITHIN
    4-6 WEEKS.
   SEASONAL DIFFERENCE IN
    IMPROVEMENT : (SIEDL ET AL (1993)
     SPRING: 93%, SUMMER 91%,
    AUTUMN 86%, WINTER 74%
        OTHER ECZEMAS
   SEB. & DYSHIDROTIC ECZEMA
      BATHING IN DEAD SEA CAUSES
    ELIMINATION OF P.OVALE & OTHER
    BODY FLORA AND EASE THE
    REMOVAL OF SKIN FAT AND
    SCALES.
    4 WEEKS REQUIRED COMPLETE
    CLEARANCE. (DUVIC,M. 1986)
           KERATOSES
   ICHTHYOSES, PALMOPLANTER
    KERATOSES & LICHEN PILARIS.
   CONSIDERABLE IMPROVEMENT IN
    LESIONS,BOTH CLINICALLY AND
    PSYCHOLOGICALLY, NOTICED
    AFTER 4 WEEKS OF CLIMATOTHER-
    APY.
             PRURIGO

   P.NODULARIS & P.SIMPLEX
   DAILY ROUTINE OF SUN EXPOSURE
    AND SEA BATHING IMPROVED THE
    LESIONS CONSIDERABLY.
  VITILIGO ( Repigmentation)


                       Almost Total
                          10.9%


                        No effect
   Significant           1.0%
     81.7%             Partial
                       6.4%




Seidl et al. (1994)
    OTHER MISCELLANEOUS
        DERMATOSES

   URTICARIA PIGMENTOSA
    ADULTORUM, NECROBIOSIS
    LIPOIDICA, MORPHOEA & ACNE
   NOT COMPLETELY CURED, BUT
    SIGNIFICANT IMPROVEMENT IN
    PATIENTS’ WELL BEING.
     LIMITED INDICATIONS
   MF TYPE 1 IS CURED BY NATURAL
    UVA RADIATION.
   AA, SCLERODERMA,LSA &
    GRANULOMA ANNULARE SHOWED
    PARTIAL IMPROVEMENT IN 4-6
    WEEKS.
      CONTAINDICATIONS
   PHOTOSENSITIVITY
   MALIGNANCIES      (MELANOMA,
    MALIGNANT EPITHELIOMA)
   ACUTE SKIN INFECTIONS
   EPIDERMOLYTIC CONDITIONS
   ORGAN FAILURES,SEVERE
    PSYCHIATRICS , ACUTE ALCOHLICS
    & AIDS
          OTHER
     CONTRAINDICATIONS

   SEVERE VARICOSE VEINS
   NON HEALED WOUNDS
   HYPERSENSITIVITY TO HIGH
    MINERAL BATHS
   DRUG INDUCED HEAT EMERGENCY
                   SIDE EFFECTS
                            Sunburn
                             45.1%




                                          Other Infections
                                               4.4%
                                         Herpes Labialis
         Photo Allergy                        4.4%
           27.5%                      Gastroenteritis
                                          7.7%
                             Edema
                             11.0%
Braun-Falco et al. (1991)
           CONCLUSION
   A UNIQUE KIND OF THERAPY
   HEALING AND RECOVERY ARE
    SMOOTH, SAFE & EFFECTIVE
   BETTER COMPLIANCE
   MINOR SIDE EFFECTS & C/IND.
   COST EFFECTIVE
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