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日本 小 児 ア レルギー 学 会誌 第4巻 第1号96~100, 1990
THE RESULTS OF SEA WATER THERAPY ON CHILDREN WITH ATOPIC DERMATITIS.
Ken-ichi Akimoto1), Hirohisa Saito1), Akira Akazawa1), Kouji Hashimoto1), Toshio Katunuma1), Kazuo
Nonomura1), Motohiro Ebisawa2), Toshikatu Nagakura2), Tadashi Uekusa3), Takebumi Onda3), Yasutoshi
Hukuda3) and Yoji Iikura1,2)
1) Department of Allergy, National Childen's Hospital, 2)Divison of Allergy, National Children's Medical
Reseach Center and 3) Ninomiya branch of National Children's Hospital.
Nine patients with atopic dermatitis were treated with sea water therapy for seven days on the pacific
beach during summer. The sea water therapy mainly consisted of washing the skin with sea water, after
which their bodies were also completely washed with soap and fresh warm water.
All patients showed remarkable improvements in skin manifestation and decreased itching. This therapy
was especially effective in severe patients who had not previously responded to either elimination diet,
medication with oral anti-allergy drugs, or steroid ointment before sea water therapy. Sea water therapy may
be useful for some children with intractable atopic dermatitis.
KEY WORDS: Sea water therapy, Atopic dermatitis
INTRODUCTION
Sometimes we can not obtain satisfactory results
by any therapy for children with severe atopic
dermatitis, even if we remove all allergens from the
patient's environments. It is a clinical observation
that the cutaneous manifestation and itching of
pattern with severe or intractable atopic dermatitis
disappeared after the summer monthes.
We hypothesized that long sea bathing might
improve the skin lesions of atopic dermatitis, based
on conversation with parents whose children's
atopic dermatitis improved after the summer sea-
son.
Therefore we have attemped to determine if sea
water bathing is effective for those children with
severe atopic dermatitis whose symptoms did not
improve after a combination of food elimination,
enviromental control, skin care and other treat-
ments. We report the benefical results of sea water
bathing for children with intractable atopic dermati-
tis.
SUBJECTS AND METHODS
1. Subjects
Nine children (5 to 14 years, mean 8.6 years) were
selected for this study, six (patient 1 to 6) with
severe and three (patients 7 to 9) with moderate
atopic dermatitis. Patients 1 to 6 had skin redness,
lickenfication, xerosis and itching over the entired
body. In particular, patient 1 had intractable lesions
on the legs and back, patient 2 had similar lesions on
the trunk, patients 3,4 and 6 had lesions on the legs
and arms, patient 5 had lesions on the body and hip.
Patient 7 to 9 had intractable atopic dermatitis only
on the legs and arms.
All patients satisfied the criteria for diagnosis of
atopic dermatitis used by Hanifin and Rajka (1).
Mean values of serum IgE for severe patients was
3305.0 IU/ml (1200 to 5400), and for moderate
patients was 2087.3 IU/ml (62 to 4600).
In all patients except one, serum IgE levels were
high, but there was no increased susceptibity to
infection.
They had been treated with a combination of
elimination diet, medication with oral anti-allergy
drug such as Tranillast, and steroid ointment with-
out satisfactory improvement.
2. Schedule of sea water therapy
The sea water therapy was administered from 10
to 16 August 1988 at Ninomiya branch hospital of
National Children's Hospital, Kanagawa-
prefecture. From 9 to 10 am and from 2 to 4 pm
patients went to the beach. Doctors and nurses
小児ア トピー性皮膚炎に対する海 水浴療法 97
washed the entire body of the patients with sea
water on the beach. Strong sunburn of the skin was
avoided by using a beach umbrella. After sea
bathing, the medical staff carefully washed the
entire of patients with soap and warm water to
completely remove sea water and sand, as the resid-
ual sea water becomes a skinirrirant later, particu-
larly in bed.
3. Methods of evaluation
The clinical effects of this therapy were estimated
by photographs taken before and after the therapy.
In addition, we sent questionnaires to the patients
and their families at the end of the therapy.
Blood examination consisted of serum IgE, IgE
RAST, specific IgG antibodies, peripheral cosino-
phile count and lymphocyte surface marker analy-
sis. Total IgE and IgE RAST was measured using
a Pharmacia kit. Specific IgG antibodies were
mesured by a modified enzyme immunoassay.
Lymphocyte surface markers were measured by
EPICS, using monoclonal
RESULTS
Six patients, who suffered from severe atopic
dermatitis showed both remarkable improvement in
the affected skin areas and also a decreased in
cutaneous itching. Skin redness, lichenfication and
The left photo shows the legs before, and the right shows the cutaneous improvement after sea water
therapy.
Table
Comparison between usual hospital treatment and sea water therapy
98 小児ア トピー性皮膚炎に対する海水浴療法
xerosis improved, especially on the intractable
lesion. The affected skin lesions of the three
patients with moderate atopic dermatitis almost
disappeared Photograph showed dramatic improve-
ment on dermatitis of the legs (patient 1).
For the first day to three days of this therapy, all
patients complained of pain from the sea water.
After four of five days, however skin eczema gradu-
ally improved and they did not complain of pain.
At the end of this therapy all patients and their
families noted questionnaires. This questionnaires
consist cutaneus itching, skin redness and total
impression of their families. The score of estima-
tion are 1=improved, o=no change and -1=worse.
The mean value of this score was 2.78.
DISCUSSION
Many factors are possible candidates for trigger-
ing atopic dermatitis (2-10). We have observed a
transcient improvement in severe atopic dermatitis
treated with strict elimination of foods. We could
not, however, obtain a complete cure of severe
atopic dermatitis. If we prolong strict elimination
of foods for more than a year, many patients suffer
a loss of body weight, psychological problems, and
a restriction of their social life. Therefore we have
investigated sea water therapy for children with
atopic dermatitis.
In our department, the therapy for severe atopic
dermatitis consist of elimination of offending foods,
medication with anti-allergy drugs, immuno-
therapy, showering three times per day, and weak
steroidal ointments. The table shows comparison
between usual treatment therapy in our department
and sea water therapy (table). Many cases of severe
atopic dermatitis need usual hospital treatment for
about 4.5 weeks. Five patients had already been
hospitalized for 3 to 16 weeks (mean 7.6 weeks)
before the sea water therapy. Sea water therapy
could shorten the duration of hospital treatment and
produce a better results than the usual hospital
treatment.
Possible reasons for its effectiveness are as fol-
lows: removing housedust mites from the skin,
killing bacteria in the skin, effects of moderate
ultraviolet from sun light, and the chemical effects
of sea water on the atopic skin.
Atopic dermatitis can be caused by house dust
mites (7,11,12). All patients except one, had strong
positive anti-house dust mite IgE antibody as mea-
sured by RAST (Pharmaeia).
Motala et al (13) reported a relationship between
total serum IgE and anti-Staphylococcus aureus
specific IgE in atopic disease. This suggests that
severe type atopic dermatitis might be related to
bacterial allergy on the skin and that the improve-
ment of affected skin regions by this therapy might
be related to the removal of skin bacteria by sea
water. In this studies, we did not measure anti-
Staphylococcus aureus specific IgE, but Staphyloc-
cocus aureus was cultured from affected skin in
eight patients before this therapy.
The benefitical effects of ultraviolet are also
significant. Several dermatologists prescribed
ultraviolet therapy including psoralen and
ultravioet A (PUVA) therapy for patients with
atopic dermatitis (14-16).
Several authors have reported specific IgG anti-
body levels in the serum of patient with atopic
disease (17-19). In this study, the milk and egg
specific IgG anitibody levels in all patients was low
both before and after the elinmation of foods.
We have previously reported (20) the effects of
oral biotin treatment in atopic dermatitis ; however,
our severe cases had normal biotinidase activdty.
Strong sunburn in dameging to the skin, espe-
cially in patient with photosensitivity (21, 22).
Cooling the skin with sea water and avoiding strong
ultraviolet irradiation by using beach umbrella will
mininize the influence of sunburn.
Long term prognosis with this therapy has a
moderate degree of satisifaction. Two patients
needed hospital treatment after this therapy. All
other patients, however, maintained improvement
of their skin condition.
The sea water therapy is safe and useful for
patients with atopic dermatitis, especially those
children with svevre disease who showed no
remarkable improvements with usual therapy.
小 児ア トピー性皮膚炎に対する海水浴療法 99
ACKNOWLEGEMENT
We would like to thank the nurses and our co-
workers at National Children's Hospital.
REFERENCES
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100 小 児ア トピー性皮膚炎に対す る海水浴療法
小 児ア トピー性皮膚炎に対する海水浴療法
1)国立小児病院ア レルギー科,2)国 立小児医療研究センター
3)国立小児病院二宮分院
秋 本 憲 一)斉 藤 博 之1)赤 沢 晃1)
橋 本 光 司1)勝 沼 俊 雄1)野 々 村 和 男1)
海 老 沢 元 宏2)永 倉 俊 和2)植 草 忠3)
恩 田 威 文3)福 田 保 俊3)飯 倉 洋 治1),2)
重 症 のア トピー性 皮 膚 炎患 児の なかには 食物 除去療法,環 境整備,薬 物 療法,免 疫療 法,ス テ ロ イ ド外 用療法等
を行 って も治療 に抵 抗 す る ものが結 構 多い.重症 ア トピー性 皮膚 炎患者 が夏休 み明 けに軽快 して い るこ とが しば し
ば経 験 し,海 水浴 がア トピー性 皮 膚 炎の治療 に役立つの ではな いか と考 え,昭 和63年 の夏 にア トピー性 皮膚 炎患児
9名 を対 象 に 一週間 の海 水浴療 法 を経験 し,好 結 果 を得 た.今 回行 った方 法は,患 者 を神奈 川 県二宮町 の国立小 児
病 院二 宮分 院 に 入院 させ,食 物 療 法,薬 物療 法等の治療 に加 え二宮町 の海岸 で午前一 時間,午 後 二時 間,海 岸 で海
水 に よ る皮膚 の洗 浄 を行 う もの であ る.僅 か一週間の短 期間で通常 の入院治療 よ り優 れ た寛解 が得 られ,厳 格 な食
物 除 去療 法の よ うな社 会的 ・栄 養 的 な問題,薬 物療法 に よる副反応 等の問題 がない ため,海 水浴 療法 は重症 の小 児
ア トピー性 皮 膚 炎 に対 して 是非 試み るべ き治療法 と考え られ た.
( Accepted: June 14, 1990)
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