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.

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1983

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)