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Spa therapy in Poland
ELSEVIER
Spa Therapy in Poland ANASTAZY OMULECKI, MD, ADAM NOWAK, MD, PhD ANNA ZALEWSKA, MD
PhD
T
he oldest health resorts, among them also Polish ones, started to develop in the twelfth and thirteenth centuries. They were usually situated around warm and hot springs. Numerous data and documents give strong evidence about popularity of balneological treatment, already ,quite well developed in the Middle Ages.’ Cieplice Slaskie, mentioned in the historical records originating from 1137, are regarded as the first Polish health resort. The first piece of information about Lgdek-Zdroj comes from 1242, whereas the lwonicz-Zdroj waters have been known since 1520. The watering place in Krynica was founded in 1793 and Busko-Zdroj in 1805.2*3 A number of spas were developing in Poland, just like in other parts of Europe. The second half of the nineteenth century is recognized as the golden age of spa treatment. The first papers on balneotherapy in Poland date from 1522 and 1555. Doctor Wojciech Oczko, the royal physician, had his work Cieplice issued in 1575. It was the first publication containing information on the indications and contraindications of treatment in health resorts. The author of the above-mentioned study is regarded as the father of Polish balneotherapy. Nowadays, balneology exerts a very strong influence on other medical specialities in Poland, in particular it supplements pharmacotherapy. The Balneological Institute in Poznan coordinates the scientific research on spa treatment. The journal Polish Balneology is also edited by this Institute. Doctors working in health resorts are the members of the Polish Balneochmatic Society. Balneology is included in the medical studies program. It is also one of the most popular subspecialities, which every doctor can obtain after passing appropriate examinations. A great variety of health resorts can be found in Poland, a country situated between the Baltic Sea in the north and the mountain ranges of Carpathians and Sudeten in the south. There are 37 watering places in Poland (Fig 1). The most famous and frequently visited watering places are in Cieplice, Ciechocinek, Krynica, Duszniki, Polanica, Kudowa, Rabka, Szczawnica, and --_the Departmelzt of Dermatology and Venereology, Medical Uniuerslfy of Lad:, Lodz, Poland. Address correspondence to Professor Anastnzy Omulecki, Department of Dermatology and Venereology, Medical University of Lodz, Krzemienecka 5, 94-01; Lodz. Poland. From
G 199ti by Elsemrr Science Inc. 655 Ar&ue of tfw Americas, New York,
NY 10010
Wieliczka. Patients with a broad variety of conditions, including posttraumatic, cardiovascular, respiratory, alimentary, gynecological, and urinary tract disturbances can recuperate in these health resorts. There are three spas-Busko-Zdroj, Ladek-Zdroj, and SwinoujG.cie-where patients with skin diseases are treated. Most often applied in balneotherapy of skin diseases are sulfurous, radioactive, alkaline, carbonated, ferriferous, and arsenical waters. The sulfurous and the radioactive waters are the most widely used.
Busko-Zdri, j The Busko-Zdroj health resort is situated in central Poland, 223 m above sea level. Its sulfato-salty waters were already discovered in the Middle Ages. The Busko-Zdroj spa dates back to 1800. Nowadays, this resort possesses 13 wells and drill holes delivering sulfato-salty waters and 1 hole with iodo-bromic saline water. The basic components of the Busko-Zdroj sulfatosalty waters are ions of sodium, chlorine, sulfur, calcium, magnesium potassium, bromine, and iodine, as well as ions of the gases hydrogen sulfide and carban dioxide. One liter of water contains from 12 to 15 g of sodium chloride, from 7.04 to 39.15 mg of sulfurous ions and hydrogen sulfide (on average 17 to 20 mgl, 400 mg of calcium, 250 mg of magnesium, 15 mg of bromine and 2.5 mg of iodine. The synergistic activity of the above mentioned chemical compounds and their beneficial proportions exert a very good therapeutical effect on the organism, without undesirable reactions after bathing.4 Busko-Zdroj is a very precious resort because of its sulfide waters that contain iodine and selenium. Such waters are regarded as unique in Europe. Also therapeutic peat saturated with sulfur compounds can be found in Busko-Zdroj.5 The majority of patients treated in Bu.sko-Zdroj suffer from occupational skin diseases, such as contact, allergic, and irritant dermatitis; psoriasis; urticaria; and different types of eczema. About 600 people with skin diseases are treated annually in Busko-Zdroj. The sulfato-salty waters are administered as baths 15 to 20 minutes in duration, with temperature ranging between 36 and 39°C. About 15 baths are taken by a patient during one stay in Busko-Zdroj.* These waters exert both local and systemic effects on the organism. They
Clinics in Dermatology
680 OMULECKI ET AL.
l
2996;14:679-683
Baltic Sea
Figure 1. Map showinglocationsof Polishhealthresorts.
enhance metabolic processes and cause blood-vessel dilatation. Waters with weak concentrations of minerals act keratoplastically, whereas those with high concentrations possess rather keratolytic properties-they soften and desquamate epidermis6 The therapeutical activity of Busko-Zdroj waters is evaluated, both by patients and their doctors, as being very beneficial in skin diseases.
Lgdek-Zdrcij The Dermatology Department of the Medical University of Eodi takes care of the sanatorium in LadekZdrbj. The curative activity of spas of Ladek has been known for more than 700 years. Ladek is a Piedmont resort, situated in a charming valley 440 to 500 m above sea level. Marvelously shaped forested hills form its
Clinics 11217ermatology
l
3996;24:679-683
immediate surroundings. Climate is fairly mild, with a majority of sunny and windless days (Fig 2). LgdekZdrdj waters originate from the Precambrian gneisses. The total output is as high as 28 m3/hour, ranging between 12 and 300 L/min from each spring. Fluctuations of water temperature are very slight, and their monthly amplitude is about 0.3”C. The spring output is fairly stable, not directly dependent on the air-pressure and rainfalls.’ Two kinds of mineral waters are found in this resort. There are typical radon waters with an average radioactivity of 1220-1300 Bq/L. The utilization concentration is from 740 up to 925 Bq/L. The other springs have sulfido-fluoride waters. Their temperature is as high as 29°C. Patients can benefit from various balneologic treatments; these include radon, sulfido-fluoride, or acidocarbonated baths; mineral-water baths with gymnastic exercises that are performed in swimming pools; underwater massage; underwater vibratory massage (“aquavibrion”); peat wrappings; needle shower; quadrichamber; sauna; and Italian air baths. While radium
salts act as destructive agents for the tissues, emanations of radium exert therapeutic and stimulative effects on the organism. The dermatologic sanatorium in Lgdek-Zdrcij is designed for 30 patients. The fixed period of residence for a patient is 24 days. In justifiable cases it can be prolonged by another 24-day period. Doctors from the E6di Dermatology Department take care of the patients and do research work. Their observations assist in preparing the most suitable selection and dosage of balneologic treatments for applications to different skin problems. They also evaluate the outcomes of balneologic treatment in Lgdek-ZdrBj. The research is intended to create the rational basis for the optimal utilization of the health resort conditions. Every year about 22,500 patients, including 600 with skin diseases, are treated in this health resort. Most often they suffer from psoriasis. Other conditions in order of frequency of occurrence are different types of eczema, atopic dermatitis, chronic urticaria, seborrheic dermatitis, and scleroderma.
Figure 2. &dek-Zdrdj, one qf the most famous spas in Europe; the oldest spa building,, constructed at the turn of the fifteenth and sixteenth centuries.
Results
of Treatment
Patients discharged from the dermatologic departments and outpatients are followed up regulariy and advised to visit the sanatorium in order to complete their treatments and maintain their good results. The effectiveness of balneological treatment is generally very high. The more detailed evaluation of balneotherapy was performed in patients with psoriasis, atopic dermatitis, and urticaria.‘,’ The assessmentincluded both immediate and later results of the treatment in 55 patients with psoriasis. In all casesthe disease was of long duration, with several recurrences in spite of the routine treatment. The patients have residual or newly appearing psoriatic lesions. During a 24-day course of balneotherapy, they took baths in mineral waters containing radon or hydrogen sulfide on alternate days. Only emollients were applied topically. Results of the treatment were evaluated on a three-grade scale: ++, complete remission; +, improvement; 0, no improvement or deterioration. The patients were examined. immediately after completion of the therapy and were followed up at 3, 6, and 12 months thereafter. In 10 of the 55 patients, there was a complete clearance; in 42, improvement; in 2, deterioration; and in one casethe treatment was without any visible effect. It was discovered that the curative activity of balneotherapy was not only confined to the immediate results. That kind of treatment had also a beneficial effect on further course of the disease. The remission period was longer than bef;ore the treatment in 27 patients. In 17 patients there were no recurrences of the disease during a 12-month observation period, and in 35 patients recurrences were less pronounced. It is concluded that the balneologic treatment in water
682
OMULECKI
Clinics in Dermatology
ET AL.
containing hydrogen-sulfide and radioactive radon has a beneficial effect in patients with psoriasis. A similar evaluation was carried out in patients with urticaria and atopic dermatitis. In 14 patients of 28 with chronic urticaria, the lesions disappeared after completing the sanatorium treatment. Regarding atopic dermatitis, in 13 patients improvement was observed, in 4 no change for the better was observed and in 1 deterioration was noted.” Good results were also obtained in 68 patients with contact dermatitis. Improvement was observed in 66% of the patients directly after completing the therapy, whereas prolonged periods of remission were seen in 48% of the treated patients.’
Swinoujkie The Swinoujscie health resort is situated in the northwestern part of Poland, on the Baltic Sea coast. The Polish coast line is 524 km long. In the warmer months, that is, between April and September, this resort serves mainly as a recreation place. VividIy located Swinoujscie is a maritime health resort that dates back to 1885. At that time, salt springs and peats were officially recognized as possessing therapeutic properties, and they were put into a much wider use. The peaceful Pevelopment of this resort lasted until World War II. Swinoujscie began to operate again as a health resort only in 1959, after it had been destroyed to the ground between 1939 and 1945. A special dermatologic center, that is, a sanatorium dealing with skin problems, can be found in Swinoujscie. This center is supervised by the Dermatology Department of the Medical University of Szczecin. It is designed to accommodate about 1,000 patients with skin diseasesannually. The usual period of balneologic treatment is 24 days for one patient. The most numerous group with skin problems comprise patients with psoriasis. Other conditions in order of frequency of occurrence are allergic skin diseases, different types of eczema, and atopic dermatitis. In addition, patients with lichen planus, morphea, seborrheic dermatitis, ichthyosis vulgaris, and venous insufficiency of the legs seek treatment. In the summer, patients are exposed to controlled solar irradiation and seawater baths. According to the Mid-European requirements for health resorts, the minimal availability of sunshine should amount to about 1500 hours annually. In Swinoujscie the annual amount is considerably higher-on average 1752 hours annually. The patients recuperating in this dermatologic sanatorium take baths in seawater that contains 0.8% mineral salts. These seawater baths are usually administered every other day, in some cases frequency is adjusted individually.i’ In cooler seasons patients take their mineral-salt
l
1996;14:679-683
baths in swimming pools and are exposed to controlled artificial ultraviolet irradiation. The patients take baths that last from 10 to 20 min. The water temperature ranges between 34 and 38°C. The water contains about 4.5% of mineral components, including sodium chloride (88.7%), calcium salts (5.9%), and magnesium components (4.5%). The saline water also contains trace amounts of iron, strontium, iodine, bromine, and silicon salts, as well as metaboric acid. During a 24-day period, one patient is supposed to receive about 30 to 70 J/cm2 of UVA or 2.4 to 3.0 J/cm2 of UVB. A special cream prepared in the proportion of one part of saline to one part of Eucerin is applied topically by the patients after a therapeutic bath. This cream promotes hydration of the epidermis.
Results of Treatment The Dermatology Department in Szczecin regularly carries out research work on patients treated in the sanatorium. One of the studies was performed on 1,141 patients with chronic eczema, urticaria, and atopic eczema. All skin conditions were in a partial remission. The patients took baths prepared in the proportion of one part saline water to one part water obtained from the water-supply system. Patients received only topical treatment and were applying emollients. The therapeutic regimen did not differ from the one described above. The results of the treatment were evaluated on a previously mentioned three-grade scale. Improvement was achieved on average in 80% of the patients. The best results were noticed in patients with atopic dermatitis.13 Much better results were achieved for patients with psoriasis. The regimen of the treatment was not any different from the one already described. A total of 3,939 patients took part in this study, and in this group almost 90% of the patients showed considerable improvement. The results that were achieved with balneologic treatment of patients with contact eczema, psoriasis vulgaris, and atopic eczema performed in Swinoujbcie, which is a maritime health resort, are in agreement with German literature data.r4,i5
Conclusion At this stage we can only once again appreciate and stress the very important role of balneologic treatment in a number of the newer and more sophisticated methods of dealing with skin problems.
References 1. Kowalenko H Z przeszlosci Polslciejbalneologii. Wiad Uzdr 196’2;56:3-6. 2. Filipowicz Z. Zarys historyczny rozwoju turystyki i uzdrowisk. Probl Uzdr 1971;56:105-63.
3. Kochariski
JW. Kuracja w Lqdku-Zdroju.
Lqdek-Zdr6j,
1992, <5--13.
4. Marzec L. Naturalne czynniki lecznicze Busko-Zdroju. Baln 1’011952;3:217-25. 5. Atlas Uzdrowisk Polskich. Pafistwowe Przedsicbiorstwo Wydawnictw Kartograficznych im. Eugeniusza Romera. Warszawa-Wroclaw, 1990,235-240. 6. Legwant 2. MoiIiwoSci wykorzystania bus&h wbd siarczkowo-siarkowodorowych w lecznictwie. Baln Pol 1995; 37:28-30.
7. DowgiaHo J. Wystepowanie i perspektywy dalszego wykorzystania w6d termalnych w Polsce.Baln Pol 1972; 17:193-J+. 8. Arkuszewska C, Broniarczyk-Dyla G, Dziankowska B, et
al. BezpoSredniei odlegle wyniki leczenia luszczycy w tqdku-Zdroju. Przegl Dermatol 1986;73:2&33. 9. Broniarczyk-Dyla G. BezpoSredniei odlegie wyniki leczenia balneologicznego chorych z wypryskiem kontaktowym w Lgdek-Zdroju. Baln Pol 1975;20:28-30. 10. Waszczykowska E, Arkuszewska C, Dgbkowski J. Ocena
wynikdw leczenia balneoklimatycznego oraz odczynowoSci sk6ry chorych z przewleklq pokrzywkg i atopowym zapaleniem Sk&y. Baln Pol 1994;36:79-85. 11. Nowak A, Wyrwicz M, Szyroki L, Klimowicz A. Natu;alna i zastepcza talassoterapialuszczyoy pospolitej w SwinoujSciu. Przegl Dermatol 1986;73:491.-7. 12. Prochacki H. Badanie nad zastosowaniem w leczeniu chor6b Sk&y niekt6rych tworzyw naturalnych uzdrowiska SwinoujScie.Przegl Dermatol 1969;56:741-7. 13. Szyroki L, Nowak A, Gajny M. Wyniki balneoklimatycznego leczenia niektbrych alergicznych chortjb sk6ry w uzdrowisku SwinoujScie.Przegl Dermatol 1980;673784-8. 14. Serowy C, Klinker L. ijber Saisoneinfliisseauf die Morbiditst sowie den Effekt und Erfolg von Klimakuren an der Ostseebeim endogenen Ekzem. Dermatol Wochenschr 1967;153:1233-44. 15. Walther E, Boer I, Piazena H, Bomski P;.Klinker L. Erste Ergebnissevon Untersuchungen zum einfluss der solare UV-Strahlung auf den Kureffekt bei psoriasisvulgaris in Heiligendamm. Dermatol Monatschr lW2;175:548-54.
Spa Therapy in Poland ANASTAZY OMULECKI, MD, ADAM NOWAK, MD, PhD ANNA ZALEWSKA, MD
PhD
T
he oldest health resorts, among them also Polish ones, started to develop in the twelfth and thirteenth centuries. They were usually situated around warm and hot springs. Numerous data and documents give strong evidence about popularity of balneological treatment, already ,quite well developed in the Middle Ages.’ Cieplice Slaskie, mentioned in the historical records originating from 1137, are regarded as the first Polish health resort. The first piece of information about Lgdek-Zdroj comes from 1242, whereas the lwonicz-Zdroj waters have been known since 1520. The watering place in Krynica was founded in 1793 and Busko-Zdroj in 1805.2*3 A number of spas were developing in Poland, just like in other parts of Europe. The second half of the nineteenth century is recognized as the golden age of spa treatment. The first papers on balneotherapy in Poland date from 1522 and 1555. Doctor Wojciech Oczko, the royal physician, had his work Cieplice issued in 1575. It was the first publication containing information on the indications and contraindications of treatment in health resorts. The author of the above-mentioned study is regarded as the father of Polish balneotherapy. Nowadays, balneology exerts a very strong influence on other medical specialities in Poland, in particular it supplements pharmacotherapy. The Balneological Institute in Poznan coordinates the scientific research on spa treatment. The journal Polish Balneology is also edited by this Institute. Doctors working in health resorts are the members of the Polish Balneochmatic Society. Balneology is included in the medical studies program. It is also one of the most popular subspecialities, which every doctor can obtain after passing appropriate examinations. A great variety of health resorts can be found in Poland, a country situated between the Baltic Sea in the north and the mountain ranges of Carpathians and Sudeten in the south. There are 37 watering places in Poland (Fig 1). The most famous and frequently visited watering places are in Cieplice, Ciechocinek, Krynica, Duszniki, Polanica, Kudowa, Rabka, Szczawnica, and --_the Departmelzt of Dermatology and Venereology, Medical Uniuerslfy of Lad:, Lodz, Poland. Address correspondence to Professor Anastnzy Omulecki, Department of Dermatology and Venereology, Medical University of Lodz, Krzemienecka 5, 94-01; Lodz. Poland. From
G 199ti by Elsemrr Science Inc. 655 Ar&ue of tfw Americas, New York,
NY 10010
Wieliczka. Patients with a broad variety of conditions, including posttraumatic, cardiovascular, respiratory, alimentary, gynecological, and urinary tract disturbances can recuperate in these health resorts. There are three spas-Busko-Zdroj, Ladek-Zdroj, and SwinoujG.cie-where patients with skin diseases are treated. Most often applied in balneotherapy of skin diseases are sulfurous, radioactive, alkaline, carbonated, ferriferous, and arsenical waters. The sulfurous and the radioactive waters are the most widely used.
Busko-Zdri, j The Busko-Zdroj health resort is situated in central Poland, 223 m above sea level. Its sulfato-salty waters were already discovered in the Middle Ages. The Busko-Zdroj spa dates back to 1800. Nowadays, this resort possesses 13 wells and drill holes delivering sulfato-salty waters and 1 hole with iodo-bromic saline water. The basic components of the Busko-Zdroj sulfatosalty waters are ions of sodium, chlorine, sulfur, calcium, magnesium potassium, bromine, and iodine, as well as ions of the gases hydrogen sulfide and carban dioxide. One liter of water contains from 12 to 15 g of sodium chloride, from 7.04 to 39.15 mg of sulfurous ions and hydrogen sulfide (on average 17 to 20 mgl, 400 mg of calcium, 250 mg of magnesium, 15 mg of bromine and 2.5 mg of iodine. The synergistic activity of the above mentioned chemical compounds and their beneficial proportions exert a very good therapeutical effect on the organism, without undesirable reactions after bathing.4 Busko-Zdroj is a very precious resort because of its sulfide waters that contain iodine and selenium. Such waters are regarded as unique in Europe. Also therapeutic peat saturated with sulfur compounds can be found in Busko-Zdroj.5 The majority of patients treated in Bu.sko-Zdroj suffer from occupational skin diseases, such as contact, allergic, and irritant dermatitis; psoriasis; urticaria; and different types of eczema. About 600 people with skin diseases are treated annually in Busko-Zdroj. The sulfato-salty waters are administered as baths 15 to 20 minutes in duration, with temperature ranging between 36 and 39°C. About 15 baths are taken by a patient during one stay in Busko-Zdroj.* These waters exert both local and systemic effects on the organism. They
Clinics in Dermatology
680 OMULECKI ET AL.
l
2996;14:679-683
Baltic Sea
Figure 1. Map showinglocationsof Polishhealthresorts.
enhance metabolic processes and cause blood-vessel dilatation. Waters with weak concentrations of minerals act keratoplastically, whereas those with high concentrations possess rather keratolytic properties-they soften and desquamate epidermis6 The therapeutical activity of Busko-Zdroj waters is evaluated, both by patients and their doctors, as being very beneficial in skin diseases.
Lgdek-Zdrcij The Dermatology Department of the Medical University of Eodi takes care of the sanatorium in LadekZdrbj. The curative activity of spas of Ladek has been known for more than 700 years. Ladek is a Piedmont resort, situated in a charming valley 440 to 500 m above sea level. Marvelously shaped forested hills form its
Clinics 11217ermatology
l
3996;24:679-683
immediate surroundings. Climate is fairly mild, with a majority of sunny and windless days (Fig 2). LgdekZdrdj waters originate from the Precambrian gneisses. The total output is as high as 28 m3/hour, ranging between 12 and 300 L/min from each spring. Fluctuations of water temperature are very slight, and their monthly amplitude is about 0.3”C. The spring output is fairly stable, not directly dependent on the air-pressure and rainfalls.’ Two kinds of mineral waters are found in this resort. There are typical radon waters with an average radioactivity of 1220-1300 Bq/L. The utilization concentration is from 740 up to 925 Bq/L. The other springs have sulfido-fluoride waters. Their temperature is as high as 29°C. Patients can benefit from various balneologic treatments; these include radon, sulfido-fluoride, or acidocarbonated baths; mineral-water baths with gymnastic exercises that are performed in swimming pools; underwater massage; underwater vibratory massage (“aquavibrion”); peat wrappings; needle shower; quadrichamber; sauna; and Italian air baths. While radium
salts act as destructive agents for the tissues, emanations of radium exert therapeutic and stimulative effects on the organism. The dermatologic sanatorium in Lgdek-Zdrcij is designed for 30 patients. The fixed period of residence for a patient is 24 days. In justifiable cases it can be prolonged by another 24-day period. Doctors from the E6di Dermatology Department take care of the patients and do research work. Their observations assist in preparing the most suitable selection and dosage of balneologic treatments for applications to different skin problems. They also evaluate the outcomes of balneologic treatment in Lgdek-ZdrBj. The research is intended to create the rational basis for the optimal utilization of the health resort conditions. Every year about 22,500 patients, including 600 with skin diseases, are treated in this health resort. Most often they suffer from psoriasis. Other conditions in order of frequency of occurrence are different types of eczema, atopic dermatitis, chronic urticaria, seborrheic dermatitis, and scleroderma.
Figure 2. &dek-Zdrdj, one qf the most famous spas in Europe; the oldest spa building,, constructed at the turn of the fifteenth and sixteenth centuries.
Results
of Treatment
Patients discharged from the dermatologic departments and outpatients are followed up regulariy and advised to visit the sanatorium in order to complete their treatments and maintain their good results. The effectiveness of balneological treatment is generally very high. The more detailed evaluation of balneotherapy was performed in patients with psoriasis, atopic dermatitis, and urticaria.‘,’ The assessmentincluded both immediate and later results of the treatment in 55 patients with psoriasis. In all casesthe disease was of long duration, with several recurrences in spite of the routine treatment. The patients have residual or newly appearing psoriatic lesions. During a 24-day course of balneotherapy, they took baths in mineral waters containing radon or hydrogen sulfide on alternate days. Only emollients were applied topically. Results of the treatment were evaluated on a three-grade scale: ++, complete remission; +, improvement; 0, no improvement or deterioration. The patients were examined. immediately after completion of the therapy and were followed up at 3, 6, and 12 months thereafter. In 10 of the 55 patients, there was a complete clearance; in 42, improvement; in 2, deterioration; and in one casethe treatment was without any visible effect. It was discovered that the curative activity of balneotherapy was not only confined to the immediate results. That kind of treatment had also a beneficial effect on further course of the disease. The remission period was longer than bef;ore the treatment in 27 patients. In 17 patients there were no recurrences of the disease during a 12-month observation period, and in 35 patients recurrences were less pronounced. It is concluded that the balneologic treatment in water
682
OMULECKI
Clinics in Dermatology
ET AL.
containing hydrogen-sulfide and radioactive radon has a beneficial effect in patients with psoriasis. A similar evaluation was carried out in patients with urticaria and atopic dermatitis. In 14 patients of 28 with chronic urticaria, the lesions disappeared after completing the sanatorium treatment. Regarding atopic dermatitis, in 13 patients improvement was observed, in 4 no change for the better was observed and in 1 deterioration was noted.” Good results were also obtained in 68 patients with contact dermatitis. Improvement was observed in 66% of the patients directly after completing the therapy, whereas prolonged periods of remission were seen in 48% of the treated patients.’
Swinoujkie The Swinoujscie health resort is situated in the northwestern part of Poland, on the Baltic Sea coast. The Polish coast line is 524 km long. In the warmer months, that is, between April and September, this resort serves mainly as a recreation place. VividIy located Swinoujscie is a maritime health resort that dates back to 1885. At that time, salt springs and peats were officially recognized as possessing therapeutic properties, and they were put into a much wider use. The peaceful Pevelopment of this resort lasted until World War II. Swinoujscie began to operate again as a health resort only in 1959, after it had been destroyed to the ground between 1939 and 1945. A special dermatologic center, that is, a sanatorium dealing with skin problems, can be found in Swinoujscie. This center is supervised by the Dermatology Department of the Medical University of Szczecin. It is designed to accommodate about 1,000 patients with skin diseasesannually. The usual period of balneologic treatment is 24 days for one patient. The most numerous group with skin problems comprise patients with psoriasis. Other conditions in order of frequency of occurrence are allergic skin diseases, different types of eczema, and atopic dermatitis. In addition, patients with lichen planus, morphea, seborrheic dermatitis, ichthyosis vulgaris, and venous insufficiency of the legs seek treatment. In the summer, patients are exposed to controlled solar irradiation and seawater baths. According to the Mid-European requirements for health resorts, the minimal availability of sunshine should amount to about 1500 hours annually. In Swinoujscie the annual amount is considerably higher-on average 1752 hours annually. The patients recuperating in this dermatologic sanatorium take baths in seawater that contains 0.8% mineral salts. These seawater baths are usually administered every other day, in some cases frequency is adjusted individually.i’ In cooler seasons patients take their mineral-salt
l
1996;14:679-683
baths in swimming pools and are exposed to controlled artificial ultraviolet irradiation. The patients take baths that last from 10 to 20 min. The water temperature ranges between 34 and 38°C. The water contains about 4.5% of mineral components, including sodium chloride (88.7%), calcium salts (5.9%), and magnesium components (4.5%). The saline water also contains trace amounts of iron, strontium, iodine, bromine, and silicon salts, as well as metaboric acid. During a 24-day period, one patient is supposed to receive about 30 to 70 J/cm2 of UVA or 2.4 to 3.0 J/cm2 of UVB. A special cream prepared in the proportion of one part of saline to one part of Eucerin is applied topically by the patients after a therapeutic bath. This cream promotes hydration of the epidermis.
Results of Treatment The Dermatology Department in Szczecin regularly carries out research work on patients treated in the sanatorium. One of the studies was performed on 1,141 patients with chronic eczema, urticaria, and atopic eczema. All skin conditions were in a partial remission. The patients took baths prepared in the proportion of one part saline water to one part water obtained from the water-supply system. Patients received only topical treatment and were applying emollients. The therapeutic regimen did not differ from the one described above. The results of the treatment were evaluated on a previously mentioned three-grade scale. Improvement was achieved on average in 80% of the patients. The best results were noticed in patients with atopic dermatitis.13 Much better results were achieved for patients with psoriasis. The regimen of the treatment was not any different from the one already described. A total of 3,939 patients took part in this study, and in this group almost 90% of the patients showed considerable improvement. The results that were achieved with balneologic treatment of patients with contact eczema, psoriasis vulgaris, and atopic eczema performed in Swinoujbcie, which is a maritime health resort, are in agreement with German literature data.r4,i5
Conclusion At this stage we can only once again appreciate and stress the very important role of balneologic treatment in a number of the newer and more sophisticated methods of dealing with skin problems.
References 1. Kowalenko H Z przeszlosci Polslciejbalneologii. Wiad Uzdr 196’2;56:3-6. 2. Filipowicz Z. Zarys historyczny rozwoju turystyki i uzdrowisk. Probl Uzdr 1971;56:105-63.
3. Kochariski
JW. Kuracja w Lqdku-Zdroju.
Lqdek-Zdr6j,
1992, <5--13.
4. Marzec L. Naturalne czynniki lecznicze Busko-Zdroju. Baln 1’011952;3:217-25. 5. Atlas Uzdrowisk Polskich. Pafistwowe Przedsicbiorstwo Wydawnictw Kartograficznych im. Eugeniusza Romera. Warszawa-Wroclaw, 1990,235-240. 6. Legwant 2. MoiIiwoSci wykorzystania bus&h wbd siarczkowo-siarkowodorowych w lecznictwie. Baln Pol 1995; 37:28-30.
7. DowgiaHo J. Wystepowanie i perspektywy dalszego wykorzystania w6d termalnych w Polsce.Baln Pol 1972; 17:193-J+. 8. Arkuszewska C, Broniarczyk-Dyla G, Dziankowska B, et
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