Balneotherapy in medicine: A review

  • Ali NasermoaddeliEmail author
  • Sadanobu Kagamimori
Review Article


Bathing in water (balneotherapy or spa therapy) has been frequently and widely used in classical medicine as a cure for diseases. This paper reviews the present literature on the use of balneotherapy in dermatologic, chronic musculoskeletal (inflammatory and non-inflammatory), metabolic and psychological conditions.

We performed a systematic review on related papers appearing in the Medline and Cochrane Library database from 1966 to 2003 that included randomized controlled and non-randomized clinical trials using balneotherapy. We also determined to reflect where possible the chemical compositions of spas.

The major dermatologic and musculoskeletal diseases that are frequently treated by balneotherapy with a remarkable rate of success are atopic dermatitis, psoriasis, rheumatoid arthritis (RA), ankylosing spondylitis, osteoarthritis and low back pain. Moreover, the effects of spa therapy on several metabolic conditions are discussed. The mechanisms by which broad spectrums of diseases respond to spa therapy probably incorporate chemical, thermal and mechanical effects.

The importance of balneotherapy either alone or as complement to other therapies should be considered after, or accompanying, orthodox medical treatments.

Key words

spatherapy balneotherapy review 


  1. (1).
    Routh HB, Bhowmik KR, Parish LC, Witkowski JA. Balneology, mineral water, and spas in historical perspective. Clin Dermatol. 1996; 14: 551–554.PubMedCrossRefGoogle Scholar
  2. (2).
    Matz H, Orion E, Wolf R. Balneotherapy in dermatology. Dermatol Ther. 2003; 16: 132–140.PubMedCrossRefGoogle Scholar
  3. (3).
    O’Hare JP, Heywood A, Summerhayes C, Lunn G, Evans JM, Walters G, Corrall RJ, Dieppe PA. Observations on the effect of immersion in bath spa water. BMJ. 1985; 291: 1747–1751.PubMedGoogle Scholar
  4. (4).
    Adler E. Some clinical experience with the springs at Zohar on the shore of the Dead sea. Isr J Med Sci. 1961; 20: 304–308.PubMedGoogle Scholar
  5. (5).
    Smith JB, Knowlton RP, Agarwal SS. Human lymphocyte responses are enhanced by culture at 40°C. J Immunol. 1978; 121: 691–694.PubMedGoogle Scholar
  6. (6).
    Inoue T, Inoue S, Kubota K. Bactericidal activity of manganese and iodide ions against Staphylococcus aureus: a possible treatment for acute atopic dermatitis. Acta Derm Venereol. 1999: 79: 360–362.PubMedCrossRefGoogle Scholar
  7. (7).
    Svejgaard E. The role of microorganisms in atopic dermatitis. Semin Dermatol. 1990; 9: 255–261.PubMedGoogle Scholar
  8. (8).
    Kubota K, Machida I, Tamura K, Take H, Kurabayashi H, Akiba T, Tamura J. Treatment of refractory cases of atopic dermatitis with acidic hot spring. Acta Derm Venereol. (Stockh) 1997; 77: 452–454.Google Scholar
  9. (9).
    Shani J, Seidl V, Hristakieva E, Stanimirovic A, Burdo A, Harari M. Indications, contraindications and possible side-effects of climatotherapy at the Dead sea. Int J Dermatol. 1997; 36: 481–492.PubMedCrossRefGoogle Scholar
  10. (10).
    Giryes H, Friger M, Sarov B. Treatment of atopic dermatitis in the Dead sea area: biology and therapy of inflammatory skin diseases. Presented at: International Symposium at the Dead Sea; November 2–6, 1997; Dead Sea, Isreal.Google Scholar
  11. (11).
    Halvey S, Giryes H, Friger M, Sukenik S. Dead sea bath salt for the treatment of psoriasis vulgaris: a double-blind controlled study. J Eur Acad Dermatol. 1997; 9: 237–242.CrossRefGoogle Scholar
  12. (12).
    Leaute-labreze C, Saillour F, Chene G, Cazenave C, Luxey-Bellocq ML, Sanciaume C, Toussaint JF, Taieb A. Saline spa water or combined water and UV-B for psoriasis vs conventional UV-B. Arch Dermatol. 2001; 137: 1035–1039.PubMedGoogle Scholar
  13. (13).
    Hjorth N. Traditional topical treatment of acne. Acta Derm Venereol. (Stockh) 1980; 89: 53–55.Google Scholar
  14. (14).
    Schempp CM, Dittmar HC, Hummler D. Magnesium ions inhibit the antigen-presenting function of human epidermal Langerhans cells in vivo and in vitro. Involvement of ATPase, HLA-DR, B7 molecules, and cytokines. J Invest Dermatol. 2000: 115: 680–686.PubMedCrossRefGoogle Scholar
  15. (15).
    Hartmann BR, Bassenge E, Pittler M. Effect of carbon dioxide-enriched water and fresh water on the cutancous microcirculation and oxygen tension in the skin of the foot. Angiology, 1997; 48: 337–343.PubMedGoogle Scholar
  16. (16).
    Danesino V. Balneotherapy with arsenical-ferruginous water in chronic cervico-vaginitis. A case-control study. Minerva Ginecol. 2001; 53: 63–69 (Article in Italian)PubMedGoogle Scholar
  17. (17).
    Dupuy P, Casse M, Andre F, Dhivert-Donnadieu H, Pinton J, Hernandez-Pion C. Low-salt water reduces intestinal permeability in atopic patients. Dermatology 1999; 198: 153–155.PubMedCrossRefGoogle Scholar
  18. (18).
    Pinton J, Friden H, Kettaneh-Wold N, Wold S. Clinical and biological effects of balneotherapy with selenium-rich spa water in patients with psoriasis vulgaris. Br J Dermatol. 1995; 133: 344–347.PubMedCrossRefGoogle Scholar
  19. (19).
    Sukenik S, Buskila D, Neumann L, Kleiner-Baumgarten A, Zimlichman RS, Horowitz J. Sulfur bath and mud pack treatment for rheumatoid arthritis at the Dead sea area. Ann Rheum Dis. 1990; 49: 99–102.PubMedGoogle Scholar
  20. (20).
    Elkayam O, Wigler I, Tishler M. Effect of spa therapy in Tiberias on patients with rheumatoid arthritis and osteoarthritis. J Rheumatol. 1991; 18: 1799–1803.PubMedGoogle Scholar
  21. (21).
    Sukenik S, Neumann L, Flusser D. Balneotherapy for rheumatoid arthritis at the Dead sea. Isr J Med Sci. 1995; 31: 210–214.PubMedGoogle Scholar
  22. (22).
    Kolarz G. Critical approach to spa treatment in rheumatic diseases. Rheumatol Eur. 1995; 24: 144–146.Google Scholar
  23. (23).
    Franke A, Reiner L, Pratzel HG, Franke T, Resch KL. Longterm efficacy of radon spa therapy in rheumatoid arthritis—a randomized, sham-controlled study and follow-up. Rheumatology. 2000; 39: 894–902.PubMedCrossRefGoogle Scholar
  24. (24).
    Tubergen A, Landewe R, Heijde D, Hidding A, Wolter N, Asscher M, Falkenbach A, Ekkehard G, Goei The H, Linden S. Combined spa-exercise therapy is effective in patients with ankylosing spondylitis: a randomized controlled trial. Arthritis Care Res. 2001: 45: 430–438.CrossRefGoogle Scholar
  25. (25).
    Tishler M, Brostovski Y, Yaron M. Effects of spa therapy in Tiberias on patients with ankylosing spondylitis. Clin Rheumatol. 1995; 14: 21–25.PubMedCrossRefGoogle Scholar
  26. (26).
    Tubergen A, Boonen A, Landewe R, Rutten-Van Molken M, Heijde D, Hidding A, Linden S. Cost effectiveness of combined spa-exercise therapy in ankylosing spondylitis: a randomized controlled trial. Arthritis Rheum. 2002; 47: 459–467.PubMedCrossRefGoogle Scholar
  27. (27).
    Buskila D, Abu-Shakra M, Neumann L, Odes L, Shneider E, Flusser D, Sukenik S. Balneotherapy for fibromyalgia at the Dead sea. Rheumatol Int. 2001; 20: 105–108.PubMedCrossRefGoogle Scholar
  28. (28).
    Nguyen M, Revel M, Dougados M. Prolonged effects of 3 week therapy in a spa resort on lumbar spine, knee and hip osteoarthritis: follow-up after 6 months: a randomized controlled trial. Br J Rheumatol. 1997; 36: 77–81.PubMedCrossRefGoogle Scholar
  29. (29).
    Kovacs I, Bender T. The therapeutic effects of Cserkeszolo thermal water in osteoarthritis of the knee: a double blind, controlled, follow-up study. Rheumatol Int. 2002; 21: 281–221.Google Scholar
  30. (30).
    Green J, Mckenna F, Redfern EJ, Chamberlain MA. Home exercises are as effective as outpatient hydrotherapy for osteoarthritis of the hip. Br J Rheumatol. 1993; 32: 812–815.PubMedCrossRefGoogle Scholar
  31. (31).
    Wigler I, Elkayam O, Paran D. Spa therapy for gonarthrosis: a prospective study. Rheumatol Int. 1995; 15: 65–68.PubMedCrossRefGoogle Scholar
  32. (32).
    Guillemin F, Constant F, Collin JF, Boulange M. Short and long-term effect of spa therapy in chronic low-back pain. Br J Rheumatol. 1994; 33: 148–151.PubMedCrossRefGoogle Scholar
  33. (33).
    Constant F, Collin JF, Guillemin F, Boulange M. Effectiveness of spa therapy in chronic low back pain: a randomized clinical trial. J Rheumatol. 1995; 22: 1315–1320.PubMedGoogle Scholar
  34. (34).
    Konard K, Tatrai T, Hunka A. Controlled trial of balneotherapy in treatment of low back pain. Ann Rheum Dis. 1992; 51: 820–822.CrossRefGoogle Scholar
  35. (35).
    Strauss-Blasche G, Ekmekcioglu C, Leibetseder V, Melchart H, Marktl W. Seasonal variation in effect of spa therapy on chronic pain. Chronobiol Int. 2002; 19: 483–495.PubMedCrossRefGoogle Scholar
  36. (36).
    Becker BE. The biologic aspects of hydrotherapy. J Back Musculoskeletal Rehabil. 1994; 4: 255–264.Google Scholar
  37. (37).
    Golland A. Basic hydrotherapy. Physiotherapy. 1981; 67: 258–262.PubMedGoogle Scholar
  38. (38).
    Ohtsuka Y, Yabunaka N, Fujisawa H, Watanabe I, Agishi Y. Effect of thermal stress on glutathione metabolism in human erythrocytes. Eur J Appl Physiol Occup Physiol. 1994; 68: 87–91.PubMedCrossRefGoogle Scholar
  39. (39).
    Shirakura T, Kubota K. Balneotherapy in hematology and immunology. Jpn J Biometeor. 1992; 29: 15–23. (Article in Japanese).Google Scholar
  40. (40).
    Kurabayashi H, Kubota K, Tamura J, Shirakura T. A glass of water at midnight for possible prevention of cerebral infarction. Stroke. 1991; 22: 1326–1327.PubMedGoogle Scholar
  41. (41).
    Muruganandam A, Drouillard C, Thibert RJ, Cheung RM-C, Draisey TF, Mutus B. Glutathione metabolic enzyme activities in diabetic platelets as a function of glycemic control. Thromb Res. 1992; 67: 385–397.PubMedCrossRefGoogle Scholar
  42. (42).
    Buczynski A, Wachowicz B, Kedziora-Kornatowska K, Tkaczewski W, Kedziora J. Changes in antioxidant enzyme activities, aggregability and malonyldialdehyde concentration in blood platelets from patients with coronary heart disease. Atherosclerosis. 1993; 100: 223–228.PubMedCrossRefGoogle Scholar
  43. (43).
    Ohtsuka Y, Yabunaka N, Watanabe I, Noro H, Agishi Y. Balneotherapy and platelet glutathione metabolism in type II diabetic patients. Int J Biometerol. 1996; 39: 156–159.CrossRefGoogle Scholar
  44. (44).
    Ohtsuka Y, Yabunaka N, Watanabe I. Noro H, Tujisawa H, Agishi Y. Thermal stress and diabetic complications. Int J Biometeorol. 1995; 38: 57–59.PubMedCrossRefGoogle Scholar
  45. (45).
    Take H, Kubota K, Tamura K, Kurabayashi H, Shirakura T, Miyawaki S, Kobayashi I. Activation of circulating platelets by hyperthermal stress. Eur J Med Res. 1996; 1: 562–564.PubMedGoogle Scholar
  46. (46).
    Nomura E, Kohriyama T, Yamaguchi S, Kajikawa H, Nakamura S. Significance of the coagulation and fibrinolytic parameters as predictors for carotid atherosclerosis. Rinsho Shinkeigaku [Clinical Neurology] 1996; 36: 741–745. (Article in Japanese)Google Scholar
  47. (47).
    Tamura K, Kubota K, Kurabayashi H, Shirakura T. Effects of hyperthermal stress on the fibrinolytic system. Int J Hyperthermia. 1996; 12: 31–36.PubMedCrossRefGoogle Scholar
  48. (48).
    Ay A, Yurtkuran M. Evaluation of hormonal response and ultrasonic changes in the heel bone by aquatic exercise in sedentary postmenopausal women. Am J Phys Med Rehabil. 2003; 82: 942–949.PubMedCrossRefGoogle Scholar
  49. (49).
    Strauss-Blasche G, Ekmekeioglu C, Leibetseder V, Marktl W. Seasonal variation of lipid-lowering effects of complex spa therapy. Forsch Komplementarmed Klass Naturheilkd. 2003; 10: 78–84.PubMedCrossRefGoogle Scholar
  50. (50).
    Kuczera M, Kokot F. The influence of spa therapy on the endocrine system. II. Erythropoietin. Pol Arch Med Wewn. 1996; 95: 21–28. (Article in Polish)PubMedGoogle Scholar
  51. (51).
    Kuczera M, Kokot F. Effects of spa therapy on the endocrine system. I. Stress reaction hormones. Pol. Arch Med Wewn. 1996; 95: 11–20. (Article in Polish)PubMedGoogle Scholar
  52. (52).
    Leibetseder V, Strauss-Blasche G, Holzer F, Marktl W, Ekmekeioglu C. Improving homocysteine levels through balneotherapy: effects of sulphur baths. Clin Chim Acta. 2004: 343: 105–111.PubMedCrossRefGoogle Scholar
  53. (53).
    Ozkan Y, Ozkan B, Simsek B. Plasma total homocysteine and cysteine levels as cardiovascular risk factors in coronary heart disease. Int J Cardiol. 2002; 82: 269–277.PubMedCrossRefGoogle Scholar
  54. (54).
    Okada M, Hasebe N, Aizawa Y, Izawa K, Kawabe J, Kikuchi K. Thermal treatment attenuates neointimal thickening with enhanced expression of heat-shock protein 72 and suppression of oxidative stress. Circulation. 2004; 109: 1763–1768.PubMedCrossRefGoogle Scholar
  55. (55).
    Yamashita N, Hoshida S, Taniguchi N, Kuzuya T, Hori M. Whole-body hyperthermia provides biphasic cardioprotection against ischemia/reperfusion injury in the rat. Circulation. 1998; 98: 1414–1421.PubMedGoogle Scholar
  56. (56).
    Benjamin IJ, McMillan DR. Stress (heat shock) proteins molecular chaperones in cardiovascular biology and disease, Circ Res. 1998; 83: 117–132.PubMedGoogle Scholar
  57. (57).
    Latchman DS. Heat shock proteins and cardiac protection. Cardiovasc Res. 2001; 51: 637–646.PubMedCrossRefGoogle Scholar
  58. (58).
    Kamioka Y, Okada S, Mutoh Y, Yazaki T. Effectiveness of comprehensive education combining hot spa bathing and lifestyle exercise education. J Jpn Assoc Phys Med Balneol Climatol. 2003; 66: 239–248 (Article in Japanese)Google Scholar
  59. (59).
    Kamioka H, Nakamura Y, Yazaki T, Uebaba K, Mutoh Y, Okada S, Takahashi M. Effectiveness of comprehensive hot spa bathing and lifestyle education in middle-aged and elderly women: randomized controlled trial of three- and six month interventions. J Jpn Assoc Phys Med Balneol Climatol. 2004; 67: 202–214.Google Scholar
  60. (60).
    Harrington L, Affleck G, Urrows S, Tennen H, Higgins P, Zautra A, Hoffman S. Temporal covariation of soluble interleukin-2 receptor levels, daily stress, and disease activity in rheumatoid arthritis. Arthritis Rheum. 1993; 36: 199–203.PubMedGoogle Scholar
  61. (61).
    Halvey S, Sukenik S. Different modalities of spa therapy for skin diseases at the Dead sea area. Arch Dermatol. 1998; 134: 1416–1420.CrossRefGoogle Scholar
  62. (62).
    Turner B, Pennefather J, Edmonds C. Cardiovascular effects of hot water immersion (suicide soup). Med J Aust. 1980; 2: 39–40.PubMedGoogle Scholar

Copyright information

© Japanese Society of Hygiene 2005

Authors and Affiliations

  1. 1.Department of Welfare Promotion and Epidemiology, Faculty of MedicineToyama Medical and Pharmaceutical UniversityToyamaJapan

Personalised recommendations