Dead Sea Mud in the

Treatment of Psoriasis
Dr. Walid Farah
Dr. Jamal Dabbas
Dr. Jalal Zubi
Dr. Jeries Daoud
Amman - Jordan
 Introduction
 Psoriasis represent the largest group of skin
disease patients treated at the Dead Sea which
have been investigated.

 In our study therapy used at home and not at

the Dead Sea.
 Methods and Materials
 March – August 1998.
 Patients treated in dermatology clinics outside
the Dead Sea above the sea level in Jordan.
 120 patients of psoriasis.
 Two groups 60 patients each.
 First group assigned to use Dead Sea Mud.
 Second group to use wash out mud ( False
mud).
 Comparison of major ingredients of
true mud and washed out mud

Ingredients True mud (mg/L) False mud (mg/L)

Ca 23556 64.5
Na 31727 81.2
K 6841 56.3
Cl 190000 1100
Mg 32493 105.1
Total Scaling 284598 1397.0
 Methods and Materials
 Age 14 – 61 years.
 All in good health apart from psoriasis.
 2 pts in true mud group and 4 pts in false mud
group lost follow up .. Daily activities.
 There were no significant difference in
demographic and epidemiological variables for
the 2 groups
 Demographic Data
Parameter True mud False mud
(n=58) (n=56)
Age (years) Mean 34 31
Range 16 - 61 14 – 58
Sex Male 34 33
Female 24 23
Race White 54 53
Black 4 3-
 Target Area
Target Area True mud False mud
(n=58) (n=56)
Chest 0 0
Abdomen 2 2
Buttocks 3 4
Back 4 3
Upper limbs 12 7
Lower limbs 20 21
Elbow 14 12
Knee 3 7
 Disease status and duration
True mud False mud
(n=58) (n=56)
Disease status Stable 38 35
at entry

Worsening 20 21

Disease Mean 6.3 7.1

duration (yrs)
 Materials and Methods
 Three signs of psoriasis
Erythema
Induration
Scaling

 Four sign scores for disease severity

0 = none
1 = slight
2 = moderate
3 = severe
 Excluded individuals
 Systemic steroids within 28 days
 Antimetabolites within 28 days
 Topical therapies for psoriasis within 14 days
 Any investigational drugs within 1 month
 Application

Apply the mud to treatment areas

twice daily for 1 hour each for a
total of three weeks , occlusive
dressing may be used when
appropriate.
 Follow Up

Patients returned for evaluation of

their response to treatment after 3 ,
7 , 14 and 21 days of drug
application ( study days 4 , 8 , 15
and 22 )
 Criteria for Evaluation
 Cleared = 100% clearance of signs ( except for
residual discoloration)
 Marked improvement = 75 – 99% clearance of
signs.
 Moderate improvement = 50 - < 74% clearance
of signs.
 Mild improvement = < 50% clearance of signs
 No change = no detectable improvement
 Exacerbation = flare of sites monitored
 Patients Self evaluation
 1 = Excellent
 2 = Good

 3 = Fair

 4 = Poor

 5 = No response

 6 = Exacerbation
 Efficacy of Treatement
Based on individual and total disease
sign scores, the percent improvement
in sign scores, the global evaluation
of change in disease status and the
patient self – evaluation of their
response to treatment .
 Safety of Treatment

Assessed by examination of
patients at each visit for local
side effects if any.
Visit Rx Pts # Mean sign scores MTSS
Eryth Scal. Indur.
0 M 58 1.9 2.1 1.9 5.9
P 56 1.85 2.15 1.8 5.8
Day M 58 2.0 2.0 1.9 5.9
4 P 56 1.9 2.1 1.8 5.8
Day M 58 1.7 1.7 1.8 5.2
8 P 56 1.9 2.1 1.9 5.9
Day M 58 1.6 1.3 1.6 4.5
15 P 56 1.8 2.0 2.1 5.9
Day M 58 1.6 1.1 1.3 4.0
21 P 56 1.6 2.0 2.1 5.7
Mean Pt. Self Evaluation ( Mean Score )
Visit True Mud False Mud
( n=58 ) ( n=56 )
Day 4 4.05 4.0

Day 8 3.0 3.95

Day 15 2.95 3.95

Day 22 3.05 4.0

 Conclusion
 Dead Sea mud applied twice daily for 3 weeks
was efficacious in the treatment of psoriasis of
variable severity.
 Much more effective than placebo.
 Rapid onset of action as 1 week of therapy.
 Exact mechanisms deserve further efforts…
Mechanical ? Thermal ? Chemical ????
 Conclusion
Within the limitations of this study, Dead Sea
mud when applied over a 3 weeks treatment
period, may be be described
SAFE
RAPID
FAIRLY EFFICACIOUS
In the treatment of psoriasis.
Dr. Jamal Dabbas

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