Clime- and Heliotherapy

1
 Introduction

Therapeutic usable Clime (Healing Clime) is the

result of special dose of temporary and local
changing atmospheric factors controlled by
physicians. The dose can be contrary to the
personally comfort feeling of patients in
according to the indications.
“The doctor is the creator of the cure clime”
(Pfleiderer)
Klim 2
 Themes

 Climetherapy  Heliotherapy
• Definitions • Radiation sources
• Clime regions • Effect of environment to the
• Clime factors global radiation
• Dose factors • Radiation and skin
• Effects • Photochemical and -biological
• Indications and contra- effects
indications • Therapeutic and toxic effects
• Cure types and structures • Photo-Brine-Therapy
• Indications, contra-indications
and risks Klim 3
 Definitions I

Climetherapy is a part of Health Resort Medicine. It is

applied as a complex measure together with other
global adjusted therapeutic measures in the cure
systems. Climetherapy belongs on a treatment concept
of many different effective factors.
In Heliotherapy one important factor of Climetherapy
will be used.

Klim 4
 Definition II

 Climetherapy is the special treatment of sick patients by

modification their exposition in the free atmosphere
(Schmidt-Kessen).
 Photo therapy or Light therapy is the therapeutic use of
photon radiation in ultra violet, visible and infrared range.
 Heliotherapy is the Photo therapy by Sunshine.
 Thalasso therapy is the therapy by use of the remedies of
the sea.

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 Definition III

 Climetherapy
• Cure treatment by use of active and strong elements
of clime
• Sea-clime
• High-altitude clime
 Climecure (cure in the clime)
• Cure treatment in areas without strong elements of
clime by physiotherapy.
• Areas in woods and medium altitudes (Dirnagl)
Klim 6
 Definitions III

 Weather is the result of circulation in the atmosphere

 Clime is the long time mean value of the local weather
elements.
 Bio-clime is the clime, which contact the body surface
and has biological effects.

(Schmidt-Kessen)
Klim 7
 Clime regions

Sea-clime
• moist, cool, windy
• Aerosol, low pollution
Clime of medium altitudes
• Wood air, not windy
Clime of high altitudes (1200 –2000 m)
• dry, cool, high part of UV
• Decrease of max. O2-uptake about 2%/per 1000m
• up to 1800 m no house-dust-mite can live

Klim 8
 General principle of Climetherapy

In-door-clime Out-door-clime
(save clime) (stress clime)
Coddling situation Adaptation to natural
environment factors

Air pollution at home Careful situation in

health resort

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 Mechanical factors

Air pressure
Wind pressure
Gravitation

Klim 10
 Thermal factors

Air temperature
Radiation temperature
Humidity
Air movement (wind, draw-winch)

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 Limits of sultry or oppressive
feeling air

Temperature
30 28 26 24 22
°C

Relative Humidity
45 50 65 70 75
%

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 Actinic factors

UV-B (280-315 nm)

UV-A (315-400 nm)
UV-A1 (artificial) (350-400 nm)
Visible Light (380-780 nm)
near infrared radiation (760-2500 nm)

Klim 13
 Chemical factors

 Ozone
• Natural concentration: 0,01 - 0,06 ppm
• Maximal working level: 0,1 ppm
• Exhausted by reaction with the earth surface 4 mg/d/m2
 Volatile oils
 Aerosols
 Radon
 Missing air pollution
Klim 14
 Electric factors I

 Ions of air
• 102 - 103 ions/ cm3 of 1019 air molecules/cm3
• about 4 ions/cm2 per breath have contact to the lung
surface
 Electrical DC fields
• Field of fine weather : 100 V/m
• Field of low-pressure front: >1 kV/m
• Field of the skin surface by movement: >1 kV/m

Klim 15
 Electric factors II

 Electric AC field
(by atmospheric impulse radiation, Sferics)
• 10-Hz-Field
 Magnetic DC field
• 0,5 Gauss
 Magnetic AC field
• by 10-Hz-Field: 10-8 - 10-10 Gauss
• by 50-Hz-AC in houses: 1-5 Gauss
Klim 16
Dose factors of the weather

 cold - hot
 shadow - sunshine
 calm - windy
 dry - moist
 fog - rain
 clean air – air pollution

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Dose factors by activity of the
patient

Resting
Sitting
Going
Jogging
Sporting

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Dose factors by shielding the
patient

Warm dresses
Wind-tight dresses
Water-tight dresses

Klim 19
Weather-phases in Bioclimatology

1 Fine weather (cool to moderate warm) East part of high pressure

2 Active fine weather (warm and dry) Middle part of high pressure
3 Over loaded fine weather (very hot and dry) West part high
pressure
4 Beginning change of weather (warm and moist) frontal side of
low pressure
5 Changed weather (cold and moist)
6z Active cold air (cold to cool, rain, windy) backside of low pressure
6 Weather normalisation (cold and dry)

Klim 20
 Weather and sickness

Weather phase 4 (frontal side of low pressure):

• inflammation in any case
• asthma-attacks,
• disorders by hypotension
• acute disorders of the heart
• thromboses
Weather phase 5 (changed weather)
• fast normalisation of the disorders Klim 21
 Weather and sickness

Weather phase 6z (backside of low pressure)

• acute and spastic disorders
• bile-bladder colic
• cardiac pain
• cardiac-attacks
• disturbance by hypertension

Klim 22
 Weather and sickness

Weather phase 6 (Weather normalisation)

• headache
• migraine
• sleep disturbances
• depressions

Klim 23
Which factors of weather are maximal
effective in weather feeling ?

Change of
•hot and dry (phase 3)
to
•cold and moist (phase 5)

Klim 24
 Hypothesis of increasing pain in
rheumatoid arthritis
1. Decrease of air temperature
2. Decrease of join temperature
3. Decrease of synovial temperature
4. Increase of synovial viscosity
5. Decrease of join mobility
6. Increase of pain

Klim 25
 What is the main reason in
weather sickness?

Disturbance in
peripheral temperature regulation.
Cause?
Lack in training
Problems in civilisation.
Klim 26
 Complaints in connection with
weather changes
1. Weariness 9. Unbroken sleep disturbance
2. Bad mood 10. Increased making mistakes
3. Unpleasure to work 11. Increased forgetfulness
4. Head pressure, headache 12. Flicker of eyes
5. Restless sleep 13. Attack of vertigo
6. Initial insomnia and 14. Heart sensations
concentrating disturbance
15. Pain in postoperative scar
7. Nervosity
16. Depressive mood
8. Pain in points of bone-fractures
Klim 27
 Follow up of non-adaptation and
disability in temperature regulation

1. Vasoconstriction of peripheral blood vessels

2. Blood flow from peripheral vessels into the
systemic circulation
3. Hypertension

Klim 28
 Main therapeutic clime effects

Improvement of the thermoregulation

Increase of the physical efficiency
Inurity and decrease in susceptibility of infection
Improvement of the skin state
Vitamin D3-formation
Relief of the respiratory tract

Klim 29
 Coldness adaptation

Decrease in coldness sensitivity

Pain threshold moves to lower temperature
Initial increase of blood pressure decrease
More increase of heart rate after adaptation
Increase of reactive heat by metabolism

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 Indications in
Health Resorts with healthy clime
Situation after deficiency of training
• Therapy: Terrain cure by cool conditions
Respiratory tract diseases
• Therapy: Terrain cure and respiratory exercise
Osteoporosis
• Therapy: Terrain cure and Heliotherapy
Skin diseases (Psoriasis, Neurodermitis)
• Therapy: Terrain cure and Heliotherapy
Klim 31
Structures of Health Resorts with healthy
clime in high altitude

Net of terrain ways minimum 30 km

(5 to 15 % ascent)
Clime pavilion
Rest- and gymnastic-field
Equipment in hydrotherapy
Bike travel ways
Patient-consultation and -leading
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 Cure forms

Out-patient clime cure

Clime compact cure

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Treatment by low coldness
stimulation

Regimen refrigerants
Training en repos

Klim 34
 Change of aerobic metabolism by
adaptation to coldness

Physical endurance performance increase

• by terrain cure in cold conditions,
• by rest cure in fresh air.

Klim 35
 Change of lactate concentration in blood during
ergometric control by rest cure in fresh air

Before
treatment

3 weeks later

By A. Schuh 1995

Klim 36
 Change of lactate concentration in blood during
ergometric control by terrain cure in cool
conditions

Before
treatment

3 weeks later

By A. Schuh 1995

Klim 37
 Other expositions and indications

 Rest cure in fresh air (1-3times daily 2 hrs.)

• convalescence of bedridden patients
 Sleep treatment in fresh air (cool breathing air)
• weather sickness
• disorders of circulatory and sleep regulations
 Air bath (use of bathing dress, kinesitherapy in cold air)
• hypotonic circulatory regulation disorders
• adipose
• fibromyalgia

Klim 38
 Indication in Sea Health Resorts

Chronic diseases of respiratory tract

• Rhinitis, sinusitis paranasalis (in Summer time),
pharyngitis, laryngitis
• Hay rhinitis (on islands), rhinitis vasomotorica
• Chronic relapsing bronchitis
• Asthma-syndrome, allergic asthma (on islands)
• Situation post pneumonia and pleurisy
Klim 39
 Indication in Sea Health Resorts

Heart- and circulation diseases

• Functional circulation disorders, hypo-tension
• Early stage of arteriosclerosis
• Well compensated essential hypertension
• In-patient rehabilitation after cardiac infarction,
cardiac- and vascular operations
• Symptom-complex of varicose
Klim 40
 Indication in Sea Health Resorts

Skin diseases
• Eczematous diseases, keratosis, urticaria chronica
• Erythemato-squamous and papular dermatosis,
Psoriasis vulgaris (May to July)
• Dermatosis with blusters
• Pyodermia, acne vulgaris
• Phlebopathy
Klim 41
 Indication in Sea Health Resorts

Chronic diseases of locomotoric system

(treatment with mud or other peloides)
• Arthrosis, spondylitis and osteochondrosis
• Post-treatment after accident- and war-lesions
and post operations

Klim 42
 Indication in Sea Health Resorts

Women’s diseases
• Chronic inflammation processes of the genitals
(treatment by use of slime)
• Concrescence complaints (treatment by use of slime)
• Cycles disorders, Ovarian insufficiency (treatment
by use of slime)
• Vegetative-endocrine syndrome
• Postmenopausal syndrome
Klim 43
 Indication in Sea Health Resorts

Diseases of children
• Chronic relapsing diseases of the upper and lower
respiratory tract.
• Infantile asthma syndrome, allergic asthma (on
islands)
• Hypotonic circulation disorders
• Skin diseases
• Disorders of development
Klim 44
Indication in Sea Health Resorts

General weakness situations

• convalescence
• Dystonia, autonomic nervous
disorders

Klim 45
 Indications in Thalassotherapy
of the respiratory tract
Months: I II III IV V VI VII VIII IX X XI XII
without Decompensation
Diseases
With moderate Decompensation
of the respiratory tract
Sinusitides and Otitides
Cardiac-circulation diseases
with weather sensitivity
Nervous excitability
Delivate, extremely susceptible
patients and infants
Babies, ill infants,
old humans

Klim 46
 Indications in Thalassotherapy
of the skin
Months: I II III IV V VI VII VIII IX X XI XII
for children and adults, and occupational eczema
Neurodermitis
By strong asthenia or dystonia autonomic nervous disorders

Urticaria, Strophulosis,
Furunculosis
Dyshidrotic Eczema

Acne vulgaris and Acne juvenilis

Ichthyosis vulgaris und Psoriasis vulgaris

Prurigo

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 Stimulus dosage
during cure treatment

4 - 8 days spar,
After this time in low steps as strong as possible
increase,
Individual dosage.

Klim 48
 Water temperature
and bath permanence
Temperature Permanence
°C minutes
Cure to inure 16 - 18 5 - 15
Hypotension 18 - 20 5 - 15
Circulation disturbance 20 - 22 10 - 20
Sports Swimming 21 - 23 15 - 25
Without healthy use 23 - 26 15 - 25
Underwater gymnastics and 27 - 29 20 - 25
kinesitherapy
Rheuma-patients 30 - 36 20 - 30 Klim 49
Permanence of the first sun-bath
by start of exposition May 1st

min
180
Skin Type
150 IV III
120 II I
90
60
30
06 8 10 12 14 16 18 h
Daytime
Klim 50
Permanence of the first sun-bath
by start of exposition July 1st
min
180
150 Skin Type
120 IV
90 III
II
I
60
30
0
6 8 10 12 14 16 18 h
Daytime
Klim 51
 Heliotherapy
• Radiation sources
• Effect of environment to the global radiation
• Radiation and skin
• Photochemical and -biological effects
• Therapeutic and toxic effects
• Photo-Brine-Therapy
• Indications, contra-indications and risks

Klim 52
 Radiation in Heliotherapy
Strahlungsbereich Wellenlänge
-4 -1
Gammastrahlung 10 bis 10 nm
-2
Röntgenstrahlung 10 bis 10 nm
Vakuum-Ultraviolett 10 bis 200 nm
UV-C-Strahlung 200 bis 280 nm
UV-B-Strahlung 280 bis 320 nm
Heliotherapy UV-A-Strahlung 320 bis 400 nm
Licht 400 bis 780 nm
Infrarot-Strahlung 780 bis 1.000.000 nm
Licht
Mikrowelle 1.000.000 bis 1.000.000.000 nm

Klim 53
 Radiation sources in Phototherapy

Temperature radiators
• Sun >300 nm
Gas-discharge radiators
• Hg 254, 313, 366
• Low pressure, high pressure, highest pressure
LASER
• He/Ne 632 nm

Klim 54
 Recovery

Spectrum of an Skin protection

against to much
sun radiation

UV-lamp Care of health

Vitamin D3

UVB UVA LIGHT

Klim 55
Global radiation of the sun

Equator

Germany

Visible Light

Klim 56
 UV-C UV-B UV-A

UV-
radiation Ozon

of the sun

Klim 57
 Change of altitude
and the part of sun-irradiation

UV-B: 15%/1000 m
• Important in high altitudes
UV-A: 2-5%/1000 m
• Important at Dead Sea level
(400 m under sea-level)

Klim 58
 Effect of clouds
to the radiation parts of sunshine

UV: Transmission 50%

Visible: Transmission 25%

Klim 59
 Reflection of UV-B

Snow 85%
Gras 26%
Sand 10-15%
Shoal mud 9-10%
moist ground 3%

Klim 60
 Reflection of white pigments
(by Luckiesh 1946)

Material % Reflexion
254 nm 297 nm 365 nm Sichtbar
MgO 93 93 94 95-97
Weißer Putz 46 65 76 90
TiO2 6 6 31 94
ZnO 2,5 2,5 4 88
Schwarze Lackschicht 5 5 5 6
Wellpappe 18-31 21-40 33-50 55-75
Klim 61
 Effective erythema dose
(nach Diffey et al. 1982)

Part of the absorbed environmental dose

Sun bath at the beach 0,75

Sitting in Swimming-pool 0,40

Skying 0,22

Walking 0,17

Sailing 0,14

Klim 62
 Penetration of UV-A- and
UV-B-rays into the skin

Visible Infrarot
51,8% 43,9%
Stratum corneum

UV-B 0,4% Stratum spinosum

Cutis

UV-A 3,9%
Subcutis

Klim 63
 Penetration into the skin
Depth to
find relative Dose in
Light  1 % of Stratum basale in % of
surface surface dose
dose
nm mm White Negro
UV-C 250 0,2 1,5
UV-B 300 0,5 18
UV-A 350 1,0 45 8
green 550 1,2 65 40
red 700 1,4 75 60
NIR 1230 2,3 95
IR 2200 1,1 75

Klim 64
 Transmission of skin layers in %
(nach Bachem und Reed 1930; modifiziert von Daniels 1969)

Hautschicht Dicke Wellenlänge in nm

in mm
200 250 280 300 400 550 750
Hornschicht 0,03 0 19 15 34 80 87 78

+ native 0,05 0 11 9 16 57 77 65
Epidermis
+ Dermis 2,0 0 0 0 0 0 5 21

Klim 65
 Action-spectres

Pigmentation

Conjunctivitis
Erythema
A
B
C
Klim 66
 Definitions

Radiation power
• Quotient between radiation flow and the
affected area (unit: W/m2)
Radiation dose
• Product of radiation power and radiation time.
(unit: Ws /m2 or J/m2)

Klim 67
 Radiation instruction
for different lamp-types
Typischer Typische Betrahlungs-
Abstand Bestrahlungs stärke bei
-zeit diesem
Abstand
2
Kromeyer-Lampe Kontakt 2s 240 W/m

2
UV-B-Strahler 0,5 m 3 min 7 W/m

2
UV-A-Strahler 0,5 m 5 – 30 min 0,4 W/m

Klim 68
 Radiation power
and biological effectiveness
UV-spectrum
Relative biologic
effectiveness 1
and radiation power in
W/m2/nm
biologic
0,01 Sensitivity
effective
UV-spectrum
0,0001

0,000001

300 325 350 375 400 Wavelength

___________
UV-B UV-A nm

Klim 69
 Rules of Photochemistry

 Photochemical reactions take place only by absorbed radiation

(Grothus-Draper).
 The photochemical effect is proportional to the product of intensity
and performance (Bunsen-Roscoe).
 The absorbed part of light by a substance depends not on the
intensity of light and increase only by their concentration (Lambert-
Beer).
 Radiation follows in quantum units and not in a continuum (Planck).
 By each absorbed quantum will be formed one activated molecule
(Stark-Einstein).

Klim 70
 Photochemical reactions

Photochemical activation: A + h  A*
Following reactions:
Energy change: A*  A + heat, light
Energy transfer: A* + B  A + B*
Splitting: A*  a1 + a2
Synthesis: A* + B  AB

Klim 71
 Photochemical radiation effects

 UV-B and C
• Dimerisation of thymidine-bricks
• Cracking of amino acids: forming of vasoactive
substances
• Inactivation most of enzymes
• Forming of steroid hydro-peroxides on the skin
(cancerogenic)

Klim 72
 UV-Spectrum
of vitamin D und ergosterine
Extinkionscoefficient Ergosterine

Extinktionscoefficient Vitamin D
20 40

Ergosterine
Vitamin D

10 20

UV-B

220 260 300 mµ

Klim 73
 Vitamin D3 development
 255-320 nm
• Change of 7-Dehydro-cholesterine to vitamin D3
• Requirement of D3 is produced by a 2 times weekly Sun-
radiation without erythema to an area like face and arms.

7-Dehydrocholesterine Vitamin D3 1,25-Dihydroxycholecalciferole

Activation of intestinal Ca- and phosphate absorption

Activation of the renal phosphate reabsorption
Activation of the intraerythrocytal glycolysis
Increase of 2,3-Diphosphoglycerate in the erythrocytes
Increase of the dissociation of oxyhemoglobine
Increase of the O2-supply of cells
Klim 74
Increase of vitamin D3-reaction products
after 4 hrs. UV-B-radiation
(Humpler 1982)
Ery Ery
30% n = 16

Ery PFK PK
20% Plasma

Ca Plasma DPG

10% PO4
Ery

P50
0%
2,45 1,28 13.95 25,5 9,25 0,59
mmol/l mmol/l µmol/l mmHg U/gHb U/gHb

Klim 75
 Primary target-cells of
UV-radiation
Corneocytes (UV-C)
Keratinocytes (UV-B)
Melanocytes (UV-B and UV-A)
Langerhans cells (UV-B)
Endothelial cells (UV-A)
Inocytes (UV-A)

Klim 76
Photobiological radiation effect
by UV-B

Erythema: max. 297 nm

• Latency: 1-4 hrs.
• Maximum: 6-9 hrs.
• MED: 36-50 mJ/cm2

Klim 77
Change of Amino acid concentration in the horny
layer by iterative UV-radiation

Klim 78
Keratinocyte reactions

Intra- and intercellular oedema

Cytolysis
Forming of sunburn cells

Klim 79
 Keratinocyte reactions
by lipid peroxidation of membranes

Odland-Granules move into the intercellular space

Lysosomes are resolved
Lysosomal enzymes are released
Mitochondria will be destroyed

Klim 80
 Keratinocyte reactions

The reaction of keratinocytes by UV-C, UV-B,

UV-A or phototoxic substances is qualitative
equivalent and is already released by sub-
erythemal doses.

Klim 81
 Photochemical radiation effects
by UV-B

Indirect pigmentation: Dose <50 mJ/cm2

• Metabolism of dopaoxidase to tyrosinase
• Oxidation of DOPA to melanin in melanocytes

Klim 82
 Melanocyte-reaction
(Melanogenesis)

Minimal Dose UV-B: about 23 mJ/cm2

Minimal Dose UV-A: 17,7 ± 8 J/cm2
Latency time: 1-14 days
Permanency: some months
Forming of black or brown Eumelanin and yellow
or red Pheomelanin
UV-protection depended on localisation
Klim 83
 Melanin-synthesis
L-Tyrosin slowly L-Dopa fast Dopachinon
Dopaoxydase Tyrosinase
Protein (Cu++)2 Protein (Cu+)2
spontan

Activation Dopachrom
Deletion of the SH-Inhibition
by Polym.
UV-radiation 280-310 nm
X-radiation Melanin
temperature increase
inflammation process
SH-blocker: As, Fe, Bi, Au, Ag, Hg
Klim 84
 Photobiologic reactions by
UV-B-radiation
Inhibition of the basal cell mitoses rate
Forming of sunburn cells suprabasal (max. 30 hrs.)
Inhibition of Langerhans cell
Liberation of interleucin 1 (max. 2 hrs.)
Reactive hyper-epidermopoesis (latency 24 hrs.;
permanency 3 weeks)
Akanthosis by following hyper-keratosis
(Miescher’sche Lichtschwiele)
Klim 85
 Langerhans cell-reaction

Inhibition of the immune answer

Blocking of T-helper cells
Stimulation of T-Suppressor cells

Klim 86
 Photochemical radiation effect
by UV-A

 Direct pigmentation:
Dose >25 J/cm2
• Intracellular peroxide forming
• Stimulation of the pigment movement in the
melanocytes

Klim 87
 The melanin-unit
1 Melanocyt by
36 Keratinocytes

Phagocytosis
of Melanosomes

Melanosomes
with Melanin
Melanocyt

Stratum basale
Klim 88
 Endothel cell-reaction

Vasodilatation
Increased vasopermeability

Klim 89
 Reaction by
UV-A -overdosage

Fever
Leucocytosis
Increase of CRP and immunoglobulin
Increase of phagocytosal effectiveness in
leukocytes

Klim 90
 Photochemical radiation effect
by visible light

Blue light 400-480 nm

• Bilirubin will be changed by new-born to a
renal eliminated substance.

Klim 91
 Jaundice of newborn
by continual radiation 450-460 nm, 34 µW/cm2/nm

Serum Bilirubin Concentration

mg/100ml Control
16 Treatment group

14

12

10

0
0,24 24 48 72 96 120 144 168 Age in hrs.
Klim 92
 Action spectrum to destroy of
bilirubin
%
Abbau von Serum-Bilirubin

25

20

15

10

0
400 450 500 550 600 650 nm

Klim 93
 Skin types

 Type I: Sunburn without  Type IV: Never sunburn

pigmentation and over average
 Type II: Erythema with pigmentation
low pigmentation  Type V: South European
 Type III: Seldom sunburn and Indian
and distinct pigmentation  Type VI: Negroid Race

Klim 94
 Skin types

Typ I Typ II Typ III Typ IV

keltic Type light-skin dark-skin mediterrian
European European Type
incidence 2% 12 % 78 % 8%
skin color Very light light Light brown darkbrown
mamilla stricking light light pigmentated dark
lentigo many often hardly never
Sunburn risk always nearly seldom never
always
Pigmentation hardly moderate always always
Protection time 5-10 min 10-20 min 20-30 min 30-40 min
Klim 95
 Representative Exposition special Persons
(nach Challoner 1976 und Leach 1978)

Group Part of absorbed

environment dose
Gardener 0,1
Sunexposition on the 0,1
balkony
Labor- and office worker 0,03
Bedridden long term 0,001
patients Klim 96
 Persons with higher UV-sensitivity

New-born and infants

Children more than adult
Bloated children
Men are 20% more sensitive than women
Old human are lesser sensitive

Klim 97
Relative UV sensitivity of different body areas

Back of the hand, lower leg 25 %

Forehead, neck, leg 25 - 50 %
Arms 50 - 75 %
Breast, abdomen, back 75 - 100 %

Klim 98
 Minimal erythema dose (MED)

Light-steps by 20-30-40-50-60-70 mJ/cm2

Back, buttocks (representative), forearms
Control after 24 hrs.
Heliotherapy will be used by tables

Klim 99
 MED and UV-A

The MED for UV-B will be decrease by

UV-A-irradiation.
(Photoaddition or Photoaugmentation ?)

Klim 100
 Erythema stage

 Suberythema: no visible erythema (sedative Dose)

 Stage I: hardly visible erythema (MED), subside after 1-2 days.
 Stage II: low reddening (5times MED), after 3 days subside by easy
little desquamation.
 Stage III: intensive reddening, about 1 week persistent, defurfuration.
Inflammation dose for small areas by treatment of acne vulgaris and
painful situations like Lumbalgo.
 Stage IV: very intensive reddening after 2 hrs. (9times MED),
vesication.

Klim 101
 Treatment of
Dermatitis solaris

 Cooling packs
 mild shaking mixture like Lotio alba, 0,5% Vioform-
Lotio
 Prescription of corticosteroids containing lotions or
Crèmes
 In very strong forms injection of Calcium and anti-
histaminica, if necessary also corticosteroides, oral or
possible i.v.

Klim 102
 Photo-Pigmentation-Index (PPI)

Quotient by erythema and Pigmentation

stage. It is to control after 72 and 120 hrs. in
4 half-quantitative stages by various points.
Good pigmentation: PPI < 1
deficient pigmentation: PPI >1

Klim 103
 Rules of Phototherapy

To use the lowest therapeutic dose

To avoid erythema
By skin diseases to irradiate till free of symptoms,
than decrease radiation dose slowly step by step.
By repeated radiation to use low single doses.

Klim 104
 Indications in UV-therapy
 Psoriasis vulgaris
 Pemphigus vulgaris
 Urticaria
 Herpes simplex o. solaris
 Neurodermitis
 Seborrhoic Eczema
 Ichthyosis
 Acne vulgaris
 Ulcus cruris
 Alopecia
 Pityriasis versicolor
 Mycosis fungoides
 Rachitis-prophylaxis
 Secondary Anaemia
 Hyperthyreosis
 Hypertension
Klim 105
 Effects and indications

Habituation and  Lichen ruber planus

 Pityriasis lichenoides
exertion of  Erythrodermie pityriasique en
influence the plaques disséminées
pruritus  Dermatitis herpetiformis
(Pemphigus vulgaris, Urticaria)
 Lighturticaria
 Herpes simplex
 Seborrhoic eczema
 Ichthyosis
Klim 106
 Effects and indications

 Inurity  Psoriasis vulgaris

 cytostatic effect  Psoriasis vulgaris
 Reticules and reticular
Hyperplasia
 Repigmentation  Vitiligo
 Peeling  Pityriasis versicolor
 Pityriasis rosea

Klim 107
 Effects and indications

 Activation of the metabolism  Acne vulgaris et

conglobata
 Alopecia areata et diffusa
 Vitamin-D-activation  Mycosis fungoides

Klim 108
Indications in the Heliotherapy
by supportive treatment

 Non active rheumatoid arthritis

 General tendo-periostosis
 Hypertension
 Osteomalacia
 Osteoporosis
 Respiratory tract diseases
 Non active Tbc
 Cardiac rehabilitation
 Depressions

Klim 109
 Use of Heliotherapy in Prevention

Light-adaptation in winter and spring time in case

of light-urticaria and other photodermatoses
Rickets prophylaxis in childhood
Infect prophylaxis and increase of the immune
resistance
Increase of the mental learning possibility

Klim 110
 Application of the Heliotherapy

Daily or two-daily irradiation by suberythemal

doses
6 applications
Increase till erythema first stage
To avoid overheating

Klim 111
 Progression of the Dose of
Sunbathes
30 % Increase

1. Tag 34 Minuten
2. Tag 44 Minuten
3. Tag 58 Minuten
4. Tag 75 Minuten
5. Tag 97 Minuten
6. Tag 126 Minuten
7. Tag 164 Minuten
8. Tag 213 Minuten
9. Tag 277 Minuten
8. Tag
10. Tag 361 Minuten Klim 112
 The sedative cure
Behandlung Intervall Tage Dosierung Reaktion Bemerkungen

1. Täglich oder jeden 2. Tag 0,5 Suberythem Die sehr leichte Reaktion soll
nach jeder Behandlung
2. 0,7 wieder auftreten.
Ansteigende Dosen bis
höchstens zum Auftreten des
3. 0,9 Erythems ersten Grades.

4. 1,1

5. 1,3

6. 1,5

Klim 113
 The tonic cure
Behandlung Intervall Tage Dosierung Reaktion Bemerkungen

1. 2—3 Tage zwischen den 1 Erythem Das Ziel ist, nach jeder
2. einzelnen Behandlungen 1,3 ersten Behandlung das Erythem
3. 1,6 Grades ersten Grades zu erzeugen.
4. 2 Bei jeder Behandlung werden
5. 2,3 Rücken und Brustseite des
6. 2,6 Körpers bestrahlt. Beim
7. 3 Auftreten von Pigmentation
8. 3,3 3-4 Wochen aussetzen und
9. 3,6 von vorne beginnen..
10. 4
11. 4,3
12. 4,6
13. 5
14. 5,3
15. 5,6
Klim 114
 The therapeutic cure
Behandlung Intervall Tage Dosierung Reaktion Bemerkungen

1. 2—3 Tage, die Reaktion 1 Erster, später Nach jeder Bestrahlung soll
2. auf die vorhergehende 1,5 zweiter Grad ein ausgesprochenes Erythem
3. Bestrahlung muß 2,25 des festgestellt werden können.
4. verschwunden sein. 3,5 Erythems. Nach 12 Sitzungen 3-4
5. 5 Pigmentation Wochen Pause.
6. 7,5 von der 6.
7. 16 Behandlung
8. 16 ab.
9. 24
10. 27
11. 30
12. 30

Klim 115
 Sunbathes in flat country altitude till 500 m
in minutes
Monat Tageszeit wolkenlos teilweise bewölkt

1. Bad 3. Bad 5. Bad 1. Bad 3. Bad 5. Bad

März Vormittags 70 90 90 90 90 90
11-14 Uhr 60 90 90 75 90 90
Nachmittags 90 90 90 90 90 90
April Vormittags 40 60 90 50 90 90
11-14 Uhr 35 70 90 45 75 90
Nachmittags 55 90 90 70 90 90
Mai Vormittags 30 55 90 40 70 90
11-14 Uhr 25 45 75 30 55 90
Nachmittags 40 70 90 50 90 90
Juni/Juli Vormittags 35 60 90 45 75 90
11-14 Uhr 30 50 90 40 70 90
Nachmittags 45 75 90 60 90 90
August Vormittags 40 70 90 50 90 90
11-14 Uhr 35 60 90 45 75 90
Nachmittags 55 90 90 70 90 90
Septem. Vormittags 60 90 90 75 90 90
11-14 Uhr 50 90 90 60 90 90
Nachmittags 75 90 90 90 90 90

Klim 116
 Sunbathes in high altitudes 1300 to 1700
m
Monat Tageszeit
in minutes
wolkenlos teilweise bewölkt

1. Bad 3. Bad 5. Bad 1. Bad 3. Bad 5. Bad

März Vormittags 50 90 90 60 90 90
Schnee 11-14 Uhr 40 70 90 50 90 90
Nachmittags 60 90 90 75 90 90
April Vormittags 25 45 75 30 55 90
Schnee 11-14 Uhr 20 35 60 25 45 75
Nachmittags 30 55 90 40 70 90
April Vormittags 35 60 90 45 75 90
kein 11-14 Uhr 30 50 90 40 70 90
Schnee Nachmittags 45 75 90 60 90 90
Mai Vormittags 25 45 75 30 55 90
11-14 Uhr 20 35 60 25 45 75
Nachmittags 30 55 90 40 70 90
Juni Vormittags 30 55 90 40 70 90
11-14 Uhr 25 45 75 30 55 90
Nachmittags 40 70 90 50 90 90
Juli Vormittags 25 45 75 30 50 90
August 11-14 Uhr 20 35 60 25 45 75
Nachmittags 30 50 90 40 70 90
Septem. Vormittags 35 60 90 45 75 90
11-14 Uhr 30 55 90 40 70 90
Nachmittags 45 75 90 60 90 90

Klim 117
 Relative MED and geographic latitude

nach Piazena

Columbia
Klim 118
 Indications in Heliotherapy
by supportive treatment of skin diseases

Pruritic dermatoses
Chronic relapsed urticaria
Atopic constitutional neurodermitis
Psoriasis arthropatica
Vitiligo

Klim 119
 Effects of visible light

Dynamisation
Increase of performance
Mood improvement

Klim 120
 Photo-Sole-Therapy I
 Indications
• Psoriasis
• Ichthyosis
 10-15 minutes bath in high concentrated brine or sea
water
 Irradiation by suberythemale dose daily
• SUP-radiator (300-320 nm) (UV-B)
• Sun

Klim 121
 Photo-Sole-Therapy II

 Indications
• Atopic constitutional neurodermitis
 10-15 minutes bath first in 1% brine or more if tolerable
 Irradiation daily by
• High performance-UV-A-radiator
• Sun

Klim 122
 Indications
in red-light- or Infrared-therapy

 Moisten eczema
 Dermatitides
 Sinusitides
 Hordeolum (sty)
 Furuncle
 chronic-inflammatory rheumatic diseases in non-acute stage
 degenerative diseases of the spine and extremity
 Soft tissue rheumatic diseases

Klim 123
 Contraindications in case of
overheating
 Disturbance of sensibility
 Congestive cardiac insufficiency
 Strong disturbance of cardiac rhythm
 Acute situation post myocardial infarct
 Hormonal disorders in diabetes mellitus, hyperthyroidism,
adrenal cortex insufficiency
 Advanced vascular disturbance

Klim 124
 Light protection

 Most of light protection agents absorb mainly UV-B.

 In this case by use of light protection agents the result is a stronger
irradiation by UV-A, because no warning erythema is developed.
 Endogenous light protection is mainly resulted by increase of horny
layer thickness. A small part of endogenous light protection is related to
the amino acids and urocanic acid in the horny layer. Melanin is
protecting, if it is deposit in the horny layer of some races or skin types.
 Light adaptation by protract and fractionated irradiation lower than the
MED can be recommended.

Klim 125
 Light protection factor

Protection time =
Endogenous protection time x Light protection factor

Light callosity: light protection factor 4

Pigmentation: light protection factor 10
Adaptation: till light protection factor 40

Klim 126
 Photo-allergy

Sulphonamide Phenothiazine
Psychopharmaca Desodorantia
Antihistaminica Optic clearing agents in
laundry
Antimycotica
Sweetening agents

Photo-allergic reaction
latency of 7-21 days.

Klim 127
 Photo-toxicity

Contamination in Eosin in lip sticks

Vaseline and face Gras-dermatitis
cosmetics
Acridine dyes Bergamot oil (eau de
cologne) Berloque-
Trypaflavin
dermatitis

Photo-toxic reactions no latency.

Klim 128
Light sensitivity in Porphyry

relative Empfindlichkeit

300 400 500 600 nm

Klim 129
 Contraindications of
Phototherapy

Light-dermatosis (photo-toxic, photo-allergic,

photosensitization, photo-anaphylactic, photo-
biotrophic reactions)
Exsudative or open Tbc
Hyperthyreosis
Ulcus ventriculi and duodeni

Klim 130
 Unsuitable is the
UV-irradiation by

Decompensation situation of the

circulation system
Acute nephritis
Cachexia
Haemophilia
Strong menstrual bleeding
X-ray-dermatitis
Klim 131
Risks in case of exacerbation

Psoriasis in stadium of outbreak

Lichen ruber planus
Pityriasis rosea
Porphyry

Klim 132
 Risks

Oncological risk in therapeutic use is insignificant.

Change in connective tissue, development of folds and
basaloma in radiated skin areas are the result of excessive
and unnecessary use of solaria in cosmetic interest or sun
exposition during long life of special occupation groups.
Melanoma are to find up to 75% as late lesion on not
irradiated areas especially as follow up of strong light
inflammations during the childhood.
Mortality in Germany is 0,2 cases per 10000 inhabitants.
Klim 133
 Benefit and Disadvantage of the
UV-radiation
 Disadvantage
Deficiency disease by underdosage
 Benefit
Dietetic use by normal dosage
Preventive use in actual deficiency diseases
Stimulation by short overdosage
Use in therapeutic treatment by special dosage (skin diseases)
 Disadvantage
Toxic skin reactions by overdosage

Klim 134
 “Sunbalance” by Greiter

Benefits
Essential Photosynthesis (Vegetation and oxygen)
Seeing and hormonal control
Vitamin D-synthesis and development of a functional skeleton and protection against
rickets
Killing of bacteria
Heat
Healing of diseases
Activation of the human organism
Improved performance economy
Improved protection of the organism by increased melanin synthesis and increased
thickness of the horny layer.
Klim 135
 “Sunbalance” by Greiter

Disadvantage
Sunburn
Premature skin ageing
Skin cancer
Phototoxic or photoallergic effects

Klim 136
 Conclusion

Clime- and Heliotherapy are stimulation treatments.

Result is the reactivation of already present self-
healing power.
Patients could be independent by use of pharmaca.
Clime- and Heliotherapy are typical naturopathic
treatments.

Klim 137
 Literature

 Phototherapie von S. Chlebarov und H.G. Pratzel im “Lehrbuch der

Physikalischen Medizin und Rehabilitation”. Hrsg. von K.L.Schmidt,
H. Drexel, K.-A.Jochheim im G. Fischer Verlag, Heidelberg, 1995
(ISBN 3-437-00797-1)
 Klimatherapie: ebenda Artikel von W. Schmidt-Kessen und mehrere
Artikel versch. Autoren in “Heilbad und Kurort. 48. Jahrgang, Heft 3
1996.”
 Elektroklima: P. Kröling: Übersichtsartikel in “Die Heilkunst 7/92, S.
241-250”

Klim 138