In contrast, such immunological Th17 inflammatory response improvement was only detected after 8 weeks of NB-UVB treatment

(4a). Furthermore, both of the treatment protocols resulted in a significant reduction in Tc17 T cells (producing IL-17 and IL-22; Fig. 5A). Finally, a similar reduction was also noted for the Th1 and Tc1 phenotype (IFN-γ and TNF-α production, Figs. 4A and 5A, P < 0.05). The role of skin-homing, Th1 NVP-LDE225 clinical trial and Th17 immune response in the immunopathology of psoriasis is demonstrated in this study. In addition, the importance of Tc1 and Tc17 immune response is also suggested. Finally, NB-UVB therapy induced excellent clinical improvement preceded by a reduction in these above systemic inflammatory markers, strongly suggesting that immune modulation mediated the observed clinical effect. Furthermore, an improvement by histological assessment is clearly demonstrated substantially validating the observed clinical improvements by using ‘Trozak’s score’ as a measure of treatment efficacy. There is evidence suggesting that bathing in the geothermal seawater without NB-UVB treatment has a beneficial clinical effect [1, 2]. It has also been noted that the scaling of psoriasis lesions

CCI-779 disappears quickly, and the lesions get thinner with less erythema, indicating that bathing in this geothermal seawater has a direct anti-inflammatory effect on psoriatic lesions [2]. Another study demonstrated the beneficial effects of bathing in geothermal seawater where NB-UVB treatment after bathing C1GALT1 gave an additional clinical effect compared with NB-UVB treatment alone [5], thus supporting our observation that bathing in the geothermal seawater might provide some additional clinical effect that was further reflected by the reduction in potential pathogenic T cells

in the peripheral blood. Psychological stress has been reported to influence psoriasis severity [17]. Inpatient treatment at the BL clinic in a relaxed environment might reduce stress and thereby indirectly improve the psoriasis lesions in addition to the UVB-induced effects. Immunological studies show that psychological stress increases the numbers of various immunological cells in the peripheral blood of patients with psoriasis, including HLA-DR+ T cells, and decreases the numbers of CD25+ T cells [18]. However, in our study, the numbers of T cells expressing HLA-DR+ and CD25+ did not change significantly in the peripheral blood with both treatments, indicating that stress did not influence the outcome of our study. The therapeutic properties of combined treatment with salt water baths and natural UV radiation (climatotherapy) and bathing in thermal water (spa therapy) have been known since ancient times [21, 22]. Today, it is being practised in many countries in the form of combination treatment of salt or thermal water baths and artificial UV radiation (balneotherapy) [21, 22].