|Grade||Level of Evidence|
|A||Multiple double-blind, controlled clinical trials.|
|B||1 double-blind, controlled clinical trial.|
|C||At least 1 controlled or comparative clinical trial.|
|D||Uncontrolled, observational, animal or in-vitro studies only.|
|Grade||Effect||Size of Effect||Comments|
Alleviates pain, inflammation and dryness after peels, laser treatment or photodynamic therapy. Promotes skin regeneration and healing.
Repairs dry skin and reduces the severity of atopic dermatitis.
Completely cleared psoriasis or improved psoriasis by more than 50% in the majority of patients after 3 weeks of treatment.
Reduces sunburn cell formation and protects against UV-induced damange to DNA, proteins and cell membranes.
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Table of contents:
Thermal spring waters are mineral waters that originate in springs. The composition and physicochemical properties of thermal spring waters is related to the nature of the geologic materials through which the water has flowed. Common soluble minerals include calcium, magnesium, bicarbonate, silicates, iron compounds, sulphur compounds and trace elements such as selenium.
Absorption of the mineral salts found in thermal spring waters seems to be limited, but there is no precise data on this subject. The penetration of salts from the Dead Sea, another mineral-rich water source, has been scientifically demonstrated and quantified, however. It is possible, therefore, that the therapeutic effects of thermal spring water lies not only in the local interaction between the mineral water and the structure of the skin surface, but also the absorption through the skin of its minerals and trace elements.
3. Effects on the skin
Thermal spring waters confer resistance to oxidative stress induced by exposure to UV light. Human skin fibroblasts and human keratinocytes cultured in a medium reconstituted with La Roche-Posay Thermal Spring Water had better resistance and higher cell survival after exposure to UVB, perhaps due to increases in the activities of glutathione peroxidase and superoxidase dismutase. Selenium, an important trace element found in La Roche-Posay Thermal Spring Water, has been shown to have beneficial effects on lipid peroxidation, reducing lipid peroxide content after UVA exposure, and increasing glutathione peroxidase activity and cell viability.
Similarly, Avène Thermal Spring Water is capable of protecting cell membranes, genomic DNA and proteins from UV-induced oxidative stress. Avène Thermal Spring Water significantly reduced UVA-induced lipid peroxidation, oxidative genomic lesions and oxidative damage to proteins in an in-vitro study on human keratinocytes.
Thermal water from Uriage-les-Bains in France has also been demonstrated to protect against UVB-induced DNA damage, through restoring the activity of catalase, an intracellular antioxidant enzyme, and the expression of claudin-6, a putative tumour suppressor.
3.2 Post-procedure healing
Various dermatology procedures such as chemical peels, laser treatment or photodynamic therapy often cause skin discomfort and safety problems, reducing patient adherence to therapy.
Avène Thermal Spring Water has been shown to help counteract the symptoms of erythema, itching, stinging and tightening of facial skin after laser resurfacing, alleviate discomfort and inflammation after photodynamic therapy, and reduce pain, dryness and redness after fractional photothermolysis.
These effects are believed to be partly associated with the low mineral content of Avène Thermal Spring Water, as a sensory analysis has indicated that skin comfort, softness and suppleness is better with thermal spring water having a lower mineral concentration.
Thermal spring water also has also been shown to improve skin regeneration and healing by promoting keratinocyte proliferation and by modulating collagen and elastic fibers in the dermis, as well as increase the expression of filaggrin, aquaporin-3, claudin-4 and claudin-6, proteins implicated in skin barrier repair and skin moisturization.
3.3 Atopic dermatitis treatment
Atopic dermatitis is a common chronic inflammatory skin disease in which epidermal barrier defects leads to dry skin.
Several studies have demonstrated the efficacy of hydrotherapy with Avène Thermal Spring Water in improving atopic dermatitis. 3 weeks of treatment positively impacted the activities of β-glucocerebrosidase, phospholipase A2, proteases and cholesterol sulphatase, enzymes that play an important role in the formation and maintenance of the epidermal barrier function.
Moreover, a comparative clinical study has revealed that spraying Avène Thermal Spring Water in addition to emollient application helps optimize the effectiveness of the emollient in repairing dry skin and reducing the severity of atopic dermatitis.
3.4 Acne treatment
Topical application of tretinoin in combination with Avène Thermal Spring Water sprays significantly decreased desquamation in an open-label, comparative study, suggesting that Avène Thermal Spring Water may increase treatment adherence by improving the local skin tolerability of topical retinoids in acne treatment.
3.5 Psoriasis treatment
In one clinical study on 92 patients with moderate psoriatic plaques, balneotherapy with and drinking of La Roche-Posay Thermal Spring Water daily for 3 weeks completely cleared psoriasis in 8% of patients and improved psoriasis by more than 50% in 48% of patients.
3.6 Rosacea treatment
La Roche-Posay Rosaliac AR, a commercial product containing Ambophenol, Neurosensine and La Roche-Posay Thermal Spring Water, appears to help prolong the efficacy of metronidazole treatment when used as an adjunctive treatment, and also significantly improved the clinical signs and symptoms of rosacea when used as monotherapy.
4. Side Effects
There have not been any published reports on the safety and long-term effects of using thermal spring water, to our knowledge. However, several studies have shown that thermal spring water has soothing and anti-irritant properties in various skin conditions, including dermatitis caused by topical retinoic acid and specific procedures such as chemical peels, laser therapy and photodynamic therapy. There have also not been any adverse events reported in clinical studies investigating the efficacy of topical thermal spring water.
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