The Long Term Ability of Heliotherapy in Improving the Quality of Life and Alleviating Disease Activity in Patients with Psoriasis

Document Type : Original Article


1 Clinical Center of Montenegro, Faculty of Medicine, University of Montenegro, Podgorica, Montenegro

2 Institute for Public Health, School of Medicine, University of Montenegro, Podgorica, Montenegro

3 Department of Dermatology, School of Medicine, University of Montenegro, Podgorica, Montenegro

4 Faculty of Medicine, University of Montenegro, Podgorica, Montenegro


Background and aim: Psoriasis is a chronic, multisystem inflammatory skin disease that adversely affects the quality of life. It is crucial to control disease activity and use all of the feasible therapeutic modalities to preserve the quality of life as much as possible. Heliotherapy uses natural sunlight in improving different skin conditions and represents the form of phototherapy. This study aims to assess the long-term effects of heliotherapy and compare it with outcomes of other research.
Materials and methods: A total of 27 patients participated in an observational study of 2-week heliotherapy conducted at the seaside of Montenegro. Disease activity and the quality of life were measured using PASI and DLQI scores at three points of time: before starting heliotherapy, after two weeks, and three months of heliotherapy.
Results: Mean PASI score before the treatment was 11,31. The results revealed a decrease in PASI values after 14 days of therapy by 30%, as well as a statistically significant decrease in PASI values ​​after three months of therapy by 29% (p <0.001). Additionally, the present study has shown a reduction in DLQI score by 41.7% (p <0.001) comparing to baseline. However, three months after the heliotherapy DLQI score was reduced by 8,33% (p=0.006) comparing to the baseline, indicating that the score was returning to the pre-therapy values.
Conclusion: To conclude, two-week heliotherapy has shown satisfying, long-lasting effects in reducing PASI score and ameliorating disease severity, but it did not show beneficial effects in improving the quality of life in the long term.


Main Subjects

[1]  Parisi R, Symmons DP, Griffiths CE, Ashcroft DM. Global epidemiology of psoriasis: a systematic review of incidence and prevalence. Journal of Investigative Dermatology. 2013;133(2):377-85.
[2]  Gisondi P, Fostini AC, Fossà I, Girolomoni G, Targher G. Psoriasis and the metabolic syndrome. Clinics in dermatology. 2018;36(1):21-8.
[3]  Jensen P, Skov L. Psoriasis and obesity. Dermatology. 2016;232(6):633-9.
[4]  Mathew C, Sridharan R, Sudhamani B. A study of the association of psoriasis with metabolic syndrome from a tertiary care centre in Kerala, South India. IP Indian J Clin Exp Dermatol 2021;7(1):18-23.
[5]  Blauvelt A, Chiricozzi A. The immunologic role of IL-17 in psoriasis and psoriatic arthritis pathogenesis. Clinical reviews in allergy & immunology. 2018;55(3):379-90.
[6]  Di Meglio P, Villanova F, Nestle FO. Psoriasis. Cold Spring Harb Perspect Med. 2014;4(8):a015354. doi:10.1101/cshperspect.a015354
[7]  De Korte J, Mombers FM, Bos JD, Sprangers MA. Quality of life in patients with psoriasis: a systematic literature review. InJournal of Investigative Dermatology Symposium Proceedings 2004;9(2):140-147.
[8]  Martínez-Ortega JM, Nogueras P, Muñoz-Negro JE, Gutiérrez-Rojas L, González-Domenech P, Gurpegui M. Quality of life, anxiety and depressive symptoms in patients with psoriasis: A case-control study. Journal of psychosomatic research. 2019;124:109780.
[9]  González-Parra S, Daudén E. Psoriasis and depression: the role of inflammation. Actas dermo-sifiliograficas. 2019;110 (1):12-9.
[10] Puig L, Thom H, Mollon P, Tian H, Ramakrishna GS. Clear or almost clear skin improves the quality of life in patients with moderate‐to‐severe psoriasis: a systematic review and meta‐analysis. Journal of the European Academy of Dermatology and Venereology. 2017;31(2):213-20.
[11] Bruins FM, Bronckers IM, Groenewoud HM, van de Kerkhof PC, De Jong EM, Seyger MM. Association between quality of life and improvement in psoriasis severity and extent in pediatric patients. JAMA dermatology. 2020;156(1):72-8. doi:10.1001/jamadermatol.2019.3717.
[12] Kwan Z, Bong YB, Tan LL, Lim SX, Yong AS, Ch’ng CC, et al. Determinants of quality of life and psychological status in adults with psoriasis. Archives of dermatological research. 2018;310(5):443-51.
[13] Tristani-Firouzi P, Krueger GG. Efficacy and safety of treatment modalities for psoriasis. Cutis. 1998;61(2 Suppl):11-21.
[14] Karppinen T, Ylianttila L, Kautiainen H, Reunala T, Snellman E. Empowering heliotherapy improves clinical outcome and quality of life of psoriasis and atopic dermatitis patients. Acta dermato-venereologica. 2015;95(5):579-82.
[15] Osmancevic A, Nilsen LT, Landin-Wilhelmsen K, Søyland E, Abusdal Torjesen P, Hagve TA, et al. Effect of climate therapy at Gran Canaria on vitamin D production, blood glucose and lipids in patients with psoriasis. Journal of the European Academy of Dermatology and Venereology. 2009;23(10):1133-40.
[16] Finlay AY, Khan G. Dermatology Life Quality Index (DLQI)—a simple practical measure for routine clinical use. Clinical and experimental dermatology. 1994;19(3):210-6.
[17] Shankar V, Ghosh S, Ghosh K, Chaudhuri U. PASI and PQOL-12 score in psoriasis: Is there any correlation?. Indian journal of dermatology. 2011;56(3):287. doi: 10.4103/0019-5154.82482.
[18] Wahl AK, Langeland E, Larsen MH, Robinson HS, Osborne RH, Polesie AL. Positive changes in self-management and disease severity following climate therapy in people with psoriasis. Acta dermato-venereologica. 2015;95(3):317-21. DOI:
[19] Harari M, Novack L, Barth J, David M, Friger M, Moses SW. The percentage of patients achieving PASI 75 after 1 month and remission time after climatotherapy at the Dead Sea. International journal of dermatology. 2007;46(10):1087-91.
[20] Kopel E, Levi A, Harari M, Ruzicka T, Ingber A. Effect of the Dead Sea climatotherapy for psoriasis on quality of life. Isr Med Assoc J 2013; 15: 99–102.
[21] Emmanuel T, Lybæk D, Johansen C, Iversen L. Effect of Dead Sea Climatotherapy on Psoriasis; A Prospective Cohort Study. Front Med (Lausanne). 2020;7:83. Published 2020 Mar 18. doi:10.3389/fmed.2020.00083
[22] Snellman E, Lauharanta J, Reunanen A, Jansén CT, Jyrkinen-Pakkasvirta T, Kallio M, et al. Effect of heliotherapy on skin and joint symptoms in psoriasis: a 6-month follow-up study. Br J Dermatol. 1993 Feb;128(2):172-7. doi: 10.1111/j.1365-2133.1993.tb15147.
[23] Wahl A, Mork C, Cooper B, Padilla G. No long-term changes in psoriasis severity and quality of life following climate therapy. J Am Acad Dermatol 2005; 52: 699–701.
[24] Noronha-Neta MI, Picciani BLS, Niemeyer-Corbellini JP, Ramos-E-Silva M, Soares FA, Carneiro S. Quantification of histopathological changes in patients with psoriasis before and after phototherapy. Photodermatol Photoimmunol Photomed. 2019 Sep;35(5):354-359. doi: 10.1111/phpp.12492.
[25] Mørk C, Wahl A. Improved quality of life among patients with psoriasis after supervised climate therapy at the Canary Islands. J Am Acad Dermatol. 2002 Aug;47(2):314-6. doi: 10.1016/s0190-9622(02)00066-x.
[26] Trøstrup H, Riis PT, Heidenheim M, Bryld LE, Jemec GB. Long-term evaluation of climatotherapy for psoriasis. Dermatol Ther. 2020 May;33(3):e13432. doi: 10.1111/dth.13432.
[27] Svendsen MT, Jeyabalan J, Andersen KE, Andersen F, Johannessen H. Worldwide utilization of topical remedies in treatment of psoriasis: a systematic review. J Dermatolog Treat. 2017 Aug;28(5):374-383. doi: 10.1080/09546634.2016.1254331.