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Dead Sea Minerals & Cosmetics

Beauty is not only Skin Deep: the Dead Sea features and Cosmetics
Marco HARARI(1-2)
(1)DMZ Medical Center at the Dead Sea, Ein Bokek 86930 (Israel) (2)Dead Sea & Arava Science Center, Neve Zohar 86910 (Israel) [email protected]
Abstract
Introduction: The Dead Sea area possesses extraordinary geo-climatic factors and repre- sents a natural health resort known worldwide for its success treating skin and rheumatic diseases. Dead Sea cosmetics – or cosmetics arguing being from this place and containing Dead Sea water or minerals – are also know worldwide but still controversies take place in the medical milieu regarding their true effect on the skin.
Material and Methods: All relevant articles cited in Medline were reviewed, including studies on minerals and mud from the Dead Sea.
Results: In vivo and in vitro studies demonstrated clearly the high potential of the Dead Sea minerals for cosmetic purposes. Magnesium and Sulfur appear to be the prominent actors in rheumatology and dermatology, when incorporated to cream or mud.
Conclusion: Even if only few studies are able to elucidate the real effect of the Dead Sea minerals in cosmetics preparations, there is enough evidence for encouraging such investi- gations and developing more products. These will enable a better use of the extraordinary reservoir of minerals represented by the deepest and most saline lake in the world.
Key words: Dead Sea, Minerals, Mud, Cosmetics.
La belleza no está sólo en la superficie de la piel: características del
Mar Mu**to y los cosméticos
Resumen
Introducción: La zona del Mar Mu**to posee extraordinarias factores geo-climáticos, y representa un centro de salud natural conocido mundialmente por su éxito en el tratamiento de las enfermedades la piel y reumáticas. Los Cosméticos del Mar Mu**to-o cosméticos originarios de este lugar, y que contiene agua o minerales del Mar Mu**to-son conocidos en todo el mundo, pero aún existen controversias en el entorno médico con respecto a su verdadero efecto sobre la piel.
A**les de Hidrología Médica 75 ISSN: 1887-0813 2012, Vol. 5, Núm. 1, 75-88 http://dx.doi.org/10.5209/rev_ANHM.2012.v5.n1.39171

M Harari Beauty is not only Skin Deep: the Dead Sea features and Cosmetics
Material y Métodos: Se revisaron todos los artículos importantes citados en Medline, incluyendo estudios sobre los minerales y el barro del Mar Mu**to.
Resultados: Estudios in vivo e in vitro han demostrado claramente el gran potencial de los minerales del Mar Mu**to con fines cosméticos. El magnesio y el azufre parecen ser los componentes más importantes en reumatología y dermatología, cuando se incorporan a la crema o el barro.
Conclusión: Aun cuando sólo unos pocos estudios son capaces para de dilucidar el efecto real de los minerales del Mar Mu**to en la preparación de cosméticos, hay suficiente evi- dencia para impulsar estas investigaciones y desarrollar más productos. Esto permitirá un mejor uso del depósito extraordinario de minerales representado por el lago más profundo y más salino en el mundo.
Palabras clave: Mar Mu**to, Minerales, Barro, Cosmético.
REFERENCE STANDARD
Harari M. Beauty is not only Skin Deep: the Dead Sea features and Cosmetics. A**l Hidrol Med. 2012, Vol. 5, Núm. 1, 75-88.
INTRODUCTION
The Dead Sea is the lowest saline lake on earth (420 meters, or about 1,300 feet, below sea level). Its therapeutic benefits have been well known for 1,500 years, with the modern era for such treatments beginning in 19591-2. Over the past 60 years, the Dead Sea has become well recognized for its balneologic activity, allow- ing climatotherapy to be used for dermatologic and rheumatologic conditions.
In particular, Dead Sea climatotherapy is considered to be very effective in the treatment of psoriasis3-4-5-6 and, to a lesser extent, atopic dermatitis7-8 and Vitiligo9- 10. Climate therapy cannot be exported. Moreover, all skin diseases treated at the Dead Sea are mainly improved by the extraordinary ultra-violet radiation of this region11-12 and not by any cream or topical treatment. However, products that con- tain Dead Sea minerals are since years and currently used to treat several derma- tologic conditions and many companies offer product lines that feature Dead Sea minerals. The array of such products includes hand and body lotions, bath salts, body butter, eye cream, cleansing mud masks, mineral mud soaps, mineral peeling soaps, body exfoliates, collagen firming creams with Sun Protection Factor, acne lotions, lightening cream with SPF, firming night creams, antidandruff and numer- ous other shampoos, scalp masks, and sunscreens.
In this paper, we propose to review the last studies dealing with the specific fea- tures of the Dead Sea minerals and their applications to cosmetics. We’ll try to draw an evaluation of their properties in two distinct parties, dealing with the use of minerals only and the application of black mud including these minerals.
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M Harari Beauty is not only Skin Deep: the Dead Sea features and Cosmetics A HUGE AMOUNT OF DISSOLVED MINERALS
The palliative effects of immersing in baths or pools of thermo-mineral water, known as balneotherapy, have been known for centuries, with modern practices dating back to the 1800s and natural health spas dating back more than 3,000 years13-14.
The Dead Sea contains exceedingly high salt concentrations and acts as a reser- voir of minerals with distinct evaporation properties. Dead Sea bath or Dead Sea balneotherapy possesses extraordinary advantage because of these unique concen- tration and composition of salts. Not surprisingly, Dead Sea salts are the source of numerous chemical and health products. Specifically, various skin conditions and allergies, as well as arthritis and respiratory disorders, have been treated with Dead Sea-derived magnesium salts and sulfur-containing mud15-16-17. Magnesium salts, which are known to have anti-inflammatory activity, are the prevailing minerals in Dead Sea water18. From 10 to 80 times more present, Dead Sea minerals concentra- tions can hardly be matched up to those present in other seas. Compared with the world's oceans, the Dead Sea is more abundant in calcium, magnesium, potassium, and bromide, and lower in sodium, sulfate, and carbonate19.
BENEFICIAL EFFECTS OF DEAD SEA MINERALS
The beneficial effects of Dead Sea (DS) bath in inflammatory skin disorders had been repeatedly evoked and reported20-21-22. DS minerals composition is especially rich in magnesium, calcium, sodium, potassium, zinc, strontium, sulfides and bro- mides. Some of these minerals are known to influence signal transduction and cell metabolism: it has been demonstrated that Mg2+ ions inhibit the antigen-presenting function of human epidermal Langerhans cells in vivo and in vitro23-24. Bathing in a magnesium-rich Dead Sea salt solution improves skin barrier function, enhances skin hydration, and reduces inflammation in atopic dry skin18. It has been also demon- strated that zinc is involved in epidermal proliferation and wound healing25-26.
The therapeutic properties of the mud are ascribed to its content of reduced sulfur species, its physical and chemical properties and its mineral content27. Therapeutic value of DS minerals, often reported on various inflammatory skin disorders, such as psoriasis, contact and atopic dermatitis, (but not yet totally proven) might be en- hanced by easier trans-epidermal pe*******on in lesion areas, due to stratum corneum damage28. Alternatively, limited pe*******on may be enough to activate signaling pathways by receptor binding or even non-binding activation may occur 29.
There are only a few studies published on the specific properties of Dead Sea minerals, but they are all showing spectacular effects, in vitro and in vivo as well, in many fields. They should encourage more investigations and more use of these natural and non dangerous active agents.
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M Harari Beauty is not only Skin Deep: the Dead Sea features and Cosmetics Enzyme stimulation in clinical studies
In 1985, Shani et al. found that glutathione peroxidase activity was significantly increased in 35 psoriatic Danes who received 4-week therapy at the Ein Bokek International Psoriasis Treatment Center along the Dead Sea in Israel. The drinking water at the center was found to be rich in selenium.
The researchers assayed the activity of erythrocyte glutathione peroxidase, the most reliable marker for increases in selenium bioavailability, in the psoriasis patients, in 25 long-time local hotel workers, and in healthy volunteers who con- sumed low-selenium water. Enzymatic activity in the hotel workers was found to be 50% higher than in the low-selenium drinkers. The investigators concluded that selenium might play a beneficial role in psoriasis treatment30.
In a study published the same year, several of the same researchers compared the pe*******on of electrolytes through the skin of healthy volunteers and psoriasis patients who bathed in the Dead Sea or comparable bath-salt solutions for a 4-week period. Only the psoriasis patients had significant increases in serum levels of bromine, calcium, and zinc29.
Anti-proliferative Action
Two years later, Shani et al. tested diluted Dead Sea brine and salt solutions, and found that they reversibly suppressed cell proliferation in vitro. They noted that bromides were more potent inhibitors than chlorides, and that potassium salts exhib- ited greater effectiveness than sodium or magnesium salts. The authors speculated that the pe*******on of minerals through the skin, along with anti-proliferative effects, may help explain the effectiveness of Dead Sea spa treatments for psoriasis31.
Interestingly, in 1996, investigators sought to identify the anti-proliferative effects of certain Dead Sea minerals that play a role in ameliorating psoriasis, by comparing the in vitro proliferation of fibroblasts grown from biopsy specimens of healthy and psoriatic skin. They found that magnesium bromide and magnesium chloride exhib- ited significantly more potent inhibitory effects on cell growth than did their corre- sponding potassium salts and sodium chloride, and that these effects were mani- fested in healthy as well as psoriatic fibroblasts32.
Moisturizing Action
In 1997, Ma'or et al. compared the cutaneous smoothing effects of three different liquid gels, one of which contained Dead Sea minerals. The formulations were applied to 20 mature women twice daily over 4 weeks, with computer-aided laser profilometry used to evaluate skin roughness before and after the treatment period.
At the conclusion of treatment, the gel containing 1% Dead Sea mineral solution was associated with a 41% reduction in skin roughness. A 28% reduction was
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M Harari Beauty is not only Skin Deep: the Dead Sea features and Cosmetics achieved with the use of the gel devoid of mineral additives, and a 10% reduction
was seen with a control gel absent any anti-wrinkle ingredients33.
Reducing Chemotherapy's Side Effects
In another recent study, researchers assessed the effectiveness of Dead Sea products on the side effects of radio-chemotherapy in 24 patients suffering from head and neck cancer. The control group consisted of 30 conventionally treated patients. The radio-chemotherapy patients were directed to use two products con- taining Dead Sea minerals - a mouthwash (Lenom, from Clinica Lenom Ltd.) and a moisturizing cream (Solaris) - three times daily for 1 week before, during, and up to 2 weeks following the conclusion of radiotherapy.
The investigators observed grade 1-2 mucositis in 13 patients treated with Dead Sea minerals (54%), with none exhibiting grade 3-4 mucositis. In the control group, 17 subjects (57%) had grade 1-2 mucositis, while grade 3-4 mucositis was noted in 4 (13%). In addition, grade 1-2 dermatitis was seen in 13 patients treated with Dead Sea minerals (54%), with none displaying grade 3-4 dermatitis, whereas grade 1-2 dermatitis was observed in 11 control patients (37%) and grade 3-4, in 5 (17%)34-35.
Anti-aging effect
Cellular and molecular characteristics of aged epidermal keratinocytes were ana- lyzed in monolayer cultures and in skin by measuring their morphological, fluoro- metric and biochemical properties. This essential work, done by the team of Milner, shed light on the aging skin process and most precisely on its characterization in keratinocytes. The study, published in 2008, showed altered expression of 16 bio- chemical markers in aged cultured cells and in tissues, including caspases 1 and 3 and beta-galactosidases activities, p16, Ki67, 20S proteasome and others.
Effects of Dead Sea minerals were analyzed as a test case, on keratinocytes cul- tures and human skin. The authors reported that Dead Sea minerals stimulated proliferation and mitochondrial activity, decreased the expression of some aging markers and limit apoptotic damage after UVB irradiation36.
Protective effect against UVB-induced stress
One year later, using DermudTM (from Ahava Laboratories), a leave-on skin preparation containing DS water and mud, but also zinc oxide, aloe-vera extract,
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pro-vitamin B5 and vitamin E, the same team tried to better objective any alteration in the biological effects induced by UVB radiation. The authors applied the cream on human skin organ cultures which were irradiated topically, and analyzed for mitochondrial activity (by MTT assay), apoptosis (by caspase 3 assay), cytokine secretion (by solid phase ELISA), overall antioxidant capacity and for uric acid content (by HPLC).
Topical application of DermudTM decreased all the effects of irradiation signifi- cantly, showing a protective, anti-oxidant and anti-inflammatory effect, which was able to reduce the deleterious effects of irradiation on skin. Photodamage and photoaging, as well as oxidative stress and inflammation in skin pathologies, might be reduced by this product, concluded the authors37.
Improvement of Atopic Dermatitis scores
The efficacy of TP, an emollient cream enriched with DS water in children with Atopic Dermatitis was recently assessed in a double-blind, randomized controlled study. 86 patients were assigned during the 12-week trial either to DS water rich cream twice daily, or to 2 controls: cream with a lower concentration of DS water and emollient without DS minerals. Efficacy was assessed every 2 weeks by SCOR- ing Atopic Dermatitis (SCORAD) and many other objective and subjective scores (Investigator Global Assessment - IGA, Patient Global Assessment – PGA, Transe- pidermal Water Loss – TEWL, Stratum Corneum Hydratation – SCH, affected Body Surface Area – BSA, Objective Severity Assessment of Atopic Dermatitis – OSAAD).
TP was the most effective regarding TEWL, SCH and OSAAD. The authors re- ported that the study clearly showed the benefits of the DS minerals enriched emol- lient as a leave-on emulsion, in term of skin barrier function. They recommended this product as an effective treatment for AD skin in acute phases and for mainte- nance therapy38.
MUD TREATMENT AND DEAD SEA MUD
Fangotherapy - the use of mud, peat, and clay for healing purposes - gained pop- ularity in the early 1800’s in Europe where it was, and still is, used to treat a variety of musculoskeletal and skin conditions. While only few double-blind studies are available in order to evaluate their efficacy these treatments have been used exten- sively on such conditions as rheumatic diseases including fibromyalgia and muscu- lar pain39-40, endocrine diseases and immune system disorders41-42-43, respiratory diseases44, a variety of skin diseases: acne45, dermatitis46, psoriasis47, and even in gynecology48. As well, numerous cosmetic companies developed products contain- ning mud as unique or major component. Here also, only few publications deal with
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the specific properties of the mud, while most of them correlate its effects to the mineral content.
A limitation of this thermal treatment is the possibility that hot applications could induce a disease flare, but beneficial effects of baths and mud packs in pa- tients affected with inflammatory rheumatic diseases, especially ankylosing spondy- litis and rheumatoid arthritis, have been reported49-50-51 and do not confirm the hesitations to use them even in unstable disease.
Very recently, a systemic review presented the level of evidence for the claims of therapeutic effects of Dead Sea treatments in several rheumatologic diseases and as well as for the safety of such treatments. The authors concluded on a good safety profile and on a proven scientific evidence for their beneficial effects. This work included papers dealing with fangotherapy, clearly indicating a potential use in any inflammatory joint disease, in acute or chronic phase52.
Dermal properties of Mud
Many types of clay are commercially available from different soils and envi- ronments around the world. All commercially available clay has the same basic properties, but clays from marine sediments or from areas around hot springs usu- ally have higher mineral contents than other clays (for example Dead Sea mud).
All types of fango have heat-retention properties and can be warmed up and ap- plied to the skin to stimulate and improve circulation. This aids nutrient and waste exchange, opens follicles, and improves the elasticity of skin. Apart from the com- mon effect of increased circulation, clay, mud, and peat each have different thera- peutic properties and uses, all connected to their incorporated minerals.
One interesting study showed clearly this issue, using in a double-blind random- ized clinical trial mineral-deleted mud pack as placebo. These mud packs, com- pletely emptied from their minerals, were used by patients suffering from Os- teoarthritis, and heated before being applied on the knees, as the natural black mud packs. The significant differences in improvement between the two groups showed clearly that the heating process was not the responsible for the beneficial effect of the mud application, but the presence of minerals in the mud53.
Clay is highly absorbent and is used to draw impurities and moisture from the surface of the skin. This drawing action simulates circulation and lymphatic flow and purifies the skin, to cure wounds, soothe irritations, as a method of cleansing the skin54. Clay minerals, used in aesthetic medicine and in cosmetic products, as active principles or excipients, and in geotherapy, pelotherapy and paramuds, are often presented, after drying slightly on the skin, as capable to aid natural exfolia- tion and improve skin texture. Despite these well accepted axioms and some inte- resting studies on this topic, we did not found an enough well-built body of evi- dence for such properties.
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Clays readily suspend to form an emulsion in water or other liquid substances. This property is useful in cosmetics as clay helps to hold other substances together and prevent separation. Clay is regularly used as an emollient and colorant in pow- ders, liquid foundations, lotions, and skin masks. Recently, in order to develop a Dead Sea Minerals (DSM) based drug delivery system for topical therapy of skin diseases, polymeric nanoparticles based on Poly (maleic anhydride-alt-butyl vinyl ether) 5% grafted with monomethoxy poly(ethyleneglycol) 2000 MW (PEG) and 95% grafted with 2-methoxyethanol (VAM41-PEG) loaded with DSM were pre- pared by means of a combined mini-emulsion/solvent evaporation process. The resulting nano-particles were characterized in terms of dimension, morphology, biocompatibility, salt content and release55.
Safety profile of mud was assessed by several publications like for example for the Dead Sea mud, which was found to be free of any special enrichment of 12 toxic trace elements, and safe for the consumer as well as its derivative products56. Moreover, a detailed microbial and chemical analysis of Dead Sea mineral mud compounded in dermatological and cosmetic preparations was performed by Ma’or and colleagues. Surprisingly, they found low numbers of colony-forming micro- organisms in the mud. Antibacterial properties of Dead Sea mud were found on many species, even after sterilization by gamma irradiation, and thought probably owing to chemical and/or physical phenomenon57.
Importance of Sulfur in Mud: the Dead Sea Mud
While mud, like clay, is mainly mineral in origin, it contains 2–4 percent organic substances, which play an important role in mud’s therapeutic use. Mud softens skin’s texture and some minerals may be absorbed from the mud into skin, although the evidence for this is still inconclusive. Therapeutic mud is matured or ripened in natural mineral water, as for Dead Sea mud. The maturing process for each mud may be slightly different, but generally involves the oxidation and reduction of the mud over a period up to twelve months long – or to thousands years56. The process of maturing mud, characterized by changes in its chemical composition and appear- ance should be carefully checked.
Sulfur is perhaps the most important component of therapeutic mud and occurs naturally in proximity to volcanoes and hot springs. Sulfur baths have been re- searched as a means of reducing oxidative stress on the body and decreasing in- flammation39. Among rheumatology, sulfur-rich mineral and mud baths were advo- cated as useful adjuvant in the treatment of fungal infections, scabies, psoriasis, eczema, and acne58. As well, sulfur is thought to exert beneficial anti-inflammatory, keratoplastic and antipruriginous effects on skin14.
One of the most popular types of sulfur-containing therapeutic mud is obtained from the Dead Sea region in Israel. It is believed to be derived from older sediments or the red-brown soils that are swept into the sea during the winter time. Sediment
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precipitations in the Dead Sea were investigated since long59 and are continuously monitored60 allowing a precise analysis of the water and its components.
Dead Sea black mud is a homogeneous mixture of Dead Sea minerals and or- ganic materials. It is believed to help in decreasing some of skin diseases and rheu- matism pains and to rejuvenate skin cells. This world-wide best seller is used at the Dead Sea in two main indications: for musculo-skeletal pain of any origin and in cosmetic procedures through a variety of treatments (facial peeling and mask and body applications).
This mud has the ability to stay warm and moist for up to an hour, thus stimulat- ing circulation and clearing skin of dead epidermal cells46. Lately, it becomes large- ly used in the spas at the Dead Sea, in combination with other natural products like aloe-vera and aromatic oils. Patients – or healthy tourists – apply the mud twice a day at the sea shore and leave it on their skin and/or their painful muscles or joints for 20 minutes. The more sophisticated procedures take place in the spa: envelop- ments (wrap) associated to medical massage and physiotherapy and cosmetic treat- ments. Many of the satisfied users will buy it on the spot for further utilization at home, or seek for restock after their return, back home.
CONCLUSIONS
Minerals and mud are used for therapeutic purposes, with some beneficial effect on health, in pharmaceutical formulations, spas and aesthetic medicine. The thera- peutic effects of mineral waters at various spas, and at the Dead Sea in particular, have been well established. Research on Dead Sea mud supports its use in the treatment of psoriasis and atopic dermatitis but most of the studies related its anti- inflammatory properties in rheumatology and musculo-skeletal diseases. Recently more studies focused on the possible positive effects of the Dead Sea minerals on the skin barrier and function. Nevertheless, such results do not explain the popular- ity of numerous skin products that contain Dead Sea mineral ingredients.
It remains unclear how effective products touted for harnessing the curative powers of the Dead Sea are in conferring similar benefits. These products likely do no harm and, given the host of other ingredients, probably at least contribute to moisturizing the skin. However, more research is necessary to establish their mech- anism of action and evaluate their efficacy in cosmetic medicine.
Although the Dead Sea may be biologically dead, it maintains its historical abil- ity to nourish the mind and body through its therapeutic qualities. Life may not be sustainable within its waters, but it most certainly thrives along its shores... and surely keeps on all around the world through its natural products.
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La belleza no está sólo en la superficie de la piel: características del Mar Mu**to y los cosméticos | A**les de Hidrología Médica La belleza no está sólo en la superficie de la piel: características del Mar Mu**to y los cosméticos Marco Harari DMZ Medical Center at the Dead Sea, Ein Bokek 86930 (Israel) Dead Sea & Arava Science Center, Neve Zohar 86910 (Israel) DOI: https://doi.org/10.5209/rev_ANHM.2012.v5.n1.39171 Palabra...