Environ. Sci. Proc. 2021, 3, x. https://doi.org/10.3390/xxxxx www.mdpi.com/journal/environsciproc
Thalassotherapy, Health Benefits of Sea Water, Climate and
Marine Environment: A Narrative Review †
Michele Antonelli 1,* and Davide Donelli 2
1 Department of Public Health, AUSL-IRCCS of Reggio Emilia, Via Giovanni Amendola 2, 42122 Reggio
Emilia, Italy; ORCID: 0000-0002-5941-6604
2 Department of Medicine and Surgery, University of Parma, 43121 Parma, Italy; firstname.lastname@example.org;
* Correspondence: email@example.com
† Presented at the 6th International Electronic Conference on Water Sciences (ECWS-6), Online,
15–30 November 2021.
Abstract: The aim of this review was to summarize any evidence-based clinical uses of thalasso-
therapy. PubMed was searched up to the 15th July 2021 for relevant studies. Overall, 560 articles
were found and 14 studies were included in this review. Clinical efficacy of thalassotherapy was
mostly tested for skin problems (psoriasis, atopic dermatitis, vitiligo) and rheumatic disorders
(fibromyalgia, ankylosing spondylitis). Disease severity and the patients’ quality of life signifi-
cantly improved after intervention, with the majority of evidence for psoriasis and fibromyalgia.
Thalassotherapy can be associated with symptomatic improvements in some health conditions.
Further studies on the topic are recommended.
Keywords: environmental health; marine climate; medicine; review; sea water; thalassotherapy
Seas cover 70% of our planet’s surface and have always been important since an-
cient times for many human activities (i.e., feeding habits, long travels, commercial ex-
changes, religion, arts, spirituality and healing rituals) (Figure 1) . Therapeutic uses of
sea water date back to ancient Egypt and are characterized by a long-standing tradition
in many countries . “Thalassotherapy”, a Greek-derived term originating from the
combination of “thalassa” (sea) and “therapy”, is still empirically recommended for pa-
tients with some skin, rheumatic or respiratory diseases . Broadly speaking, thalasso-
therapy includes not only baths in sea or sea-like salty water, but also seaweed or sand
baths, sunlight exposure, inhalation of marine aerosol and, in general, any controlled in-
teraction with marine environments and their natural elements for health-promoting
purposes . With rising attention over human-environment relationships and empirical
evidence from traditions, biomedical research has recently started to explore the role of
different natural settings for well-being improvement , including potential benefits
offered by coastal areas, their waters and climate.
The aim of this review was to briefly summarize evidence-based clinical uses of
Citation: Antonelli, M.; Donelli, D.
Thalassotherapy, Health Benefits of
Sea Water, Climate and Marine Envi-
ronment: A Narrative Review. Envi-
ron. Sci. Proc. 2021.
Academic editor: Marcel J.F. Stive
Publisher’s Note: MDPI stays neutral
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Copyright: © 2021 by the authors.
Submitted for possible open access
publication under the terms and con-
ditions of the Creative Commons At-
tribution (CC BY) license (https://cre-
Environ. Sci. Proc. 2021, 3, x FOR PEER REVIEW 2 of 4
Figure 1. Sea waves in Japanese art. Picture freely released by Karen Arnold under the “CC0 Pub-
lic Domain” licence. Available online at: https://www.publicdomainpictures.net/ (accessed on 20
This research was designed as a narrative review of the scientific literature. Pub-
Med was searched from inception up to the 15 July 2021 for clinical studies about the
efficacy of controlled exposure to marine or marine-like (i.e., salt lake) environments for
any health condition. The MeSH term “thalassotherapy” was used to retrieve relevant
articles and narrow down the search. The following PICOS criteria were chosen for in-
clusion and exclusion of research items:
• P (population): healthy subjects or patients with any disease diagnosed in accord-
ance with international guidelines.
• I (intervention): thalassotherapy, defined as any controlled interaction with marine
or marine-like environments and their natural elements for health-promoting pur-
• C (comparator): any type of comparison, including no control.
• O (outcomes): any measurable clinical improvement, including changes in symp-
tom scores and health-related quality of life.
• S (study design): any type of clinical study involving human subjects. In vitro and
in vivo laboratory experiments were excluded, as well as commentaries, technical
reports and literature reviews.
Articles were excluded when their full-text version was unavailable/irretrievable or
when they had no English summary. Studies published prior to 1980 were also excluded
for being too outdated. Retrieved evidence was summarized and critically discussed.
Overall, 560 articles were found, but only 152 studies were published after 1980.
Research items matching the PICOS criteria were 14 [6–19]. Results of studies eligible for
inclusion were reported in Table 1. Clinical efficacy of thalassotherapy was tested for the
following health conditions:
• Skin problems, mostly psoriasis, but also atopic dermatitis and vitiligo.
Environ. Sci. Proc. 2021, 3, x FOR PEER REVIEW 3 of 4
• Rheumatic disorders, such as fibromyalgia and ankylosing spondylitis.
Thalassotherapy included a combination of sea water balneotherapy, climate ther-
apy, controlled sunlight exposure, physical exercises and rehabilitation programs. Ses-
sions were held in different locations, ranging from the Dead Sea (a salt lake) to the At-
lantic Ocean. Treatment duration was quite heterogeneous, but lasted 3 to 6 weeks on
average. Results indicated that thalassotherapy can significantly improve disease sever-
ity, symptoms and quality of life in different health conditions. Only 6 trials had a con-
trol group, whereas the other studies had an observational or a pre-post design.
Table 1. Summary of evidence from included studies.
17.5 ± 11.0
4.4 ± 4.6
35.3% of patients
showed excellent im-
ment, 35.3% poor re-
↓ dermal immune cell infiltration
↑ enkephalin levels
14.8 ± 5.4
1.8 ± 3.1
16.6 ± 11.0
4.0 ± 4.2
31.7 ± 13.3
1.4 ± 1.9
↓ skin in-
Post test difference
87.5 ± 13.4%
86.1 ± 11.3%
Environ. Sci. Proc. 2021, 3, x FOR PEER REVIEW 4 of 4
↑ skin pig-
3.9% of patients
showed total re-
Pre-post test ASAS
−3.7 ± 2.2
Pre-post test ASAS
−1.7 ± 1.9
2 and a
Post test QALYs-VAS
0.23 ± 0.08
Post test QALYs-VAS
0.19 ± 0.06
C-BT + ex-
but in a
Pre-post test FIQ
−40.6 ± 11.1
Pre-post test FIQ
−38.7 ± 10.9
C-BT + ex-
2 and a
Pre-post test FIQ
−6.3 ± 11.4
Pre-post test FIQ
−0.9 ± 10.2
Notes: ASAS: ASsessment in Ankylosing Spondylitis (improvement criteria); BPSS: Beer Sheva Psoriasis Severity Score;
BT: Balneotherapy; C-BT: Climato-Balneotherapy; Con.: Control; FIQ: Fibromyalgia Impact Questionnaire; Int.: Interven-
tion; ORS: Observational Retrospective Study; PASI: Psoriasis Area Severity Index; QALYs: Quality-Adjusted Life Years;
QoL: Quality of Life; RT: Rehabilitation Therapy (set in a thalassotherapy center); SCORAD: SCORing Atopic Dermatitis;
TEWL: Trans-Epidermal Water Loss. ↑: significant increase; ↓: significant decrease.
There is evidence to support the notion that thalassotherapy can be beneficial to
improve several diseases, especially chronic inflammatory conditions and degenerative
illnesses. Mechanistic studies suggest that these benefits may be due to a combined ac-
tion of different natural components:
• Highly mineralized water immersion, associated with symptomatic improvements
in osteoarthritis, back pain of rheumatic origin, fibromyalgia, psoriasis, atopic der-
matitis, chronic venous insufficiency of lower limbs and other health problems .
• Marine climatic conditions, characterized by pleasing mild temperatures and sunny
• Controlled sunlight exposure, beneficial for patients with psoriasis and to boost the
body’s vitamin D supply .
• Interaction with biogenic compounds released in the environment by seaweed, al-
gae and coastal vegetation .
• Hot sand baths, possibly useful for some rheumatic diseases .
• Marine aerosol inhalation, with beneficial effects for some respiratory conditions
Environ. Sci. Proc. 2021, 3, x FOR PEER REVIEW 5 of 4
Health benefits of thalassotherapy may last for around 90 days after treatment, es-
pecially in patients with psoriasis . Some concerns were expressed for long-term clin-
ical safety of this therapeutic practice, in particular for potentially higher incidence of
skin cancer due to excessive sunlight exposure. In this regard, it is essential to be medi-
cally checked before undergoing a cycle of thalassotherapy and to strictly follow profes-
sional recommendations in order to avoid high ultraviolet radiation exposure .
In conclusion, thalassotherapy can be associated with symptomatic improvements
in some health conditions. Further studies on the topic are recommended to better quan-
tify the effect size of intervention, as well as to assess long-term benefits, risks and any
moderators of the effect.
Author Contributions: Conceptualization, M.A.; Methodology, M.A. and D.D.; Validation, M.A.
and D.D.; Investigation, M.A. and D.D.; Resources, M.A. and D.D.; Data Curation, M.A. and D.D.;
Writing—Original Draft Preparation, M.A. and D.D.; Writing—Review & Editing, M.A. and D.D.;
Visualization, M.A. and D.D.; Supervision, M.A. and D.D.; Project Administration, M.A.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.
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