The skin positivity movement has helped chip away at the stigma surrounding acne, scarring, freckles and stretch marks. But so far there’s been less discussion about psoriasis, an inflammatory condition that causes flaky red patches of skin covered with silvery scales, which affects around 2% of the UK population and usually develops before the age of 35. The condition often leaves skin sore, itchy and uncomfortable, and scaly patches of skin are most often found on the elbows, knees, belly button, scalp and ears.
In psoriasis, the skin cell generation process on the outer layer is faster than usual, occurring over days rather than weeks, explains London-based dermatologist Dr Justine Kluk. There are many causes, but you’re more likely to be affected if it runs in the family (genetics) or if it’s triggered by environmental factors like stress, smoking, infection and certain medication, such as beta blockers, she adds.
Social media accounts like Get Your Skin Out are now helping to raise awareness and lobby for better treatment of the long-lasting condition, which currently has no cure. There are multiple treatment options to help keep it under control and the NHS offers three main types, depending on the severity of the condition – topical (creams and ointments), phototherapy (ultraviolet light exposure) and systemic (oral and injected medications) – but everyone's symptoms are different and these don't always work, leading people to seek alternative treatments.
One such treatment is bathing in the Dead Sea (balneotherapy) and exposing affected skin to the sun (heliotherapy) within a strictly controlled environment and under medical supervision. The salt lake, which borders Jordan and Israel's West Bank, is known for its unique natural skin healing properties, leading people with psoriasis to flock there every year. "A systematic review of published research into Dead Sea therapy collated in the medical journal Seminars in Arthritis and Rheumatism in 2012 concluded that there is bona fide evidence that Dead Sea treatments can be effective for psoriasis," says Dr Kluk. "This is due to both the special characteristics of solar ultraviolet radiation in the Dead Sea and the Dead Sea water balneotherapy."
Jessica*, a 29-year-old producer in London, swears by the Dead Sea's properties for treating her psoriasis. Alongside making drastic changes to her diet, it's the only treatment that's ever worked for her, since she was diagnosed with the condition at 13. "I'd tried hundreds of treatments before the Dead Sea, from topical creams and treatments, to hospital UV therapies, to strong oral medications that have serious side effects. None of them worked for me, or the side effects were way too damaging to sustain long term – one drug permanently affects your liver, while another could cause infertility," she says. So when someone at a house party suggested the all-natural Dead Sea, it gave her hope.
Jessica now spends a fortnight every year at the Mövenpick Resort & Spa Dead Sea on the Jordan side of the lake, a normal hotel with a designated area for medical patients that is separated by gender and allows for total privacy. At around £2,500, this won't be an option available to everyone, "but as the only thing that worked for me, it was worth saving for," Jessica says.
It makes such a huge difference to be able to feel confident and have clear skin for summer, to be free to wear what I want and feel 'normal'.
"The first year I went for two-and-a-half weeks – most people go for between two to four weeks – and my skin was totally clear by the time I'd left, for the first time since I was 13. I've been back every year in May since – you can only go during May or September when the weather isn't too cold or hot." A typical day involves a 15-minute bathe in the Dead Sea first thing, then alternating between lying in the sun and shade from 7.30am to 12pm and then again from 2.30pm until 6pm, when there's another 15-minute bathe. Jessica doesn't wear any sunscreen (more on the serious risks of this later), only oil, for the whole holiday in the 40C heat, so has to be careful not to get heatstroke.
Jessica doesn't consider it a "holiday" but says it's worth the time and money spent. "It's incredibly hard, mentally and physically. It's like being trapped in a Groundhog Day, sweltering Barry's Bootcamp class. But you have lots of time to read and watch TV series, and my skin normally clears by the end of the trip. It makes such a huge difference to be able to feel confident and have clear skin for summer, to be free to wear what I want and feel 'normal'."
This year's Dead Sea visit coincided with some larger lifestyle changes, too. At the recommendation of nutritionists, ayurvedic doctors and online forums, Jessica overhauled her diet in the hope it would clear up her psoriasis, an autoimmune disease. The advice suggested the answer lay in the gut: strengthening her gut bacteria, increasing her body's pH level and cutting out "toxins and irritants". In practice, this means she follows recipes from @mygoodnessrecipes, which are vegan, gluten-free and contain no refined sugars or nightshade vegetables. It also means no smoking, caffeine or booze, and includes lots of water, supplements, exercise and rest. "Within two to three months I saw improvements and my skin is now almost as clear as after a trip to the Dead Sea."
Lynsey Atkin, 34, an advertising creative director based in London, has a family history of psoriasis and woke up one day with the condition at 18. She first went to the Dead Sea in 2007, when her skin was affected all over and "the worst it's ever been" after reading about it on an online forum. "I was desperate... so I borrowed the money, got a one-day-service passport and was flying to Jordan 10 days later. I went out for 15 days and came back 95% clear – the psoriasis on my hands remained, but cleared at home."
I was desperate... so I borrowed the money, got a one-day-service passport and was flying to Jordan 10 days later.
Atkin has been back six times and usually spends two-and-a-half weeks in the sun. "These days I share a room with my friend, which dramatically reduces the cost, but otherwise it costs up to £3,000." Like Jessica, she's adamant the trips aren't "holidays". "You get institutionalised really quickly, but it’s the routine that gets you through." Her condition is unpredictable and prone to flaring up randomly – "That’s the worst thing about it. I could wake up tomorrow covered in it, or I could go a couple of years without a major flare" – so it's comforting for her to know "there’s a place I can go if it all goes terribly wrong."
When asked if there were any health and safety risks to being exposed to the sun for so long without protection, the hotel assured Refinery29 that the area's natural properties provide protection. "Because the area lies far below sea level, [the sun] shines through an extra atmospheric layer, a natural sunscreen of evaporating water and chemicals from the body of water, as well as a thick ozone layer," says Natalia Sunna, manager of the Zara Spa at Mövenpick Resort & Spa Dead Sea.
"This weakens the harsh and dangerous ultraviolet B (UVB) rays chiefly responsible for sunburn, and greatly increases the amount of safe sun exposure time." This makes the region "ideal for heliotherapy. Patients can safely spend three to six hours a day under the sun’s healing rays to relieve disorders ranging from skin conditions to joint diseases."
However, skin experts generally advise against sunbathing at the best of times (even with sunscreen). Dr Kluk warns that exposing yourself to the sun without medical supervision and protection is dangerous. "The problem with uncontrolled sun exposure in the absence of medical supervision is that there is a very real risk of increasing your lifetime risk of deadly skin cancers, such as melanoma, which are currently on the rise anyway."
She continued: "It's firmly recommended that psoriasis sufferers take appropriate precautions to prevent sunburn by applying a broad spectrum SPF30+ sunscreen before sun exposure and then maintain protection by topping it up regularly throughout the day. Sunbathing without adequate protection and the use of commercial sunbeds to treat psoriasis are strongly discouraged. If you're struggling with psoriasis, please make an appointment to review the treatment options with your GP and discuss referral to a consultant dermatologist for a course of phototherapy if appropriate." Dr Kluk recommends that anyone heading to the Dead Sea for psoriasis relief protects themselves from skin cancer by using proper protection.
*Name has been changed.