High-altitude climatotherapy

High-Altitude Climatotherapy

Corresponding Member Prof. Nikolay K. Tsankov, M.D., D.Sc.

 

In 1962, the first symposium in the world dedicated to the climatotherapy of skin diseases was held in Sofia. This event laid the foundation for organized climatotherapy in Bulgaria. Two specialized branches were established under the guidance of the Scientific Institute of Dermatology and Venereology:

  • A high-altitude branch (located in the Saragyol area in the Rila Mountains, at an altitude of 2,018 meters), and
  • A marine branch (in the village of Sveti Vlas on the Black Sea coast).

Used since ancient times for the treatment of various ailments, climate as a therapeutic tool dates back to Hippocrates (460–375 BC), the father of medicine, who was the first to document and introduce climatotherapy and balneotherapy in medical practice.

Today, climate has been studied from multiple perspectives by specialists such as biologists, bioclimatologists, physiologists, physicians, and others. People who ascend to high altitudes for sports or health reasons, as well as those living in mountainous regions, are exposed to four potentially stress-inducing factors (1):

  • Lower partial pressure of oxygen;
  • Increased solar radiation;
  • Cold exposure;
  • Reduced water vapor content in inhaled air.

The skin is the first to come into contact with environmental changes and irritants, which is why it is considered the phylogenetically oldest adaptive system.

Adaptation to meteorological and atmospheric factors develops quickly but is temporary and depends on the duration of exposure—meaning the effects do not persist once a person returns to their usual living conditions (2). Researchers from the National Institute of Dermatology and Venereology have conducted high-altitude climatotherapy on different geological terrains: in the Pirin Mountains on quartz terrain, on Vitosha Mountain on granite, and in the Rhodopes (Pamporovo) on grassy terrain (3). Despite similar meteorological conditions, they observed varying biotropic effects (2).

The role of geographical and geological terrain factors in high-altitude climatotherapy remains underexplored and presents a promising topic for investigation by future generations of researchers.

One of the main reasons for the positive therapeutic effect observed in patients with allergic skin conditions (allergodermatoses) is the increase in plasma cortisol levels. High-altitude climate, along with controlled physical activity, stimulates adrenal function and the secretion of higher levels of plasma cortisol (4). In 1987, A. Lalova found that in 71.4% of 35 patients with atopic dermatitis, elevated levels of immunoglobulin E were reduced (4).

It’s also important to consider the complete mental and physical relaxation experienced by those undergoing high-altitude climatotherapy, as well as the emotional impact of the beautiful mountain scenery. The daily routine in climatotherapy centers differs entirely from that in hospitals—patients remain under medical supervision, but live immersed in the healing natural environment.

Organized high-altitude treatment in our country has been carried out since 1960 in the Pirin Mountains (Vihren Hut, 2064 m above sea level), Rila (Saragyol, 2018 m above sea level, village of Govedartsi, 1300 m above sea level), Rhodopes (Pamporovo, 1600 m above sea level, Kurtovo, 1840 m above sea level), and Vitosha (Rodina Hut, Sredets Hut, 1650 m above sea level). The best therapeutic results were obtained in Saragyol (Rila) and Vihren Hut (Pirin). The resort Pamporovo is more suitable for the treatment of chronic urticaria (5).

The political and economic changes that occurred in our country after 1989 brought about a number of changes in the conduct of high-altitude climatotherapy. The base in the Rila Mountains (Saragyol, 2018 m above sea level) ceased to exist. Patients now pay for climatotherapy themselves (accommodation and food).

Since 2010, Prof. Zdravka Demerdjieva has organized annual high-altitude treatment in Belmeken (Rila, 2050 m above sea level). The base mainly treats children with atopic dermatitis (6). Atopic dermatitis is considered a disease of civilization. It is more frequently observed in countries with a high socio-economic standard and a polluted environment. According to the National Eczema Association (USA), in the last thirty years, the incidence of atopic dermatitis has increased, with the percentage of affected children being 8% in 1997, and in 2024 the percentage exceeds 12%.

Out of 88 children treated between 2010 and 2015 at the Belmeken base, clinical recovery was observed in 32 of them (37.5%), significant improvement in 27 of them (30.6%), improvement in 23 children (26.1%). No change in condition was observed in only 8 children (4.3% of those undergoing climatotherapy) (6).

The mechanism of action of biotropic meteorological and climatotherapeutic factors in the conditions of the high mountain is well studied and scientifically substantiated. The improvement in the condition of the patients and the achievement of long-term remissions is due to the removal of the patients from their surrounding environment, their isolation from civilization, stimulation of adrenal gland activity, increased levels of plasma cortisol, increased phagocytic and peroxidase activity of leukocytes, normalization of lysosomal enzyme levels (7,8).

In mountain air, a higher amount of ozone and increased ionization (negative ions) are detected, which have a beneficial effect on the organism.

High-altitude climatotherapy is one of the great achievements of the Bulgarian dermatological school, which has brought prestige and well-deserved recognition worldwide. In an age of ever-new technologies and artificial intelligence, many will recall Hippocrates’ call – “Back to nature!”

BIBLIOGRAPHY:

  1. Climatotherapy of Skin Diseases. (Ed. Nikola Botev Zlatkov). Sofia: Medicine and Physical Culture, 1989.
  2. Pophristov, P., Botev, Sht. On the Methods of Studying the Influence of Climatic Factors on the Skin.10, 1964, pp. 146–159.
  3. Pophristov, P., Botev, Sht., Khlebarov, S. et al. High-Altitude Climatotherapy of Patients with Skin Diseases in the Rhodopes at the Pamporovo Resort. 10, 1964, pp. 96–101.
  4. Lalova, A. Variations in Plasma Cortisol Levels in Patients with Urticaria and Neurodermatitis Undergoing High-Altitude Climatotherapy. Dermatology and Venereology14(4), 1975, pp. 246–248.
  5. Lalova, A. Climato-Physiological Studies on Certain Skin Reactions Under the Influence of Climate and Movement Factors. Dissertation, DM, Sofia, 1974.
  6. Demerdjieva, Z., Tsankov, N. High-Altitude Climatotherapy in Children with Atopic Dermatitis. – Practical Pediatrics, 23(6), 2021, pp. 24–27.
  7. Vidinova, Y., Lalova, A. Immunological Changes in Patients with Endogenous Eczema Undergoing High-Altitude Climatotherapy. Dermatology and Venereology  26(3), 1987, pp. 13–20.
  8. Mikhailov, P., Lalova, A., Tsankov, N. et al. Lysosomal Enzymes in the Serum and Bullous Fluid of Patients with Allergic Dermatoses Before and After High-Altitude Climatotherapy. Dermatology and Venereology  22(4), 1983, pp. 14–17.