What is it about?
This prospective pilot study examined the microscopic appearance of small blood vessels in human skin and muscle following balneotherapy at the Techirghiol Balneal and Rehabilitation Sanatorium in Romania. The study included 35 patients. Thirty received one of three mud treatments: heated mud packs, cold mud applications, or mud baths. Five patients received hydrotherapy as a comparison group. Approximately 24 hours after completing the treatment course, skin and deltoid muscle biopsies were collected and examined using conventional histological methods. Researchers observed differences between groups in the number of small vessels showing morphological features interpreted as angiogenesis-related. In skin tissue, the highest mean vessel counts were recorded in the heated mud pack and cold mud groups. In muscle tissue, the highest mean count was observed in the cold mud group. The findings provide preliminary evidence of different microvascular patterns across treatment groups. Because biopsies were collected only after treatment, the study cannot directly establish the magnitude of changes from each patient's pretreatment condition.
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Why is it important?
Balneotherapy research often focuses on clinical outcomes such as pain, mobility, and functional improvement. Less is known about the microscopic characteristics of human tissues following these treatments. This study introduces a histological perspective by examining skin and muscle biopsies obtained after different forms of mud therapy and hydrotherapy. The observed differences raise questions about how treatment conditions, including temperature and application methods, may relate to microvascular responses in different tissues. Its main contribution is demonstrating the feasibility of investigating these questions through direct tissue examination in a clinical balneotherapy setting. The results remain exploratory. The small sample size, non-randomized allocation, absence of pretreatment biopsies, and lack of long-term follow-up limit causal interpretation. Further controlled investigations, incorporating molecular vascular markers and clinical outcomes, are needed to determine whether these observations represent treatment-related angiogenesis and whether they have therapeutic significance.
Perspectives
As the first author of this study and a physician in Physical Medicine, Rehabilitation, and Balneology, I consider its most important contribution to be the application of histological investigation to a clinical field traditionally evaluated through functional and symptomatic outcomes. Examining human skin and muscle tissues after different balneotherapy procedures offered an opportunity to investigate microvascular patterns beyond routine clinical observations. The differences observed between treatment groups are scientifically interesting, but I regard them as a starting point for further investigation rather than definitive proof of newly formed vessels or therapeutic benefit. This research is connected to our broader work on the natural therapeutic resources of Techirghiol Lake, including the physicochemical characterization of sapropelic mud. Bringing together histological findings, physicochemical measurements, and clinical observations may help clarify the physiological mechanisms associated with balneotherapy. Future studies should include stronger comparison groups, pretreatment measurements where feasible, blinded tissue assessment, and complementary molecular methods.
Dr Traian Virgiliu Surdu
Universitatea Ovidius din Constanta
Read the Original
This page is a summary of: Microvascular Responses in the Dermis and Muscles After Balneotherapy: Results from a Prospective Pilot Histological Study, Water, June 2025, MDPI AG,
DOI: 10.3390/w17121830.
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