No effect of Turkish bath (Hammam) on sunburn after exposure to natural ultraviolet radiation: A randomized controlled blinded trial

BACKGROUND: Scrubbing of the skin during Hammam, a Turkish spa treatment, removes cells from the ultraviolet radiation absorbing stratum corneum. AIM: The aim of this study was to assess if skin is more susceptible to sunburn after a Hammam treatment. METHODS: In this randomized controlled trial with a paired design, healthy adult participants with skin types 1-3 were randomized to receive Hammam treatment on one side of the back while the other side was used as control. Participants had 30 minutes of sun exposure on their backs. Erythema and pain were assessed before and 1, 4, 8, and 24 hours after sun exposure. Erythema was assessed by a visual scale and by using chromatography on high-resolution photos. Pain was assessed with the Visual Analogue Scale (VAS). The primary outcome was the difference in chromatography-assessed erythema from baseline to the 24-hour assessment, compared between the Hammam- and the control side. Secondary outcomes were differences in pain and visually assessed erythema. RESULTS: Twelve participants were included with complete follow-up. Eight participants had type-3 skin and four had type-2 skin. There was no difference between the Hammam and the control side for any of the outcomes. Even though erythema assessed by chromatography was slightly higher for the Hammam side, the difference was insignificant. CONCLUSION: Hammam treatment did not increase sunburn, measured by UV-induced skin erythema and pain, compared with untreated skin following 30 minutes of sun exposure.