# Cosmeceuticals and Thalassotherapy: Recovering the Skin and Well-Being after Cancer Therapies
## 3 Cosmeceuticals for Skin Care of Oncologic Patient
### Vitamins
#### 3.2.8 Thermal Spring Waters  
The use of thermal spring waters for anti-inflammatory treatment has been endorsed by numerous clinical studies. They are generally mineral-medicinal waters (or natural minerals in their most common denomination) of low or medium mineralization, rich in selenium, zinc, and magnesium, among other minerals and trace elements [56; 57]. Several studies have been carried out to demonstrate the mechanisms of action of the spring waters. Research with two thermal spring waters (Avene and LaRoche-Posay) demonstrated that both waters are able to reverse the induction of interleukin-6 and the formation of reactive oxygen species after UVB stimulation, and it seems likely that trace elements such as selenium and zinc are critical for the observed effects [58]. Furthermore, Avene thermal spring water mediated inhibition of TNF\(\alpha\)-induced E-selectin and ICAM-1 expression, and this inhibition could be attributable to the suppression of NF-\(\kappa\)B transcription factor pathway activation [59]. Additionally, a cream containing an extract obtained from _Aquaphilus dolomiae_, isolated from the deep aquifer of Avene thermal spring water, showedto be particularly useful for treating pruritus and persistent itch [60]. Others such as Vichy volcanic spring water seem to be capable of repairing the skin barrier, protecting against the aggressions of the exposome through improving antioxidant status and strengthening the immune defenses [61].  
Other studies showed that thermal spring waters can have immunomodulatory effects; thus, a study showed that Avene spring water is endowed with an immunomododulatory potential. Avene spring water limits the DC stimulatory capacity of Th1 and Th17 cell responses by impairing their maturation, IL-12 and IL-23 production and accessory cell function [62]; another study with the same spring water showed that mast cells, dendritic cells (DCs) and CD4+ T cells are modulated [63]. The antinociceptive effect of a cream made with thermal water rich in calcium and sulfur derivatives has also been shown [64]. Other recent studies showed that the microbial communities detected in hot springs may be involved on the improvement of skin homeostatic defense linked to the control of its physiological microbiota and innate immunity [65; 66], with anti-inflammatory and immunomodulatory effects [67], and in the re-epithelialization of damaged skin or reinforcing the epidermal barrier [68; 69; 70; 71; 72; 73]. In addition, other studies showed that skin care with these types of products is very well tolerated, so cosmetic skin care is recommended to minimize skin reactions [74; 75].  
The interest in the prevention of burns caused by radiotherapy treatment has also led to the formulation of a gel with thermal water that is compared with a cream with trolamine, observing a similar efficacy to the latter in the prevention of burns, although tolerance is better with the thermal spring water gel and the onset of itching occurs at a later stage [76].  
Finally, it is worth mentioning that some thermal spa initiatives have been launched to improve the management of chronic alterations and patient education, among which oncological alterations are included [77].