{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,6]],"date-time":"2026-05-06T08:15:35Z","timestamp":1778055335273,"version":"3.51.4"},"reference-count":51,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,4,27]],"date-time":"2026-04-27T00:00:00Z","timestamp":1777248000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJMS"],"abstract":"<jats:p>Comano thermal water (CTW) is a hypotonic, bicarbonate\u2013calcium\u2013magnesium mineral water traditionally used to manage chronic inflammatory and relapsing skin diseases. This review summarises and discusses the available clinical, experimental, and translational evidence on CTW, with a particular focus on dermatological indications. The physicochemical properties of CTW, along with the presence of a stable, non-pathogenic microbial community, are examined in relation to their potential biological activity. Clinical studies indicate that CTW-based balneotherapy, alone or in combination with narrowband Ultraviolet B (UVB) phototherapy, is associated with improvements in disease severity, symptom burden, and quality of life in patients with psoriasis and atopic dermatitis, and has a favourable safety and tolerability profile. Experimental data further suggest that CTW may exert anti-inflammatory and immunomodulatory effects, modulate keratinocyte function, support skin barrier restoration, and influence the cutaneous microenvironment, including microbiome-related pathways. The review also outlines emerging evidence for CTW in skin regeneration and in upper airway inflammatory conditions treated via inhalation-based approaches. Overall, this review suggests that CTW may serve as a biologically active therapeutic resource, warranting further investigation as a complementary approach within integrative management strategies for inflammatory and barrier-related conditions.<\/jats:p>","DOI":"10.3390\/ijms27093893","type":"journal-article","created":{"date-parts":[[2026,4,28]],"date-time":"2026-04-28T11:33:37Z","timestamp":1777376017000},"page":"3893","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Clinical and Mechanistic Evidence for Comano Thermal Water: A Narrative Review"],"prefix":"10.3390","volume":"27","author":[{"given":"Ermanno","family":"Baldo","sequence":"first","affiliation":[{"name":"G.B. Mattei Institute for Research in Medical Hydrology and Thermal Medicine, 40138 Trento, Italy"},{"name":"Italian Society of Paediatric Allergy and Immunology (SIAIP), 20126 Milano, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0167-7617","authenticated-orcid":false,"given":"Damiano","family":"Abeni","sequence":"additional","affiliation":[{"name":"IDI\u2014IRCCS Istituto Dermopatico dell\u2019Immacolata, 00167 Rome, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Agostini","sequence":"additional","affiliation":[{"name":"School of Specialisation in Medical Hydrology, University of Pisa, 56126 Pisa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7804-6143","authenticated-orcid":false,"given":"Ubaldo","family":"Armato","sequence":"additional","affiliation":[{"name":"Section of Maxillofacial Surgery and Dentistry, Department of Surgery, 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Complessa\u2014UOC), Ospedale Civile di Livorno, 57124 Livorno, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6974-7685","authenticated-orcid":false,"given":"Anna","family":"Chiarini","sequence":"additional","affiliation":[{"name":"Section of Maxillofacial Surgery and Dentistry, Department of Surgery, Dentistry, Pediatrics & Gynecology, University of Verona, 37137 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7016-8421","authenticated-orcid":false,"given":"Giorgio","family":"Ciprandi","sequence":"additional","affiliation":[{"name":"Department of Medicine and Health Sciences, University of Molise, 86100 Campobasso, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5523-4910","authenticated-orcid":false,"given":"Ilaria","family":"Dal Pr\u00e0","sequence":"additional","affiliation":[{"name":"Section of Maxillofacial 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Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3344-7194","authenticated-orcid":false,"given":"Olivier","family":"Jousson","sequence":"additional","affiliation":[{"name":"Department of Cellular, Computational and Integrative Biology (CIBIO), Centre for Medical Sciences (CISMed), University of Trento, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6371-528X","authenticated-orcid":false,"given":"Serena","family":"Manara","sequence":"additional","affiliation":[{"name":"Laboratory of Computational Metagenomics, Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eugenio","family":"Mira","sequence":"additional","affiliation":[{"name":"Fondazione I.R.C.C.S. Policlinico San Matteo, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1507-4067","authenticated-orcid":false,"given":"Giovanni","family":"Nicoletti","sequence":"additional","affiliation":[{"name":"Advanced Technologies for Regenerative Medicine and Inductive Surgery Interdepartmental Research Center T.A.Me.Ri.C.I., University of Pavia, 27100 Pavia, Italy"},{"name":"Department of Clinical, Surgical, Diagnostic and Paediatric Sciences, University of Pavia, 27100 Pavia, Italy"},{"name":"Surgery Unit, ASST (Azienda Socio-Sanitaria Territoriale) di Pavia, 27100 Pavia, Italy"},{"name":"Integrated Unit of Experimental Surgery, Advanced Microsurgery and Regenerative Medicine, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7169-4829","authenticated-orcid":false,"given":"Calogero","family":"Pagliarello","sequence":"additional","affiliation":[{"name":"Division of Dermatology, ASUIT (Azienda Sanitaria Universitaria Integrata del Trentino), 38123 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renato","family":"Pedron","sequence":"additional","affiliation":[{"name":"Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anna","family":"Peroni","sequence":"additional","affiliation":[{"name":"Dermatology Clinic, University of Verona, 37129 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vittoria","family":"Rizzo","sequence":"additional","affiliation":[{"name":"Department of Molecular Medicine, University of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicola","family":"Segata","sequence":"additional","affiliation":[{"name":"Laboratory of Computational Metagenomics, Department of Cellular, Computational and Integrative Biology (CIBIO), University of Trento, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Glenda","family":"Tettamanti","sequence":"additional","affiliation":[{"name":"ASST (Azienda Socio-Sanitaria Territoriale) of Pavia, 27100 Pavia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Zanoni","sequence":"additional","affiliation":[{"name":"Comano Thermal Spa Consortium, 38070 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giuseppe","family":"Zumiani","sequence":"additional","affiliation":[{"name":"Independent Dermatologist, 38122 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mario","family":"Cristofolini","sequence":"additional","affiliation":[{"name":"G.B. Mattei Institute for Research in Medical Hydrology and Thermal Medicine, 40138 Trento, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"S31","DOI":"10.1111\/j.1529-8019.2008.00200.x","article-title":"Balneotherapy for chronic plaque psoriasis at Comano spa in Trentino, Italy","volume":"21","author":"Peroni","year":"2008","journal-title":"Dermatol. Ther."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"597","DOI":"10.1007\/s00484-023-02438-y","article-title":"Comparative analysis of balneotherapy in European public health systems: Spain, France, Italy, and Portugal","volume":"67","author":"Hellmann","year":"2023","journal-title":"Int. J. 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