Not everyone responds emotionally through the skin, nor do all people react the same way to having a skin problem. But evidence suggests that in some people, psychological issues often intersect with skin physiology, and treating both may offer the best chance for improvement.
When feelings of anxiety or depression intrude, medications such as antidepressants may be recommended. Many nonpharmacologic interventions, including mind-body techniques, have shown promise, though most studies are small and uncontrolled. Some approaches have effects that are not disease-specific but general — reducing stress and anxiety, improving the patient’s sense of control, and enhancing immune function. Clinicians may use one or more of the following:
- Hypnosis. The hypnotic state, involving focused concentration or awareness, can affect many physiological functions, including blood flow, pain sensation, and immune response. A trained hypnotist is not necessarily required; many people can successfully practice self-hypnosis through relaxation, meditation, or focused breathing techniques (see below). In this state, the mind has a heightened capacity to affect autonomic functions (those we have little conscious control over, such as heart rate). A therapist using the technique called guided imagery may ask the patient to imagine having healthy skin or picture immune cells on the march. In small studies, hypnosis has been shown to decrease stress and anxiety; reduce pain and inflammation; control sweating and itching; speed healing; and limit behaviors such as scratching, picking, or hair pullingBelgian researchers reported in the August 2006 issue of the Journal of the American Academy of Dermatology that 67% of patients with significant hair loss (alopecia) who underwent hypnosis (including self-hypnosis) had total or partial hair regrowth during treatment, although some of them lost the hair again during the four-year follow-up period. In some studies, hypnotherapy, especially combined with behavioral and relaxation techniques, has helped reduce itching and scratching in people with atopic dermatitisHypnosis has been studied extensively for treating warts. In one controlled trial, which compared hypnosis to no treatment at all, 53% of the hypnotized patients — but none of the unhypnotized patients — lost at least some of their warts. Another trial compared hypnotic suggestion (of the warts healing and shrinking) to salicylic acid (the standard treatment for warts), placebo salicylic acid, and no treatment. The hypnotized participants lost significantly more warts than subjects in the other three groups.
- Relaxation and meditation. The relaxation response (a technique pioneered in Western medicine by Dr. Herbert Benson at Harvard Medical School), progressive muscle relaxation, focused breathing, and mindfulness meditation are well-established antidotes to the harmful effects of the body’s response to stress. The mechanisms by which these practices (and hypnosis) fight disease or promote healing aren’t fully understood, but they’re one focus of a discipline called psychoneuroimmunology, which studies interactions among the brain, the immune system, and behavior.Relaxation techniques have been used along with conventional medical care in treating acne, eczema, hives, hyperhidrosis, and psoriasis. One small study of psoriasis patients found that those who listened to mindfulness meditation tapes while undergoing standard phototherapy (psoralen plus ultraviolet A, or PUVA) healed faster than those who had the light treatment alone.
- Psychotherapy. Many psychotherapeutic approaches can help in treating difficult skin disorders. For example, in cognitive behavioral therapy, the individual and her therapist can work to change behavior that damages the skin, as well as thought patterns that cause distress or hamper medical treatment. Supportive counseling can offer reassurance and help an individual better understand her skin ailment. Talk therapy may be particularly helpful with skin problems that for one reason or another have resisted every conceivable medical fix; an underlying psychological difficulty may be “speaking through the skin,” and exploring that possibility may be good for both skin and mind.
