The skin and the brain interact through psychoneuroimmunoendocrine mechanisms and through behaviors that can strongly influence the initiation or flaring of skin disorders. OBJECTIVE: To obtain knowledge of these factors to assist in designing treatment plans for specific skin disorders. METHODS: Psychocutaneous disease literature for the past 80 years was reviewed. RESULTS/CONCLUSION: Therapeutic options include standard psychotropic drugs and alternative herbs and supplements, the placebo effect, suggestion, cognitive-behavioral methods, biofeedback, and hypnosis. When simple measures fail to produce the desired results, combinations of drugs or addition of nonpharmacological therapies may produce better results. Psychophysiological skin disorders may respond well to nonpharmacological therapies that counteract stress, supplemented when indicated by anxiolytic or antidepressant drugs. Treatment of primary psychiatric disorders that affect the skin often results in improvement of the associated skin disorders. Psychiatric disorders secondary to skin disorders may also require treatment.

Expert Opin Pharmacother. 2008 Apr;9(6):973-85. Shenefelt PD. Department of Dermatology and Cutaneous Surgery, University of South Florida, Tampa, FL 33612, USA. pshenefe@health.usf.edu

This study investigated whether hypnotherapy provides a significant therapeutic effect in Saudi Arabian patients with irritable bowel syndrome. Patients (n=26) were consecutively recruited at a psychiatry outpatient clinic after diagnosis by a gastroenterologist and a medical evaluation for irritable bowel syndrome. Each patient had 12 sessions of hypnotherapy over a period of 12 weeks (1 session per week). Patients completed a scale measuring symptom severity before and 3 months after the trial. Hypnotherapy significantly enhanced a feeling of better quality of life more in male than in female patients, and bowel habit dissatisfaction was reduced more in female than in male patients.

East Mediterr Health J. 2007 Mar-Apr;13(2):301-8. Al Sughayir MA. Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia. fmrahim@ksu.edu.sa

Psychological and educational interventions have been used as an adjunct to conventional therapy for children with atopic eczema to enhance the effectiveness of topical therapy. There have been no relevant systematic reviews applicable to children. OBJECTIVES: To assess the effectiveness of psychological and educational interventions in changing outcomes for children with atopic eczema. SEARCH STRATEGY: We searched the Cochrane Skin Group Specialised Register (to September 2004), the Cochrane Central Register of Controlled Trials (The Cochrane Library Issue 2, 2005), MEDLINE (from 1966-2005), EMBASE (from 1980 to week 3, 2005 ), PsycINFO (from 1872 to week 1, 2005). On-line: National Research Register, Meta-register of Controlled Trials, ZETOC alerts, SIGLE (August 2005). SELECTION CRITERIA: RCTs of psychological or educational interventions, or both, used to manage children with atopic eczema. DATA COLLECTION AND ANALYSIS: Two authors independently applied eligibility criteria, assessed trial quality and extracted data. A lack of comparable data prevented data synthesis. MAIN RESULTS: Five RCTs met the inclusion criteria. Some included studies required clearer reporting of trial procedures. Rigorous established outcome measures were not always used. Interventions described in all 5 RCTs were adjuncts to conventional therapy. Four focused on intervention directed towards the parents; data synthesis was not possible. Psychological interventions remain virtually unevaluated by studies of robust design; the only included study examined the effect of relaxation techniques (hypnotherapy and biofeedback) on severity. Three educational studies identified significant improvements in disease severity between intervention groups. A recent German trial evaluated long term outcomes and found significant improvements in both disease severity (3 months to 7 years, p=0.0002, 8 to 12 years, p=0.003, 13 to 18 years, p=0.0001) and parental quality of life (3 months to 7 years, p=0.0001, 8 to 12 years p=0.002), for children with atopic eczema. One study found video-based education more effective in improving severity than direct education and the control (discussion) (p<0.001). The single psychological study found relaxation techniques improved clinical severity as compared to the control at 20 weeks (t=2.13) but this was of borderline significance (p=0.042). AUTHORS' CONCLUSIONS: A lack of rigorously designed trials (excluding one recent German study) provides only limited evidence of the effectiveness of educational and ychological interventions in helping to manage the condition of children with atopic eczema. Evidence from included studies and also adult studies indicates that different service delivery models (multi-professional eczema school and nurse-led clinics) require further and comparative evaluation to examine their cost-effectiveness and suitability for different health systems.

Cochrane Database Syst Rev. 2007 Jul 18;(3):CD004054. Ersser SJ, Latter S, Sibley A, Satherley PA, Welbourne S. Bournemouth University, Institute of Health & Community Studies, Royal London House, Christchurch Road, Bournemouth, Hampshire, UK, BH1 3LT.

sersser@bournemouth.ac.uk

Three adult cases of psychogenic dermatitis of atypical presentation were treated with direct suggestion under hypnosis (DSUH), which included suggestions for developing cooling, soothing and healing numbness in the affected areas. After a trial of 5 sessions over a period of 2 months, the results in all 3 cases were determined to be unappreciable and unsuccessful. The patients were subsequently treated with hypnoanalysis including ideomotor questioning, regression to onset, and reframing followed by direct suggestions under hypnosis (DSUH) for healing of all affected areas except a negotiated index finger on the nondominant hand. This technique proved an effective treatment that extinguished the flair-ups in 6 visits or less over a period of 2 months. These cases were followed at intervals of up to 1 year and no evidence of relapse found.

Cited from American Journal of Clinical Hypnosis, Jan 2005

Notable changes have been observed in the application of psychological therapies to medicine, including psychodermatology. This review article surveys current methods used by psychologists in the management of stress-related skin disorders, including hypnosis, relaxation training, biofeedback, operant conditioning, and cognitive-behavioral therapy.

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Hypnotic suggestion successfully alleviated the behavioral picking aspect of acne excoriee des juenes filles in a pregnant woman who had been picking at the acne lesions on her face for 15 years. Acne excoriee is a subset of psychogenic or neurotic excoriation.

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The skin and the nervous system develop side by side in the fetus and remain intimately interconnected and interactive throughout life. Because of the skin-nervous system interactions, there is a significant psychosomatic or behavioral component to many dermatologic conditions. This permits complementary nonpharmacologic psychotherapeutic interventions, such as acupuncture, aromatherapy, biofeedback, cognitive-behavioral therapy, hypnosis, placebo, and suggestion, to have positive impacts on many dermatologic diseases. Complementary pharmacologic psychotherapeutic interventions, such as herbs and supplements, also may help improve some dermatologic disorders.

Division of Dermatology and Cutaneous Surgery, College of Medicine, University of South Florida, 12901 Bruce B. Downs Boulevard, Tampa, FL 33612, USA. pshenefe@hsc.usf.edu