Hypnosis In Dermatology

Hypnosis is the intentional induction, deepening, maintenance, and termination of the natural trance state for a specific purpose. For the much maligned stage hypnosis, the purpose is entertainment. For medical hypnotherapy, the purpose is to reduce suffering, to promote healing, or to help the person alter a destructive behavior. The hypnotic phenomenon has been used since antiquity to assist in healing.

All individuals enter spontaneous mild trances daily while absorbed in watching television or a movie, in reading a book or a magazine, or in another activity or meditation. With appropriate training, an individual may intensify this trance state in himself or herself or in another individual and use this heightened focus to induce mind-body interactions that help to alleviate suffering or to promote healing. The trance state may be induced by using guided imagery, relaxation, deep breathing, meditation techniques, self-hypnosis, or hypnosis induction techniques. Individuals vary in their ability to enter the trance state, but most can obtain some benefit from hypnosis.^[1]

In dermatology, hypnosis may help decrease pain and pruritus in the skin; intervene in psychosomatic aspects of skin diseases; and lead to the resolution of some skin diseases, including verruca vulgaris. Suggestion without formal trance induction may be effective in some cases. Sulzberger and Wolf^[2] reported on the use of suggestion to treat verrucae.

Precisely defining hypnosis has proven to be challenging. Marmer^[3] described hypnosis as a psychophysiological tetrad of altered consciousness consisting of narrowed awareness, restricted and focused attentiveness, selective wakefulness, and heightened suggestibility. For a more detailed discussion of the definitions of hypnosis, see the texts by Crasilneck and Hall^[4] or Barabasz and Watkins.^[5]Many myths exist about hypnosis that overrate, underrate, or distort the true capabilities of hypnosis.

Hypnosis can regulate blood flow and other autonomic functions that are not usually under conscious control. The relaxation response that occurs with hypnosis also affects the neurohormonal systems that regulate many body functions. Studies on the influence of hypnosis on immediate immune responses have shown the ability of hypnotized volunteers to significantly decrease the flare reaction to the histamine prick test. Similarly, in one study, the effect of hypnotic suggestion on delayed cellular immune responses has shown significant effect on the size of erythema and on palpable induration but no significant effect in other studies.

A report by Braun^[6] on different allergic responses; dermatologic reactions; and effects on seizure disorders, pain control, and healing in the same individual with multiple personality disorder (now called dissociative identity disorder) shows how much influence the mind can have on physiologic reactions and disease processes, depending on the personality present. The report also described the differences in physiologic responses and disease conditions for selected individuals under hypnosis compared with their normal waking state.

Hypnosis may be used to increase healthy behaviors, to decrease situational stress, to reduce needle phobias, to control harmful habits (eg, scratching), to provide immediate and long-term analgesia, to ameliorate symptoms related to diseases (eg, pruritus), to accelerate recovery from surgery, and to enhance the mind-body connection to promote healing.^[7] Hypnosis can be especially helpful in dealing with skin diseases that have a psychosomatic aspect. Griesemer,^[8] who was trained both in dermatology and in psychiatry, recorded the incidence of emotional triggering of dermatoses in his patients during 1 year in his practice. He developed an index for various skin diseases, with 100 indicating an absolute psychosomatic component and zero indicating no psychosomatic component to the skin disease.

Good references on the responsiveness of skin diseases to hypnosis are found in the somewhat outdated book by Scott^[9] and in the chapter on the use of hypnosis in dermatologic problems in the text by Crasilneck and Hall.^[4] Koblenzer^[10] also mentions some of the uses of hypnosis in common dermatologic problems. In an excellent resource book for patients, Grossbart and Sherman^[11] discuss mind-body interactions in skin diseases and include hypnosis as recommended therapy for a number of skin conditions.