Carol Soutor, M.D., writes about efficacy and safety of mind-body therapies for the treatment of various skin conditions.
Dermatologists routinely see patients with stress-induced skin problems such as a child with a flare of atopic dermatitis on the first day of school, a teenager with an acne flare before final exams, an adult who develops urticaria before public speaking or the patient who cannot stop scratching and picking at their skin. We also see patients with significant anxiety and depression related to their chronic skin conditions.
Usually, we do not routinely recommend psychotropic medications or suggest psychotherapy for all patients with stress-related cutaneous disorders, and many patients do not follow through with these recommendations even when they are made.1
Mind-body therapies (MBT)s offer an integrative care approach to these problems, which may be as effective and safer than other management options. Mind-body therapies include treatments administered by practitioners and selfdirected practices that patients do on their own. Examples of MBTs used to treat skin conditions include meditation, mindfulness, breathing techniques, biofeedback, progressive muscle relaxation, hypnotherapy, acupuncture, yoga and tai chi.
With recent advances in psychoneuroimmunology, we now have a greater understanding of how both acute and chronic stress can affect the skin and how MBTs can diminish some of the effects of the stress response. The effects of stress on the skin are primarily mediated by the hypothalamic-pituitary-adrenal (HPA) axis and the sympathetic-adrenal medullary axis. Stress can trigger inflammation, dysregulate immune function, impair the skin’s barrier function, slow wound healing and alter blood flow to the skin.2
Mind-body therapies can mitigate many of these deleterious effects on the skin. The mechanisms by which they do this are complex and have not yet been fully investigated. However, it has been established that MBTs activate the parasympathetic nervous system and downregulate the sympathetic nervous system, which, in turn, can mitigate some aspects of the stress response. In addition, MBTs beneficially affect the areas of the brain that deal with emotional regulation and psychological response to stressors.3
Many MBTs have been standardized and have evidence for efficacy in a wide range of physical and mental disorders, especially depression and anxiety. They have been reported to be beneficial in many cutaneous disorders, including psoriasis, atopic dermatitis, lichen planus, acne, rosacea, herpes simplex, post herpetic neuralgia, verruca vulgaris, alopecia areata, trichotillomania, urticaria, pruritus, prurigo nodularis and hyperhidrosis.4
Mind-body therapies are also increasingly popular with the general public. A survey of 2,055 adults showed that 18.9% had used at least one MBT in the previous year and 40-50% reported that these therapies were “very helpful for their condition.5 Many people view MBTs as being central to their overall well-being and do not reserve their use just for times of illnesses.
Most clinic and hospital health care systems offer MBTs. Our oncology colleagues frequently utilize mind-body practitioners and may be a source for advice on referrals. Insurance coverage varies depending on location and patient’s specific policy. Self-directed therapies such as mindfulness and meditation are of no cost and many of the other therapies are relatively low cost compared to the alternatives. A recent study showed that people who use certain MBTs lowered their total health care utilization costs by 43%.6
In summary, many of our patients are already using MBTs for various reasons and many others would benefit from their use. Dermatologists should consider recommending MBTs as part of an integrative approach to managing skin disorders.
Dr. Soutor is adjunct professor at University of Minnesota
1. Sansone RA, Sansone LA. Antidepressant adherence: are patients taking their medications? Innov Clin Neurosci. 2012;9(5-6):41-46.
2. Dhabhar FS. Psychological stress and immunoprotection versus immunopa- thology in the skin. Clin Dermatol. 2013;31(1):18-30.
3. Muehsam D, Lutgendorf S, Mills PJ, et al. The embodied mind: A review on func- tional genomic and neurological correlates of mind-body therapies. Neurosci Biobehav Rev. 2017;73:165-181.
4. Shenefelt PD. Use of hypnosis, meditation, and biofeedback in dermatology. Clin Dermatol. 2017;35(3):285-291.
5. Wolsko PM, Eisenberg DM, Davis RB, Phillips RS. Use of mind-body medical ther- apies. J Gen Intern Med. 2004;19(1):43-50.
6. Stahl JE, Dossett ML, LaJoie AS, et al. Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization. PLoS ONE. 2015;10(10):e0140212.