In this study, functional MRI scans were done to look for activation of pain areas in people with fibromyalgia. Interestingly, simply suggesting that pain would lower did decrease both the pain and MRI changes. This suggests that the suggestions your physician gives you (e.g., there is hope vs. “no one can get you well”) become self fulfilling prophecies. If fact, statements like “no one can get you well” used to be called putting a “curse” on someone. Yet this is what physicians often do—ignoring how their words have the power to harm as well as heal.

What makes these “curse” statements by physicians so nasty is that they are wrong and borne of ignorance. Most physicians these days are aware, almost exclusively, of only the most expensive medications, surgery and procedures. They believe this puts them scientifically on the cutting edge, not realizing that what they think is science is really slickadvertising by drug companies masquerading as educational activities. A quick check of which companies sponsor a conference and what percentage of speakers are promoting these companies’ products (for big bucks) should quickly disabuse one from thinking the conference is much more than an advertisement. Journals also are effected by the drug advertising (ever wonder why you never see ads for cars or golf clubs in medical journals? No one would be insane enough to pay for those ads—except that it buys “good relationships” with the journal’s handlers. The silver lining to this problem is that the scientific literature is also full of studies showing effective treatment for many “untreatable” medical problems. These are usually so cheap, though, that doctors never hear about them (they tend to be in smaller journals with less drug ads). So what the physician is really saying is that “there are no extremely expensive medications for your problem that the drug company propaganda has indoctrinated me about, so I can’t help you.” Tell them thanks for their honesty, and go find a holistic physician who has looked at the rest of the science—and who usually can help. (see theAmerican Board of Holistic Medicine to find a doctor). To do your own medical sleuthing, get a medical report on your illness from Jan Guthrie at the Health Resource. I never cease to be amazed at studies they find showing help for “untreatable” problems.

But back to the study… suggestions of pain relief given under hypnosis were even more effective at decreasing pain sensation and the amount of stimulation of pain areas in the brain. All this goes to show that your ability to affect the outcome of your illness should not be underrated. In fact, a large part of the Art of Medicine is working with you to mobilize your own internal healing abilities. That medicine has derisively called your ability to affect healing the “placebo effect,” suggesting that only the doctor has the power to help you—and that anything you do on your own shows you are crazy—shows how aggressively the medical establishment works to disempower you. But you do have the ability to often heal yourself given good information. As it is said “Knowledge is Power!”

As the surgeon attends to your leg, the nurse continues talking to you as though nothing unusual is happening. “You just feel a little more pressure,” she says calmly, and you find yourself imagining that none of the pain you’ve been experiencing all along is really that bad. The operation is completed in what seems like no time at all.

It never occurs to you that you are under the influence of hypnosis, but that is what they tell you when you later ask what happened. You arethankful for the relief you experienced while the surgeon sawed off your leg. You are testimony to the popular belief that hypnosis is a special state of consciousness in which many mental feats become possible–such as enduring surgery sans anesthesia.

Ever since Franz Anton Mesmer proposed his theory of animalmagnetism more than 200 years ago, hypnosis has fought an uphill battle for scientific credibility. The establishment relegated it to the domain of stage performers and quacks for most of that time. But in the past few decades the phenomenon has enjoyed an increasing amount of scientific interest, as well as widespread clinical application for an array of medical and psychological purposes, from removing warts to retrieving memorieslong buried in the unconscious.

This sudden ascent to respectability began a little more than 30 years ago, when psychologist Ernest Hilgard, Ph.D., a former president of the American Psychological Association, set up the Laboratory of Hypnosis Research at Stanford University. At about the same time, psychiatrist Martin Orne, M.D., of Harvard and psychologist T. X. Barber, Ph.D., of the Medfield Foundation, pioneered hypnosis research at their respective organizations. Since then, dozens of research programs on hypnosis have sprung to life in universities and medical schools in the United States, Canada, Europe, and Australia.

The burgeoning hypnosis field also supports two independent professional organizations and two major journals devoted exclusively to the topic. The Society for Clinical and Experimental Hypnosis, which publishes the International Journal of Clinical and Experimental Hypnosis, currently enrolls over 1,000 members. The American Society of Clinical Hypnosis, publisher of the American Journal of Clinical Hypnosis, boasts almost 4,000 members. Several smaller organizations flourishing in a number of foreign countries publish their own journals on the subject.

In clinical practice here and elsewhere, hypnosis has simply taken off. Inspired by the late psychotherapist Milton Erickson, M.D. (considered by many to be the father of modem medical hypnosis), thousands of self-proclaimed “Ericksonian” disciples regularly feature hypnosis therapy in their clinical repertoire. So do a large number of “classical” psychotherapists who don’t remotely consider themselves Ericksonians. Then there are the thousands of practitioners, clinically unlicensed, who advertise their services as hypnotists.

Excitement is building over reports citing the effectiveness of the therapy for a growing number of medical and psychological applications. Here’s a sampling:

o Hypnosis has been used in place of anesthesia to numb the pain of childbirth and major surgical procedures such as amputation, abdominal surgery, and the removal of testicular tumors, and such painful procedures as dental surgery and hemorrhoidectomies. The ability to tolerate such pain while under the influence of hypnosis is laid to an altered state that allows patients to dissociate from and become consciously unaware of it.

o Hypnosis is used in an effort to dislodge deeply buried memories relating to past events. Therapists employ “hypnotic regression”–mentally taking a subject back in time to reexperience the past. The thinking is that hypnosis affords direct access to unconscious memories without resistance or distortion, making it an exceptionally reliable tool for exploring long-forgotten details of early childhood and a powerful investigative tool for drawing out critical details of crimes.

o Numerous reports attest the effectiveness of hypnosis in the treatment of warts. In those who have been hypnotized, warts later disappear entirely on their own, without medicine or surgery. Since warts are virally induced, this striking phenomenon has fueled belief that hypnosis somehow mobilizes immune response.

eMedicine Specialties > Dermatology > Internal Medicine

Hypnosis - Applications in Dermatology and Dermatologic Surgery

Author: Philip D Shenefelt, MD, MS, Associate Professor, Department of Dermatology and Cutaneous Surgery, University of South Florida College of Medicine; Past Chief, Section of Dermatology, James A Haley Veteran Affairs Medical Center
Contributor Information and Disclosures

Updated: Apr 23, 2009

Introduction

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.

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 Wolf¹ reported on the use of suggestion to treat verrucae.

Precisely defining hypnosis has proven to be challenging. Marmer² 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 Hall³ or Barabasz and Watkins.⁴ 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 Braun⁵ 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. Hypnosis can be especially helpful in dealing with skin diseases that have a psychosomatic aspect. Griesemer,⁶ 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 Scott⁷ and in the chapter on the use of hypnosis in dermatologic problems in the text by Crasilneck and Hall.³Koblenzer⁸ also mentions some of the uses of hypnosis in common dermatologic problems. In an excellent resource book for patients, Grossbart and Sherman⁹ discuss mind-body interactions in skin diseases and include hypnosis as recommended therapy for a number of skin conditions.

Methods of Medical Hypnotherapy

Hypnosis is not a therapy in and of itself. Instead, it is a tool that can be used to reveal psychological and behavioral roadblocks to healing. Therapies that can be enhanced by hypnosis include supportive (ego-strengthening) therapy, direct suggestion, symptom substitution, and hypnoanalysis.

In adults, induction of the hypnotic state is achieved by any of a number of methods that focus attention, soothe, and/or produce monotony or confusion. In children, the hypnotic state can be induced by having the child make-believe that he or she is watching television, a movie, or a play or by using some other distractive process that uses the imagination.

Supportive (ego-strengthening) therapy while in a hypnotic state includes positive suggestions of self-worth and effectiveness. Posthypnotic suggestion is often included, and further strengthening of the effect can be obtained by recording an audiocassette tape that the patient can repeatedly use for self-hypnosis later. The strengthened ego is better able to repress or confront discordant elements that inhibit healing.

Direct suggestion while in the hypnotic state is a frequently used method of decreasing discomfort from pain, pruritus, burning sensations, anxiety, and insomnia. Again, posthypnotic suggestion and repeated use of an audiocassette tape for self-hypnosis help to reinforce the effectiveness of direct suggestion. Direct suggestion may produce a sufficiently deep anesthesia in highly hypnotizable individuals for cutaneous surgery. Direct suggestion can also be used to reduce repetitive acts of skin scratching or picking, nail biting or manipulating, and hair pulling or twisting. Unwanted psychophysiologic responses, such as hyperhidrosis, blushing, and some types of urticaria, can also be controlled by direct suggestion. Some skin lesions can even be induced to resolve by using direct suggestion; the classic example is verrucae.

Symptom substitution retrains the subconscious by means of hypnosis to replace a negative habit pattern with a more constructive one. For example, scratching can be replaced by another physical activity, such as grabbing onto something and holding it so tightly for a half minute that it almost hurts. Other stress relievers that can be substituted for scratching include athletic activities, artwork, verbal expression of feelings, or meditation.

Hypnoanalysis may help patients with chronic psychosomatic dermatoses that are nonresponsive to other simpler approaches. LeCron’s^10,11 list of the 7 most common factors causing emotional difficulties and illnesses (ie, conflicts, motivation, the effect of suggestion, organ language, identification, self-punishment, and the effect of past experiences) is a good starting point for exploration in hypnoanalysis. Ewin and Eimer¹² provide a user-friendly method of detecting and neutralizing the emotional impact of sensitizing or precipitating events. They use ideomotor signaling to obtain recollection of significant memories that may be preverbal or nonverbal. Results may occur more rapidly than with standard psychoanalysis. Only well-qualified and appropriately licensed practitioners should perform these types of hypnosis.

The author discusses the successful use of hypnoanalysis in dermatology.¹³ The author has slightly modified Ewin’s mnemonic for LeCron’s 7 key factors to COMPASS, as follows:

• C onflict
• O rgan language
• M otivation
• P ast experiences
• A ctive identification
• S elf-punishment
• S uggestion

The diagnostic value of screening for psychosomatic factors related to skin disorder triggering or exacerbation is illustrated in the above case. It is possible to rule out a likely psychosomatic component if the focused history and COMPASS ideomotor questioning for all 7 factors is negative. With 1 or 2 factors positive, appropriate reframing may be sufficient, but with more factors positive, more intensive psychotherapy would be appropriate.

Hypnotic Relaxation During Dermatologic Surgery

A variety of dermatologic procedures can produce pain or anxiety in patients. Skin procedures that are somewhat painful but usually do not require a local anesthetic include moderate depth chemical peels, cryodestruction of skin lesions, curettage of molluscum, excision of skin tags, extrusion of comedones, incision and expression of milia, laser treatment of vascular lesions, strong microdermabrasion, and sclerotherapy. Dermatologic procedures that require a local anesthetic include electrodesiccation and curettage, incision and drainage of an abscess, laser ablation of skin lesions, liposuction, punch biopsy, shave biopsy, surgical excision, and surgical repair. Cutaneous procedures that may require conscious sedation include deep chemical peels, dermabrasion, laser resurfacing, and extensive liposuction. All of these procedures may be augmented by hypnotic relaxation and/or hypnotic analgesia.

Recent experimental evidence helps to elucidate the nature of the mechanisms of pain relief during hypnosis. Faymonville et al found that pain reduction mediated by hypnosis was localized to the mid anterior cingulate cortex, as observed by using a positron emission tomography (PET).¹⁴

In an electroencephalographic (EEG) study of hypnosis effects versus distraction effects on cold pressor pain, Freeman et al¹⁵ observed significantly greater high theta (5.5-7.5 Hz) activity in persons who were highly susceptible to hypnosis (based on the Stanford Hypnotic Susceptibility Scale, Form C or SHSS:C scores) compared with persons who were less susceptible to hypnosis at parietal and occipital sites during both hypnosis and waking relaxation. Freeman et al also found that in persons who were highly susceptible to hypnosis, hypnosis provided significantly greater pain relief than distraction or waking relaxation. These individuals also had significantly greater pain relief via hypnosis than those who were less susceptible to hypnosis. These PET and EEG studies support state-based theories of hypnosis as opposed to sociocognitive theories of hypnosis.

Until recently, the clinical literature on hypnosis for pain and anxiety relief was mostly on the case report level. In older literature, Blankfield¹⁶ reviewed adjunctive hypnosis in the care of patients who underwent surgery. Overgeneralizing from case reports can be risky.

In a meta-analysis of hypnotically induced analgesia, Montgomery et al¹⁷ found that hypnosis relieved pain in patients with headache, burn injury, heart disease, cancer, dental problems, eczema, and chronic back problems. Their study quantified the magnitude of hypnoanalgesic effects. For most people, hypnotic suggestion relieved pain regardless of its type.

Light and medium trance states are sufficient for most purposes, but a deep trance state is required for hypnotic anesthesia for surgery. Faymonville et al¹⁸ randomly assigned 60 patients undergoing plastic surgery with conscious sedation either to a control group with stress-reducing strategies or to a hypnosis group. Intraoperative and postoperative anxiety and pain were significantly lower and significantly smaller amounts of medication were required for conscious sedation in the hypnosis group.

Mauer et al¹⁹ studied 60 patients who underwent hand surgery and received either standard treatment or standard treatment augmented with hypnosis. The hypnosis group had significantly decreased perceived pain intensity, expression of perceived pain, and anxiety compared with those of control subjects. Patients in the hypnosis group also had significantly fewer medical complications and a higher postoperative recovery rate.

Montgomery et al²⁰ studied 20 women randomized to standard care versus preoperative hypnosis for excisional breast biopsy. They found brief (10 min) hypnosis to be effective in reducing postsurgery pain and distress both before surgery and after surgery. Defechereux et al²¹ reported a prospective randomized study of thyroid and parathyroid procedures performed under hypnosis, local anesthesia, and minimal conscious sedation in patients compared with similar surgery performed under conventional anesthesia in 20 patients. Defechereux et al found that patients in the hypnoanesthesia group had significantly less inflammatory response, hemodynamic dysregulation, postoperative pain, postoperative fatigue, and convalescence time. Bleeding, operative times, and surgical comfort were similar in both groups.

Lang et al²² conducted a prospective randomized trial of adjunctive nonpharmacologic analgesia for invasive radiologic procedures in 3 groups: percutaneous vascular radiologic intraoperative standard intravenous conscious sedation care; structured attention; and intravenous conscious sedation that included self-hypnotic relaxation. Pain increased linearly with time in the standard group and in the structured attention group, but it remained flat in the hypnosis group. Anxiety decreased over time in all 3 groups but more so in the hypnosis group. Drug use was significantly higher in the standard group, intermediate in the structured attention group, and lowest in the self-hypnosis group. Hemodynamic stability was significantly higher in the hypnosis group than in the other 2 groups. Procedure times were significantly shorter in the hypnosis group than in the standard group. Individual imagery was quite varied.²³

Lang et al²² concluded that hypnosis worked better in reducing pain and anxiety, in maintaining hemodynamic stability, and in shortening the procedure time than standard intraprocedural care; the results of the structured attention group were in between those of the hypnosis group and the standard care group.

Lang and Rosen²⁴ used the data from the above study to perform a cost analysis of standard intravenous conscious sedation compared with intravenous conscious sedation that included self-hypnotic relaxation. The average cost per case associated with standard sedation was $638 compared with an average cost of $300 per case for sedation augmented by hypnosis. The cost savings averaged $338 per case.

Permitting the patient to choose his or her own self-guided imagery seems to allow most individuals to reach a state of relaxation during procedures. The author has used the technique from the invasive radiologic studies modified for dermatology with good success in dermatologic surgery.²⁵ Eye-roll induction was most commonly used by the author; this method works quickly for most patients.

Hypnotherapy for Specific Dermatologic Conditions

Much of the older literature about the effectiveness of hypnosis on specific dermatologic conditions is based on one or a few uncontrolled cases. The word may is used below to qualify recommendations that are based on weak evidence. In recent years, randomized controlled trials have produced more reliable information. Unfortunately, randomized controlled trial results are still not available for most of the disease categories. The list of dermatologic conditions below is not all-inclusive, but it does include most of the dermatologic conditions for which hypnosis is reasonably helpful in reducing symptoms or in improving aspects of the condition. They are arranged on the basis of the strength of scientific evidence for the effectiveness of hypnosis, starting with the strongest evidence.²⁶ Those dermatologic conditions supported by only one or a few case reports are listed in alphabetical order toward the end of this section, starting with acne excoriée.

Randomized controlled trials

Verruca vulgaris²⁷

The early report by Sulzberger¹ on the efficacy of suggestion in treating warts has since been confirmed numerous times. Numerous reports attest to the efficacy of hypnosis in treating warts.^28,29 In a well-conducted randomized controlled study by Spanos et al³⁰ that serves as a typical example, 53% of the experimental group had improvement of their warts 3 months after the first of 5 hypnotherapy sessions, while none of the control group had improvement. Hypnosis can be successful as a therapy for warts.

Psoriasis

Stress is often a factor in the onset, exacerbation, and prolongation of psoriasis. Hypnosis and suggestion have been shown to have a positive effect on psoriasis. In a typical case report, 75% clearing of psoriasis was reported by using a hypnotic sensory-imagery technique. A case of extensive, severe psoriasis of 20 years’ duration showed marked improvement by using sensory imagery to replicate the sensations in the patient’s skin that he had experienced during sunbathing. Another case of severe psoriasis of 20 years’ duration fully resolved with a hypnoanalytic technique.

Tausk and Whitmore³¹ performed a small randomized double-blind controlled trial by using hypnosis as adjunctive therapy in psoriasis, with significant improvement in individuals who were highly susceptible to hypnosis. Hypnosis can be useful as an adjunct therapy for resistant psoriasis, especially if an emotional factor is significant in the triggering of the psoriasis.

Venipuncture in children

Liossi et al conducted a prospective, randomized, controlled trial to compare the efficacy of a local anesthetic (EMLA), EMLA plus hypnosis, or EMLA plus attention in children receiving venipuncture. Children in the EMLA-plus-hypnosis group reported less anticipatory anxiety and less procedure-related pain and anxiety; they were rated as demonstrating less behavioral distress during the procedure than patients in the other 2 groups. Additionally, parents whose children were randomized to the EMLA-plus-hypnosis group experienced less anxiety during their child’s procedure than parents whose children had been randomized to the other 2 groups.³²

Nonrandomized controlled trials

Atopic dermatitis

Stewart and Thomas³³ treated 18 adults with extensive atopic dermatitis whose conditions had been resistant to conventional treatment with hypnotherapy. In a nonrandomized controlled study, they used relaxation, stress management, direct suggestion for nonscratching behavior and for skin comfort and coolness, ego strengthening, posthypnotic suggestions, and instruction in self-hypnosis. The results were statistically significant for reduction in itching, scratching, sleep disturbance, and tension. The use of topical corticosteroids decreased from the original amount by 40% at 4 weeks, 50% at 8 weeks, and 60% at 16 weeks. For milder cases of atopic dermatitis, hypnosis, along with moisturizing, can be sufficient as a primary treatment. For more extensive or resistant atopic dermatitis, hypnosis can reduce the required amount of other conventional treatments.³⁴

Case series

Alopecia areata

Gupta et al³⁵ found a strong correlation between high stress reactivity and depression in patients with alopecia areata. Willemson et al³⁶ used hypnotherapy for 21 patients, 9 with alopecia universalis and 12 with extensive alopecia areata. After hypnotherapy, all patients had significantly lower anxiety and depression. Complete scalp hair regrowth occurred in 9 patients, including 4 with alopecia universalis and 2 with ophiasis. Over 75% scalp hair regrowth occurred in another 3 patients. Five patients had a significant relapse of alopecia. Hypnosis is appropriate as a stress reducer and sometimes is successful as a primary treatment method for alopecia areata.

Urticaria

Two cases of urticaria responding to hypnotic suggestion were reported in a study. The study included an 11-year-old boy whose urticarial reaction to chocolate could be blocked by hypnotic suggestion so that hives appeared on only one side of his face in response to that hypnotic suggestion. A case series study of hypnosis with relaxation therapy on 15 patients with chronic urticaria for an average duration of 7.8 years showed that within 14 months, 6 patients’ conditions had cleared and 8 had improved, with decreased medication requirements reported by 80% of patients. One patient’s condition did not improve. Hypnosis may be useful as a therapy for chronic urticaria.

Individual case reports

Acne excoriée

Hollander³⁷ reported success in controlling the picking aspects of acne excoriée in 2 cases by using posthypnotic suggestion. While in a hypnotic state, the patient was instructed to remember the word scar whenever she wanted to pick her face and to refrain from picking by saying scar. The excoriations resolved but not the underlying acne. The author has also used this technique successfully.³⁸ Hypnosis, combined with standard acne treatments for the acneiform aspects, may be an appropriate treatment of the excoriation aspect of acne excoriée.

Congenital ichthyosiform erythroderma

Several cases of remarkable clearing of congenital ichthyosiform erythroderma of Brocq have been reported following direct suggestion for clearing under hypnosis. For example, Kidd³⁹ reported improvement in a 34-year-old father and his 4-year-old son. Hypnosis, in addition to the use of emollients, may potentially be useful.

Dyshidrotic dermatitis

Reduction in the severity of dyshidrotic dermatitis has been reported with the use of hypnosis as a treatment. Greisemer’s⁶ data indicate a significant psychosomatic component for dyshidrosis; therefore, hypnosis may be useful as a therapy.

Erythema nodosum

Resolution of erythema nodosum of 9-year duration occurred in a 44-year-old woman after hypnoanalysis.¹³ Five of the 7 key COMPASS factors were positive in this case.

Erythromelalgia

One case report exists of successful treatment of erythromelalgia in an 18-year-old woman using hypnosis alone followed by self-hypnosis. Permanent resolution occurred.

Furuncles

Jabush⁴⁰ described a 33-year-old man with recurrent (since age 17 y), multiple furuncles that containedStaphylococcus aureus; the furuncles were unresponsive to multiple treatment modalities. The patient had a negative self-image. Hypnosis and self-hypnosis with imagined sensations of warmth, cold, tingling, and heaviness resulted in dramatic improvement over 5 weeks, with full resolution of the recurrent furuncles. He also substantially improved from a mental standpoint. The hypnosis was hypothesized to have helped in some way to normalize the immune response to the bacteria. Conventional antibiotic therapy is the first line of treatment for furuncles; however, in unusually resistant cases with significant psychosomatic overlay, hypnosis may help to end the recurrent cycles of infection.

Glossodynia

When oral pain has a psychogenic component, hypnosis may be effective as a primary treatment. Even with organic disease, hypnosis may temporarily relieve pain.⁴¹

Herpes simplex

Lessening of discomfort from herpes simplex eruptions is similar to that for postherpetic neuralgia. Reduction in the frequency of recurrences of herpes simplex following hypnosis has also been reported. In cases with an apparent emotional trigger factor, hypnotic suggestion may be useful as a therapy for reducing the frequency of recurrence.

Hyperhidrosis

Hypnosis and autogenic training may be useful as adjunctive therapies for hyperhidrosis.

Ichthyosis vulgaris

A 33-year-old man with chronic ichthyosis vulgaris that was better in the summer and worse in the winter began hypnotic suggestion therapy in the summer and was able to maintain the summer improvement throughout the fall, winter, and spring. Hypnosis may be useful as an adjunct therapy for ichthyosis.

Lichen planus

Both the pruritus and the lesions may be reduced in selected cases by using hypnosis as a therapy for lichen planus.

Neurodermatitis

Several cases of neurodermatitis have reportedly resolved by using hypnosis as a therapy. Neurodermatitis remained resolved, with up to 4 years of follow-up.⁴² Iglesias⁴³ reported 3 cases of neurodermatitis that failed to respond to direct suggestion under hypnosis but that responded to hypnoanalysis with ideomotor signaling followed by reframing. Hypnosis may be useful as a therapy for neurodermatitis.

Nummular dermatitis

Reduction of pruritus and resolution of lesions have been reported with the use of hypnotic suggestion as complementary therapy for nummular dermatitis.

Postherpetic neuralgia

The pain of acute herpes zoster and postherpetic neuralgia can be reduced by hypnosis. Hypnosis may have a place as a therapy for postherpetic neuralgia.

Pruritus

The intensity of pruritus may be modified and improved by hypnosis. For example, a man with chronic myelogenous leukemia had intractable pruritus, which improved with hypnotic suggestion. Hypnosis may be used as a therapy for intractable pruritus.

Rosacea

Improvement of rosacea, especially the vascular blush component, has been reported in selected cases of resistant rosacea where hypnosis has been added as a therapy.

Trichotillomania

Several cases of successful adjunctive treatment of trichotillomania with hypnosis have been reported. Hypnosis may be a useful therapy for trichotillomania.⁴⁴

Vitiligo

Hautmann and Panconesi⁴⁵ detailed the psychoneuroendocrinimmunologic aspects and mechanisms of vitiligo. Occasional cases of vitiligo have improved by using hypnotic suggestion as a therapy.

Advantages and Disadvantages of Hypnotherapy

Hypnosis is currently an underused therapy in dermatology. In appropriately selected patients, it can decrease or eliminate symptoms, and, in some cases, it can induce lasting remissions or cures of skin diseases. Discussing this option with patients allows the dermatologist to gauge the patient’s receptiveness to this treatment modality. The time requirements for screening patients, educating them about realistic expectations for results from hypnosis, and performing the hypnotherapy are generally no longer than those for screening, preparing, and educating patients about cutaneous surgery and then performing it.

Many dermatologists choose to refer patients with complex cutaneous surgical problems to competent specialists in dermatologic surgery. Likewise, many dermatologists choose to refer patients with complex psychosomatic dermatologic problems to competent specialists in hypnosis-assisted therapy. Those dermatologists who prefer to refer patients to hypnotherapists may obtain referrals and information from the American Society of Clinical Hypnosis or similar professional organizations.

Advantages of medical hypnotherapy for skin diseases include the ability to obtain a response where other treatment modalities have failed; the ability to reduce relapses; and the ability of patients to self-treat and gain a sense of control when taught self-hypnosis reinforced by using audiotapes, nontoxicity, and cost-effectiveness. Adding this treatment can result in pleased and grateful patients.

Disadvantages of medical hypnotherapy in dermatology include the extensive training required; the low hypnotizability of some patients; the negative social attitudes still prevalent about hypnosis; and the lower reimbursement rates for cognitive therapies, such as hypnosis, when compared with procedural therapies, such as cutaneous surgery. The low hypnotizability of some individuals is consistent over time, as measured by the Hypnotic Induction Profile.

Training in Medical Hypnotherapy

The American Society of Clinical Hypnosis offers weekend, regionally held, 20-hour courses in beginning, intermediate, and advanced hypnosis. Information may be obtained from its Web site (ie, American Society of Clinical Hypnosis). Other organizations also offer training. Mentors are available once the practitioner has obtained the necessary basic training.

Legal Requirements for Practicing Medical Hypnotherapy

In the United States, a state license is required to practice medicine. The exact details in terms of legal limitations vary from state to state; therefore, checking state statutes is recommended and imperative. In some states (eg, Florida), the practice of hypnotherapy is limited to licensed practitioners. The training requirements depend on the type of license. Outside of the United States, most jurisdictions have their own laws or statutes that dictate who may legally practice hypnosis. One should check for details in his or her local area.

As with all medical procedures, informed consent is crucial before proceeding with medical hypnotherapy. Although it does not need to be a written consent, informed consent should be well documented in the patient’s chart if no written form is signed by the patient.

In many states, prior hypnosis may be considered to taint the memory with respect to legal testimony given by patients if they are plaintiffs, victims, or witnesses. If the area to be addressed by medical hypnotherapy might be open to future litigation, the credibility of the patient’s testimony may suffer. This potential legal issue should be included in the informed consent discussion.

Delving into repressed memories is a legally risky issue because of legal claims by patients that therapists have created false memories. Only adequately trained physicians, psychiatrists, and psychologists who know how to avoid asking leading questions should venture into this area.

The above information is not warranted to be legally correct. If indicated by the situation, conferring with a qualified attorney to obtain legal advice is recommended.

Patient Selection

Suitable candidates for the use of hypnosis are patients who are mentally intact; not psychotic or intoxicated; motivated, not resistant; and preferably moderately or highly hypnotizable, as rated by the Hypnotic Induction Profile described by Spiegel and Spiegel or by the Stanford Hypnotic Susceptibility Scale and its variants. However, a moderate or high degree of hypnotizability is not critical to the success of self-guided imagery for relaxation and discomfort reduction.

Patient selection is an important aspect of successful medical hypnotherapy in dermatology. Hypnosis-assisted therapy works best in moderately to highly hypnotizable patients who are appropriately motivated and who have dermatoses with a large psychosomatic component or are otherwise known to be responsive to intervention with hypnosis. As with any therapy, starting with simple, easy cases is best, referring the more complex cases to those with more experience. As the practitioner gains experience, more difficult cases may be added.

When appropriately applied, hypnosis can be effective and gratifying in many cases. It is not a panacea. Although it appears to work miracles for some and to fail completely for others, most results lie somewhere in between. A key factor in producing positive results is the specific type of therapy chosen to be assisted by hypnosis. Careful selection of the disease process, the patient, and the provider, as well as appropriate use of hypnosis, can decrease suffering and morbidity from skin disorders with minimal adverse effects.

Keywords

hypnosis, medical hypnotherapy, hypnotherapy, hypnoanalysis, hypnotic relaxation, hypnosis during surgery, methods of hypnotherapy, advantages of hypnotherapy, disadvantages of hypnotherapy