Skin conductance conditioning with dyshidrotic eczema patients

Integrative Treatment Approaches with Mind-Body Therapies in the Management of Atopic Dermatitis

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the mind and body via the skin-brain axis have led to an interest in mind-body therapies (MBT). The aim of this article is, therefore, to reinforce the importance of psychodermatological care in AD. We performed a focused literature review on holistic practices or integrative MBT in AD, including education, cognitive behavioral therapy, habit reversal, meditation, mindfulness, hypnotherapy, eye movement desensitization and reprocessing, biofeedback, progressive muscle relaxation, autonomous sensory meridian response, music therapy, massage, and touch therapy. A multidisciplinary holistic approach with MBT, in addition to conventional pharmacologic antipruritic therapies, to break the itch-scratch cycle may improve AD outcomes and psychological well-being. Although there is a paucity of rigorously designed trials, evidence shows the potential benefits of an integrative approach on pruritus, pain, psychological stress, anxiety, depressive symptoms, and sleep quality. Relaxation and various behavioral interventions, such as habit reversal therapy for replacing harmful scratching with massaging with emollient 'plus', may reduce the urge to scratch, while education may improve adherence to conventional therapies.

Stress and Skin: An Overview of Mind Body Therapies as a Treatment Strategy in Dermatology

Stress has multiple and wide-ranging physiologic and clinical impacts on skin disease. This has led to an interest in mind body therapies as potential adjunct treatments for skin disease. The stress response results in the activation of the endocrine, neurologic, and immune systems, with a resulting cascade of impacts, that are both systemic and cutaneous. The 2 main arms of the stress response are the sympathetic nervous system and the hypothalamic-pituitary-adrenal axis. The resultant release of cortisol, catecholamines, and neuropeptides has multiple effects. Clinically, these have been shown to increase skin inflammation, increase itching, impair skin barrier function, impair wound healing, and suppress immunity. Mind body therapies are those that focus on the interaction between the mind and the body, with the goal to influence physical function and impact health. These have been shown to ameliorate some of the harmful physiologic changes attributed to stress or to reduce harmful behaviors. In some cases, such as with biofeedback, they may also result in beneficial physiologic changes. Treatments such as meditation, biofeedback, hypnosis, guided imagery, and others have been evaluated in the treatment of skin disease and have shown some benefits. Although randomized controlled trials are limited, these interventions have shown beneficial effects on itching, psychosocial outcomes, and even skin severity. These interventions have been evaluated in diseases such as atopic dermatitis, psoriasis, trichotillomania, and others. Given the potential benefits, improvements in psychosocial outcomes, and a low risk profile, referral to qualified practitioners or multidisciplinary clinics should be considered for some patients.

Complementary and Alternative Medicine for Atopic Dermatitis: An Evidence-Based Review

BACKGROUND

Complementary and alternative interventions are becoming increasingly utilized as adjuncts to conventional treatment of atopic dermatitis (AD). While the number of studies continues to grow, the vastness of the subject coupled with the relatively poor quality and small size of the studies limit their usefulness to clinicians.

PURPOSE

Our aim was to comprehensively review randomized controlled trials (RCTs) of complementary and alternative therapies for AD.

METHODS

Searches were performed on PubMed, the Cochrane Central Register of Controlled Trials, EMBASE, and the Global Resource for EczemA Trial (GREAT) databases, focusing on RCTs of alternative or complementary AD therapies, with a sample size of ≥10, through March 2015 and limited to the English language. A total of 70 manuscripts met the inclusion criteria and were included in the final analysis.

RESULTS

There is at least some level I evidence to support the use of acupuncture and acupressure, stress-reducing techniques such as hypnosis, massage, and biofeedback, balneotherapy, herbal preparations (with many important caveats), certain botanical oils, oral evening primrose oil, vitamin D supplementation, and topical vitamin B₁₂. Many other therapies either have sufficient data to suggest that they are ineffective, or simply do not have enough evidence to formulate a verdict.

CONCLUSIONS

Careful review of the literature reveals several promising therapies in this domain; such findings may help direct further research that is necessary to bolster clinical recommendations for alternative or complementary treatments of AD.

Psychodermatology: an update

It has been estimated that in at least one third of dermatology patients, effective management of the skin disorder involves consideration of associated emotional factors. This article provides an overview of psychodermatology with a focus on the more recent literature and an emphasis on the clinical aspects and psychologic therapies for (1) cutaneous associations of psychiatric disorders and (2) psychiatric associations of certain cutaneous disorders that are known to be influenced by psychosomatic factors. This article also provides an update on the use of psychotropic drugs (i.e., the antianxiety, antidepressant, and antipsychotic agents) for the treatment of mental disorders that occur in conjunction with cutaneous conditions. Some of their other pharmacologic properties, such as the antihistaminic and analgesic effects of some antidepressant agents are also reviewed.

Hand dermatitis: practical management and current concepts

hand dermatitis (HD) is a common clinical challenge, its management a clinical art. The vexing problem of etiologies is simplified by classifying causative factors as either exogenous or endogenous. Most patients respond to avoidance of irritants combined with appropriate topical corticoids and lubrication. While certain aspects of treatment must be individualized, many of the protective and lubricating measures are routine. Patient compliance with these routine, and necessarily involved, measures is greatly improved by using printed instruction forms. A minority of patients with HD will challenge the most skilled clinician. At present, technics for determining the role of endogenous versus exogenous factors are not satisfactory. Even repeated and involved patch testing combined with prolonged observation may leave a nagging uncertainty . . . is there an overlooked allergen responsible for this chronic dermatitis? The chronic, endogenous, palmar, vesicular dermatoses represent a stubborn therapeutic problem. Potent corticoids under occlusion, while often effective, tend to produce atrophy. Intralesional corticoids are practical only for small areas. Systemic corticoids, while producing dramatic relief, only postpone the problem, since their side effects preclude long-term usage. At times psoralens and ultraviolet A (PUVA) therapy provides effective control. With perceptive persistence, most chronic HD can be effectively controlled. It is worth the effort, for often it means restoring a social and economic outcast to a useful and happy life.

Use of biofeedback in treating chronic hyperhidrosis: a preliminary report

Preliminary findings attesting to the successful therapeutic use of biofeedback training in reducing symptoms of chronic hyperhidrosis are reported. Eleven of the fourteen adult patients trained with biofeedback were able to demonstrate clinical improvement in their excessive sweating 6 weeks after termination of treatment. Relaxation was suggested as the active ingredient in the biofeedback treatment effect. These findings support a recent report of the successful use of biofeedback in treating patients with dyshidrotic eczema.