The skin is a mirror of the inner self, and we frequently use phrases which reflect this; ‘getting under your skin’, ‘thin skinned’, ‘thick skinned’, ‘itching to do something’ for example. These all reflect the fact that it is recognised as a measure of our vulnerability. We use these phrases without thinking about them. It is only when the skin begins to malfunction that these expressions really start to have a meaning.

To understand where non-viral or bacterial skin conditions come from, it is appropriate to look at where the skin develops when we are in embryonic stage. The epidermis and nervous system originate from the ectoderm, and as such, when the embryo fully develops a strong series of connections exist between the two. Therefore, an imbalance within the nervous system may frequently be reflected in the epidermis itself. It can be a signal of an implicit vulnerability to a situation, or a response to that initiating trigger itself. Therefore, treating the symptom alone for psychogenic disorders is not as effective as treating the trigger as well. This is why hypnosis for skin conditions can be so productive.

Hypnosis is effective for the treatment of dermatological conditions in three specific ways. Firstly, treatment of the root cause; secondly, remission of the symptom, and finally through treating the conditioned response to the symptom.

It is very important to be aware of the very distressing effects which these types of condition have on the individual, and their sense of self.
An initial consultation would consist of, among other things, finding out what the patient enjoys doing, and what they do to relax. This information is then fed back to the patient in hypnosis to establish biofeedback connections with positive associations. When talking about something we enjoy, we begin to come out of ourselves, and take our mind off things which are a concern. This demonstrates that there are times when the patient is not so aware of their problem, and this they do naturally by becoming occupied in something else. This is done also to establish that the symptom is not always constant, and therefore manipulable.

One of the most important questions which the therapist must ask before treating the patient with hypnosis is to find out which of the three component parts of the problem, the cause; the symptom; or their reaction to the symptom is the thing which is of most concern to them. The emphasis here is on which element of the condition they wish to take control of first.

Control

With any condition with a psychogenic component, the patient suffers from feelings of being out of control, this is made worse by the visibility of the symptom. This visibility has social implications and can hold the patient back from forming the social bonds which in themselves can take them away from the problem, i.e. manipulate the symptom. Unlike standard treatment, where the patient is booked in for a course of sessions, the patient is asked to initially come back after a three week period. This is the length of time usually considered for an idea to become sufficiently fixed in the mind. The patient will then designate the speed and frequency of subsequent sessions. This is to allow the patient another area of control which strengthens confidence in themselves and their commitment to the therapeutic process. 

Stress

Stress increases the vulnerability of the autonomic nervous system and this has a direct effect on the epidermis. This increases the dermatological symptoms and sets the patient into an anxiety loop. The worse the external stress becomes, the more the autonomic nervous system reacts in response, the worse any dermatological reaction.

One of the most effective ways the therapist can help in alleviating the symptom is to teach the patient self hypnosis for stress reduction. This allows the patient to regain a level of control of certain autonomic functions of the system, such as breathing and regulation of the heart rate. This serves the twofold process. It demonstrates that autonomic functions can be manipulated using hypnosis, and by reducing the stress component of the problem, the symptom itself will reduce. 

Treating the trigger

There are two categories into which individuals with a problem fall. The first is those who need to know why they do something before they can move away from the problem, and those who feel they have already dealt with that aspect of the problem and simply require a remission of the symptoms. 

Those people who need to know why they have their problem require treatment involving analysis or regression. The aim of these techniques is to give an insight into the root cause of the problem. This work can be done in a context free manner, so it is not necessary in hypnotherapeutic treatment for the material to come to consciousness, only that the emotional content is released in a cathartic manner. The underlying principal is that the release of the emotional component will eradicate the need for the symptom.

For those whose primary concern is the eradication of the problem, i.e. those who feel that the initiating reason for their condition is not relevant to them anymore, the trigger still needs to be dealt with. In these instances, dissociation techniques are often used. These techniques concentrate on a resolution or re-integration of a problem part – the part which caused the problem. With dermatological conditions which provoke a conditioned reflex such as scratching, the most distressing aspect for the individual is the feeling that they are scratching without any conscious awareness, such as in their sleep. The principal of dissociation brings back the part which scratches, and re-integrates it into the whole, therefore eradicating the need for the symptom, and bringing the trigger under conscious control.

Dealing with the symptom

As the symptom provoked can itself cause additional problems, such as poor self image, and a lack of confidence, this aspect is addressed through ego-strengthening techniques. This reduces the stress and helps take the patient out of themselves, and away from focussing on the condition. 

As some dermatological conditions respond well to exposure to ultra violet light, creative visualisation in hypnosis can be used to take the patient to a warm beach, where they can safely experience the healing effects of the sun. If the patient is receptive to imagery, the same physiological and psychological changes will be produced as if they were actually experiencing it. Changes in skin pigmentation corresponding to sun exposure have been seen in this therapeutic application of visualisation. Finding out what the patient uses effectively to ease the symptom can also be fed back in hypnosis, and therefore amplified on the unconscious level at which the problem has been operating. 

A final aspect in dealing with the symptom in this type of hypnotherapeutic intervention is the generation of new, healthy skin. This can be done in one of two ways. Either the patient is asked to remember a time when their skin was healthy, i.e. a time before the condition occurred, or imagery is used of how they wish themselves to look when their skin is healthy.

Coping with the reaction to the symptom

In addition to the symptom itself, the conditioned response needs to be extinguished. Scratching or itching, which gave temporary relief to the patient from the condition, itself becomes a habit. Even when the trigger has been removed and the new dermatological response generated, the reaction still remains in place and must also be deconditioned. If this is not done, at any time in the future should the individual become stressed or their immune system depleted, the habit can resurface and cause an apparent re-occurence of the symptom. Once the patient becomes aware that their skin condition is deteriorating, they begin to focus on that area, they become more stressed, and the pattern becomes a vicious circle until the condition starts afresh. 
The scratching or itching can be dealt with by hypno- desensitisation, a gradual process which weans the individual off the behaviour. 

Glove anaesthesia

Glove anaesthesia is a hypnotic technique which can also be used in hypnosis to allow the patient to alter perception of sensitivity. A specific technique which uses suggestions of cold and numbness is used for dermatological conditions. This is used to produce vaso-constriction for a numbness or coolness to reduce sensitivity to the itch itself. This is done by teaching the patient how to produce analgesia in their hand. They are then taught how to transfer this lack of sensitivity/numbness or coldness to any part of the body they wish. This stage of the treatment reduces the physical need for the itching or scratching, and allows the skin to begin to heal until the habitual element of the behaviour is extinguished. In certain instances, warmth can be generated to produce vaso-dilation to increases the blood supply to the area it is needed, and speed up the physical healing process.

Case study

A twenty five year old female patient presented with severe eczema, particularly on her hands. Her condition occurred periodically over nine years and she had tried various treatments from steroid treatment to homeopathy. 
When asked what her main concern with regard to the condition was at that moment in time, she responded that she was currently working on a high pressure project which she found particularly stressful. Her primary concern was that she should be able to get through the project without undue associated stress which caused her palpitations and trembling. 
     
In the first consultation she was taught self hypnosis which she was to practise every evening and whenever she felt the need during the day. This improved her ability to go into a hypnotic state, while also allowing her to take direct action to control her main area of concern. 
     
Once the project was completed, she returned to continue her treatment. She was aware of when the condition started and felt that this was no longer relevant to her. A dissociation technique was used to re-integrate the part which ‘took over’ when she scratched, and re-integrated. This was done to bring the trigger back under conscious control. 
     
In a subsequent session, imagery of relaxing warm beaches was used, as she had stated that exposure to sunlight alleviated her symptom. As part of the post-hypnotic suggestion she was asked to look for changes in her skin condition, and to become as involved in her environment as possible. The redness of the skin was by this time reducing, and she noticed that the more severe thickening of skin on her hands was also lessening. 
     
Continued use by the patient of self-hypnosis during this time, as well as positive ego- suggestions increased her ability to take control of herself, and she noted that her confidence was increasing in social situations. As the timescale and number of sessions was also under her control, she indicated that she felt confident to discontinue with the sessions and would continue to practise her self hypnosis. At this stage it was suggested that should she wish to return in three months time, or if she felt the need to contact the therapist during that time she could. This was done as a safety net proviso, and allowed the patient ongoing security should anything come up in that time. 
     
After four months the patient returned to show what she called her ‘new self’. The skin was healthy, and only the more severe areas around the finger joints still showed slight discolouration. The patient was happy with her progress and discussed all the things which she now felt confident to do.

Conclusion

Working with dermatological conditions is one of the most rewarding types of treatment in hypnosis. The changes which take place can be viewed directly, and as the condition improves, so confidence increases, and the patient gets into a positive mindset about themselves and their future. If you wish to undertake a course of hypnotherapy for dermatological conditions, go to your medical practitioner first to check that there is not a physiological basis for your condition. In the UK, practitioners of these techniques can be found by telephoning the British Society of Clinical Hypnosis on 0171-499 2813.