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Hypnosis in Dermatology

Article  in  Archives of Dermatology · April 2000

DOI: 10.1001/archderm.136.3.393 · Source: PubMed

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 REVIEW

Hypnosis in Dermatology
Philip D. Shenefelt, MD, MS

Background: Hypnosis is an alternative or complemen- native or complementary therapy, including acne

tary therapy that has been used since ancient times to treat
medical and dermatologic problems.
Objective: To describe the various uses for hypnosis
as an alternative or complementary therapy in dermato-
logic practice.
Methods: A MEDLINE search was conducted from Janu-
ary 1966 through December 1998 on key words related
to hypnosis and skin disorders.
Results: A wide spectrum of dermatologic disorders
may be improved or cured using hypnosis as an alter-
excoriée, alopecia areata, atopic dermatitis, congenital
ichthyosiform erythroderma, dyshidrotic dermatitis,
erythromelalgia, furuncles, glossodynia, herpes sim-
plex, hyperhidrosis, ichthyosis vulgaris, lichen planus,
neurodermatitis, nummular dermatitis, postherpetic
neuralgia, pruritus, psoriasis, rosacea, trichotilloma-
nia, urticaria, verruca vulgaris, and vitiligo.
Conclusion: Appropriately trained clinicians may success-
fully use hypnosis in selected patients as alternative or
complementary therapy for many dermatologic disorders.
Arch Dermatol. 2000;136:393-399

From the Division of
Dermatology and Cutaneous
Surgery, Department of
Internal Medicine, College of
Medicine, University of South
Florida, Tampa.
T
HE HYPNOTIC phenom-
enon has been used since
ancient times in the form of
trance induction to assist
healing. Each of us goes
into spontaneous mild trances daily while
engrossed in watching television or a
movie, reading a book or magazine, or oth-
erwise being absorbed in some activity or
meditation. With proper training, an in-
dividual can intensify this trance state in
himself or herself or in another indi-
vidual, and use this heightened focus to
induce mind-body interactions that help
alleviate suffering or promote healing. The
state of altered consciousness known as a
“trance state” may be induced using guided
imagery, relaxation, deep breathing, medi-
tation techniques, self-hypnosis, or hyp-
nosis-induction techniques. Some indi-
viduals are more highly hypnotizable than
others, but most can obtain some benefit
from hypnosis. In dermatologic practice,
hypnosis may help reduce skin pain and
pruritus, ameliorate psychosomatic as-
pects of skin diseases, and hasten the reso-
lution of some skin diseases, including ver-
ruca vulgaris. Even suggestion, without
formal trance induction, can be effective
in some patients. Early articles on the use
of suggestion to treat verrucae include
those by Bloch1 and Sulzberger and Wolf.2
The precise definition of hypnosis has
proven to be slippery. Marmer3 defined hyp-
nosis as a psychophysiological tetrad of al-
tered consciousness consisting of nar-
rowed awareness, restricted and focused
attentiveness, selective wakefulness, and
heightened suggestibility. For more de-
tailed discussion of the definitions of hyp-
nosis, see Crasilneck and Hall4 or Wat-
kins. 5 Many myths exist regarding
hypnosis—too numerous to enumerate and
refute here—that overrate, underrate, and
distort the true capabilities of hypnosis.
PSYCHOPHYSIOLOGIC
EFFECTS OF HYPNOSIS
To what degree hypnosis can affect physi-
ological factors such as blood flow and re-
lease of chemical mediators, as opposed
to a purely psychological response, is of-
ten difficult to measure reliably. Nonethe-
less, many patients note subjective im-
provement of symptoms and, in some
cases, objective reductions in the size,
number, or intensity of skin lesions. The
exact psychophysiologic mechanisms by
which hypnosis induces improvement are

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 Table 1. Emotional Triggering of Dermatoses
MATERIALS AND METHODS in 4576 Patients*

Time Interval
A MEDLINE search was conducted from January 1966 Diagnoses Between Stress
through December 1998 on key words related to hyp- Emotionally Occurrence and
nosis and skin disorders. Hypnosis was searched as Diagnosis Triggered, % Clinical Change
a MeSH category, and “hypnosis” and “hypnotic” as Hyperhidrosis 100.0 Seconds
title and abstract words. Names of specific skin dis- Neurotic excoriations 97.5 Seconds
eases were searched as MeSH categories, and as title Lichen simplex chronicus 98.4 Days to 2 wk
and abstract words. Boolean “and” combinations of Alopecia areata 96.4 2 wk
hypnosis and hypnotic with names of specific skin Warts, multiple and spreading 94.9 Days
diseases produced relevant references. References ear- Rosacea 94.1 2d
lier than 1966 and book references were obtained from Pruritus 85.7 Seconds
the reference lists that were included in articles. Pref- Lichen planus 81.8 Days to 2 wk
erence was given to articles based on controlled tri- Dyshidrotic hand dermatitis 75.8 2 d for vesicles
als when available. Case reports were included to cover Atopic dermatitis 70.2 Seconds for itching
the use of hypnosis in treating skin diseases when con- Factitial dermatosis 69.2 Seconds
trolled trials had not yet been reported. Urticaria 68.1 Minutes
Psoriasis 62.3 Days to 2 wk
Traumatic dermatitis 55.6 Seconds
Dermatitis not otherwise specified 55.6 Days
Acne vulgaris 55.3 2 d for papules
not fully elucidated. Hypnosis is known to be able to regu- Telogen effluvium 54.7 2-3 wk
late blood flow and other autonomic functions not usu- Nummular dermatitis 51.8 Days
ally under conscious control. The relaxation response that Seborrheic dermatitis 40.6 Days to 2 wk
Herpes simplex and zoster 35.7 Days
occurs with hypnosis also affects the neurohormonal sys-
Vitiligo 33.3 2-3 wk
tems that in turn, regulate many body functions (see the Nail dystrophy 28.5 2-3 wk
discussion and references in the remainder of this sec- Pyoderma and bacterial infections 29.1 Days
tion). Cysts 27.0 2-3 wk
Results of studies6-8 of the effect of hypnosis on im- Warts, single and multiple 17.4 Days
mediate immune responses show the ability of hypno- Contact dermatitis 15.3 2d
Fungal infections 8.7 Days to 2 wk
tized volunteers to significantly decrease the flare reac-
Basal cell carcinoma 0 ...
tion to the histamine prick test (P,.02). The effect of Keratoses 0 ...
hypnotic suggestion on delayed cellular immune re- Nevi 0 ...
sponses was significant on erythema size (P,.02) and
palpable induration (P,.01) in one study,6 but not in oth- *Modified from Griesemer.14 Ellipses indicate no relationship.
ers.9,10 However, even simple suggestion has been shown11
to induce contact dermatitis in an area not touched by
lacquer tree allergen but believed by sensitized individu- vide immediate and long-term analgesia, reduce symp-
als to have been so touched; the same individuals did not toms related to disease such as pruritus, improve
react when actually touched by lacquer tree allergen but recovery from surgery, and facilitate the mind-body
believed that they had not been so touched (P,.01). Simi- connection to promote healing. Hypnosis can be an
larly, using hypnosis, volunteers in a double-masked pro- especially useful tool for treating skin diseases that
tocol12 who were told to increase their sensitization to 1 have a psychosomatic aspect. Griesemer14 and Griese-
of 2 experimental allergens—dinitrochlorobenzene and mer and Nadelson15 recorded the incidence of emo-
diphenylcyclopropenone—while decreasing it to the other tional triggering of dermatoses in 4576 patients during
showed a significant difference in reactions between al- 1 year (Table 1).
lergens they were told under hypnosis to enhance and Good reference sources for skin disease response to
those they were told to diminish (P,.01). hypnosis are found in the somewhat outdated book by
Results of a study13 of persons with multiple per- Scott,16 and in a chapter on the use of hypnosis in der-
sonality disorder (now called dissociative identity dis- matologic problems in the book by Crasilneck and Hall.4
order) and different allergic responses; dermatologic re- Koblenzer17 also mentions the use of hypnosis in com-
actions; and effects on seizure disorders, pain control, and mon dermatologic problems. An excellent book for pa-
healing in the same individual, depending on the per- tients by Grossbart and Sherman18 discusses mind-body
sonality present, show how much influence the mind can interactions in skin diseases, and includes hypnosis as
have on physiological reactions and disease processes. recommended therapy for a variety of skin conditions.
This study cited similar related differences in physiologi- Some dermatoses that have responded to hypnotherapy
cal responses and disease conditions for some individu- are discussed in the following subsections.
als under hypnosis vs in their normal waking state.
Treatment strategies that include hypnosis may METHODS OF MEDICAL HYPNOTHERAPY
be used to improve healthful behaviors, diminish situ-
ational stress, alleviate phobias (eg, to needles or Hypnosis is a tool, analogous to a scalpel, that is used to
bugs), control harmful habits such as scratching, pro- cut through psychological and behavioral roadblocks to

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 healing. It is not a therapy in and of itself. The therapies
that can be facilitated by hypnosis include supportive (ego Table 2. Literature Summary for Hypnosis
strengthening), direct suggestion, symptom substitu- in Skin Disorders*
tion, and hypnoanalysis.16,19-21
Study
Induction of the hypnotic state in adults can be Type of
achieved by a variety of methods that focus attention, Disease Therapy RCT NRCT CS MCR SCR
soothe, or produce monotony or confusion. 4,5 In chil- Acne excoriée C 24
dren, the hypnotic state is often induced by having the Alopecia areata C 26
child pretend that he or she is watching television, a movie, Atopic dermatitis C 28
or a play, or by using some other distractive process that Congenital ichthyosiform C 30
erythroderma
uses the imagination.22
Dyshidrotic dermatitis C 33
Supportive (ego-strengthening) therapies during a Erythromelalgia A 34
hypnotic state include positive suggestions for self- Furuncles C 35
worth and effectiveness. Posthypnotic suggestion is Glossodynia C 36
often used, and further strengthening of the effect can Herpes simplex C 38
often be obtained by making an audiocassette tape that Hyperhidrosis C 39
Ichthyosis vulgaris C 40
the patient can use repeatedly for self-hypnosis. The
Lichen planus C 33
strengthened ego is then better able to repress or con- Neurodermatitis C 42
front discordant elements that block healing. Nummular dermatitis C 33
Direct suggestion while in the hypnotic state is the Postherpetic neuralgia C 38
most commonly used method of decreasing discomfort Pruritus C 45
from pain, pruritus, burning sensations, anxiety, and in- Psoriasis C 52 50
somnia. Posthypnotic suggestion and repeated use by the Rosacea C
Trichotillomania C 53
patient of an audiocassette tape for self-hypnosis helps Urticaria C 59
reinforce the effectiveness of direct suggestion. For deeply Verruca vulgaris ACP 80 81 71
hypnotizable individuals, direct suggestion may pro- Vitiligo C 33
duce a sufficiently deep anesthesia to permit cutaneous
surgery. Direct suggestion can also be used to reduce com- *RCT indicates randomized control trial; NRCT, nonrandomized control
pulsive acts such as skin scratching or picking, nail bit- trial; CS, case series; MCR, multiple case reports; SCR, single case report;
C, complementary; A, alternative; and P, primary. Numbers in the body of the
ing or manipulating, and hair pulling or twisting.16 Psy- table are reference numbers.
chophysiologic responses such as hyperhidrosis, blushing,
and some forms of urticaria can also be controlled by di-
rect suggestion. Some types of skin lesions can even be reliable information. 23 However, randomized con-
induced to resolve themselves by using direct sugges- trolled trial results are still not available for most dis-
tion, the classic example being verrucae (see the “Ver- ease categories. Although this list of dermatologic con-
ruca Vulgaris” subsection). ditions is not all-inclusive, it includes most of the
Symptom substitution is a method of retraining the dermatologic conditions for which hypnosis has been
subconscious through hypnosis to replace a destructive found to be reasonably helpful in reducing symptoms or
habit pattern with a more constructive one.13,16 For ex- improving aspects of the condition (Table 2).
ample, scratching can be replaced by some other physi-
cal activity, such as grabbing onto something and hold- Acne Excoriée
ing it so tightly for half a minute so that it almost hurts.
Other outlets for stress that can substitute for scratch- Hollander24 reported success in controlling acne excoriée
ing include athletic activities, artwork, verbal expres- in 2 patients by using posthypnotic suggestion. Under hyp-
sion of feelings, and meditation. nosis, the patient was instructed to remember the word
Hypnoanalysis may prove useful in patients with scar whenever she wanted to pick her face and to refrain
chronic psychosomatic dermatoses that are nonrespon- from picking by saying scar instead. The excoriations re-
sive to other, simpler approaches. Results may occur more solved, whereas the underlying acne did not. Therefore,
quickly than with standard psychoanalysis.16 hypnosis may be an appropriate primary alternative treat-
ment for the excoriation aspect of acne excoriée, with stan-
USES OF MEDICAL HYPNOTHERAPY FOR dard acne treatments for the acneiform aspects.
SPECIFIC DERMATOLOGIC CONDITIONS
Alopecia Areata
Many older studies of the effectiveness of hypnosis on
specific dermatologic conditions are based on 1 or a few Gupta et al25 found a strong correlation between high stress
uncontrolled cases. Although these findings are in- reactivity and depression in patients with alopecia ar-
cluded in the following subsections, they await further eata (P,.001). Hypnosis can be used to teach patients
confirmation. The word may is used to qualify recom- to control high stress reactivity. Although there are an-
mendations that are based on skimpy evidence. This weak- ecdotal reports of hypnotherapy improving alopecia ar-
ness should be kept in mind when evaluating the infor- eata, results of a small clinical trial26 of medical hypno-
mation and recommendations presented. In recent years, therapy with 5 patients who had extensive alopecia areata
the trend toward more controlled trials has produced more showed a significant increase in hair growth in only 1

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 patient; 3 had a slight increase in hair growth, and 1 had
no change. Hypnosis improved psychological variables
in these 5 patients.26 It seems that hypnosis may be more
appropriate as a complementary therapy than as a pri-
mary alternative treatment for alopecia areata.
Atopic Dermatitis
There are numerous anecdotal articles27 in the literature
of improved atopic dermatitis in children and adults as a
result of hypnotherapy. In a clinical trial, Stewart and
Thomas28 treated 18 adults with extensive atopic derma-
titis who had been resistant to conventional treatment with
hypnotherapy. They used relaxation, stress management,
direct suggestion for nonscratching behavior, direct sug-
gestion for skin comfort and coolness, ego strengthening,
posthypnotic suggestions, and instruction in self-
hypnosis. Their results were statistically significant (P,.01)
for reduction in itch, scratching, sleep disturbance, and ten-
sion. Reported topical corticosteroid use decreased by 40%
at 4 weeks, 50% at 8 weeks, and 60% at 16 weeks. For milder
cases of atopic dermatitis, hypnosis along with moistur-
ization can suffice as a primary alternative treatment. For
more extensive or resistant atopic dermatitis, hypnosis can
be a useful complementary therapy that reduces the amounts
required of other conventional treatments.
Congenital Ichthyosiform Erythroderma
Mason29 described remarkable resolution of congenital
ichthyosiform erythroderma of Brocq in a 16-year-old boy
after direct suggestion for resolution under hypnosis. Simi-
lar yet less spectacular results were confirmed by Wink30
in 2 sisters aged 8 and 6 years, by Schneck31 in a 20-year-
old woman, and by Kidd32 in a 34-year-old father and his
4-year-old son. In light of these case reports, hypnosis
may be potentially useful as a complementary therapy
to emollients.
Dyshidrotic Dermatitis
Reduction in severity of dyshidrotic dermatitis has been
reported with the use of hypnosis as a complementary
treatment.33 Data from Griesemer14 (Table 1) indicate a
significant psychosomatic component for dyshidrosis, so
hypnosis may be useful as a complementary therapy.
Erythromelalgia
In one case report34 of successful treatment of erythro-
melalgia in an 18-year-old woman using hypnosis alone
followed by self-hypnosis, permanent resolution oc-
curred.
Furuncles
Jabush35 described a 33-year-old man with recurrent mul-
tiple Staphylococcus aureus–containing furuncles since age
17 years that were unresponsive to multiple treatment
modalities. He had a negative self-image. Hypnosis and
self-hypnosis with imagined sensations of warmth, cold,
tingling, and heaviness brought about dramatic improve-
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ment in 5 weeks, with full resolution of the recurrent fu-
runcles. The patient also improved substantially from a
mental standpoint. Presumably, the hypnosis helped nor-
malize his immune response to the bacteria. Conven-
tional antibiotic therapy is the first line of treatment for
furuncles, but in unusually resistant cases with signifi-
cant psychosomatic overlay, complementary use of hyp-
nosis may help end the long-term susceptibility to re-
current infection.
Glossodynia
When oral pain has a psychogenic component, hypnosis
may be effective as a primary treatment.36 Even with or-
ganic disease, hypnosis may give temporary relief from pain.
Herpes Simplex
Onset of herpes labialis was intentionally triggered by hyp-
notic suggestion in a patient.37 Ameliorization of discom-
fort from herpes simplex eruptions is similar to that for
postherpetic neuralgia (see the “Postherapeutic Neural-
gia” subsection). Reduction in the frequency of recur-
rences of herpes simplex after hypnosis has also been re-
ported.38 In cases with an apparent emotional trigger factor,
hypnotic suggestion may be useful as a complementary
therapy for reducing the frequency of recurrence.
Hyperhidrosis
Hypnosis or autogenic training may be useful as adjunc-
tive therapies for hyperhidrosis.39
Ichthyosis Vulgaris
A 33-year-old man with lifelong ichthyosis vulgaris that
was better in summer and worse in winter began hyp-
notic suggestion therapy in the summer and was able to
maintain the summer improvement throughout the fall,
winter, and spring.40 Hypnosis may thus be useful as a
complementary therapy for ichthyosis.
Lichen Planus
Pruritus and the accompanying lesions may be reduced
in selected patients using hypnosis as a complementary
therapy for lichen planus.16,33
Neurodermatitis
Several cases of neurodermatitis have resolved using hyp-
nosis as an alternative therapy,41-44 and stayed resolved
for up to 4 years of follow-up. Hypnosis may be useful
as a complementary or even alternative therapy for neu-
rodermatitis.
Nummular Dermatitis
Reduction of pruritus and resolution of lesions has been
reported,16,33 with use of hypnotic suggestion as a comple-
mentary therapy for nummular dermatitis.
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 Postherpetic Neuralgia
The pain of acute herpes zoster and of postherpetic neu-
ralgia can be reduced by hypnosis.16,38 Hypnosis may have
a place as a complementary therapy for postherpetic neu-
ralgia.
Pruritus
The intensity of pruritus may be modified and im-
proved by hypnosis.16 An example45 is that of a man with
chronic myelogenous leukemia whose intractable pru-
ritus was much improved with hypnotic suggestion. Hyp-
nosis may be used as a complementary therapy for in-
tractable pruritus.
Psoriasis
Stress plays an important role in the onset, exacerba-
tion, and prolongation of psoriasis. Hypnosis and sug-
gestion have been shown to have a positive effect on
psoriasis.46-48 In a typical case report,49 75% resolution
of psoriasis was reported using a hypnotic sensory-
imagery technique. Another case50 of extensive severe
psoriasis of 20 years’ duration showed marked improve-
ment using sensory-imagery to replicate feelings in the
patient’s skin that he had experienced during sunbath-
ing. Yet another case51 of severe psoriasis of 20 years’
duration resolved fully with use of a hypnoanalytic
technique. Tausk and Whitmore52 performed a small,
randomized double-masked controlled trial using hyp-
nosis as adjunctive therapy in psoriasis, with significant
improvement in highly hypnotizable patients. Hypnosis
can be useful as a complementary therapy for resistant
psoriasis, especially if there is a significant emotional
factor in its triggering.
Rosacea
Improvement of rosacea, especially the vascular blush
component, has been described in selected cases of re-
sistant rosacea in which hypnosis has been added as
complementary therapy.16,33
Trichotillomania
Several cases of successful adjunctive treatment of tricho-
tillomania have been described.53-55 It seems that hypno-
sis may be a useful complementary therapy for tricho-
tillomania.
Urticaria
Inhibition of immediate-type hypersensitivity response
by direct suggestion under hypnosis was described for 8
of 12 patients.56 In another study,57 flare but not wheal
sizes were significantly reduced after hypnosis com-
pared with sessions without hypnosis. Two patients with
urticaria that responded to hypnotic suggestion were de-
scribed in another study,58 including an 11-year-old boy
whose urticarial reaction to chocolate could be blocked
by hypnotic suggestion, so that hives appeared on one
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side of his face but not the other in response to that hyp-
notic suggestion. In a study59 of hypnosis with relax-
ation therapy on 15 patients with chronic urticaria of 7.8
years’ average duration, within 14 months, 6 patients had
resolved and another 8 improved, with decreased medi-
cation requirements reported by 80% of patients. In se-
lected individuals, it seems that hypnosis may be useful
as complementary or even alternative therapy for chronic
urticaria.
Verruca Vulgaris
Results of the early studies by Bloch1 and Sulzberger and
Wolf2 on the efficacy of suggestion in treating warts have
since been confirmed numerous times to a greater or lesser
degree,60-63 as well as not confirmed in a few studies.64,65
A recent study66 with negative results was criticized for
using a negative suggestion about not feeding warts rather
than a positive suggestion about having the warts re-
solve. Numerous studies67-82 attest to the efficacy of hyp-
nosis in treating warts, but this was not confirmed in a
study83 that tried to replicate the success reported by Sin-
clair-Gieben and Chalmers84 of using hypnotic sugges-
tion to cause warts to disappear from one hand but not
the other in persons with bilateral hand warts. In a well-
conducted study85 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,
whereas none of the control group had improvement. In
summary, it seems that hypnosis can be helpful as comple-
mentary or alternative therapy for warts.
Vitiligo
Hautmann and Panconesi86 described in detail the psy-
choneuroendocrinimmunologic aspects and mecha-
nisms of vitiligo. Occasionally, patients with vitiligo have
improved using hypnotic suggestion as complementary
therapy.16,33
APPROPRIATE USE OF MEDICAL
HYPNOTHERAPY IN DERMATOLOGIC PRACTICE
Hypnosis currently is underused as an alternative or
complementary therapy in dermatologic practice. For
selected skin diseases in appropriately selected patients,
it can decrease or eliminate symptoms and, in some
cases, induce lasting remissions or cures. Discussing
this option with patients will allow the dermatologist to
gauge the patient’s receptiveness to this treatment
modality. Time requirements for screening patients,
educating them about realistic expectations for results
from hypnosis, and actually performing the hypno-
therapy are generally no greater than for screening, pre-
paring, and educating patients about cutaneous surgery
and then actually performing it. Just as many derma-
tologists choose to refer patients with complex cutane-
ous surgical problems to competent specialists in der-
matologic surgery, many dermatologists would choose
to refer patients with complex psychosomatic dermato-
logic problems to competent specialists in hypnosis-
assisted therapy. Dermatologists who prefer to refer
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 patients to hypnotherapists or who desire further infor-
mation about training in hypnotherapy can obtain
referrals and information from the American Society of
Clinical Hypnosis or similar professional organizations.
Advantages of medical hypnotherapy for skin dis-
eases include nontoxicity, cost-effectiveness, ability to
obtain a response when other treatment modalities fail,
ability to reduce relapses, and ability of patients to self-
treat and gain a sense of control when taught self-
hypnosis reinforced by using audiocassette tapes. Add-
ing this treatment capability can result in pleased and
grateful patients.
Disadvantages of medical hypnotherapy in derma-
tologic practice include the extensive practitioner train-
ing required, the low hypnotizability of some patients,
the negative social attitudes still prevalent about hypno-
sis, and the lower reimbursement rates for cognitive thera-
pies such as hypnosis compared with procedural thera-
pies such as cutaneous surgery. The training requirements
for hypnosis are no more extensive than those required
for cutaneous surgery. Social attitudes and reimburse-
ment policies can be changed with time. The low hyp-
notizability of some individuals is, to a large extent, “hard-
wired” into their brains and tends to be consistent over
time, as measured by the Hypnotic Induction Profile.87
Patient selection is an important aspect of success-
ful medical hypnotherapy in dermatologic practice. Part
of the art of being a dermatologist is being able to choose
appropriate therapeutic modalities for specific patients.
Hypnosis-assisted therapy works best in moderately to
highly hypnotizable patients who are appropriately mo-
tivated, and who have dermatoses with a large psycho-
somatic component or that are otherwise known to be
responsive to intervention with hypnosis. As with any
therapy, it is best to start with simple cases, referring the
more complex cases to those more experienced. As the
practitioner gains experience, more difficult cases may
be added.
Hypnosis, like any other tool, can be effective and
gratifying in many cases, when appropriately applied. Like
any other tool, hypnosis is not a panacea. It seems to work
miracles for some and yet, to fail completely for others;
most results lie somewhere in between. The specific type
of therapy chosen to be assisted by hypnosis is also a key
factor in producing positive results. With proper selec-
tion of disease process, patient, and provider, hypnosis
can decrease suffering and morbidity from skin disor-
ders with minimal adverse effects.
Accepted for publication June 24, 1999.
Reprints: Philip D. Shenefelt, MD, MS, Division of Der-
matology and Cutaneous Surgery, Department of Internal
Medicine, Mailstop MDC 019, College of Medicine, Uni-
versity of South Florida, 12901 Bruce B Downs Blvd, Tampa,
FL 33612 (e-mail: pshenefe@hsc.usf.edu).
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