Stress and Skin: Implications for Psoriasis, Acne, Rosacea, AD, and More


Excoriation Disorder: Treatment Tips

Excoriation (skin picking) disorder, which is characterized by the need or urge to pick, scratch, pinch, touch, rub, scrub, squeeze, bite, or dig the skin, can be a difficult to treat, according to a recent study that reviewed alternative therapies and their benefits for the treatment of excoriation disorder for use in conjunction with psychotherapy and pharmacotherapy in the management of a challenging group of patients. Treatments for excoriation disorder include pharmacotherapy, psychotherapy, and alternative therapies, including yoga, aerobic exercise, acupuncture, biofeedback, hypnosis, and inositol and N-acetylcysteine, among others. Study authors reviewed literature published in the last 15 years through a search of PubMed to critically consider the evidence for the use of alternative therapies in the treatment of excoriation disorder.


Yoga: May influence the structure and functioning of the areas of emotional processing involved in the pathophysiology of excoriation disorder and other body-focused repetitive behaviors, such as trichotillomania. Although still limited, the authors concluded use of yoga as a treatment has given useful results.

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Derm Insider: Conquer Burnout
Recognizing the signs of burnout is the first step to conquering this epidemic among physicians. Leading dermatologists Brian Berman, MD, PhD and Neil Sadick, MD talk to host Neal Bhatia, MD about the latest research into physician burnout and the probable causes, from an increase in legislative issues affecting medicine to the increased administrative burden doctors face today. They offer tips for how to recognize signs of burnout in themselves and colleagues, and share strategies for managing time and stress to help avoid burning out.

Aerobic Exercise: People suffering from excoriation disorder typically have a worsening of their behaviors with negative mood and anxiety. As exercise has qualities that allow individuals to improve their mood and reduce their anxiety, the authors conclude it is likely that it also can help reduce behaviors like hair pulling or scratching, and should be considered to be an adjunctive therapy.

Acupuncture: The mechanism of action of acupuncture increases serotonergic activity and releases endorphins in the hypothalamus and limbic region, which could be beneficial in patients with trichotillomania and excoriation disorder, according to the study.

Biofeedback: The study found several case reports that have suggested the value of biofeedback in reducing tics, which bear some psychophysiological similarities to body-focused repetitive behaviors, such as trichotillomania and excoriation disorder.

Hypnosis: When used as a channel for other types of interventions, such as psychotherapy, hypnosis can help counteract the stress that triggers the picking behaviors in some patients.

Inositol and N-acetylcysteine: Although more research is needed, the authors noted that these are promising drugs that may be helpful in reducing the picking behavior.

The researchers concluded that all these alternative therapies show promise for treating excoriation disorder and that mainly yoga and aerobic exercise have been shown useful in combination with psychotherapy and pharmacotherapy. More study is needed to obtain solid evidence about the long-term beneficial effects of these alternative therapies for the treatment of excoriation disorder.

—Adv Mind Body Med. 2017 Winter;31(1):10-13.

Combating Burnout

The 2017 Annual Meeting of the American Academy of Dermatology will be held in Orlando, FL, March 3-7, 2017. Among the educational sessions, there are several that recognize the problem of physician burnout and offer tips for recognizing signs of burnout and tools for conquering it.

Session: Stepping Out of the Fry Pan: Tools to Mitigate Burnout

Sunday, March 5, 2017, 1:00 PM - 3:00 PM, Room W312A

Co-Directors Kathleen Julie Hectorne, MD, FAAD and Rochelle R. Torgerson, MD, PhD, FAAD will lead this session to identify factors that cause burnout in dermatologists in various practice settings. Participants will be able to identify signs of burnout in themselves and others, leaving this session with strategies for reducing personal burnout as well as strategies for working within the larger organization to minimize the stressors that cause burnout.

Session: Dermatologist Burnout: How to Spot it and How to Avoid it

Sunday, March 5, 2017, 7:00 AM - 8:00 AM, Room W315B

Andrea Tesvich Murina, MD, FAAD will direct this session with speaker William L. Waller, MD, FAAD on how burnout is becoming an increasingly bigger problem among physicians. Noting that burnout leads to emotional exhaustion, loss of meaning in work, and feelings of ineffectiveness, this session will look at how it decreases productivity, morale, and quality of care. While solving the problem of physician burnout requires system wide changes, this session will offer several steps that dermatologists can take to improve their own wellness.

Bureaucracy, Compliance, and Burnout: What it Means to Dermatologists

Monday, March 6, 2017, 7:30 AM - 8:30 AM, Room W315A

Directed by J. Matthew Knight, MD, FAAD, this session includes Neal D. Bhatia, MD, FAAD, Mark D. Kaufmann, MD, FAAD, and Suzanne Olbricht, MD, FAAD as speakers. This panel discussion/Q&A will analyze the factors (regulatory, social, and economic) contributing to heightened feelings of frustration and anxiety for dermatologists, whether employed or in private practice. They will analyze the silent epidemic of physician burnout among American physicians, and discuss strategies to prevent, identify, and mitigate burnout for dermatologists.


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About Practical Dermatology

Practical Dermatology is the monthly publication that provides coverage of medical care, cosmetic advancements, and practice management for clinicians in the field. With straight-forward, how-to advice from experts in various fields, we strive to enhance quality of care and improve the daily operation of dermatology practices.