Biofeedback and Self-Regulation, Vol. 19, No. 4, 1994


An Hypothesis Explaining the Successful
Treatment of Psoriasis with Thermal Biofeedback:
A Case Report

Mark Goodman
The Union Memorial Hospital, Baltimore

This is a single case report of a 56-year-old Caucasian female referred for biofeedback by her dermatologist after seven years of failed standard medical treatment for psoriasis. Patient's presenting complaint was the embarrassing psoriasis lesions on her arms. Following 13 weekly one-hour finger/hand thermal biofeedback treatments, all 11 presenting psoriasis lesions (2-6 cm) had disappeared. Interestingly, any new psoriasis lesions that surfaced during our treatment disappeared without leaving palpable or visible scarring~ unlike lesions that were present prior to biofeedback treatment. Patient was unmedicated for psoriasis during our treatment and continues to be unmedicated and asymptomatic at 12-month follow-up.

Descriptor Key Words: psoriasis; thermal biofeedback.

Psoriasis is a noncontagious chronic disease marked by epidermal proliferation of the skin. Its lesions usually appear initially as small erythematous papules and enlarge or coalesce to form red elevated plaques with silvery scales at various anatomic sites (Diseases and Disorders Handbook, 1990). Psoriasis is characterized by recurring remissions and exacerbations often related to unpredictable systemic/environmental factors such as pregnancy, cold weather, and emotional stress.

The etiology and pathogenesis of psoriasis remain an enigma. Fine (1988) states that psoriasis is an autoimmune disorder, as do Reeves and associates (1986), who go on to "cite clinical evidence that there is an intimate relationship between psoriasis and autoimmunity and that this association may comprise an unusual if not unique type of collagen vascular disease . . ." (p. 18), similar in many ways to Raynaud's syndrome or polymyositis scleroderma.

Skin, the largest organ of the body, responds to emotional stimuli (e.g., facial blushing due to embarrassment, which is a modification of blood circulation beneath the skin). Health of the skin is dependent upon proper subcutaneous blood flow. Modification of blood circulation beneath the skin from vasoconstricting stressors which shunt blood away from the periphery or upper layers of the skin may result in cutaneous ischemia, urticaria (hives; Shelley & Shelley, 1985), telogen effluvian (Kligman, 1961), pruritis (itching), and psoriasis (Jellner, Arnetz, Enerother, & Kaliner, 1985; Koblenzer, 1988; Rook & Dawber, 1982).

Thus, the skin is an excellent dependent measure for studying psychophysiology/behavioral medicine because of its easily observed, noninvasive "hard endpoints." Hence this report is quite relevant because of the paucity of successful treatment data currently in the literature on psoriasis and psychophysiology.


The patient was a 56-year-old widowed Caucasian female (Ms. S.), referred for biofeedback to our service by her dermatologist as a "last effort" at successfully treating her 10-year history of unremitting psoriasis. The patient was primarily interested in the amelioration of psoriasis lesions on her arms that would allow for reduced embarrassment when wearing short-sleeved clothing. The patient reported physical abuse from her husband for 25 years, which ended when her husband died and coincided with the onset of psoriasis. This association was one of several topics reportedly discussed in counseling following the death of the patient's husband. Her presentation did not fit PTSD criteria, but was viewed as the result of a chronic sympathetic hyperarousal syndrome. Her medical history was noncontributory except for osteo-arthritis, which responded weil to treatment with 800 mg of ibuprofen daily.

1. This study was done while the author was affiliated with the Homewood Hospital/The Johns Hopkins Health Care System, Baltimore, Maryland.
2. Address all correspondence to Dr. Goodman, c/o Terri Harold, Secretary, The University of Maryland Baltimore County, Department of Psychology & Behavioral Medicine, 5401 Wilkens Avenue, Baltimore, Maryland 21228. The author expresses gratitude to Dr. Russell Hibler for his invaluable biofeedback supervision on this case, and to Terri Harold for manuscript preparation and editing.