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