Atopic dermatitis (AD) is a chronic inflammatory skin disease with a complex pathophysiology characterized by intense pruritus, often associated with psychological stress and atopic and non-atopic comorbidities that significantly reduce quality of life. The psychological aspects of AD and the interaction between the mind and body via the skin–brain axis have led to an interest in mind–body therapies (MBT). The aim of this article is, therefore, to reinforce the importance of psychodermatological care in AD. We performed a focused literature review on holistic practices or integrative MBT in AD, including education, cognitive behavioral therapy, habit reversal, meditation, mindfulness, hypnotherapy, eye movement desensitization and reprocessing, biofeedback, progressive muscle relaxation, autonomous sensory meridian response, music therapy, massage, and touch therapy. A multidisciplinary holistic approach with MBT, in addition to conventional pharmacologic antipruritic therapies, to break the itch–scratch cycle may improve AD outcomes and psychological well-being. Although there is a paucity of rigorously designed trials, evidence shows the potential benefits of an integrative approach on pruritus, pain, psychological stress, anxiety, depressive symptoms, and sleep quality. Relaxation and various behavioral interventions, such as habit reversal therapy for replacing harmful scratching with massaging with emollient ‘plus’, may reduce the urge to scratch, while education may improve adherence to conventional therapies.

Psychodermatology is a subdiscipline of dermatology at the intersection of dermatology, psychiatry, and psychology. In dermatology clinical practice, patients may present with skin disease that affects their mental health, or skin disorders induced or worsened by psychological/psychiatric problems so there is a need for specialised education of dermatologists, as well as multidisciplinary teams, to achieve better management of these patients. Understanding the interaction between the central nervous system and the skin underlying psychocutaneous disorders could help identify alternative therapies that may improve patient well-being. The concept of pleasurable touch has received increasing attention following the discovery of C-tactile (CT) fibres. While afferent C-fibre stimulation is usually associated with pain, temperature, or itch, CT-fibres are stimulated optimally by a stimulus not in the nociceptor range but by a gentle, low-force stroking. As this affective touch may counteract unpleasurable sensations, such as pain and itch, and elicit positive feelings, the potential benefits of gentle touch and massage are interesting for dermatological, especially psychocutaneous, disorders. Here we provide an overview of the skin-brain connection to help understand the benefits of touch and massage, as illustrated with studies on atopic dermatitis and burns, as an adjunct to dermatological treatment for improving patient well-being and optimising treatment outcomes.

Atopic dermatitis (AD) is a chronic inflammatory skin disease with a significant psychological impact. The cardinal symptom of all phenotypes and severities is chronic pruritus with repetitive itching and scratching due to a vicious itch–scratch cycle that can be worsened or triggered by stress. Neuroimaging of brain areas responsible for itch processing in healthy subjects versus patients with AD has provided insights into the brain circuits involved in itch central perception. In patients with AD, the dorsolateral prefrontal cortex appears to be overactive while regulating the itch–scratch circuit, and this persistent hyperactivation over time may disrupt this brain region. Common mechanisms between addiction and scratching could explain why some patients with AD continue to scratch despite showing clinical improvements from conventional treatments. In addition, molecular knowledge indicates bidirectional neuroimmune circuits between the peripheral nervous and immune system and dysregulated skin cells may aggravate and perpetuate AD severity. We provide an overview of the basic mechanisms that underlie the itch–scratch cycle in AD, especially neural sensitization of nonhistaminergic itch-specific pathways, and discuss how integrative therapies may interfere with central and peripheral mechanisms of chronic itch to reduce neuroinflammation and break the itch–scratch cycle. The connection between mind and body in the itch–scratch cycle, involving central mechanisms, suggests that integrative and multidisciplinary treatment approaches could be helpful as an adjunct to pharmacological treatment in the clinical management of AD. Integrative therapies may potentially help to reduce pruritus and scratching, psychological stress and sleep disturbances, and improve immune and skin barrier dysregulation, AD outcomes, and patient well-being.

Background: Acne vulgaris is a chronic inflammatory skin condition with a multifactorial pathogenesis. The clinical appearance of acne and its sequelae may differ according to phototypes. Data regarding the potential benefit of dermocosmetics (DC) regardless of phototype are lacking and assessing acne improvement can be difficult, given the lack of visual support in people with skin of colour. A DC regimen, combining a cleanser and a cream, both containing thermal spring water, has been developed for the management of mild‐to‐moderate acne, for all skin phototypes studied.Objectives: To assess the efficacy and local tolerance of a DC routine in mild‐to‐moderate acne and to visualize the clinical improvement in all skin phototypes.Methods: In an open‐labelled, multicentre clinical study, subjects of any phototype aged above 11 years and above with mild (N = 48, 55.2%) or moderate (N = 39, 44.8%) facial acne applied the DC twice daily for 56 days. No other acne care was allowed. Acne severity, as well as inflammatory and noninflammatory lesion counts, were assessed at baseline, Days 28 and 56. Photographs were taken using a novel imaging tool based on multimodal acquisition, to show clinical improvement over time.Results: Eighty‐seven subjects, 41 adults and 46 adolescents, were included; 59.8% were female and were aged between 11 and 44 years. The total acne lesion count decreased by 34%, the noninflammatory lesion count by 28%, and the inflammatory lesion count by 52% at Day 56. All % changes were statistically significant (p < 0.05). The GEA score decreased, with 25% of subjects showing at least a one‐grade improvement at Day 28 and 59% at Day 56. Local tolerance was excellent.Conclusions: The tested DC care is beneficial for the improvement of acne and is very well tolerated in all skin phototypes studied.