Canker Sores (Aphthous Stomatitis)

These painful sores appear recurrently on inner cheeks, lips, gums, tongue, and palate. They afflict 20 percent of the population, most commonly between the ages of ten and forty. Treatment is symptomatic:  Xylocaine for pain, corticosteroids for inflammation, and antibiotics for secondary infections. Their cause is unknown, but recurrences have been linked to emotional and physical stress, premenstrual tension, injury, and fever. Emotional stress is the most commonly cited precipitant, particularly domestic, financial, and sexual problems.

If you suffer from canker sores, use your Time Line to discover what, if any, stresses appear to trigger them. The most common tasks associated with this symptom involve difficulty growing up, expressing anger, and looking for love?but as in all symptoms, individual emotional links may differ.

Canker sores are often seasonal:  worst in the winter and spring, better in the summer. Examine your own seasonal pattern for hints that will help you design an effective ideal imaginary environment.


Darier Disease (Keratosis Follicularis)


Genetic at least in part, Darier Disease (no longer referred to as "Darier-White" ) usually appears between the ages of ten and twenty. Blockage of sebum production causes pustular sores at hair follicles, palms, nails, and mucus membranes. There is a risk of secondary infection.

One controversial theory connects Darier disease with vitamin A deficiency; in fact, ointments of vitamin A or its derivatives have proved effective for some.

A clinical report by Wink found hypnotherapy effective. A railroad worker had suffered recurrent pimples on his forehead, hands, and upper back since adolescence. It flared up when his wife cuckolded him, as happened periodically, and improved when she returned. After vitamin A and steroids had failed, hypnotherapy produced some improvement:  the top of his left forearm improved noticeably within a week, as had been specifically suggested in the trance state. Further remission was achieved by having him return, in imagination, to the time before the symptom had appeared, when he was twelve years old. The results were then even more striking.

Often, but not invariably, Darier disease follows a seasonal pattern:  it improves in cooler weather and is worst in the summer; sunlight in particular aggravates it. These facts may be helpful in designing an appropriate imaginary ideal environment.


Dermatitis (Eczema)

(Griesemer Index:  52 to 76 percent; incubation period:  seconds to days)


Eczema and dermatitis are interchangeable names for the same group of conditions, inflammations of the skin that may include redness, swelling, eruptions, oozing, crusting, and scaling. Itching, often severe, commonly accompanies eczema. There are five types of eczema?lichen simplex chronicus, atopic dermatitis, contact dermatitis, hand dermatitis, and nummular dermatitis.

Atopic dermatitis often appears early in life but may arise at any time. Medical treatment includes environmental adjustments to minimize irritation; local creams and medications, including steroids; and antihistamines and phototherapy.

Many investigators have linked eczema to very early unsatisfied hunger for love and affection. Victims are often the children of anxious, undemonstrative, overprotective mothers who, often despite the best of intentions, cannot provide the stroking and cuddling that babies require to thrive. Significantly, the rate of eczema is lower among breast-fed infants; the critical factor may be the cuddling and skin contact that accompanies nursing.18 Along with the hunger for love, eczema patients frequently must deal with much anger, typically unconscious.

I regard atopic eczema as a disease of two or more people, not just the patient himself or herself. The original relationship is usually mother and child; in adulthood, the same emotional turmoil is transferred to marriage, particularly one that revives the same issues of love and rejection.

No one profile fits all atopic eczema sufferers, but many are intensely active, compulsively driven people. They tend to be bright children who learn quickly and do well at school. Possibly, this striving personality type, like the eczema itself, represents a reaction to the insecure feeling of being unwanted and unloved.

The emotional impact of atopic eczema can be devastating. It can interfere with the stroking and fondling a young child needs to build a strong sense of self. The skin becomes the focus of attention and emotion to which all else becomes secondary:  happiness, anger, sadness, and joy are embodied in the scratching and treating of troubled skin, leaving little room for normal relationships with friends and family. In adolescence, the pain and embarrassment of eczema interfere with normal relationships; focus on the pleasure and pain of scratching can disrupt the normal course of sexual development.

Because emotional issues are so central in the course and impact of atopic eczema, the whole range of psychological techniques and biofeedback have all been used with documented success. Be especially alert for certain tasks:  "crying for love," "expressing anger," and "control." Nummular dermatitis (named for its coin-shaped pattern of skin lesions) is usually more troublesome in the winter and may go into remission in the summer; consider this in developing an ideal imaginary environment. One study documented a major role for emotional difficulties in this type of eczema:  all exacerbations were linked to stressful events.

In hand eczema (dyshidrotic eczema or pomphloyx), the skin of the hand becomes dry, cracked, and flaking. Victims are typically driven and self-critical, oppressed by a sense of failure and guilt. In some cases, the eczema follows compulsive behavior patterns:  the "dishpan hands" of the fanatic housekeeper and the cracked, desiccated skin of those whose compulsive cleanliness leads to constant hand washing.

A German study links dyshidrotic eczema to a struggle for autonomy, an attempt to "take one's life into one's own hands," or an expression of the contrary feeling that "I can't handle this." Military reports suggest that eczema of the hands and feet may express the wish to avoid marching to danger or using the hands to kill.

Psychological techniques, including short- and long-term psychotherapy, hypnosis, psychoanalysis, behavioral therapy, and biofeedback, have worked well.

Contact eczema would seem to be a straightforward matter of the body's response to noxious chemicals or plants, but in fact psychological factors are often important, as dramatized by Japanese studies (see the Introduction).

The course and treatment of contact dermatitis are complicated when occupational exposure is involved. Suspicion and fear about noxious chemicals, quite justified by the American industrial tradition of disregard for workers' welfare, may lead to excessive hand washing, which aggravates any irritation. Workers' compensation rewards continued illness and penalizes recovery. Contact dermatitis is more prevalent where workers are dissatisfied and alienated, suggesting a combination of chemical and psychological factors; fast-spreading "pseudo epidemics" have been known to take place.

Lichen simplex chronicus (neurodermatitis) refers to specific patches of eczema caused by rubbing or scratching. Chapters 5 and 12 may prove especially useful. Obermeyer described a forty-year-old woman who developed a rash on the nape of her neck:  she had stilled her conscience, guilty over an affair with a married man, by "putting it all in the back of my head."

Generally, the earlier eczema appears and the more widely it spreads, the more work will be necessary for improvement. The different kinds of eczema are among the problems that people present to me most often. They have provided some of the most gratifying applications of the techniques.

Hair Disorders 

Diffuse Hair Loss (Telogen Effluvium)

(Griesemer Index:  55 percent; Incubation period:  two to three weeks)


In contrast to alopecia, in which hair loss is total or limited to well-marketed areas, hair is lost gradually and diffusely over the entire head or body. It resembles the hair loss that often comes during pregnancy or two to four months after childbirth or that follows a serious illness. The cause of telogen effluvium is unclear, and there is no definitive medical treatment.

The process may be triggered by emotional stress. Kligman has documented five cases in which hair was lost after profound, severe strain. In one, a prisoner who had been tried for murder escaped conviction three times on technicalities but was found guilty at his fourth trial. After two months, he started to lose his hair.

Any psychological technique that addresses stress and personal turmoil is worth a trial for this condition.

Hair Loss (Alopecia Areata and Alopecia Totalis)

(Griesemer Index:  96 percent (for areata); Incubation period:  two weeks)

A range of medical conditions can cause general or localized hair loss; in some cases, an immune defect appears to be part of this disorder. Conventional therapies include corticosteroids, anthralin (Drithocreme), minoxidil (Rogaine), immunotherapy, and PUVA (psoralen cream and ultraviolet A light)

Emotional factors are frequent. Wittkower and Russell found that patients with alopecia fell into three groups. Two-thirds had neurotic conflicts severe enough to warrant therapy; typically, they were shy, inhibited, and depressed. In one-fourth, hair loss had been triggered by a specific traumatic event. There was no clear-cut emotional problem or stress in the remaining group.27

Traumatic events that precipitate hair loss often involve threats to the person or those who are close to him. From the battlefields of World War I, for example, came reports of soldiers losing their hair during combat:  one French soldier lost all his body hair within two weeks after an especially vicious battle and it did not return. (Often, however, hair grows back within several months after emotional pressure is relieved).28

Among young children, Melman and Griesemer found a consistent pattern linking the loss of hair with other losses, particularly the loss of love. One child lost her hair rapidly after being abandoned by her parents; a nine-year-old lost her hair two weeks after a violent fight between her parents. Anger is often involved:  they report a four-year-old boy who was enraged when people didn't give him things and whose rage was followed by hair loss.

The same pattern may occur later in life. An eighteen-year-old man suffered sudden hair loss two weeks after calling a woman to make his first date; the anxiety of the dating game was probably less significant than his symbolic separation from childhood. Adult hair fallout often occurs against a background of sensitizing childhood loss.


Hair Plucking (Trichotillomania) 

Normal children pluck and pull their hair, in frustration, the same way they bite their nails and suck their thumbs. Excessive or persistent hair pulling may require a psychologist, not a dermatologist. When it starts later in life or continues past childhood, it is likely to represent more serious problems.

Typically, trichotillomania severe enough to require treatment is associated with the loss of love. One case history describes a twelve-year-old girl whose hair thinned noticeably when economic problems forced her to live apart from her family; when reunited, the situation improved. The birth of a baby brother, rejection by parents, illness of a sibling that absorbs all a parent's attention?all these have triggered hair pulling.30

Other case histories connect hair pulling with anger following an insult to self-esteem:  one child began this behavior after having her hair cut short as a punishment.  A Japanese report by Oguchi and Miura suggests a child who pulls his hair is acting on behalf of a troubled family:  he is simply the "symptom bearer."

The tasks most often connected to hair pulling are "crying for love," sexuality, and the expression of anger. Hypnotic techniques, including an adaption of the "soothing hand" technique  may be particularly helpful.

In one case, psychotherapy alone did little for a twenty-six-year-old woman who compulsively and habitually pulled out her hair. However, it was successfully combined with the hypnotic suggestion that she would become aware of her action as she reached for her hair and this would make her scalp so sensitive that touching it would be painful.

If you are dealing with a child who pulls her hair, you can be optimistic:  simple behavior changes, such as providing more love and attention, may accomplish much, together with psychotherapy or hypnosis, if indicated.


Pattern Baldness

The loss of hair that many men and some women experience from their twenties onward is related to aging, heredity, and the male hormones, androgens. Beyond cosmetic procedures, minoxidil (Rogaine) seems to help about one-third of men but must be continued to maintain results. For women, medications to alter the role of androgens are often effective.

There are no reports of psychological factors producing this type of baldness, but the psychological impact is often a major part of the experience. Men, and to an even greater extent women, may become emotionally devastated and totally preoccupied with their hair loss.

One patient of mine, a South American agronomist with an international reputation, became preoccupied with the loss of his hair, counting the fallout in his brush daily and agonizing over the drain after each shower. For him, it became clear, the loss of hair represented the loss of potency:  a bald man was a joke, a buffoon, and his slow transformation into such a person was understandably upsetting. In therapy, it became clear that these fears were linked to his father, a prominent politician held in high public esteem by his community but in reality a tormented man addicted to painkilling drugs. To my patient, the loss of his hair signaled his own inexorable descent to his father's "degenerate" level.


Herpes (Herpes Simplex Virus/HSV)

(Griesemer Index:  36 percent; Incubation period:  days)


The herpes viruses are a large family responsible for a wide range of diseases. The name comes from a Greek word meaning "to creep" and reflects the observation that such infections often creep or crawl across the body. Herpes viruses share the ability to become latent?they retreat into hiding places in nerve cells and reappear weeks, months, or years later (see chapter 19 for further information).

Herpes simplex infections are extremely widespread,perhaps more common than the common cold, and may occur anywhere on the skin and in a number of internal organs as well. Fingers are a possible site, particularly among dentists and dental hygienists; through skin contact, wrestlers can contract "herpes gladitorium."

Disease Directory Part Three

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