Mindfulness meditation (MM) is a practice with origins in Buddhist tradition that has been increasingly evaluated for its clinical application. Though mindfulness is a heterogeneous practice, it generally involves regulation of attention and an attitude of openness.¹ There are numerous ways mindfulness meditation has been adapted including mindfulness-based stress reduction and mindfulness-based cognitive therapy. Many of these adaptations of MM have been evaluated in the literature for their clinical effectiveness in treating disease.

Still, there is no clear understanding as to how MM affects disease. Evidence shows that MM may decrease pro-inflammatory gene expression such as NF-κB and IL-6 via psychoneuroimmunological pathways.^2,3 MM may also influence dermatological disease severity through behavioral mechanisms by disrupting the scratch-itch cycle and improving treatment adherence.³

This review evaluates the available literature on controlled mindfulness meditation trials in psoriasis, atopic dermatitis, hidradenitis suppurativa, alopecia areata, vitiligo, pruritus, and acne, with an emphasis on disease severity, quality of life, and mental health outcomes.

We conducted a literature review on mindfulness meditation interventions in dermatology using the Embase, Web of Science, PubMed, and PsycInfo databases. We searched using the following criteria:

“(mindfulness OR meditation OR ‘mindfulness-based stress reduction’ OR mbsr) AND (dermatology OR psoriasis OR eczema OR ‘atopic dermatitis’ OR pruritus OR ‘skin disease’ OR acne OR alopecia OR ‘hidradenitis suppurativa’ OR vitiligo)”.

Study selection was conducted using Covidence systematic review software, and this process was documented using a PRISMA 2020 flow diagram. After screening for duplicates and eliminating irrelevant articles, we found 54 relevant studies. A full-text review was subsequently conducted to determine final eligibility. Studies were included if they compared a mindfulness intervention against a control in adult patients with non-cancerous dermatological diseases. Only controlled studies were included in this review to increase the reliability of the evidence by only comparing intervention to a control group. Eligible studies were required to evaluate at least one of the following outcomes: quality of life, disease severity, or mental health. We excluded systematic reviews, case reports, and case series as well as studies that focused on pediatric populations. Studies that did not report findings in English were also excluded.

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Among dermatological conditions, mindfulness interventions have been most extensively studied in psoriasis. In a landmark 1998 study, Kabat-Zinn and colleagues first demonstrated that guided mindfulness meditation, when performed during phototherapy, led to significantly faster rates of skin clearing compared to phototherapy alone.⁴ Patients with moderate-to-severe psoriasis undergoing phototherapy or phototherapy in combination with a systemic agent were randomized to listen to guided mindfulness-based stress reduction tapes or nothing during their treatments. Skin status was assessed by nurses and photographed, and the images were subsequently evaluated by dermatologists who were blinded to treatment assignment. Patients in the mindfulness meditation group demonstrated significantly faster rates of psoriasis lesion clearance. However, the study did not find any significant changes in psychological outcomes. The small sample size may have contributed to the lack of significance.

Since this initial study, multiple randomized controlled trials of mindfulness-based stress reduction (MBSR), mindfulness-based cognitive therapy (MBCT), and other mindfulness formats have been conducted. Findings across studies have been variable, although many report some degree of benefit among patients with psoriasis.

Several studies have evaluated the effects of mindfulness-based cognitive therapy (MBCT) in patients with psoriasis. In a pilot trial, Fordham et al compared MBCT with treatment as usual (TAU) in patients with varying degrees of psoriasis and reported improvements in self-administered psoriasis severity scores and quality of life measures in the MBCT group relative to TAU.⁵ Consistent with these findings, Maddock et al observed significant improvements in psoriasis severity, anxiety, depression, and psychological well-being among participants receiving the mindfulness intervention, whereas no improvement was observed in the TAU group.⁶ However, no significant differences in psoriasis severity, anxiety, or psychological well-being between groups were observed at a three-month follow-up, suggesting that the benefits of MBCT may be temporary. In contrast, D’Alton et al found no significant differences among participants with stable psoriasis in a randomized controlled trial testing three different forms of MBCT.⁷ The authors suggested that this lack of effect may be explained by a potential floor effect, as participants had low baseline levels of psychological distress and were required to have stable psoriasis at study entry. Overall, these findings suggest that MBCT may provide short-term benefits for psoriasis severity and quality of life, although results vary across studies and treatment results may depend on baseline psychological distress.

Three further studies evaluated different mindfulness interventions in psoriasis patients. One abstract presented a study by Adamzik et al that evaluated a mindfulness-based stress reduction (MBSR) intervention that resulted in no significant difference in psoriasis severity, but improved anxiety, depression, and worry scores.⁸ Another study evaluated an intervention that combined breathing, cold exposure, and meditation and found improved psoriasis severity, quality of life, depression, and sleep scores.⁹ The final study on psoriasis that we found compared a brief mindfulness-based intervention to TAU and discovered improved mindfulness and psoriasis severity in the mindfulness group compared to the TAU group.

Overall, these studies show great promise for mindfulness as an adjunct treatment for psoriasis. The results are mixed, but most of the studies found benefits to mindfulness in at least one outcome measure. Challenges to interpretation of the findings in psoriasis include heterogeneity of interventions (MBCT vs MBSR vs guided meditation), variable delivery (online vs in-person; group vs individual), varying disease severity, small sample sizes, and reliance on patient-reported severity (saPASI, SCORAD). Larger scale studies comparing the effects of mindfulness on people with different psoriasis severity may help narrow down which groups of people mindfulness may benefit most.

Atopic dermatitis (AD) is a chronic inflammatory skin disease in which psychological stress is known to exacerbate symptoms and contribute to disease flares. A large randomized trial by Kishimoto et al evaluated an eight-week online MBSR and self-compassion program.³ They found that every outcome measure demonstrated greater improvement in the treatment group than in the waitlist control group. Participants reported significantly improved quality of life scores, alongside improvements in disease severity, measures of itching and scratching, anxiety, and depression. These significant differences persisted at 13-week follow-up. These findings suggest that mindfulness-based approaches may improve both dermatologic symptoms and quality of life in patients with AD. However, more research is needed in this area to evaluate the impact of mindfulness-based interventions across diverse AD populations.

Evidence for mindfulness interventions in alopecia areata is more limited compared to

other dermatological diseases, but it appears to be growing. At the time of our search, there was one controlled trial on an MBSR intervention in alopecia areata. Despite a small sample size, the study found significant improvements in quality of life and anxiety after 8 weeks of a MBSR intervention, but no significant improvement in the control group.¹⁰ Additionally, although not included in this review due to a lack of control group, there was one further study evaluating MBCT in patients with alopecia that showed improved psychological outcomes in participants when compared to baseline.¹¹ Overall, the evidence shows promise for MM in treatment of alopecia areata though larger randomized controlled trials are needed to more thoroughly evaluate its effectiveness.

Hidradenitis suppurativa (HS) is another inflammatory skin condition correlated with increased anxiety and depression, as well as decreased quality of life. However, there is a paucity of research examining mindfulness interventions in HS patients. In our literature search, we identified only one trial evaluating MM in patients with HS. In a pilot randomized trial by Lopez et al, 11 HS patients were randomly assigned to receive either six weeks of mindfulness lectures or HS education lectures.¹² The results showed no meaningful difference in quality of life measures, but the mindfulness participants reported improved mindfulness scores and sleep quality. Importantly, this represents the first interventional trial of mindfulness in HS, although limited by a small sample size, high attrition, and the lack of peer-reviewed publication. Mindfulness interventions in HS patients have great potential as demonstrated by the results in psoriasis and the limited data available.

Two studies assessed the effectiveness of MM on heterogeneous groups of patients with chronic skin conditions. Both studies included patients with psoriasis, atopic dermatitis, and vitiligo; one study additionally included acne, and the other included pruritus. The study by Sengupta and Wagnai found significant improvements in all measured outcomes compared to a waitlist control group, including quality of life, depression, anxiety, stress, self-esteem, and well-being.¹³ The second heterogeneous study showed improvement in quality of life that reached near-significance compared to a control condition.¹⁴ These studies emphasize the potential impact of MM in conditions like psoriasis and AD while providing new evidence for potential benefits to meditation in other conditions like acne, vitiligo, and chronic pruritus.

Acne vulgaris, vitiligo, and chronic pruritus are similar to psoriasis and AD in that they are dermatological conditions with a well-established psychosocial burden. However, we found no controlled studies evaluating the impact of mindfulness meditation exclusively on acne vulgaris, chronic pruritus, and vitiligo. Research in this area represents a clear opportunity for future investigation given the results of the controlled mindfulness studies on varying skin conditions.

Mindfulness meditation (MM) has shown benefits in multiple randomized controlled trials for dermatologic diseases. There have been improvements seen in multiple realms such as disease severity, quality of life, anxiety, and depression. Most randomized controlled trials on MM in dermatology were conducted in patients with psoriasis, but we also found trials evaluating MM in patients with atopic dermatitis, hidradenitis suppurativa, acne, pruritus, and vitiligo.

The evidence for MM in psoriasis is robust, while the evidence in other dermatological diseases is more limited. Many studies included in this review were only available as abstracts which limits the ability to evaluate study design, methodology, and risk of bias. Moreover, many studies had small sample sizes, heterogeneous interventions, differing disease severity, and varying outcome measures making comparisons across studies challenging.

Importantly, no adverse events connected to mindfulness meditation have been reported. Therefore, mindfulness meditation seems to be a very low-risk intervention for dermatology patient populations.

Some patients with psoriasis may benefit from mindfulness meditation to improve disease-specific quality of life, anxiety, and depression. There is some data to suggest that MM may have a role in the management of atopic dermatitis, but more studies are needed to confirm this. The data for hidradenitis suppurativa, alopecia, vitiligo, acne, chronic pruritus are of uncertain significance due to various limitations. Larger, standardized randomized controlled trials with objective dermatologic outcomes are warranted to further evaluate the impact of mindfulness on disease-specific outcomes and/or dermatologic quality of life measures.

No funding was received for this study.