**3. Side effects**

mast cell degranulation in the dermis. It is reported that may be the cause of the pathological

Even though acupuncture treatment in dermatological diseases is safe and inexpensive, improperly performed acupuncture can cause potentially serious adverse effects such as vasovagal events, local infections, damage to internal organs, pneumothorax, spinal cord

The hypnotic phenomenon has been used over thousands of years, and it is a form of trance induction. Recently, the use of hypnotic therapy in somatic medicine has been supported by the British Medical Association in 1955 and the American Medical Association in 1958. A hypnotic trance can be described as an altered state of consciousness with "inward focus." It can be differed from other states of consciousness by electroencephalography (EEG) and imaging modalities. A hypnotic state can be induced by a therapist or an individual can induce hyp-

Hypnosis has been used for several indications such as induction of anesthesia or to heal irritable bowel syndrome and psychosomatic diseases as well as a variety of skin disorders including AA and trichotillomania. Nowadays, medical hypnosis is performed by physicians whom have received appropriate training in many countries all over the world. For some selected skin disorders, with proper training and selection of appropriate patients, medical

Hypnosis is a cost-effective and nontoxic therapy and can be used in dermatological treatment especially in patients with psychosomatic component [119, 120]. In a preliminary study, hypnotic sessions including relaxing suggestions and symptoms-oriented suggestions were held as a complementary or the only treatment once every 3 weeks in patients with severe AA, alopecia totalis, or alopecia universalis. Twelve of 21 patients showed significant improvement after 4–13 (mean 5.5) sessions of hypnosis, while treatment success could not be achieved in 9 patients. But also, minimal relapses were observed in all patients responded well [121]. In another prospective cohort study, it has been suggested that hypnosis had no significant contribution on hair regrowth in patients with refractory

Despite confusing conclusions have been reported about the efficacy in the treatment of AA, hypnosis seems to be salubrious in the treatment of both children and adolescents with trichotillomania. Cohen et al. reported that complete resolution of their complaints was seen in two children after 7–8 weeks and in one child after 16 weeks. Even if just a recurrence was observed in one patient during follow-up, the patient completely recovered again with hypnotic retreatment [123]. *Iglesias A* observed that three pediatric cases completely disappeared to their trichotillomania behavior after 7 or less hypnotic sessions [124]. In addition to children, hair pulling was significantly reduced with imaginative techniques in adolescents with trichotillomania [125]. According to these results, hypnotherapeutic approach

hypnosis can relieve symptoms and in some cases can cure the illness [119, 120].

changes causing AA but reliable evidence is not yet available [117, 118].

injury, and hepatitis B infection [116].

notic trace in himself or herself (self-hypnosis) [119, 120].

**2.3. Hypnotherapy**

362 Hair and Scalp Disorders

AA [122].

The side effects reported after CAM is often minimal. Contact dermatitis was reported with onion juice in patients with AA, thus patients should be informed about skin irritation on the skin surface in contact with the onion juice (**Figure 1**) [53]. *S. repens* that can be used as both orally and topically may cause undesirable adverse effects such as mild stomach discomfort, contact dermatitis, feeling of coldness, mild burning sensation, undesirable smell, itching, and acne [63, 65, 66]. Vasovagal events, local infections, damage to internal organs, pneumothorax, spinal cord injury, and hepatitis B infection are some of the side effects that can be encountered after acupuncture therapy [116]. Prurigo nodularis also reported on extremities of a patient shortly after acupuncture [126].

**Figure 1.** Contact dermatitis developed after topical application of onion and garlic on face of a patient with AA.
