My big "aha patient" for the stress/immune/basal cell connection was a woman that I have cared for over many years. About 15 or more years ago she was in the middle of a heart-wrenching phase in her life and her skin was popping basal cell carcinomas like popcorn. Out of the blue, she started showing up with 3 or 4 basal cell cancers every visit, even in places where the sun hadn't shown for years. Yes, like many of my patients, she was middle aged with years of California sun exposure, but it was odd. Plus, this lovely woman's skin made keloid scars so every basal cell was additionally traumatizing by the lack of control that anyone can have over an itchy and lumpy keloid scar. I saw her many times a year for about 5 years. Then, miraculously, when her life turned around, poof - like magic - the basal cell carcinomas stopped. It’s been years and nary a one since then; in fact, she barely needs me anymore. We’re both thrilled that her skin turned around just as her life did.I’ll always remember her journey and how her skin suffered at the same time her emotional well-being was pelted by life trauma. I’ve observed many more patients whose "skin-cancer spells" parallelled "emotionally-painful spells" and this article helps us wrap our heads around the why. Here are the fascinating connections between basal cell carcinoma development and stress experience that the author's found:
- Among basal cell cancer patients who experienced a recent severe life event, those who were emotionally maltreated by their mothers or fathers as children were more likely to have poorer immune responses.
- Note that at the same time, emotional maltreatment was unrelated to basal cell carcinoma responses among those who had not experienced a stressful life event.
“that stressful events and the negative emotions generated by them, especially early in life, can dysregulate immunity enough to produce clinically significant changes, such as impaired responses to vaccines, slowed wound healing, promotion of inflammation, and dampened markers in both innate and adaptive immune function. They explained further that childhood maltreatment has been associated with elevated inflammation and higher antibody titers to the herpes simplex virus type 1 and to multiple diseases including cancer (and that) the immune system plays a prominent role in BCC tumor appearance and progression.”There's a really important take-home message here for all of us:
When life dishes out serious stress, we need to take good care of ourselves because significant stress disrupts our immune system. Instead of just soldiering on, we need to create a strategy of nurturing self care to help our body get through the situation without adverse health consequences. This is doubly true for people with a history of parental emotional abuse during their childhood. As for we dermatologists, the health consequences of stress induced immune dysregulation may well show up in our offices.This also means that when you are under stress, your nurturing self care needs to include taking good care of your skin. We know that UV rays from the sun cause immune dysfunction inside your skin, resulting in the growth of skin cancers. Don't compound stress related immune dysfunction with UV immune dysfunction. Instead, sun protect your skin to help reduce the risk of basal cell skin cancers adding to your problems:
- Wear a good sun hat and cover as much exposed skin as possible with clothing.
- Seek the shade when you can instead of staying out in the direct sun.
- Wear a good mineral zinc oxide sunscreen on all uncovered skin. The hat and the sunscreen I can help with!