Operated by Aclaris Therapeutics

PSYCHOLOGICAL EFFECTS

If You’re Feeling Bad About Having SKs, You’re Not Alone

“For at least 50 percent of my patients, there is an emotional burden to having seborrheic keratosis (SK). And it doesn’t necessarily correlate with how big or thick or ugly the lesion is.”

So says Richard Fried, M.D., Ph.D., who is both a dermatologist and clinical psychologist. He has conducted research on improving the effects of aging, including treating seborrheic keratosis. Through his Yardley, PA-based practice, Dr. Fried has found that people’s feelings about having SK stem from their particular anxieties about the lesions. “Some people worry that their seborrheic keratosis lesions look like warts and that other people will think they are contagious or unhygienic,” says Dr. Fried. Other people think of the lesion as ugly and worry that it makes them look unattractive. Patients have told him that they literally and figuratively want to hide. “If the lesion is on their face, they feel like they have something right out in front that people can see from across the room. They might avoid eye contact because they are so self-conscious. Or, if they have lesions on their body, they avoid wearing a bathing suit or shorts. Some men don’t take their shirt off in public for years,” he says. Many people think of their lesions as the stigmata of old age. “Like wrinkles, under-eye bags and loss of volume in the cheeks, the lesions are one more stark reminder of our waning youth,” explains Dr. Fried. This is particularly true if you have lesions on your face or a slew of lesions on your body. But it can go deeper than that for people who are distressed by the lesion’s link to aging. “Tremendous symbolic significance may be attached to the lesions because they often run in families. SK makers tend to make SK makers,” he says. So when a forty-year-old gets her first lesion on her face, she might think, “Oh, no, here we go.” And she suddenly sees her grandmother when she looks in the mirror. Or, if she sees one pop up on her shoulder, she may imagine her whole back covered in them, just like her mother’s, he says. The sense of genetic inevitability can be very upsetting. “Many people want those first lesions off. If they start to develop multiple lesions, they will get them removed 10 or 20 at a time,” he says. In the extreme, these patients have zero tolerance for the lesions, even if they number more than 50. They want them all removed. For other patients, the emotional reaction to their lesions evolves. “They may not be overly bothered by them until the lesions reach a critical mass; then they say, ‘enough already’ and want them treated,” says Dr. Fried.

In Dr. Fried’s research, he has found that removing lesions can profoundly affect how patients feel and behave.

male-sk-stomachSome patients may not even notice their lesions until one day they do, in a flash. “They have an ‘aha’ moment. They might be in a dressing room and look in the mirror and say, ‘Omigosh, when did that happen?’ They suddenly feel as though they’ve aged overnight,” says Dr. Fried. This shift in consciousness often spurs a desire to pursue treatment. What about the half of Dr. Fried’s patients who say they aren’t bothered by their SK? Some patients only want reassurance that the lesions are benign; they decide they can live with them. Some still harbor some misgivings about them; they just aren’t ready to remove them yet. “You have to really look into a patient’s eyes to see what he or she is saying about the lesions. Sometimes, a patient will say he doesn’t care about them, but it turns out that he’s embarrassed to admit he cares. He worries he’s being superficial. He might even say something like, ‘I have a cousin who has cancer. So how dare I be bothered by these benign lesions?’” Many patients who are conflicted in this way wind up getting their lesions treated later. This is especially true if their seborrheic keratosis lesions look like warts or are big or numerous. In Dr. Fried’s research, he has found that removing seborrheic keratosis lesions can profoundly affect how patients feel and behave, especially when they were very bothered by them. “When they look in the mirror a week later and see the lesion is gone, they say, ‘To heck with you and your crummy message about aging. It isn’t all downhill from here. I look better,’” says Dr. Fried. His patients report less anxiety and depression and more confidence. They eat better and exercise more. They are more amorous with their partners. They start wearing tank tops and bathing suits again. Overall, they exhibit a new body confidence that springs from the simple removal of lesions.