Trigger versus Cause: Even the debate can cause stress


From the Editor…
The following article was written by Candace Cooper, a PRP Patient Advocate from Fort Smith, Arkansas, and published in the August 2015  of the PRP community newsletter, On the Road…Our Journey from Onset to Remission.

by Candace Cooper, PRP Patient Advocate

“While everyone can’t agree on a definition of stress, all of our experimental and clinical research confirms that the sense of having little or no control is always distressful – and that’s what stress is all about.”  —

Like many of you, I was no stranger to stress and what it can do to the body when PRP showed up in my life. A few years before PRP, several deadlines that began in late November and ended in mid-December required me to work many 12-hour days during those two months. The pressure of long days coupled with Christmas preparations for my family brought me shingles one year and intense back pain the next. In both situations, after the deadlines and the holidays were over, I experienced a complete recovery.

PRP came into my life after a three-year downward spiral of marital, home, and financial devastation. I was far from recovery and still trying to find my way through the wreckage when red lines appeared in the creases of my eyelids. Soon after small crimson spots surfaced around my mouth. You know the rest of the story.

After I was diagnosed, which took over a year, and learned that there is no known cause for PRP, I began to feel that my continual stress and emotional downturn during those years had definitely brought about my PRP.

Tanya R — Croatia
I go for stress, too. After three very frustrating years on my work, I developed first mild PRP symptoms over two months. While I was going through first tests and exams, I experienced awful trauma in my family. In two to three days my hands, feet and face became red and then I was diagnosed very quickly. So, I’m sure, even if stress didn’t cause PRP, it triggered the eruption – I’m positive about it.

Meagan W — San Luis Obispo, CA
If I was to guess what “caused” my onset, it would be major stress and my back injury.

Tami C — Minnesota
My trigger was stress. I was looking for a house and scrimping, saving working two full-time jobs.

Trigger vs Cause

Is there a difference between “trigger” and “cause”? After I was finally diagnosed, my dermatologist told me that PRP is latent in the body until it is triggered by something. When I told him what had happened to me, he didn’t give much credence to my theory that my emotional state had been a determining factor. I think that he had something chemical in mind as the causative factor. Trigger = cause seems logical to me, and after all, my dermatologist has never had PRP.

Flares defines flare as “to blaze with a sudden burst of flame.” That’s a perfect description of the red, burning skin that accompanies a PRP outbreak Whether PRP is caused by stress or not, once you have it, many of those afflicted with the disease agree that stress can contribute to flares:

Scott M — Dearborn, MI
I’m convinced stress hormones play a big part in triggering a flare up and its severity.

Trine T — Aarhus, Denmark
I have read several times that PRP can come back/flare up when big things happen in your life that emotionally affect you. I know myself that stress is my enemy.

Sarah R — Skipton, North Yorkshire, England, UK
I’ve got bright red spots everywhere and more are erupting as the stress I feel builds.

Jeremy B — Canberra, Australia
A subset of people are predisposed – probably genetically predisposed – to PRP, but not all, and perhaps very few, actually develop PRP. What is needed, which many on the list have previously observed or raised as a possibility, is some sort of trigger event – typically stress – which has started the PRP. If you take Griffiths’ estimate of PRP incidence – 1 in 400,000 – then for the sake of argument, perhaps 1 in 40,000 are predisposed to PRP, but only 1 in 10 (of those 40,000) actually experience the necessary level or type of stress event to trigger the development of PRP.

Richard G — Philadelphia, PA
Many have commented about the possible connection between stress and PRP. If stress is so prevalent, then why is PRP a rare disease? To me, the incidence and prevalence of PRP would be much higher if stress was a factor. It would not be a rare disease. Clearly, other things are going on with this disease, and not everyone has been subjected to stress prior to onset.

Something to Ponder

These comments by two fellow PRPers brought me up short and caused me to rethink my beliefs on what can cause PRP. 

Why don’t more people have PRP if its potential is there in our bodies waiting to be actualized and stress is a likely trigger? Could it be, as Jeremy B speculates, that a very minute number of all those predisposed to PRP actually manifest the disease and that is the reason for its rarity? Or is it just that “stress is difficult to define, because it is so different for each of us” ( Is PRP rare because, as unique individuals, each of us requires exactly the right type and amount of stress to activate what is present but not visible in our bodies?

I’m going to look for a tube of steroid cream and try not to get too stressed out while I think about that.

Karen Beetow — Rochester, NY
I was at my worst when I was so stressed out and depressed with my job. Stress is the biggest cause of both and will def have effects on inflammation of all types.

Mary M — Novato, CA
The exhaustion felt in the first 6-12 months after onset is exacerbated by stress.

Brian H — Calgary, Alberta, Canada

Stress and More Stress

Once you have PRP, the “Catch 22” or “you can’t win for losing” part of the whole situation is that the symptoms of this disease (that may be initially caused or triggered by stress) are so troubling that they create another type of aggravation in your life. Your body is telling you that it doesn’t like you any more and is turning your skin red and trying to get rid of it at the same time.  The comment by Brian H that “it is easy to get caught up in the day-to-day crisis” is right on the mark. Just having the disease is an additional type of stress that must be endured.

Food for Thought

I am convinced that stress played a big part in my personal experience with PRP, but the comments of fellow PRP patients and caregivers reminds me, once again, that we are all on our own journey with this disease.

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