An Affiliate of Anne Arundel Dermatology

pdf of this article

For more information about skin conditions and their treatment, contact:


Gregory J. Wilmoth, MD
Eric D. Challgren, MD
Margaret B. Boyse, MD
Laura D. Briley, MD
Tracey Cloninger, PA-C

Stephanie N. Shannon, FNP-C

4201 Lake Boone Trail, #200
Raleigh, NC 27607
Telephone: (919) 782-2152


4201 Lake Boone Trail, #207
Raleigh, NC 27607
Telephone: (919) 863-0073

For Chronic Skin Problems,
the Key Is Management

When considering the role that patients’ choices play in causing and treating chronic skin diseases, Dr. Gregory Wilmoth of Southern Dermatology & Skin Cancer Center in Raleigh is philosophical. “With some chronic skin diseases, you do have choices, with others you do not,” he observes. “If you get psoriasis, it’s just genetically bad luck. On the other hand, when it comes to sun damage, there’s no question that the decisions we make play a major role. The problem is, most of those choices are made when we’re young, and we have to deal with the consequences much later in life.

Dr. Wilmoth: “Frequent, regular skin checks are the principal way we identify problems.”

“It seems to me,” observes Dr. Wilmoth, “that—for many chronic diseases—we really don’t have much control other than how to manage them. That’s where choice comes in. If you have high blood pres-sure, for example, you can alter your diet and salt intake, but—if you’re going to manage the disease successfully, you may also have to take medica-tion. People with chronic dis-eases need to reassess their thinking. That’s the key, I think: if you can’t fix the problem, you can learn to manage it in an optimal way.”

Managing Sun Damage

“Damage to the skin from excessive exposure to the sun,” notes Dr. Wilmoth, “is one of the most significant chronic health issues we face today. It’s certainly a major focus of our practice. The good news is that there is much more awareness today of the health risks of sun exposure and many more products to protect us from sun damage. So, I’m optimistic that the current generation of children will avoid much of the harm their parents and grandparents experienced.

“That said, skin cancer is the most common cancer in the United States, and it’s estimated that over 9,000 people are diagnosed with skin cancer and 20 people die from it—every day. Non-melanoma skin cancers, including basal cell carcinoma and squamous cell carcinoma, affect more than three million Americans every year. And although melanoma accounts for only one percent of all skin cancers, it causes the majority of deaths.

“So although, for most people, sun damage comes in the form accelerated aging—wrinkles and discoloration—a smaller group will have damage to the skin cells themselves, or to their immune function. That damage will later become keratosis, squamous or basal cell skin cancer, or melanoma. Usually I start seeing these patients by age 40, and manage their skin conditions for the rest of their lives. When I refer to ‘managing,’ I’m talking about watching any pre-cancers that they have, or cancers they may develop.”

To ensure that such cancers are prevented or caught early, Dr. Wilmoth encourages patients to have frequent, regular skin checks, especially after the age of 30. “Don’t wait to see the doctor only when you think you have a problem,” he advises, “that increases the risk of cancer. The fact is, most people have no idea how to recognize what skin cancer looks like—some skin cancers are symptom-free; they don’t bleed; they may look a little different, but they don’t hurt.”

Treating Sun-Damaged Skin

Detecting and treating precancers and cancers is a priority at Southern Dermatology, but addressing the non-cancerous forms of sun damage is also important. “In fact, a lot of what we do,” notes Dr. Wilmoth, “is related to cosmetically repairing sun damaged skin. And we have a wide variety of tools—from skin care products to topical medications to laser treatments—that can be extremely effective in improving the appearance and texture of the skin, and slowing down what is commonly viewed as the ‘aging’ process.”

Very severe damage is a challenge, he acknowledges. “But it can certainly be improved. If a 40-year old comes in wanting to restore really leathery skin, we can’t make it disappear, but a fairly deep, aggressive procedure—such as a chemical peel or laser resurfacing—will definitely improve the condition. And topical creams, lotions, and medications can help maintain it.

“Sun-damaged skin that’s blotchy and brown can be repaired with surface treatments and less aggressive laser procedures,” he says. “And we’ve had great success in repairing and maintaining sun-damaged skin with intense pulsed light (IPL) therapy, which damages the bad pigment cells and stimulates new growth, and with laser resurfacing, where old skin is removed and allowed to grow back smooth again.”

Dr. Wilmoth also points out that skin cancer treatment doesn’t interfere with cosmetic skin repair. “We can do both. In fact, a lot of people will go through treatments that are designed for medical purposes when they’re developing skin cancers and pre-cancers and they end up looking better because we’ve removed a lot of those lesions. In most instances, medical and cosmetic treatment can work hand-in-hand.”

Ultimately, however, notes Dr. Wilmoth, the most important choices are the ones patients make to protect themselves from the sun. “We offer many ways to repair sun-damaged skin, but prevention is by far the best option—which means using sunscreen and wearing clothing to protect your skin from sun exposure. And this is important at any age. I recognize that much of the sun damage we experience now occurred when we were in our teens; but it doesn’t stop there. Keep in mind that humans were not designed to be inside all the time, and there are so many mental and cardiac health benefits from being outside. So, don’t hesitate to be outside—just be smart: lather on the sunscreen, wear protective clothing, and go out in non-peak sun hours.”