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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

Health Challenges in the Global Village

“When you look at the ‘village’ in which we are raising our children,” observes Dr. Eric Challgren of Southern Dermatology and Skin Cancer Center in Raleigh, “one of the things that stands out, regrettably, is our children’s all too common poor diet—a diet that results in significant health issues. This is not a small problem.

Fifth grader Tyler Doolittle gets a thorough skin check from Dr. Challgren, as his mother, Jennifer Torres looks on.

“Today,” he points out, “families lead more hectic lives, and it seems all too clear that, when it comes to diet, convenience is of a higher priority than nutrition. Most of the food we consume is packaged, processed, or picked up at the drive-in window of the local fast-food restaurant. Fast-food restaurants are switching or adding healthier options, but it doesn’t mean people are partaking when it’s so much cheaper to eat on the fly.

“Adding to that is the increasingly sedentary lifestyle we all lead, because most adults no longer work physical jobs and our kids aren’t as physically active playing outdoors. The most obvious result is the tremendous increase in obesity—especially among children.”

Overweight kids have a higher risk factor for diabetes, he points out, “but it’s not only diabetes; added weight can affect their health in many ways their entire lives. Further, medical skin treatments become more challenging when treating an inactive, heavier person.”

Dr. Challgren also notes a growing concern about “the environmental toxins which we are exposed to daily. There is such a gray zone of uncertainty when it comes to environmental toxins, but they seem to be increasing the incidence of eczema. And it’s as yet unknown how nano-particulates may be triggering autoimmune disorders. It may be some time before we understand the full impact of these environmental factors on our children’s health and development.

“Finally,” he says, “when you add the digital world to this pervasive mix—where kids no longer socialize face-to-face but instead rely on cell phones, headphones, and gaming devices—the picture is daunting. And all these factors correlate with medical challenges.

“Probably a third of our patients are kids,” notes Dr. Challgren. “So we take these cultural and environmental challenges seriously. In a typical week, the majority of problems we see are the classic bread-and-butter dermatology for kids: eczema, atopic dermatitis, acne vulgaris, warts, molluscum. Diet, obesity, environmental toxins, even the digitally-driven world—all play a part in how we treat these diseases.

Treating Acne: Like Climbing a Ladder

“Acne is one of the conditions we treat most often in children and adolescents,” notes Dr. Challgren. “Barring neonatal acne, we generally start seeing kids with acne at around 12 years old; although we’re now seeing more examples of earlier puberty—and therefore earlier acne.

“Typical acne results from a clogging of the oil glands under the skin. No one knows why this happens to some people and not to others—although there’s clearly a genetic factor involved. Hormonal changes play a significant role, and inflammation is a factor.

“I liken treating acne to climbing a ladder,” Dr. Challgren says. “It’s a step-by-step process of treating the disease in a way that works best for the individual patient. Patients usually come in after having tried some over-the-counter treatment, or they may have already been treated by their pediatrician. The next rung is to try different prescription topicals, and if that doesn’t work, some variant of an oral med, most likely an antibiotic. That’s your mainstay. You can also go the avant-garde route—dietary modification, reducing the glycemic load in their diet.

“Finally,” he adds, “we can use photo treatments, laser options, and peripheral treatments such as vitamin-based therapy, niacinamide, and zinc-based vitamins. And if the patient is not progressing after trying all that, the top rung of the ladder would be isotretinoin (Accutane), which we use a good deal. It’s a functionally good drug with a mixed reputation. I tell patients I would go on it, or would put my kids on it, without hesitation, if needed. Not all patients need it; some come in and go right to the top rung.”

An Individualized Approach to Acne

Dr. Challgren explains that there is no cure, per se, for acne, other than perhaps isotretinoin. “Most youngsters are just going through puberty and you can’t alter that. When they come in at age 12 with mild acne, there’s a good chance they’ll still be battling it at 16, so we have them on meds throughout that time.”

Acne could be considered a chronic disease because of the length of time it takes for it to go away, the doctor notes. “I compare it to psoriasis or eczema—there’s no real cure for some of these conditions, you just have to do the treatment. The secret is: you have to stay on them.

“But our goal is not for a patient to be on X regimen for seven years; each patient is different and we monitor the treatment, stopping and starting or changing as appropriate. If they’re definitely not improving, then we rethink the game plan: ‘Why is it not working? Is it because they’re not using the medicine? Or can’t tolerate the medicine?’ It’s usually one of those. And with teenagers, a lot of times it’s compliance; they’re simply not using the medication as prescribed.”

Classic acne usually goes away between ages 17 to 19 years because hormones finally adjust, Dr. Challgren notes. About 25-35 percent of patients will have acne into adulthood. “Some adults will come in that had minimal acne in their teens but are getting it later in life. Again, that often involves environmental factors and hormonal changes. Genetics also plays a key role. Usually if mom and dad were both on Accutane, their kids have a higher chance of developing acne.”

Beware of Doctor Google

“It’s worth noting,” says Dr. Challgren “that the digital world we live in that is so hugely influenced by the Internet and social media, has a significant impact on acne treatment—in fact on medical care generally. For one thing, Dr. Google offers an overwhelming amount of advice. And, unfortunately, a lot of it is confusing, or flat-out wrong. For example, go on line and you’ll be advised to get a tan to help your acne (bad advice) and also be told not to do so (good advice)—and much, much more.

“Even more challenging is the onslaught of marketing on the Internet and through social media. Although there hasn’t really been anything new developed medically for acne therapy in recent years, you wouldn’t know if from the marketing. Acne treatment is a billion-dollar industry, most of it over-the-counter—and heavily advertised. Consequently, a lot of acne is self-treated—sometimes successfully, sometimes not. Since products and medications work differently for different patients, it underscores the importance of a treatment plan that’s individualized.”