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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

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



4201 Lake Boone Trail, #207

Raleigh, NC 27607
Telephone: (919) 863-0073

Our Skin Reflects Toxicity in Our Lives

The unwritten rule in dermatology is that 10 percent of all cases have some underlying toxic psychological component, such as anxiety, depression, or high levels of stress—and stress is a marker of the condition of the internal environment, notes Dr. Eric Challgren, of Southern Dermatology & Skin Cancer Center in Raleigh.

Dr. Challgren prepares a patient for a photo dynamic therapy treatment, to promote healing of sun-damaged skin.

Acne, eczema, or psoriasis, he says, are probably the top three dermatological conditions commonly linked to stress issues, each with toxic potential.

Dr. Challgren notes that “there have been fairly conclusive studies linking the pressure of final college exams to a flare-up of acne, for example. And we’ve all heard of acne eruptions prior to a prom or wedding or other special event. Today many patients feel like our society is going to implode. These social toxins put more stress on people’s lives, which doesn’t necessarily cause illness, but they can exacerbate a problem and can certainly trigger symptoms.

“We definitely see acne vulgaris, psoriasis, rosacea, eczema, and certain types of hair loss worsen when linked to stress. Under stress, the body produces hormonal steroids, such as cortisol and corticosteroid. Like other hormonal steroids, these chemicals target the skin in a disruptive way, often causing acne flare-ups, for example.”

Another example, notes Dr. Challgren, is a condition called prurigo nodularis, or what dermatologists call ‘pickers nodules’ or ‘neurotic excoriations,’ which is believed to have an underlying psychological drive. Initially, it may be triggered by a bug bite or a mild eczema, and then something causes it to flare. Neuroses and anxiety create the urge to pick and scratch.”

It’s a challenging disorder to treat, he notes, “because you don’t know how much is, in fact, a dermatologic issue and how much is a psychological response. The two mesh, and who’s to say that social toxins—which people experience daily—are not playing a role in the increased stress and anxiety of these afflicted people?”

A Window to Your Body

Your skin is simply an external reflection of what’s going on with the rest of your body, in Dr. Challgren’s view. “As your skin goes, so goes your body. If certain things are going wrong with your skin, it’s just as likely that something could be going wrong internally. You can’t compartmentalize your health: if your heart or kidneys aren’t functioning properly, it will eventually affect some other health condition, as well.

“When I have a patient who comes in and says that their world is a balloon ready to burst, I anticipate that a multi-disciplinary approach is needed,” says Dr. Challgren. “Obviously, our main focus in dermatology is to be able to effectively look at the skin as a whole and decide what’s going on. If it’s a physical and/or psychological problem, we treat the condition using our most effective options. If it’s something that’s simple, like poison ivy, we treat it and we’re done. If it’s something like chronic eczema, there may be an underlying stressor—such as a nerve-racking job or a death in the family—which needs to be addressed. It’s up to physicians to triage patients to some degree and say, ‘OK, you have eczema, but I can clearly see that you’re crying about the loss of your mother.’ Or, ‘You’re scratching because you’re not sleeping and it’s exacerbating the whole treatment process.’ Part of our job is to direct them to the correct specialist, which sometimes may be a therapist.”

Need to Triage 

Dr. Challgren points out that this approach is the same if the patient came in with horrific psoriasis with joint deterioration. “In that case, we would need to involve a rheumatologist in the patient’s care. Or if they had some type of infectious pattern that’s not getting better, they may need to see an infectious disease doctor. A patient may say that his eczema is getting better, but his knees are swollen and hurting; I would then direct him to an orthopedist. It’s up to practitioners to be able to triage patients properly, whether it’s a physical illness, or the challenge of handling the stress and toxicities of every-day life. It’s not the same for every patient.  Everyone has their own unique story and ailments.”

A good example of the interconnection of illness and stress, recalls Dr. Challgren, “was a patient I had—a lady in her early 50s—with eczema. Her mother, who was probably in her late 80s, passed away. They had a very tight relationship—constantly together. My patient was really struggling with her loss and would tear up quite emotionally—and this had been going on for a couple of years. As she went through bouts of more acute depression, her eczema would flare up—getting worse as she stressed about dealing with the estate and we would get it back under control with meds. But none of this solved the real problem—the stress from the passing of her mother or dealing with the estate process. She wound up having to seek multi-disciplinary assistance: from an internist, a psychiatrist, and us for various ailments—and the treatments were all intertwined. We would adjust meds to calm her eczema; her psychiatrist adjusted her meds as needed. It was a real combination approach to healing.

“We see many patients in similar circumstances. They’re good for a while and then suddenly they’re burning the candle at both ends and their acne flares up because they’re strung out. Those cases can be tricky and challenging.”

Epidemic of Skin Cancer

In considering the impact of the “toxic world,” Dr. Challgren noted the steady rise in the incidence of skin cancer. “We’re seeing melanomas, squamous, and basal cell cancers,” he says. “Cancers of the skin are definitely becoming an epidemic. Our lifestyles have changed—people are vacationing more, they’re sunning and tanning more. It’s true that education about the dangers of sun exposure is better, encouraging people to use sunscreen, but tanning beds are still rampant everywhere, and people are still not sufficiently protective of their skin.

“And the sun is not the only toxic threat to the skin,” he points out. “The skin is a barrier, the body’s shield to the world around it, and it is under constant assault from a multitude of environmental products and events. Skin problems rank near the very top in claims for Worker’s Compensation, for example, as the result of exposure to solvents and chemicals, cuts and abrasions, contact dermatitis, and much more.

“I don’t think there’s an easy one-pill solution for any of this. Overall, full-body wellness is always best with the Zen approach to life—a way that would lead to peace and relaxation—but most people don’t have the time to eat healthy, exercise, and meditate. In fact, there are many ways to stay mentally and physically sound, keeping the toxic overloads at bay. Everyone needs to find what works best for them. And it is our job to be helpful and well-informed as patients find their own path to healing.”