An Affiliate of Anne Arundel Dermatology

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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 S. Pascale, 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

Outer Signs of Inner Turmoil

“When I consider the link between mental and physical health,” observes Dr. Eric Challgren of Southern Dermatology & Skin Cancer Center, “the key word that comes to mind is ‘stress.’ Our mental and physical selves definitely tie together—at all times; I don’t think you get one without the other. But it seems to me that the interrelated health problems arise from stress. Certainly, the connection between stress and a great variety of skin conditions is very clear.”

Dr. Challgren prepares a patient for an extensive exam to determine the cause
of her skin condition.

He notes that a certain amount of stress is a normal part of life and “that’s actually good to a certain point. But when then you tack on global stress—such as we’re experiencing from the pandemic—the levels can become toxic.

“I don’t think acute stress is a problem,” he says. “It’s the more chronic stresses—the high cortisol levels over time—that have such a profound effect on health. We see that impact in many skin conditions that are exacerbated by stress. And we also see the reverse: skin conditions that can in themselves be stress-inducing; skin cancer is a classic example. It’s not at all uncommon for a person to receive a diagnosis of skin cancer with emotional reactions ranging from terror to anger to fear.”

The Skin Responds to Stress

“There are many skin problems,” says Dr. Challgren, “that can at least be exacerbated by stress, and some of that reaction can feed back on itself. That’s true, in part, because the psychological component of many common skin diseases stems from concerns people have about how they look. Skin diseases such as acne, atopic dermatitis, and psoriasis can be highly visible.

“We see this mind-body connection in particular with diseases that are aggravated by stress and where the diseases themselves create more stress. It’s a vicious cycle. And, while often these aren’t dangerous conditions with a long-term impact on mortality,” he notes, “they do have a long-term impact in terms of quality of life.

“Psoriasis is a good example. It is an immune-mediated disease,” he explains, “that presents as scaly skin lesions that may cover as much as 90 percent of the body, and can be quite uncomfortable. And this is a disease that intensifies in response to stress. Additionally, because of its visibility, psoriasis causes the patient more stress. As a result, these patients often feel socially isolated—which has a serious impact on quality of life. And studies show that chronic psoriasis patients also suffer significantly higher rates of chronic depression.

“So, it’s a vicious cycle,” he observes. “Stress makes the symptoms worse; the increased symptoms produce more stress. You can’t really separate them: your attitudes toward your health impact your health and your health issues affect your attitudes.”

Anxiety Produces Skin Problems

Dr. Challgren notes that some dermatological disorders are outlets for dealing with high levels of anxiety. “Each person handles stress differently,” he observes. “And for one person, it may manifest as neurotic excoriations (skin picking); for another, it might be hair loss.

In the case of neurotic excoriations, he explains, “patients come in picking and scratching, severely irritating their skin. And it’s not uncommon for them to deny that they’re doing it, even when it’s clinically obvious that they are. But other patients will make the connection between the emotional stress and the picking and scratching behavior. “They’ll say: ‘Yeah, I started doing this four months ago when my husband got diagnosed with cancer.’”

Other examples of stress-induced psychological and skin problems include a condition called trichotillomania—where children may twirl or pull out their hair—and telogen effluvium, where an emotional or physical stress causes a shift in hair growth patterns leading to hair loss.

The Big Picture

“The inescapable connection between mental and physical issues,” observes Dr. Challgren, “makes it especially important for us to step back and look at the bigger picture for each of our patients. As a specialist, it’s easy to zero in on the specific skin problem and maybe miss the other cues of a larger, more complex health issue. By stepping back, we may see the emotional components of the problem—and can help address them.

“A good example of this is a recent patient of mine who is being treated for hidradenitis suppurativa (HS), an inflammatory disorder of hair follicles/sweat glands, mainly in the groin and armpits. HS can cause inflammation, scarring, pain, and cysts, and can be difficult to treat. After extensive medical therapy, the patient had surgery, but although she healed nicely from a surgical standpoint, she experienced disproportionate pain afterwards—being unable to raise her arm or to work.”

Dr. Challgren prescribed both antidepressants and medications for the chronic pain, explaining that sometimes you have to look at the bigger picture. “In this case,” he says, “the primary physical problem had driven a secondary emotional problem.

“Dealing with psychological problems is not really in our wheelhouse,” he acknowledges, “but when a patient feels dismissed—as this one did—it’s important to find a healing path that takes into account both their mental and physical needs. With this patient, we’re exploring many options—including medication and physical therapy—to find that healing path.”

COVID Impact

“There’s no denying that a year and a half of stress related to Covid-19 has had an impact,” says Dr. Challgren. “And one of the unfortunate results of the pandemic—especially last year—has been that some patients have been less likely to seek care, or have delayed care.

“That’s not been a problem with patients dealing with conditions such as psoriasis,” he says. “It’s more of an issue with respect to skin checks. An example of this is a patient who hadn’t been checked in two years, despite a history of skin cancer. She came in with a sore on her scalp that had been there for perhaps over a year, but because of the pandemic, she hadn’t wanted to come in to have it looked at. Unfortunately, it is a serious melanoma that would have benefitted from much earlier intervention.”