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SOUTHERN DERMATOLOGY & SKIN CANCER CENTER
An Affiliate of Anne Arundel Dermatology

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THE DERMATOLOGY & SKIN CANCER CENTER

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


THE SKIN RENEWAL CENTER AT SOUTHERN DERMATOLOGY

4201 Lake Boone Trail, #207

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

Self-Treating Skin Conditions
Can Be High-Risk Behavior

The inclination to self-treat many skin problems may be common, but results can run the gamut from effective to potentially disastrous. Dr. Eric Challgren of Southern Dermatology and Skin Cancer Center in Raleigh encourages his patients to be informed— but not to substitute their own judgment for professional care.

A critically important part of his job: Dr. Challgren does a routine skin check for this patient, looking for conditions—such as cancer— that may require treatment that is far from routine.

“Sometimes,” he cautions, “it makes sense to seek medical care for even apparently minor skin problems. If you have a skin condition and you do not know what it is, come in; let us evaluate it. If you have a skin problem that is not improving over time, come in. If it’s spreading, come in. If it’s a brand-new skin problem that you’ve never seen before, come in.
He also encourages patients to continue regular maintenance care, for example: to continue prescribed biologic therapy for psoriasis, psoriatic arthritis, or other chronic skin diseases.

“I appreciate that some people have been reluctant to seek in-person care due to the pandemic,” he acknowledges, “but there are certain problems that should not wait. Furthermore, we are taking all precautions necessary to ensure a safe environment for all our patients and staff.”

Self-Treating Skin Cancer: Very High Risk

Perhaps highest on the list of concerns, says Dr. Challgren, is skin cancer, which patients frequently misdiagnose. “In today’s digital world,” he notes, “it is increasingly common for a patient—after consulting Dr. Google—to come in with a lesion or growth that they have been self-medicating with over-the-counter treatments for six months or more. Meanwhile, in a matter of minutes, we are able to determine if the skin issue is life-threatening.

“Because you can see most everything that’s on the skin, or right beneath it, it’s easy for people to Google ‘growths’ or to look for a picture that matches what they believe they see on their skin and, on their own, try to determine if their problem is, in fact, cancerous or in other ways serious. This is a very bad idea. And, of course, not all cancers fit the textbook pictures found on the Internet.”

And so, says Dr. Challgren, “we most often see two extremes. On the one hand, there are people who are worried about melanoma who come in with very benign growths, that are of no consequence. At the other extreme are those who have had a ‘mole’ for a few years or longer, which has bled a few times but not really bothered them. When they finally come to us, their growth is a late-stage melanoma. The people in this second group are very often the ones who have been using Dr. Google and treating themselves with OTC skin care products.”

Diagnosis Can Be Tricky, Even for Professionals

Dr. Challgren adds that it’s not just patients, but non-dermatologic specialists who can mistake different conditions in the skin. “Visual disorders of the skin may look very similar, overlapping and mimicking one another,” he explains. “But while they look similar, they may require very different treatments.

“We frequently see patients who have misdiagnosed cold sores and ringworm, for example. They then treat the condition with an over-the-counter product designed for something else, which is ineffective in treating the actual problem. Patients who treat their ‘fever blisters’ around the mouth with cold sore products, for example, may in fact be suffering from contact dermatitis, a far different condition.

“When evaluating the effectiveness of OTC products,” says Dr. Challgren, “my rule of thumb is this: If you’re treating a skin condition that typically should be getting better or going away in a relatively short time, and it’s not doing that, we need to consider other possibilities. First, we need to be sure we have the right diagnosis. And even if we do, we should be asking if there are other medications that might be more effective.”

Another self-medication problem Dr. Challgren sees frequently is when patients take medication prescribed for one skin disorder and use it for another, assuming they’re the same thing. “That can actually make it worse,” he says. “For example, if they’re treating ringworm with an eczema cream, it won’t get better—because they’re not treating the actual problem. And even worse,” he recounts, “are the cases where patients apply topical steroids on a true fungal infection. It’s like spraying Miracle-Gro on the weeds in your garden—they just grow rampantly.”

And evaluating skin growths and pigmentation changes can be particularly tricky, he notes, even for dermatologists. Assessing pigment changes, can be especially challenging, because people accumulate more pigmented spots with age. This is where dermatologists’ experience in visual examination comes into play,” he notes, “and helps us differentiate the harmless from the possibly harmful.”

Consequences of the Wrong Kind of “Self-Care”

In his practice, Dr. Challgren sees misdiagnoses and treatments that range from the merely uncomfortable to potentially life threatening. He describes one such frequently-seen progression: “Someone gets a scrape. They put Neosporin on it, and get a blistery rash, which they think is infected, so they keep putting more and more Neosporin on it, making the problem worse. Finally, they go to a primary care provider, who puts them on an antibiotic for a supposed infection, which doesn’t work. Eventually, we’ll see the patient, and identify the problem—which is quite common—as an allergic reaction to the Neosporin.”

That’s a frustrating, but relatively minor problem; but Dr. Challgren notes that the consequences of misdiagnosis and treatment can be far more severe. “I had one patient who had been told he had a wart on his finger by a well-meaning friend. The patient kept applying over-the-counter wart treatments, but the ‘wart’ kept growing. The ‘wart’ turned out to be an aggressive squamous cell carcinoma, which had by then metastasized to the axillary lymph nodes.”

To avoid problems such as this, Dr. Challgren advises: “be alert, be aware, be diligent— do not self-medicate, do not ‘trust your intuition,’ do not rely on information you’ve gathered from the Internet or other sources. Work with your provider to establish a safe protocol of care— and then abide by that protocol religiously.”

The essence of such a self-care plan, notes Dr. Challgren, is basic and regular skin checks. “Maybe the most important thing I encourage patients to do is a monthly self-evaluation of their skin. Check from head-to-toe; you know yourself better than anyone.”