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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

The Doctor Orders: Movement in Abundance

With three active youngsters and participation in a busy medical practice at Southern Dermatology & Skin Cancer Center, Dr. Eric Challgren finds it easy—and essential—to keep movement in all parts of his life.

Dr. Challgren performs a routine but critical skin check, always searching for variables that could indicate the need for clinical attention.

He is an avid seasonal athlete, biking, skiing, playing softball and swimming, depending on the time of year.

“From the point of view of the health of the skin, movement in abundance is just what the doctor ordered,” he says. “We all know exercise is essential for cardiovascular health, and to help maintain range of motion. It is important for the health of the skin, as well. It increases blood flow, which helps nourish skin cells and keep them healthy. Blood carries oxygen and nutrients to working cells throughout the body—including the skin. It has the effect of cleansing our skin from the inside.”

A Doughy Look

Lack of motion is clearly evident in the condition and appearance of the skin, Dr. Challgren notes. “People who are very sedentary open themselves to serious, ongoing health issues, such as painful and degenerating joints, obesity, heart disease, and constant back pain.

“The skin of a very sedentary person often has an almost doughy look, especially in dependent areas like the lower legs and the abdomen. There is often evidence of decreased skin integrity. It’s clear that at least a moderate, regular amount of movement is necessary for overall well-being and cutaneously—in terms of the health of the skin—there are important benefits.”

Health&Healing: There’s a positive link between exercise and stress reduction, as well.

Dr. Challgren: Exercise is one of the most effective stress management techniques we have. And as you reduce stress through exercise, there’s also a beneficial effect on such stress-sensitive skin conditions as acne, rosacea, eczema and even psoriasis.

Exercise is invaluable for me. More than 25 years ago, I was diagnosed with ankylosing spondylitis, which at this point affects almost my entire spine. There’s a good deal of pain, but it is tolerable. Medications help a good deal, but the most important functional therapy for me is activity and motion.

Activity and mobility is the key to not having fusions and other detrimental side effects. The more sedentary you become with any disease—particularly the one I have—the long-term consequences can include loss of mobility and functionality—which of course can lead to many other problems.

H&H: That suggests that, despite the pain, you have a pretty rigorous and dependable exercise program right now.

Dr. Challgren: Right now my exercise program is kicking back in. Nine months ago I tore my ACL while coaching soccer, and had corrective surgery that precluded much in the way of exercise for a while. Now I’m in the process of switching over to an elliptical machine for an extensive workout, four times a week.

H&H: At the same time, there are cautions related to exercise.

Dr. Challgren: Also accurate. Many studies over a long period show a link between sports participation and skin cancer. One study showed that participation in water sports is an independent risk factor for melanoma.

Another study found that 15 percent of female professional golfers have skin cancers before the age of 30—well above the norm. It’s also true that athletes who participate in their sports at higher altitudes—on snow-covered mountains, for example—place themselves at increased risk for sun damage to their skin, including skin cancer, because of higher ultraviolet radiation levels. Lip cancers among professional skiers are quite common, for example.

The bottom line is that weekend warriors as well as those more intensely involved with athletics need to be especially sensitive to their exposure to the sun—when and where it occurs, the level of intensity, and the condition of their own bodies.

We’ve come to understand that there is a significant link between ultraviolet radiation and suppression of the immune system. Most of us love the sun, we all need the sun’s energy and a reasonable dose of Vitamin D, and it is vital that we protect ourselves from the sun’s damaging rays.

Applying a high quality sun protection lotion wherever our skin may be exposed to the sun—to our face, neck, hands, forearms, legs—needs to become a daily habit just like brushing our teeth. We can teach our children to do this, forming a habit that will serve them well during their entire lives.

Equally as important as the use of quality sunscreens is the use of protective clothing, especially including hats. Search on the Internet for “sun protection clothing” and you’ll find a great selection of items for infants, children and adults, including hats, shirts, pants and shorts, shoes and accessories, even sun protection flotation swimwear.

H&H: Black heel is a skin problem that usually results from intensive movement.

Dr. Challgren: Sports such as tennis, basketball, soccer, and racquetball require repeated and sudden starts and stops, often on hard surfaces.

It’s not unusual, as a result of this jarring and repeated motion, to have a tearing of superficial blood vessels in the heel. The resulting condition, called black heel, usually presents as an irregular, black macular lesion on the heel that can be easily confused with a melanoma lesion. It’s important that we take a good history to avoid an unnecessary biopsy.

Usually this condition will clear up in two to three weeks with rest. Sometimes placing felt in the shoe is helpful. If any doubt exists as to the diagnosis, we can do a blood test using skin shavings or, if doubt persists, a biopsy that will definitively rule out or confirm the possibility of melanoma.

There are similar issues for what dermatologists and athletes alike call “tennis toe” or “jogger’s toe.” This is a mechanical injury of the toenail that results from repeated minor or, sometimes, major trauma.

It is important to differentiate these conditions from malignant melanoma, which will sometimes present under fingernails or toenails. These hematomas occur under the large toenails of tennis, squash, and racquetball players; the second and third toes of soccer and football players, and in the fourth and fifth toes of runners and joggers.

Generally, the harder the playing surface, the greater the impact on the shoe and therefore the greater the chance of developing this condition. Treatment and prevention include trimming the nails and purchasing shoes that have an adequate toe-box. If that approach fails to ease the pain, there’s always the possibility of a hairline fracture of a toe that may need to be evaluated.