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SOUTHERN DERMATOLOGY & SKIN CANCER CENTER

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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

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

We Are All Concerned About How We Look

“It’s stating the obvious to note that everybody is concerned about how they look,” notes Dr. Gregory Wilmoth of Southern Dermatology in Raleigh, with a smile.

Dr. Wilmoth: vigilant in checking for skin conditions that may need medical attention.

“Because this is true, there’s a huge psychological component to many common skin diseases, such as acne, atopic dermatitis, and psori-asis. These aren’t dangerous conditions with a long-term impact on mortality, but they are highly visible diseases displayed—often prominently —on the skin, and as such they do have a long-term impact in terms of quality of life concerns.

“Particularly with a condition such as psoriasis,” Dr. Wilmoth continues, “patients often feel limited in their own lives—like they cannot do things others can do—because of the appearance and condition of their skin.”
Psoriasis—an auto-immune disease—presents as scaly skin lesions which may cover as much as 90 percent of the body, and can be quite uncomfortable.

Notes Dr. Wilmoth: “Patients with psoriasis get stared at, asked ‘What is wrong with you?’, and often feel socially isolated due to a general lack of understanding that the condition is not contagious,” Dr. Wilmoth notes. “Because of these kinds of experiences, people with a condition such as psoriasis tend to have lowered self-confidence and experience higher rates of anxiety and depression.”

The Torment of Acne

Another simple example many can relate to is acne—the hormone-driven tormentor of the teenage years. Studies have shown that adolescents with acne endure more bullying and teasing from peers, and experience higher instances of social challenges during high school than those with clear skin.

“Interestingly,” Dr. Wilmoth notes, “though these skin conditions are not inherently dangerous, quality of life scores among these populations are lower than those with diseases such as hypertension, diabetes, or heart disease—all ailments that are in fact associated with higher rates of mortality. Psychologically, it’s easy to ignore your high blood pressure—but it’s not easy to ignore your psoriasis or acne or atopic dermatitis, which is right there in front of you every day.

“Furthermore,” notes Dr. Wilmoth, “how one feels out in public in terms of appearance isn’t the only issue faced by patients with chronic skin conditions. Personal relationships with friends and co-workers, and intimate relationships with spouses, can suffer as well. Quality of life of a spouse may be affected by night-time scratching and other behaviors that disrupt sleep, or the desire of one partner to avoid social situations. Really, the psychological well-being of a whole family can be impacted by these diseases.”

The Stress Cycle

Clearly, notes Dr. Wilmoth, skin problems can contribute a great deal to mental and emotional stress—and that stress itself can contribute to the actual manifestation of skin problems.

“There are skin conditions that can at least be exacerbated by stress,” he notes, “and some of that reaction can feed back on itself. Psoriasis, again, is a good example of this reaction. While it is often a difficult condition to treat free of other influences, it certainly tends to flare in direct relation to stressful conditions—thereby inducing higher levels of stress in the process. And we’ve seen repeatedly how acne will flare at times of stress—as a young lady prepares to attend her first prom, for example, or how the patient whose mother has become ill will suddenly find her psoriasis worsen significantly.”

Other skin conditions, such as vitiligo, are not disease-related but carry an unusually high emotional price tag for many,” Dr. Wilmoth says.
Vitiligo is a condition in which there is loss of pigment—with complete absence of disease—from areas of the skin resulting in irregular white spots or patches, even though the skin has normal texture. And the presence of vitiligo may indicate other disease processes going on in the body, he notes.

“The course of the condition is unpredictable,” says Dr. Wilmoth. “And there is two-fold concern with this condition in terms of its psychological impact. There are certainly psycho-social implications to address; this can be a glaringly obvious skin issue that causes an affected person to stand out in a crowd, and is thus a major source of distress for some people. And it may signal the existence of physical issues as well, such as the possibility of underlying diabetes, thyroid disease, or other auto-immune conditions.”

Reading the Skin

Based on an understanding of skin pathology, Dr. Wilmoth tells us, “we are often able to make a first diagnosis of many diseases simply by an expert examination of the skin. Health problems such as HIV infections, polycystic ovary disease, diabetes, inflammatory bowel disease, or connective tissue disorders such as lupus—can all be reflected in the skin if you know how to read it.

“Dermatologists are very visual people. As we look at a patient’s skin, we’re constantly running possibilities through our mind to explain what we see. A patient may present, let’s say, with a severe itching problem over their entire body. As the exam proceeds, we seek to determine if the condition is neurologically driven. Or is this patient under high levels of stress that could explain the problem? And we consider the possibility of internal issues—a problem with the liver or kidney functions, or perhaps medications the patient is taking that are the source of the problem. Is there an underlying parasitic infection, or an internal malignancy?

“With the patient’s cooperation, we do what it is necessary to find the cause of the skin condition—the excessive itching, in this case—and in the process it is not uncommon to find a serious underlying condition such as a lymphoma or a parasitic infection that needs appropriate treatment.
“The skin is our largest organ, and detecting and successfully treating skin conditions is both challenging and immensely rewarding, for both patient and doctor.”