The Skin Often Warns of Silent Disease

SOUTHERN DERMATOLOGY &
SKIN CANCER CENTER

For more information about skin conditions and their treatment, contact:

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


Gregory J. Wilmoth, MD
Eric D. Challgren, MD
Margaret B. Boyse, MD
Laura D. Briley, MD
Tracey Cloninger, PA-C
Stephanie S. Pascale, MSN, FNP-C

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

THE SKIN RENEWAL CENTER AT SOUTHERN DERMATOLOGY
4201 Lake Boone Trail, Suite 207
Raleigh, NC 27607
Telephone: (919) 863-0073

Dr. Wilmoth: “Frequent, regular skin checks are the principal way we identify problems.”

“Not only is the skin our largest organ but, for the careful observer, it often reveals vital information about an array of diseases that, in early stages, are free of symptoms,” observes Dr. Gregory Wilmoth of Southern Dermatology and Skin Cancer Center in Raleigh.

“For example,” he explains, “rashes appearing as pimples, lumps, bumps, and blisters can be visible clues to such underlying conditions as kidney, liver, thyroid or even Hodgkin’s disease, as well as diabetes, inflammatory bowel disease, or connective tissue disorders such as lupus.”

Dr. Wilmoth acknowledges that many common skin problems are just that—skin problems. The challenge, he says, “is to recognize the symptoms that suggest more complex health issues.

And while other doctors may misinterpret a rash as a benign problem, dermatologists are trained to understand those subtle differences. One good example of this is severe acne in teenagers, which sometimes signals the existence of polycystic ovary disease, often as the result of an imbalance in androgen hormones.”

Skin Issues That Are More Than They Seem

“Dermatology is a highly visual specialty,” notes Dr. Wilmoth. “And the art of seeing clearly what others may miss is an essential skill in the life of a dermatologist. In fact, the skin is a mirror reflecting whatever is going on in the body—including chemical imbalances and stress, as well as disease. And symptoms that show up in the skin are important clues to what is going on underneath.”

Certain skin problems, explains Dr. Wilmoth, deserve special attention because they signal more complex, serious underlying issues. These include xanthoma, lupus, and dermatomyositis.

Xanthoma, for example, is a common skin condition that can forewarn elevated cholesterol, which is often a precursor of heart disease,” he explains. “This disease—which we commonly see in older patients—is basically a concentration of fat beneath the surface of the skin. As a result of that concentration, the skin takes on a yellowish hue, and patches on the skin have a slightly bumpy texture, usually appearing on the eyelids, knees, and elbows.

“It’s a good example of a silent disease,” he notes. “It does not itch, nor is it painful. What’s important is that it may be a symptom of underlying metabolic disorders that are associated with an increase in blood lipids—such as diabetes and some types of cancer. We can surgically remove these bumps, but the key is to identify and control the underlying disorders.”

Among other diseases that can also be detected by way of our skin, are connective tissue diseases, such as lupus. “Lupus,” explains Dr. Wilmoth, “is a chronic autoimmune disease, ranging from mild to severe, in which the immune system becomes hyperactive and attacks normal tissue. Sometimes lupus may first show up as a rash on the face, often in a design similar to a wolf’s face—across the cheeks and nose. It’s not uncommon for an early-stage lupus rash to be misdiagnosed as rosacea by a practitioner who is unaccustomed to seeing the variety of rashes and skin conditions that make up the professional life of a dermatologist. Again, the lupus rash is most often a silent indicator of an underlying problem, which, although free of pain or itching, is a serious health issue.”

Symptoms of lupus—which remains incurable but can be effectively managed—vary greatly from one patient to another. Patients with severe problems are best treated by a team approach where effective care can be rendered by dermatologists, rheumatologists, nephrologists, immunologists, and family practice physicians.

Dermatomyositis is another connective tissue disease we see that may signal more serious problems,” says Dr. Wilmoth. “The classic version of dermatomyositis involves a skin rash with a muscle weakness. However, often it’s not fully developed at the time that you encounter the patient, and some patients won’t have any muscle involvement.

“But, while the symptoms may not be extreme, the reason this disease is of concern is that—for a good proportion of patients—dermatomyositis is a manifestation of underlying carcinoma. They may have cancer of the colon or lung or pancreas, or in some other location. So, in my assessment of these patients, particularly later age adults, I advise additional cancer screening—such as mammography, colonoscopy, and blood work—to rule out the possibility of an underlying cancer.”

Melanoma: A Silent Killer Demanding Vigilance

Melanoma is one of the most well-known serious diseases affecting the skin. “And, because it is a cancer,” notes Dr. Wilmoth, “it is a true silent killer. It doesn’t itch. It doesn’t hurt. There’s not a bump. It’s asymptomatic. Just a brown patch of skin. And sometimes, unfortunately, by the time a person finds out they have melanoma, it can be very advanced, even lethal.”

“With early detection, there are rarely complications in the treatment of basal and squamous cell skin cancers,” notes Dr. Wilmoth, “both of which are the result of over-exposure to the sun. There is a better than 90 percent cure rate for these types of cancer. But it is melanoma—where cells are wildly out of balance and dividing rapidly—that gets our very focused, undivided attention.

“Dermatologists, of course,” says Dr. Wilmoth, “are trained to see the difference between a cancerous and benign skin growth, but in my experience, eight out of ten people come here with a melanoma somewhere on their body because they intuitively know there’s a problem. They come here because ‘It looks funny,’ or because ‘My wife has been bugging me about this mole; she thinks it looks funny.

“What we look for are moles that are changing or increasing in size, changing their character or their color or causing some kind of symptom, such as bleeding or hurting. But the simple cue is that a mole is changing in some way.

“I want to emphasize,” adds Dr. Wilmoth, “that the vast number of moles that appear on our skin—and most adults commonly have 40 or more moles at any one time—are perfectly harmless. But I want to find the ones that aren’t harmless; that are, in fact, potentially lethal.”

The main diagnosis is still done by clinical examination, says Dr. Wilmoth, “but monitoring one’s own skin health is easy and helps ensure that cancers will be detected early, when they are most treatable. So, we encourage our patients to be vigilant, and to keep an eye on freckles and spots on their body. Get a friend or spouse to check your back or take a close look in the mirror. And make a point of monitoring changes in moles themselves using ABCDE guidelines—looking for changes in asymmetry, border, color, diameter, and evolution (the ABCDEs). A monthly exam is fine, but it may not need to be that often. Ideally, everyone will have a skin check with a dermatologist regularly, and certainly every year beyond the age of 50.”

More Provider Articles

Poor Sleep: A Silent Threat to Health

A little appreciated hidden health risk, observes Dr. Charles Ferzli of the TMJ & Sleep Therapy Centre in Cary, is poor sleep. “Indeed,” he says, “quality sleep is a critically important foundation for health, and poor sleep contributes directly to many serious diseases—including diabetes, heart disease, hypertension, depression, and more. It is during our nightly sleep cycle that our body regenerates and heals. And when that cycle is disrupted, it affects inflammatory processes in the body, contributing to disease and impairing our ability to heal.
Read More

Coming Back from Obesity: Weight Loss and Body Surgery

“Plastic surgery is not a one-step solution to obesity. While body contouring procedures can provide transformative results, they have major limitations on how much fat they can safely remove. Further, not only does excess weight have serious health consequences, but obese patients are at greater risk of complications during and after surgery.”
Read More

Hormonal Balance: A Silent Symphony Supporting Health

“Any conversation about the risk of so-called ‘silent diseases,’ will inevitably lead to a discussion of hormones and hormone imbalance,” observes Dr. Jennifer Burch of Central Compounding Pharmacy in Durham. “Osteoporosis, diabetes, hypertension, heart disease—all these conditions are influenced in significant ways by our hormones, and particularly by hormone imbalances.
Read More

Hidden Toxins in the Home

“One lesson I’ve learned in my 29 years in this business,” says Bill Dolch, “is that most people are unaware of the toxins they’re exposed to in their own homes.” Mr. Dolch is the owner of Certified Indoor Air, Inc., of the Triangle, a company providing comprehensive mold testing and air quality inspections in the Greater Triangle area.
Read More

Silent Diseases, Hidden Threats: An Integral Approach to Healing

In today’s world, many diseases remain silent until they reach advanced stages. Conditions such as heart disease, diabetes, sleep apnea, obesity, and chronic stress quietly undermine our health without immediate symptoms. These hidden threats, compounded by drug side effects and environmental toxins, pose significant challenges for diagnosis and treatment.
Read More

The Hidden Threats of Social Platforms

When parents and caregivers think about hidden threats to their children, social media and messaging is a huge source of anxiety for many. At a time when many adults are themselves feeling more isolated and reports of childhood anxiety are rising, it is right to feel cautious. At the end of July, the Senate passed a bipartisan bill proposing new safety and privacy regulations for minors on social media and on-line communication platforms. This work was fueled in large part by testimonies from families whose children succumbed to bullying, harassment, and other negative impacts of on-line networks. While this legislation…
Read More

Surgery and Silent Diseases: Proceed With Caution

Among the more challenging aspects of my work,” notes Dr. Gregg, “are the risks involved when a patient has an underlying disease, such as diabetes. “Diabetes patients,” she explains, “have significantly higher risks from surgery because of their high blood sugar levels, especially when the disease is not well controlled. There is an increased risk of infection, slower wound healing, and potential kidney and heart problems. So it is critically important that we evaluate each patient’s case carefully, make sure they are aware of these increased risks, and—most importantly—that we get clearance from the physician helping them manage their diabetes….
Read More

The Medicine of Meetings

Founded in 1935, after a meeting between two strangers in Akron, Ohio, Alcoholics Anonymous has helped save and impact countless lives since its inception. Through its unique approach in utilizing a “spiritual solution to a medical problem,” the organization’s famous 12-Step Program has spawned other peer-to-peer “Anonymous” groups with the same basic principle that only those similarly afflicted can truly comprehend a mutual malady. This type of support transcends religious, racial, socioeconomic, and cultural differences, as reflected in A.A.’s two million active members across 120,000 groups in 180 countries. At its core, A.A. is a process by which people get…
Read More

Hidden Pain

I believe most of us are walking around carrying some kind of pain. We may experience the loss of a beloved partner, whether through a breakup or death. Many of us grieve parents, grandparents, children, friends, or other loved ones. Some of us have lost jobs or a place to live. Many of us have experienced diminishments to our health or way of life. We may have lost our innocence through betrayal or emotional, physical, or sexual abuse in a relationship that should have been safe. We all have our share of pain. Even if we have support at the…
Read More

The Skin Often Warns of Silent Disease

“Not only is the skin our largest organ but, for the careful observer, it often reveals vital information about an array of diseases that, in early stages, are free of symptoms,” observes Dr. Gregory Wilmoth of Southern Dermatology and Skin Cancer Center in Raleigh.
Read More

Are Bio-Identical Hormones the Only Answer for Menopausal Symptoms?

We tend to think that menopause is all about hormones, right? Therefore, taking hormones should provide relief for hot flashes, vaginal dryness, weight gain, moodiness, hair loss, and more. As a physician who has been prescribing bio-identical hormone therapy (BHRT) for women for nearly two decades, I can say that prescription hormones alone often provide only partial answers.
Read More

The Brain’s Response to Silent Diseases

“Typically, depression weakens the ability of the patient to manage and moderate the pain they’re experiencing, so they often slip into a loop: increasing pain induces more severe depression which intensifies the pain.”
Read More