Ever look at an unfamiliar spot or blemish and wonder if it’s a blackhead, pimple, or sun spot? Worse, ever consider that it could be something more? To the untrained eye, unusual skin presentations can cause confusion and alarm. They can also go misdiagnosed, often not getting the attention they require. This is because many skin conditions can seem similar in appearance to one another, says Shari Marchbein, board-certified dermatologist and clinical assistant professor of dermatology at New York University School of Medicine.
“For example, a pink flaky spot or rash can be eczema, dandruff, ringworm, psoriasis, or even a skin cancer, like squamous cell carcinoma,” she says. Unfortunately, patients sometimes report to the dermatologist’s office sharing a previous diagnosis that is incorrect and having missed out on valuable treatment time. Because this occurs more often than documented, we’ve highlighted the top four skin conditions most commonly, well, diagnosed — and how to look out for them.
Basal Cell Carcinoma
In some cases, skin cancer can be mistaken as a small blemish. Basal cell carcinoma (the most common skin cancer in the U.S. – one in five people will have it in their lifetime, according to the Skin Cancer Foundation) “can often start as a small pink bump that can be confused or misdiagnosed as acne,” says Marchbein. Because of this, dermatologists typically recommend coming into the office for examinations if a new spot is present for more than three weeks and is consistently growing, bleeding, or changing in any way.
Another common misdiagnosis is rosacea disguised as acne, says Estee Williams, a board-certified medical, cosmetic and surgical dermatologist and clinical professor in dermatology at Mount Sinai Medical Center in New York City. “Pimples, breakouts, zits … everyone knows what acne is, but many people have not heard of rosacea, even though 16 million Americans have the condition,” she says. The chronic skin condition of the face has two prominent traits — redness and skin sensitivity — which makes the disease difficult to both diagnose and treat.
“When it comes to rosacea, there are 50 shades of red — anything from rosy cheeks to pimples that are often mistaken as acne,” says Williams. “Even the most-seasoned dermatologist may find it challenging to distinguish the two, and what’s more, acne medications tend to make rosacea worse.” Williams warns that if you have sensitive skin, tend to blush or flush easily, or have pink pimples that take a long time to heal, you might have rosacea.
Many people self-diagnose themselves with a dry, flaky scalp when, in fact, they have psoriasis, according to Joshua Zeichner, the director of cosmetic and clinical research in dermatology at Mount Sinai Hospital in New York City. “Psoriasis is a condition in which your immune system gets angry at your skin and attacks it,” he explains. “We don’t understand why this happens.” In this case, the skin typically develops flaky plaques, which typically show up on the elbows and knees, but can also be found on the scalp. Dermatologists can suggest prescription options to help with inflammation.
In Zeichner’s experience, eczema — an inflammatory condition in which the skin develops microscopic cracks, causing a loss of hydration — can often be confused for the fungal infection ringworm. “Many people come into the office having used an antifungal cream on a scaly, red rash on the body,” he says. “I find that more times than not patients are actually suffering from eczema.”
In order to avoid a misdiagnosis, it’s important to seek expert insight and treatment from a board-certified dermatologist (a skin expert with eight years of extra training and expertise) any time you have an unusual skin finding or concern, says Marchbein.
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