It’s easy to think that if something weird is going on with your skin, you just need to go to the dermatologist to get a clear answer about what’s up. But because so many issues can look the same, that answer isn’t always the right one.
“Dermatology is a visual specialty, and two conditions can look very similar,” says Ivy Lee, MD, a dermatologist practicing in Los Angeles. “It takes little details like how something has changed recently or the way it’s responded to home remedies to differentiate between them. A patient might also have multiple issues going on at the same time, so the picture can get very muddy.”
Worried that a diagnosis you received might not be quite right? Here are four skin issues doctors tend to have the most trouble identifying, according to Dr. Lee. Plus, additional insights on dealing with a possible misdiagnosis—for any skin condition—from women who’ve been down that path.
Causing painful lumps under the skin, hidradenitis suppurativa (HS) is caused by blockages in hair follicles, which cause bacteria to get trapped. “This is a classic example of something that can be misdiagnosed—it’s often confused with acne or folliculitis (a.k.a. inflamed hair follicles),” says Dr. Lee. Making it even harder to diagnose: One of the defining characteristics is that the bumps show up in the groin or buttocks—something some patients might be too embarrassed to mention. That might explain why, according to a study out of France, it takes an average of six to eight years from the appearance of the first symptoms to receiving a correct diagnosis.
That was certainly true for Sara McClimon, 26, an Atlanta-based firefighter. She first noticed weird bumps in her groin around the time she was 10 or 11 but didn’t tell her mom about it for a few years. “We went to a dermatologist, and I showed him the bumps on my chest and back, where it had spread, but didn’t even mention the ones in my groin,” she says. “He said it was just cystic acne.” Even though the medication prescribed didn’t make it better, McClimon ignored it until college. “It got really bad my freshman year, and I went to a new dermatologist who took one look at me and told me I had HS,” she says. “It was a little scary to get the diagnosis because I didn’t know what HS was, but at least I had an answer and didn’t just have acne that would never go away.”
Breaking out in zits around your mouth? It might be perioral dermatitis, which is a red rash that can appear on the face. “It can be confused with other conditions like acne and seborrheic dermatitis (a kind of dandruff on the face)—there’s a lot of overlap,” says Dr. Lee. Dermatologists need to look for specific signs that the perioral dermatitis isn’t acne, like a clear border directly around the lips, per a review in the Journal of the Saudi Society of Dermatology & Dermatologic Surgery.
It took Sarah Kay Hoffman, 37, owner of a Minnesota-based online media company, more than 15 years to figure out what was causing the rash on her face. “It started out as a red, scaly rash around my nose when I was 13 years old,” she says. That started a cycle of going to the doctor, getting a diagnosis (for everything from eczema to a fungal rash), trying an ointment for a few weeks, having symptoms improve briefly, then seeing them come back looking worse than it did before. “I was frustrated but thought it was just normal skin stuff that everyone goes through,” she says. It wasn’t until she saw a new doctor in 2014 for a different issue that she finally got the diagnosis of perioral dermatitis—and hasn’t had a flare up since finally getting properly treated. (The condition is typically treated with a steroid cream, according to The American Osteopathic College Of Dermatology.)
This might be the most common form of cancer in the United States, per the Centers for Disease Control and Prevention (CDC), but it’s not always easy to diagnose. “It can be incredibly deceiving because skin cancer moles can mimic a lot of other harmless moles,” says Dr. Lee. For example, instead of being black, a cancerous mole can be colorless and look a bit like a pimple, Dr. Lee says.
That doesn’t come as a surprise to Mandy Matney, a 30-year-old journalist in Hilton Head, South Carolina. She had what looked like a pimple on her forehead, but it kept scabbing over and wouldn’t go away. “I went to see a doctor and he kind of made fun of me for wanting to get it checked out," she recalls. "He said it looked fine and dismissed my concerns that it might be cancerous.”
A year later, she went to another dermatologist—and found out the spot was basal cell carcinoma, a form of skin cancer. She had the spot removed, but is still upset it took so long to get the correct diagnosis. “My mom had melanoma, and I have a friend who died of skin cancer,” says Matney. “I was scared and angry that I could have had it dealt with a year earlier if the doctor had taken me seriously.”
This disease results in red, scaly skin that can be sore or itch—symptoms that aren’t all that unique. “Both psoriasis and eczema can look the same, but they tend to be located in different parts of the body,” says Dr. Lee. “The problem is that they don’t always show up in traditional locations.” That can raise the odds of a misdiagnosis—something that only becomes apparent when the prescribed treatment plan doesn’t work.
Alice Lee, a 22-year-old student in England, noticed something was going on with her skin about 10 years ago. “It started as red raised patches on my scalp, then spread down my neck and face,” she says. “I lived with it for a year and it was diagnosed as just bad dandruff.” The anti-dandruff shampoo she was told to use helped a little, but the red patches remained and began to spread even further down her body. That led to yet another misdiagnosis of ringworm.
Four years after symptoms started, she went to a new doctor for an ear issue, and that doctor mentioned that she had psoriasis. “I was so confused because I’d never been diagnosed with that before,” she says. “It felt so wonderful getting the right diagnosis and being able to receive proper treatment! It really changed my life!” (Treatments for psoriasis range from topic creams and ointments to ultraviolet light therapy to drugs, per the CDC.)
Dealing with a misdiagnosis
So what should you do if you have a skin condition and are worried about the accuracy of your diagnosis? Here are a few useful tips to follow:
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