When to see a dermatologist

The Skin Cancer Foundation and other experts recommend seeing a dermatologist once a year—or more, if you have a chronic skin condition or are at high risk of skin cancer. That being said, you may be able to save yourself the trip (and money) by learning the signs of different skin conditions and whether or not they’re cause for alarm. If you’ve noticed a new rash or bump, you might be wondering, “Should I see a dermatologist?” Here’s when it’s a good idea—and when to see someone else.

When to see your primary care provider

For most skin issues, your primary care provider (PCP) is a good first stop. They will examine you, and if necessary, refer you to a specialist. According to the Cleveland Clinic, the following common skin conditions don’t usually require a dermatologist’s attention.

Mild acne

Your primary care provider can diagnose whiteheads, blackheads, and moderate acne breakouts, according to Cheryl Rosen, MD, a board-certified dermatologist and director of dermatology at BowTied Life. Acne can usually be treated with antibiotics, over-the-counter creams containing benzoyl peroxide, azelaic acid or salicylic acid, or prescription creams with retinoids.

Rosacea

Rosacea appears as pustules or redness on the nose, cheeks, chin and forehead. The cause is unknown, but it can be triggered by stress, heavy exercise, alcohol consumption or exposure to harsh weather conditions. There’s no cure for rosacea, but moderate to severe cases can be treated with oral or topical medicines such as metronidazole gel, Mirvaso (brimonidine) and Rhofade (oxymetazoline).

Warts

Warts are caused by a virus and are more common in children. Sometimes warts are hard to distinguish from other skin conditions, but your PCP can diagnose and treat warts. Some warts do resolve spontaneously; although, this may take years. Your primary care provider may prescribe salicylic acid to treat them or freeze the wart at a visit.

Minor rashes

If you have a rash, see your PCP first as it’s likely something he or she can handle it. If the rash is rapidly spreading or painful and your provider can’t get you in quickly, you may need to be seen at an urgent care center. Telemedicine visits are also appropriate and may help you be seen and diagnosed faster. “A rash that is not improving with topical antifungals, moisturizers, or over-the-counter cortisone warrants a trip to the dermatologist,” says Emily Wood, MD, a board-certified dermatologist at Westlake Dermatology in Austin, Texas.

Bug bites

Most insect bites are self-limited and resolve on their own. Unless you have an allergic reaction, most stings and bites can be treated at home. If they do not resolve, or you are concerned, visit your PCP for diagnosis and treatment.  Antibiotic ointment or some anti-itch cream may be prescribed.

Simple cysts

Skin cysts appear as small round bumps or blackheads. Cysts don’t cause problems and don’t need treatment. Your local doctor can diagnose them and advise you on if it’s safe to just ignore them. If you want a cyst removed, your PCP can do this in the office.

Athlete’s foot

This is a common fungal infection characterized by scaly or peeling skin between the toes. It’s easily cured with over-the-counter creams or sprays, such as Lamisil AT (terbinafine) or Lotrimin AF (clotrimazole)—or by prescription in more severe cases.

Dandruff

A common condition that causes dry skin to flake on the scalp and eyebrows, dandruff can sometimes be itchy but is otherwise asymptomatic. It is unknown what causes dandruff, but it can be treated easily with over-the-counter dandruff shampoos. The American Academy of Dermatology recommends shampooing twice a week with dandruff shampoo if you are white or Asian American and once a week if you are Black.

Mild, benign lesions

Your family doctor can treat common harmless skin tumors, like cherry angiomas or skin tags—no visit to a specialist necessary. These may look like red dots on your torso or extra pieces of skin the same color as your body.

When to see a dermatologist

Aside from visiting the dermatologist for yearly checkups, your primary care physician may refer you if any of the above conditions worsen or doesn’t respond to standard treatment. The following symptoms can signal that you need a specialist’s attention:

• A mole or freckle is changing in shape or size
• Rough, scaly patches on your skin
• A rash that covers more than 10% of your body, especially when accompanied by pain or fever
• Persistently dry, itchy, or reddened skin that doesn’t respond to PCP treatment 
• Severe acne that may cause scarring
• Patches of skin that are lighter or darker in color than the rest of your body
• Sores that don’t heal within two weeks
• Unexpected hair loss or bald spots
• Signs of aging or unsightly veins

These could be signs of one of the following conditions that a dermatologist is best suited to treat.

Eczema (atopic dermatitis)

Caused by your immune system overreacting to an allergen or irritant, eczema causes skin to get dry, itchy and red. Moisturizing creams or ointments, skin-care products containing cortisone or ceramide, or antihistamine medications can help control itching. 

Pityriasis rosea

This condition usually starts with a single itchy, red patch of skin that goes away after a few days and is replaced days or even weeks later by a rash across the back and chest. This rash typically persists for a few weeks and heals without scarring. Medicated lotions, such as Hydrocortisone 1% cream can soothe itchiness and may help the rash resolve more quickly.

Alopecia areata

This condition, caused by an autoimmune disease that attacks the body’s hair follicles, leads to patches of hair falling out. This hair loss can affect just a small area, a person’s head (alopecia areata totalis) or even their entire body (alopecia areata universalis). Treatment for alopecia can include corticosteroids that may be injected, taken orally or applied topically. Rogaine (minoxidil) is also often used as a treatment for hair thinning.

RELATED: Why is my hair falling out?

Vitiligo

Affecting about 1% of the population, vitiligo is a skin disorder that causes skin to lose its color. It can also cause hair growing from the hypopigmented skin to turn white. Vitiligo occurs when the body’s immune system destroys melanocytes (the skin cells that produce melanin, a chemical that gives skin its color). There is no cure for vitiligo, but corticosteroids (such as Cutivate or Elocon), light therapy and even surgery can help treat the condition or improve the appearance of affected skin.

Tinea versicolor

A painless fungal infection, tinea versicolor affects the skin’s pigmentation, leading to patches of skin that can be lighter or darker than the surrounding skin. Most common in teens and young adults, tinea versicolor can be treated with antifungal lotions, creams or shampoos—such as Nizoral (ketoconazole) or Loprox (ciclopirox). However, it may still recur after treatment, and skin color can remain patchy and uneven for weeks or even months. 

Acanthosis nigricans

Most commonly found in people who are obese or have diabetes, acanthosis nigricans causes skin to thicken and turn dark and velvety to the touch. This usually occurs in the armpits, groin, or back of the neck. In rare cases, acanthosis nigricans can be a warning sign of a tumor growing in an internal organ. There is no specific treatment for acanthosis nigricans other than addressing any underlying issues that might be causing the skin to change color.

Psoriasis

Often similar in appearance to eczema, psoriasis leads to patches of thickened, red skin that can be warm and covered with white or silvery scales. Psoriasis may cause arthritis in affected joints. Psoriasis is a chronic condition that waxes and wanes throughout life. It usually doesn’t go away for good, and there is no cure. Treatment with steroid creams, moisturizers, light therapy, or the medication Anthralin can ease symptoms or help stop the spread of the rash.

RELATED: Psoriasis vs. eczema

Moles and spots

Most moles and spots are harmless, but you should keep an eye on them just in case, as some may become cancerous. “Look out for any mole or spot that may fall into the ABCDEs of melanoma, meaning: asymmetry of the lesion, irregular borders, multiple colors, diameter (larger than about a pencil eraser) or if the lesion is evolving,” says Dr. Wood. “A good rule of thumb is to look out for the ‘ugly duckling,’ or the spot that looks different from the other moles or spots.” 

Ask your PCP at your annual wellness visit to check your skin. You should point out any moles or skin lesions that have changed in appearance.

In addition to recommending treatments and prescribing medications, dermatologists may also perform procedures in their office to treat skin conditions. Common procedures include the following:

• Laser surgery
• Chemical peels
• Dermabrasion
• Laser resurfacing
• Mole removal
• Light therapy
• Sclerotherapy 

Dermatologists “may also offer cosmetic services such as laser hair removal and botox injections,” explains Dr. Wood. If you’re concerned about wrinkles or spider veins, dermatologists are well-suited to treat them. Many cosmetic procedures are not covered by your medical insurance.

RELATED: What a dermatologist can do for you

It’s important to note that dermatologists may be harder to get an appointment with or require a referral, depending on your insurance plan. It is best to start with your primary care provider. The cost of a dermatology visit depends on your health insurance or Medicaid or Medicare coverage. Most non-cosmetic procedures performed by dermatologists are covered by insurance, but you may have to meet your annual deductible or satisfy a copay or out-of-pocket costs. If you don’t have health insurance or have to meet your deductible, let the dermatology office know. They may have a “cash price.” Expect to pay, on average, anywhere from $100-$200 for the office visit, with additional charges for any tests or procedures.

When to see an allergist

Skin conditions are one of the most common forms of allergy treated by allergists and immunologists, according to the American Academy of Asthma and Immunology. The following symptoms can be typical of skin issues treated by an allergy specialist:

• Itchy, red skin
• A rash that occurs suddenly after exposure to a certain substance
• Skin issues combined with sneezing, itchy eyes, or nasal congestion

The following conditions are typically caused by an allergic reaction to some outside stimulus. If it’s your first time having a reaction, your primary care provider is a good first stop. If the problem becomes recurrent or severe despite treatment, an allergist is the next best step. 

Urticaria (hives)

Raised, red dots or welts on the skin, are called hives. They can be itchy and are often accompanied by swelling of the underlying tissue (angioedema). Hives are caused by an allergic reaction. Once the person no longer has exposure to the allergen causing the problem, hives generally fade within 24 hours but may be noticeable for several days afterward. Hives are often treated with allergy medications like Benadryl (diphenhydramine), Claritin (loratadine), Allegra (fexofenadine), Zyrtec (cetirizine) or Xyzal (levocetirizine) as these medicines decrease the histamine release, which is responsible for the hive. 

Contact dermatitis

Also caused by an allergic reaction, contact dermatitis is a red, itchy, painful rash that usually occurs on the skin that came into contact with an allergen, but it may be widespread across the body. Contact dermatitis caused by a known substance—for example, poison ivy or poison sumac—will typically resolve within a few weeks. If contact dermatitis is severe or the origin is unknown and it persists longer than a month or two, see a dermatologist or allergist to diagnose the cause of the rash. Often the cause of the rash is unknown despite testing. Treatment usually involves moisturizers or anti-itch medicines—like hydrocortisone or Benadryl Itch Relief—to ease symptoms until the cause can be determined.

In some cases, allergy shots, or immunotherapy, may help to resolve symptoms.

When to seek urgent or emergency treatment

In very rare cases, a skin condition can be a sign of a medical emergency and may require timely medical attention. If you have any of these symptoms, seek immediate treatment:

• Painful, peeling skin
• Blisters on skin after exposure to sun or chemicals
• Streaks of redness under the skin that spread quickly
• Blisters in the mouth, eyes, or genitalia
• Any skin symptoms accompanied by a fever, joint pain, difficulty swallowing, severe headache, or muscle pain

“Blisters in the mouth, eyes and/or genitalia can be a sign of a dermatologic emergency known as Steven Johnson Syndrome,” says Dr. Wood. “If this rash goes untreated, it is potentially fatal.”

“Any type of skin condition that is causing significant pain, swelling or bleeding (such as bad sunburns, chemical burns or severe acute rashes) should be considered an emergency,” adds Dr. Rosen. “These conditions can quickly lead to further health problems if not treated properly. For example, severe sunburns can cause dehydration and shock, chemical burns can cause infection, and rashes can spread to other parts of your body.