From the Clinic Desk: 5 Surprising Skin Conditions I’ve Diagnosed This Year
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As a dermatologist in Cape Town, I see hundreds of patients every month, many coming in for what they think are minor concerns—dry patches, discolouration, breakouts that won’t go away. But sometimes, what looks simple isn’t simple at all.
Here are five surprising diagnoses I’ve made in my practice recently—and why they matter:
1. A “Rash” That Turned Out to Be Lupus
A young woman came in thinking she had eczema. The redness was persistent, especially after sun exposure. But her history—and a closer dermoscopic evaluation—pointed to a more systemic concern. After a biopsy and referral, we diagnosed cutaneous lupus, an autoimmune condition. Early detection allowed for prompt management and prevented further complications.
2. That “Wart” Was Actually a Skin Cancer
A gentleman in his 50s had a raised lesion on his hand he thought was a wart. But it was firm, crusty, and growing slowly. We did a biopsy—and it came back as a squamous cell carcinoma. Thankfully, it was caught early, surgically removed, and didn’t spread. Skin cancer can masquerade as something harmless—that’s why trained eyes matter.
3. Chronic Itch Revealing a Blood Disorder
Itching with no rash is one of dermatology’s most underappreciated red flags. One patient’s intense night-time itch led to a diagnosis of polycythaemia vera, a rare blood condition. Dermatologists don’t just treat skin—we often spot internal diseases before other symptoms emerge.
4. Pigmentation That Wasn’t “Just Sun Damage”
A middle-aged woman presented with blotchy dark patches on her cheeks and forehead. At first glance, it looked like melasma, but something didn’t sit right. Further investigation and biopsy revealed lichen planus pigmentosus, a condition with very different treatment needs. Misdiagnosis here could have meant months of frustration with the wrong therapy.
5. Acne… That Wasn’t Acne
A young man had what looked like cystic acne—but it was hidradenitis suppurativa, a chronic inflammatory skin disease. This condition needs a completely different treatment plan than acne, and early intervention can greatly reduce scarring and flare-ups.
What This Tells Us
These stories are a reminder that specialist dermatological care isn’t about guesswork. It’s about careful listening, detailed observation, and knowing what patterns to look for—and when to dig deeper.
Whether it’s a strange spot, an unexplained itch, or “just acne,” if it’s bothering you, let’s take a closer look.
📍 Book your consultation at Dermatology & Hair Institute, 28 Brookdale Ave, Pinelands, Cape Town
🔗 dermatologist.capetown
— Dr Altaaf Parker, MBChB (UCT), FCDerm (SA) Summa Cum Laude