An Affiliate of Anne Arundel Dermatology

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


Gregory J. Wilmoth, MD
Eric D. Challgren, MD
Margaret B. Boyse, MD
Laura D. Briley, MD
Tracey Cloninger, PA-C

Stephanie S. Pascale, FNP-C

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


4201 Lake Boone Trail, #207
Raleigh, NC 27607
Telephone: (919) 863-0073

Environmental Challeges to Healthy Skin

Maintaining healthy skin can sometimes feel like waging a daily battle against the elements—but what “elements” matter most? According to Tracey Cloninger, PA-C, and Stephanie S. Pascale, FNP-C, both internal and external factors can influence skin health. As practitioners at Southern Dermatology and Skin Cancer Center, they offer multi-faceted treatments to combat all of the elements—both those around us and those within us.

Tracey Cloninger, PA-C, and Stephanie Pascale, FNP-C (right) examine signs of sun damage on a patient’s face.

Hazards Abound

“Allergies or sensiti- vities to cosmetics have definitely been on the rise over the past 10 years,” notes Ms. Cloninger. “That’s because we’re exposed to so many potential irritants—often out of our awareness.

“For example,” she says, “according to the Environ-mental Working Group, women use an average of 12 products a day, containing 168 different chemicals— many of them causing irritation or creating a potential allergen. Men use fewer products, but they also are exposed to 85 chemicals daily. Other researchers suggest the problem is much greater—estimating that we’re exposed to over 500 different chemicals daily. But whatever the exact number, there’s no question that in our normal, every-day lives we encounter many, many chemicals that are potentially irritating to our skin.”

On the plus side, she notes, “many companies have become more aware of possible triggers and are trying to eliminate some of the worst offenders. Still, it can be difficult to determine what ingredients a product even contains, let alone which might bother you—which is why contact dermatitis is such a common problem.”

Testing for Contact Dermatitis

“In fact,” says Ms. Cloninger, “contact dermatitis is one of the conditions most frequently treated at Southern Dermatology, so testing for skin sensitivities is one of my key responsibilities.”

She points out, however, that “there’s a distinction between the testing we do and what an allergist will test for. We don’t, for example, test for food allergies. Our focus is on contact sensitivities. We use the North American Patch Test to identify contact allergies for up to 90 distinct substances. These can be found in lotions and shampoos, fragrances, sunscreen, even rubber! If someone comes in with a rash that just is not getting better,” she says, “you question whether a contact allergy is keeping those embers burning. And often it takes very careful sleuthing to determine the specific allergen.”

In one such instance, Ms. Cloninger saw a patient who had sought treatment elsewhere for a rash. But two different prescription-strength steroid creams failed to improve it. In an ironic twist, patch testing revealed that he was allergic to an ingredient in the steroid creams. This type of detective work can be an important part of helping patients, she notes, “but it’s not the only part. Educating our patients to help eliminate or avoid the identified triggers is equally important.”

The Role of Genes

Unlike true allergies, notes Ms. Cloninger, “there’s not necessarily a genetic component driving contact dermatitis. However, in a condition known as the atopic triad—which includes higher occurrence of hay fever or inhalant allergies, asthma, and eczema—genetic predisposition and environmental sensitivities intersect.

“There are also some conditions—such as psoriasis and rosacea—with a strong genetic component. And different kinds and shades of skin can be prone to different types of problems, or can simply age differently.”

The Ultimate Environmental Hazard: Sun Damage

The environmental influences on skin health go well beyond the irritants found in cleaning products and cosmetics. “Actually,” notes Stephanie S. Pascale, FNP-C, “the most significant environmental ‘threat’ to the skin is the sun. Sun damage is the source of skin cancers, as well as the wrinkling, discoloration, and other problems typically associated with aging.”    

In her work, Ms. Pascale assists patients to repair damage from years of sun exposure, while also screening for signs of skin cancer and treating precancerous conditions. “What I appreciate about my work,” she says, “is that it includes both medical and aesthetic components.

Meet the Practitioners

Both Tracey Cloninger, PA-C, and Stephanie Pascale, FNP-C, bring a wealth of varied health care experience to their roles at Southern Dermatology and Skin Cancer. Ms. Cloninger began her career as a physical education teacher, next earning a Master’s degree in exercise physiology towards a career in physical therapy. Ultimately, she chose to shift her focus to more pro-active care, which led her back to school to become a Physician Assistant; she has been with Southern Dermatology for 16 years.

Ms. Pascale, now a family nurse practitioner, started her career as a cardiology nurse at UNC Hospitals. Working at United Healthcare at Wake Med helped round out her understanding of how the clinical and business aspects of health care interconnect. She ultimately returned to direct patient care, earning her Master of Science degree in nursing, becoming a Family Nurse Practitioner and working in her passion for dermatology.

“We offer a wide range of options for repairing sun damage, including laser resurfacing treatments such as Halo or Fraxel, and light-based treatments such as broadband light (BBL)—allowing us to tailor the treatments specifically to the individual needs of the patient.

“For example,” says Ms. Pascale, “we use a number of laser treatments—including the Excimer laser, broadband lights (BBL), pulsed dye laser (PDL), photodynamic therapy (PDT), and more.; and each of these lasers is designed to address specific conditions. Further, they also offer appropriate treatment for different skin types. With any darker-pigmented skin, for example, there is increased risk of post-inflammatory hyperpigmentation, or even worse, the potential for scarring or blistering. So, it’s really important to use the right lasers for those skin types.

“And they are powerful tools, as well,” she notes “for treating condi-tions such as psoriasis and rosacea. That is an important benefit of the approach we take of combining medical and aesthetic treatments. For example, the Excimer laser or the photo booth can help psoriasis patients reduce or eliminate plaques. Laser treatments can also decrease inflammation and redness in rosacea patients. Similarly, using a topical medication and laser treatment for rosacea might lessen the need for oral medication. Or, perhaps, the topical medication might reduce the number of laser treatments needed to maintain clear skin.”

Essential Protective Care

Both Ms. Cloninger and Ms. Pascale emphasize the value of proactive skin care and maintenance—especially sun protection. Additionally, regular anti-aging treatments—such as removal of actinic keratoses—not only offer cosmetic benefits, but can decrease the risk of types of skin damage that could progress to squamous cell cancer. Ms. Pascale recommends topical vitamin C treatments, as well, to help counter ongoing damage from ionizing radiation, free radicals, and blue light exposure from screen time.

Of course, both practitioners advocate the importance of sun protection. Yet sunscreens themselves can contain problematic ingredients. “It’s not uncommon,” notes Ms. Cloninger, “for people to be allergic to some of the ingredients in chemical sunscreens. Fortunately, physical sunscreen formulations containing zinc and titanium rarely cause contact dermatitis.”