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REGIONAL DERMATOLOGY
OF DURHAM

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REGIONAL DERMATOLOGY
OF DURHAM

Elizabeth H. Hamilton, MD, PhD
Amy Stein, MD
Julie Dodge, PA-C
4321 Medical Park Dr., #102
Durham, NC 27704
Telephone: (919) 220-7546 (SKIN)
www.dermatologydurham.com

Links Between Skin Issues and
Traumatic Life Events

Dr. Amy Stein and her colleagues at Regional Dermatology in Durham—Dr. Elizabeth Hamilton and Julie Dodge, PA-C—are relentless in seeking the cause and effect of a great variety of skin conditions that are often related to some level of trauma.

Dr. Stein begins an annual skin check, looking for signs of potential health problems

“We consider severe sunburn—a really bad burn—a traumatic event that has the potential to cause grave health consequences—most notably, skin cancer,” notes Dr. Stein.

“This very morning, one of my patients—I’ll call her Ginny—came in to see me. She has a history of melanoma, as well as non-melanoma skin cancer and a variety of pre-cancerous lesions. She came in to see me looking about as dark as a wooden door, and in other areas of her body, as red as a tomato. She had been cooking in the sun.

“‘I’m so sorry,’ she said to me. ‘I was at the beach, it was cloudy and overcast, and I just simply forgot to reapply my sunscreen.’

“My first reaction, quite honestly, was an urge to administer a bit of parental scolding, but I contained myself. But I did ask, with some sense of desperation, ‘What are you doing??!! We know so well how many ways, and how seriously, excessive exposure to the sun can damage your whole self, inside and out. And you know, if you keep this up, you’re likely to have more skin cancers and you’ll be on the path to be a wrinkled little old lady in the future. There are certain harmful things you can avoid in life, and excessive sun exposure is pretty near the top of that list.’”

Health&Healing: What are the long-term consequences of chronic severe sunburns?

Dr. Stein: There is an increased risk of skin cancer associated with chronic burns. And radiation exposure creates a similar increased risk. We see people who, years ago, had radiation treatment for acne—and so they perhaps had radiation on their face, their chest, and their back, and now we are removing skin cancers because of the increased harm from those earlier treatments. People are at risk for having inflammation or dermatitis or itching in those areas that received treatment in the past.

Health&Healing: What about other “outdoor traumas” such as poison ivy or insect bites?

Dr. Stein: Most of us spend a good deal of time outdoors as the spring brings warmer weather, and many of us wind up with poison ivy. Some people have a minor outbreak, and it requires no medical attention at all. No medications recommended.

And then there are people who feel if they simply look at poison ivy they will be widely compromised, head to toe. Often I say to these patients, “We love steroids, but we hate systemic steroids because of all the potential side effects.” But it’s true that some people simply require systemic steroids with antihistamines, and topical agents as well, because they feel simply miserable with this affliction. And with this approach, the condition clears quite rapidly.

Health&Healing: A diagnosis of melanoma skin cancer is a traumatic event by itself.

Dr. Stein: Sadly enough, the diagnosis of melanoma has become increasingly common. The good part of that message is that people, in far greater numbers, are becoming more diligent in getting regular skin checks, which is a blessing they give themselves. Quite often, those are the phone calls that are the more difficult to make: informing a person that testing reveals that they have melanoma.

The response to that information varies a good deal, but often entails what is perhaps a defense mechanism. “Will I need surgery?’ “Will I have a scar?” Often, it seems, we need to play a psychologist’s role and counsel people on diagnosis and procedures.

Pathology examination provides us with invaluable information. Whenever there is a significant depth of invasion of the cancer, there are standards of care. If there is a melanoma that is of a certain depth and/or location, we refer out in general; we are very fortunate to have excellent centers locally that can offer far more extensive treatment options. For example, in private practice we do not give immunotherapy for treatment of melanoma. That is absolutely, exclusively a university medical center kind of offering.

Health&Healing: Scars are a form of trauma as well.

Dr. Stein: The mind-body connection manifests in many ways—which is another way of saying that traumatic events can have long and unpredictable outcomes. I’m reminded of one of my great friends growing up in high school. She had a bite from a dog on her cheek, inflicted when she was very young. Although the scar from this incident became, to most people virtually unnoticeable, to her that scar was all she saw when she looked in a mirror. She always had makeup to cover that area. And when we were playing sports, such as soccer, she would always have concern that people would see her “awful scar.” At times she simply refused to join us swimming in a pool or at the beach because “people would see her.” She was dealing with a powerful emotional and psychological “laceration” for as long as I knew her—and perhaps still to this day. It remains for me a powerful example of the potential power of a traumatic event.

Scarring of any kind most often—almost always—has traumatic overtones. A lot of people tell us they have scars, when in fact they really, luckily, have post-inflammatory changes rather than true scars. The most important step is addressing, first, the actual process that is leading to the post-inflammatory changes—such as acne, or folliculitis, or other inflammatory types of conditions. The critical step is to get that condition under control. Then, when that is achieved, there are different topical applications we recommend.

And there are actually different procedures we offer for various types of scarring that are very promising with their results. They are cosmetic in nature, and they effectively address cosmetic issues that in the not-so-distant past we would have had to say, “Sorry, you simply have to deal with it.” Now we have more options to address the full range of issues that come to dermatologists. We can, for example, now treat pitted acne scars with a procedure called SkinPen—or micro-needling.

There are simply many more effective options for dealing with a host of dermatological issues than there was even a decade ago.