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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

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



4201 Lake Boone Trail, #207

Raleigh, NC 27607
Telephone: (919) 863-0073

Loving Care for Our Largest Organ: Our Skin

In a time when cosmetic beauty is sold in every conceivable outlet—TV commercials, billboards, print advertisements, even discount beauty in the form of groupons for fillers, plumpers, lasers and lifts—it is surprising that overexposure to the sun and smoking are still a relatively common indulgence. Surprising because these two activities have such a significantly negative impact not only on overall health, but on physical appearance— aging the skin beyond its years rapidly and dramatically.

Dr. Eric Challgren

It is perhaps because of our society’s focus on the cosmetic that just how much harm these two activities cause to one’s appearance and how significantly they contribute to premature aging has been undersold.

“Let me be clear: sun exposure and chronic smoking are the two fastest ways to age your skin,” says Dr. Eric Challgren of Southern Dermatology & Skin Cancer Center in Raleigh, a definitive assertion strongly supported by research and clinical experience. “If you want to add 20-plus years to your appearance, tanning and smoking will do it every time.”

Sunshine State

“Sun exposure is, in fact, the primary reason we develop visible signs of aging on the skin,” he continues. “That said, some sun exposure is inevitable and even necessary. For example, when bare skin is exposed to sunlight—UVB rays specifically—a reaction occurs within the skin resulting in the creation of vitamin D, an essential nutrient the body needs.

“However, over exposure is detrimental, causing wrinkles, sun spots, pigmentation, degrading the texture, and eroding skin elasticity—which leads to sagging.”

And these, of course, are just the cosmetic effects to the skin—and only half the story. The popularity of sun-tanned skin brought about the popularity of indoor tanning beds, and with it a huge increase in skin cancer, both minor and major.

“A study reported in JAMA Dermatology concluded that the number of skin cancer cases due to indoor tanning is higher than the number of lung cancer cases due to smoking. That is probably a surprising fact to many people,” Dr. Challgren acknowledges. “Furthermore, in the US alone, there were over 419,000 annual cases of skin cancer attributed to indoor tanning—and of that number, 6,199 were melanoma, the most lethal type of skin cancer.”

A summary of the article mentioned by Dr. Challgren put out by The Skin Cancer Foundation stated that in the US, 35 percent of adults and 55 percent of college students have engaged in indoor tanning. “That’s not too surprising given what we know about indoor tanning behaviors and society’s flawed view that an artificially tanned look is beautiful,” Dr. Challgren notes.

Few Options

“Assessing sun damaged skin is a daily part of my practice,” he goes on. “The bad news is, there’s really not much that can be done once skin is severely damaged by sun or by smoking. There are a few surgical options that may produce minor improvements, but there is no cream or minor, inexpensive treatment that can reverse or erase years of sun-abuse inflicted on the skin.”

Dr. Challgren strongly suggests following the Cancer Foundation’s recommendations for people of all ages, genders and ethnic backgrounds:

  • Avoid indoor tanning; take precautions in the sun by limiting outdoor time between 10 a.m. and 4 p.m;
  • Seek the shade when outdoors;
  • Use a broad spectrum SPF 15+ sunscreen or SPF 30+ (see box) for extended stays outdoors;
  • Wear protective clothing, including wide-brimmed hats and UV-blocking sunglasses.


The other major method of self-inflicted harm to the skin is smoking. Smoking, Dr. Challgren explained, will age the skin every bit as quickly as sun tanning, and the combination of the two can be devastating.

“I can tell immediately when a patient is a smoker just by looking at their skin,” Dr. Challgren says. “The purse-string wrinkles around the mouth from years of sucking on a cigarette, the sallow quality of the skin from anti-oxidant damage, the damage smoking does to collagen fibers causing sagging and loss of elasticity—all of these are tell-tale signs I can spot right away.

“What I can’t tell right away in a chronic smoker is their age,” he concedes. “I can almost always tell a patients age by a thorough skin exam. However chronic smokers’ skin betrays an age much older than their chronologic years.”

The other major, perhaps more familiar, damage smoking causes is of course, various types of cancers.

“We often are called upon to assess sores and lesions on the tongue, in the mouth, or on the lip—and without question the habit of smoking contributes to these oral cancers. A complication of smoking beyond precipitating the development of cancer that many don’t realize, is the difficulty this habit causes for wound healing. Wounds, such as those caused by the removal of a skin lesion, need oxygen and nutrients carried by the blood in order to heal. Carbon monoxide, which is ingested through cigarette smoke, is vasoconstrictive, creating a state of decreased blood flow—particularly to extremities. So while I can surgically remove a cancerous growth from the skin, the chronic vasoconstrictive state of the long-time smoker is going to make wound healing a long and difficult process.”


A third method of self-inflicted harm to the skin is excessive alcohol intake.

“Telangiectasia, more commonly known as spider veins due to their thin and branching appearance, is one of the earlier signs of alcohol abuse,” Dr. Challgren explained. “As regulation of vascular control begins to fail in the brain as a result of sustained alcohol use, the skin betrays the damage being done inside the body. Laser treatment options do exist to help decrease the unsightly appearance of these enlarged and broken blood vessels on the face and other parts of the body, but once developed the quality of the skin will really never be the same.

“The moral of the skin’s story,” Dr. Challgren concludes, “is that hard living comes with hard consequences, and the skin will tell the story of how hard you have chosen to live.”