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For more information about skin conditions and treatment, contact:



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)

Our Skin Reflects Our Habits

“There are few, if any, poor health habits that are not reflected in some way in the appearance and condition of the skin,” notes Dr. Elizabeth Hamilton, of Regional Dermatology of Durham. “The skin, the largest organ in the human body, mirrors the health of the entire physical and even emotional system. Four major lifestyle choices—smoking, tanning, obesity, and substance abuse—directly and seriously impact its health.”

Dr. Hamilton and her colleagues, Dr. Amy Stein and Julie Dodge, PA-C, are deeply committed to providing quality skin care information to their patients.

Furthermore, she continues, “Smoking and sun are synergistic for skin cancer. If you smoke you increase your risk of getting cancer ten-fold; and your risk increases ten-fold from excessive sun. But if you do both, your chances of developing skin cancer multiply to about a hundred-fold. I’ve seen patients for years who have lots of pre-cancerous keratosis and squamous cell skin cancers and suddenly they stop smoking and you see a reduction in pre-cancers immediately. It doesn’t take decades; it happens abruptly. It’s the same when people start using sunscreen; the changes are apparent quickly.”

Smoking and Wounds

When a person smokes it tends to slow down the healing of wounds, notes Dr. Hamilton. “If you have skin cancer surgery with a graft or a flap, there’s a reduction in oxygenation of those flaps and grafts with the first puff of a cigarette. So for skin cancer surgery in general, especially when flaps or grafts are put on, smoking can reduce the likelihood that they are going to take.

“Smoking cuts off the skin’s blood supply through the circulatory system,” she explains, “because nicotine is a very potent vasoconstrictor. The toxic chemicals delivered by cigarettes cause the very small arteries in the skin to contract or squeeze down, diminishing blood supply to the tissue. As a consequence, skin ages faster in smokers than in non-smokers. And, over time, you see deep vertical wrinkles around the lips of patients who smoke, caused by the muscles sucking down on cigarettes over the years. The drain on the blood supply to the skin tissue usually contributes to dryness, resulting in a leathery appearance of the skin that is often gray in color.”

Reasonable Limits for Sun Exposure

“Our skin deserves our attention and protection,” says Dr. Hamilton, “so our exposure to the sun needs to be limited; we can obtain all the vitamin D we need through supplementation. The more sun we are exposed to, the faster our skin ages. With this comes a loss of elasticity to our skin, premature wrinkles and a leathery look, and an increase in permanent skin reddening including blood vessel formation, age spots, and uneven pigmentation.

“Sometimes,” notes Dr. Hamilton, “what people do is beyond belief. We had a patient with a history of melanoma, the most lethal type of skin cancer. Tan lines were apparent when she was being examined. When asked if she still tans, she replied, ‘Absolutely!’ She tans because she ‘needs to look healthy, and when she’s tan, she feels healthy.’ This patient is engaged in a very high-risk activity since she’s already had experience with melanoma.”

Obesity and Your Skin

Obesity has a number of effects on the skin, notes Dr. Hamilton. “There is a skin disorder, acanthosis nigricans, which manifests as the velvety thickening of the skin, usually around the neck and sometimes over the joints. People sometimes think that the skin is merely dirty, but it’s really the effect of obesity altering the body’s growth factors. We find this in larger, overweight patients, and sometimes in overweight adolescents.  It’s more common in people who have diabetes and people of African descent. We can try treating it with lactic acid to exfoliate the skin, but ultimately, weight loss is the only thing that’s going to make it better.

“Recently I saw a young teenager who was brought in because of leg discoloration. This individual was so overweight that they had obstruction of their venous outflow from their legs. The pannus was compressing their blood return and thus they had the kind of vascular changes in their legs that you would expect to see in a 70-year old person!”

Dr. Hamilton pointed out that skin-on-skin problems are far more common among obese patients. “Skin does not like to reside against or on top of skin,” she explains. “Intertrigo is an example of such a problem that is strongly linked to obesity. We usually see it in the groin, sometimes under the armpits, under the breast, and in the belly folds. It’s an inflammatory condition—often manifesting with a red patch or plaque—that sometimes leads to erosions in the skin and occasionally scaling. It is caused in part by moisture, bacteria, or fungi in the folds of the skin. It can itch and be painful, but it can be treated simply and effectively. The best treatment, of course, is weight loss.”

Problem Habits Interfere with Treatment

Notes Dr. Hamilton: “Psoriasis is a common skin condition for which there is no cure. It’s not caused by problem habits, but the condition is exacerbated and its treatment made more difficult by smoking, alcohol, and stress. The cause of psoriasis is unknown and multi-factorial, but we do know it involves an accelerated rate of skin cell production. Dead skin cells accumulate and form thick patches, and obesity is one of many factors that works against psoriasis.

“There are many examples of lifestyle choices interfering with treatment,” notes Dr. Hamilton. “One is cutaneous lupus, for which one of the common treatments used is a medication called Plaquenil, which is an antimalarial drug. People who smoke tend not to respond as well and it’s speculated it’s a direct effect of the smoking on the medication. Another example is the use of Accutane or Isotretinoin for severe acne. Tanning interferes with the drug because it’s very sun sensitive.

“If you routinely drink alcohol,” she continues, “you should check your medications’ warnings. Some medications are adversely affected by the use of alcohol. Methotrexate is used to treat severe psoriasis, but this medication mixed with alcohol can cause severe damage to the liver. Cellulits, rosacea, staph skin infections—these and many other skin conditions, are complicated by alcohol consumption.

“In our practice we encourage our patients to make good lifestyle choices: exercise, eat a well-balanced diet, and discontinue destructive habits such as tanning, smoking, over-eating, and substance abuse. Altering these bad habits can be life-changing.”