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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
(919) 220-7546 (SKIN)

Subduing Muscle Movement

Dr. Elizabeth Hamilton and her colleagues at Regional Dermatology of Durham, Dr. Amy Stein and Julie Dodge, PA-C, frequently respond to requests to subdue facial muscle movement with Botox injections.

Dr. Hamilton applying a Botox treatment.

“Rather than encouraging movement, Botox does just the opposite,” notes Dr. Hamilton with a smile. “The purpose of Botox treatment is to relax muscles, not get them moving!

“Botox is one of those rare medical procedures that is almost too good to be true,” she says. “It is very effective for relaxing deep facial lines that even a face lift can’t treat, because these are lines of facial expression. These facial furrows form mainly in response to contracting of underlying muscles.

“As long as the patient continues to use those muscles, these lines will appear—face lift or not. Botox works by temporarily decreasing the pull of these muscles, usually for a period of three to six months.”

Botox, Dr. Hamilton explains, “is the brand name for botulinum toxin type A, a natural product long known as a potent blocker of nerve impulses. A very tiny amount of Botox is injected to relax the appropriate facial muscle. The procedure is quick, effective, and relatively simple and pain-free, with no down time for the patient. A patient may come in on their lunch hour, have the procedure, and go back to work in the afternoon with no ill effects.

“Rarely there are side effects that are temporary, and the cosmetic results are quite pleasing. In the worst case, the patient may prefer their ‘natural’ look, and they can take comfort in knowing that it will return on its own in a matter of a few months.”

Sports and Acne

Sports-induced acne—profes-sionally known as acne mechanica or traumatic acne—probably causes more frustration for young athletes than many other skin conditions, notes Dr. Hamilton.

“This is a form of acne caused by heat, pressure, occlusion of the skin and repetitive frictional rubbing against the skin. We see this especially in football players, as a result of the helmets and helmet straps and shoulder pads they wear. It can, at times, be very severe.”

There are a number of common-sense measures that help prevent the onset of this type of acne, Dr. Hamilton notes. “Wearing a clean, cotton T-shirt under a sports uniform is a good idea, because the cotton absorbs sweat and reduces friction of the uniform against the skin.

“It’s also important for these young athletes to keep and use only their own equipment, and not swap shoulder pads or helmets with other players. It’s also a good idea to shower immediately after a workout, making certain to thoroughly wash those areas of the body that were under straps and padding—such as the shoulders, back, and chest.

“Finally, it’s also a very good idea to apply anti-acne medication to sports-induced acne as soon as the lesions appear, to help keep the condition under control. When the condition persists and erupts, it’s time to see a dermatologist for effective treatment.”

On the Move

While Dr. Hamilton is pleased to arrest muscle movement for her patients with Botox, she also will encourage them to get up and move in other aspects of their lives.

“If I don’t exercise, my metabolism shuts down,” she says. “Exercise is a mood stabilizer for me and for most people, who generally are happier and healthier when they are physically active, rather than sedentary. It is hard to be sad when you are doing something positive.”

And while she exercises, like most other people, Dr. Hamilton perspires—which is a good thing.

“Sweating is a vital human cooling mechanism in hot climates such as ours,” she says, “and we should be happy when we do it. Total failure to secrete sweat can cause the body to overheat, which can lead to heat-stroke—a serious medical condition.”

While sweating fulfills an invaluable function, Dr. Hamilton notes that it is also often linked to a variety of skin conditions, “from heat rash, flaring rosacea, acne mechanica, and intertrigo—a common red rash in folds.  As temperatures rise, we see these conditions with increasing frequency. In the summer months especially, people tend to sweat a lot—and skin problems often reflect that fact.

“As a general observation, I believe what is good for our insides is good for our outsides. I don’t attempt to be more specific than that. I do have a number of patients who are avid athletes. They bike, they swim, they run—and bless their hearts—their skin just takes it.

“Even though they make a good faith effort to do everything I ask them to do,” she says, “they are simply getting too much sun on their skin. You can’t spend that much time outside without visible consequences. Some people do a better job of protecting their skin than others, but if you run for two hours a day you will experience a great deal of net sun damage—even if you are wearing sun protective clothing. Activity is important and great, and sun protective clothing has come a long way—but at the end of the day, it can still be hot and sticky and sweaty.

“I’m convinced that being active is an important component of being healthy. There’s value in looking at what you are doing when you don’t move. Are you watching the world go by on TV? If you don’t move and get out and get involved with life, what do you do? I do think many people get caught up in observing rather than doing.”

Health&Healing: Rosacea seems to flare with exercise, as well.

Dr. Hamilton: Everyone who does vigorous exercise will get flushed. The reaction is magnified in the rosacea patient. They tend to flush earlier, with more intensity, and to retain the flush longer. There are steps they can take to reduce these effects. They can, for example, exercise in the cool of morning or early evening—or in an air-conditioned gym, if that works best for them. And they can adjust the length of their workouts, and the nature of their exercise, to minimize the effects of a rosacea flare-up.

In the summer months, we also tend to see other skin conditions that thrive in a moist environment. Tinea cruris (jock itch) and tinea pedis (athlete’s foot) occur more often in warm moist conditions. We advise patients to wear socks that are made of absorbent synthetic material (to keep moisture away from the skin) to keep feet drier, and to change socks frequently.

H&H: And heat rash can be a problem.

Dr. Hamilton: Most often it’s superficial but annoying, often linked to exercise, which clears pretty easily when we exfoliate the top layer of skin. A more severe form of heat rash is called miliaria rubra, with blockage of the sweat glands at a deeper level, causing itching and irritation. Even more severe is miliaria pustulosis, a complication of miliaria rubra in which the sweat is infected with pus-producing bacteria and may require oral antibiotics.

The most significant abnormality is rupture of the ducts of sweat glands, miliaria profunda. By blocking enough sweat glands, heat rash can potentially prevent sweat from cooling the body.