“A variety of inflammatory skin conditions—such as acne, eczema, rosacea, and psoriasis—make up much of the clinical concerns at Southern Dermatology and Skin Cancer Center,” says Dr. Laura Briley.

“These are not ‘self-inflicted’ health problems,” she notes. “Indeed, the exact causes of many of these problems aren’t known but are believed to be related to a combination of genetic and environmental factors.

“However, while the unhealthy choices we make don’t cause these diseases, they certainly affect them! That’s because they cause inflammation—so any inflammatory disorder will be made much worse by smoking, or substance abuse, even chronic sun exposure.

“This is a significant problem with conditions such as rosacea and psoriasis,” explains Dr. Briley, “because although they can be controlled, these diseases can’t be cured.

“Treating inflammatory diseases has always been a challenge,” notes Dr. Briley, “because it involves the whole immune system. Happily, the latest treatment breakthroughs have made a huge difference in managing these otherwise incurable conditions. Today, for example, newer biologic drugs are able to target the exact body part that’s out of balance—and only that part—and treat it more specifically.”

However, Dr. Briley notes that a critical component of managing these inflammatory diseases is to eliminate or reduce the things that trigger inflammation. “Medications alone can’t fully manage these diseases; the patients’ choices play a critical role.”

Inflammatory Choices

“We all make choices every day—good and bad—that affect our health in significant ways,” says Dr. Briley. “Of particular concern are what I would call ‘inflammatory choices’—those that cause inflammation. For those suffering from inflammatory diseases, such choices contribute to the disease and make management extremely difficult.”

SMOKING: “Smoking deserves special mention as a problem choice,” notes Dr. Briley, “because it is an assault on every cell in the body—it’s in the blood vessels, it’s in the immune system, it produces inflammation at every level. And in addition to causing inflammation, it is actually a physical insult to the skin because the smoke comes back on the skin. People age so much more rapidly with smoking. They have more wrinkles and lose the elastic tissue in their skin. And that damage is probably irreversible. For inflammatory conditions, if you stop causing the inflammation, it’s always going to improve. But some of smoking’s skin damage is permanent.”

STRESS: Perhaps the most potent “inflammatory choice” affecting skin health is one that is subconscious, notes Dr. Briley. “Without exception, we see on an everyday basis how stress complicates and exacerbates every one of these skin problems. The patient with psoriasis has a sudden flare with the loss of a beloved pet. The young man’s acne blossoms several days before he walks in to take his SAT exams. Itching is often a sign of stress—I see a strong correlation between the two. Stress reduction techniques can therefore be an important tool for managing inflammatory skin diseases.”

SUN: “It’s hard to overstate the impact of chronic sun exposure,” notes Dr. Briley. “Unprotected exposure to the sun is the principal cause of skin cancer and the primary cause of photo-aging, and it can be a major trigger for some inflammatory conditions, such as rosacea. Furthermore, when combined with smoking, it can be devastating.”

PERSONAL TRIGGERS: “For patients dealing with chronic inflammatory skin diseases—and this is particularly true for rosacea—there will be what I would call ‘personal triggers’ causing flares. It might be a certain food or personal care product. What’s important is that each patient knows—and avoids—their own personal triggers.

Rosacea

“Rosacea,” notes Dr. Briley, “is a classic illustration of an inflammatory skin condition. It is a kind of subset of adult acne that is more chronic in nature, and it can be an exasperating, incurable problem—flaring in response to a wide range of triggers.

“It typically begins slowly with intermittent redness along the cheeks and the nose, with a strong tendency to blush easily,” she explains. “But it includes a broad spectrum of symptoms ranging from irritation and redness to extremely oily skin and pimples.”

She notes that while food and even alcohol can trigger flares, each individual is likely to respond uniquely. “For many people,” she says, “sun exposure can dilate the blood vessels, triggering inflammation and rosacea. Others who have oiler skin may have what are known as demodex mites in their skin. There’s also a genetic component, where people with the fairest skin type tend to be more prone to rosacea.

“Left untreated, rosacea invariable worsens,” she explains. “But, fortunately, we now have a range of very effective treatments to offer patients—while addressing their specific symptoms.”

Psoriasis

“Psoriasis is 100 percent an inflammatory condition,” says Dr. Briley, “and especially sensitive to inflammatory choices. So when you smoke, you’re just increasing the amount of plaques. Furthermore, psoriasis has so many comorbidities, so anything that exacerbates the condition has a much broader impact. There is an extra incidence of heart disease with psoriasis patients, and I have a lot of psoriasis patients who are recovering alcoholics. And a particular problem with psoriasis is the higher incidence of depression. There is a lot that is tied up in that depression because if you have skin that people don’t want to see or they think you’re infectious, it can be really debilitating.

“Thankfully, the new biologic medications have revolutionized psoriasis treatment. Where we used to be happy if somebody had ten percent of their body covered, with most of these treatments you can get people to where it’s one percent or less. And so that has really decreased the amount of depression and hopefully, substance abuse that goes with that. “But, despite these advances, inflammatory choices patients make—such as smoking or substance abuse—will continue to make psoriasis worse.”