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“We need to make a lot of good choices, every day throughout our lives, to preserve, protect, and enhance the health and appearance of our skin,”

says Dr. Laura Briley at Southern Dermatology & Skin Cancer Center in Raleigh.

“Let’s imagine that a 22-year-old woman—I’ll call her Patricia—comes to me with her beautiful, flawless skin. Her goal is to preserve this wonderful appearance and condition of her skin for the rest of her life, and she’s asking me for a plan to achieve that goal.

“First and foremost, I will tell her, she must keep sun off of her face as much as possible. We certainly do not want to deplete her vitamin D level, so she needs to wear a protec-tive sun blocker that includes either titanium dioxide or zinc oxide—a sun blocker, and not a sunscreen.

“The rays of sunlight that age our skin are usually UVA rays,” Dr. Briley explains. “UVB rays cause more of our skin cancers, such as basal cell and squamous cell, and UVA rays probably trigger a lot of the melanomas we see. Tanning beds are exclusively UVA light, and for healthy skin they are forbidden.

“Some of our sunscreens present themselves as protec-tant of both UVA and UVB rays, but this protection breaks down after 30 minutes to an hour once the skin is exposed to sunlight. And virtually no one reapplies sunscreen every hour.

“By contrast, sun blockers are not oxidized by sunlight, and the sun’s rays actually just bounce off of them and they provide good protection for several hours.

“So Patricia needs to wear a sun block every day, and now most make-up includes sun block, as do moisturizers. But I advise patients to add a layer of sun blockers under their makeup.

“At night time, I will recommend some form of retinoid, such as Retin-A, to increase collagen in the face to prevent or slow the onset of wrinkles. It also has some ability to prevent sunspots and pre-cancerous lesions.

“Moisturizing on a nightly basis, particularly under the eyes, is helpful. Over time, structurally we all change and we all slightly droop in our facial appearance—often due to genetics. I’ll tell Patricia to take a good look at her mother, and see what facial appearance issues, if any, she finds unwel-come. It’s likely they will exist for her later on, as well.

“Early on, when wrinkles and unwanted lines begin to form, Botox injections can be a very effective preventive treatment. If Patricia wants to move through her thirties and forties free of wrinkles, we’ll offer her Botox treatment on a regular basis. And there are really a great number of highly effective skin enhancement options, along with expert guid-ance, offered in our Skin Renewal Center.”

RaVagEs of sMokingIn many instances, Dr. Briley and her colleagues deal

with the complications that exist with skin care patients who smoke. “As a skin cancer clinic, we are especially aware that our patients who smoke are, with rare exception, terrible wound healers. Their bodies are full of inflammatory toxins. And inflammation comes across the skin. It causes wrinkles, and thickening of the skin. There are actually medications for lupus that simply do not work for smokers.

“Some of our patients who have inflammatory condi-tions such as psoriasis or lupus tend to have much more severe diseases if they are smokers, because they’re putting so much more inflammatory toxins into their body.”

Health&Healing: A long-time smoker comes to you and says he’s put down cigarettes forever. He wants to know how—or if—he can replenish and restore the health of his skin.

DR. bRiley: Simply quitting the smoking habit will improve this patient’s health in so many different ways. Together we would work to increase the moisturization of his skin, and try to restore some of the elasticity of the skin. This would involve a daily routine of moisturizing and sunscreen.

We have many different cosmetic options for him to consider—choices such as chemical peels or use of the Frax-el laser to smooth the top layers of his skin. Many smokers tend to have more dilated capillaries, and together we might consider use of vascular lasers to improve that condition.

The process would be to explain, in detail, the options that experience tells us would be beneficial in improving his appearance, and the healing time and costs involved in each of these choices. Some of the deeper wrinkles we see with many smokers, especially around their mouth, are very dif-ficult to treat. But if they have made a powerful commitment to put this habit behind them, we can find procedures that will, at the very least, improve the condition and appearance of their skin.

H&H: What is the relationship of obesity and health of the skin?

DR. bRiley: There are without question certain skin condi-tions that are more prevalent with the obese. What we increasingly understand is that inner fat cells have bountiful inflammatory hormones. In diseases such as psoriasis, for example—one of our major inflammatory diseases—the hormone that is driving the condition is made in the fat cells. When our psoriasis patients lose weight, their skin dis-ease improves—an extremely important patient choice that helps in multiple ways. If a 300-pound patient with psoria-sis loses 100 pounds, their skin condition will improve—across the board. And I still have 110-pound patients with psoriasis, so there are clearly many other factors involved in this disease state. h&h

s o u t H E R n D E R M a t o L o g Y & s k i n C a n C E R C E n t E R

for more information about skinconditions and their treatment, contact:

SOUTHERN DERMATOLOGY & SKIN CANCER CENTERGregory J. Wilmoth, MDEric D. Challgren, MD

Margaret R. Boyse, MDLaura D. Briley, MD

Tracey Cloninger, PA-C��0� Lake Boone trail, suite �00

Raleigh, nC �7�07telephone: (9�9) 78�-��5�noRtH RaLEigH offiCE

(Mondays only)�00�0 falls of neuse, suite �0�

Raleigh, nC �7���telephone: (9�9) 78�-��5�

SKIN RENEWAL CENTER AT SOUTHERN DERMATOLOGY

��0� Lake Boone trail, suite �07 Raleigh, nC �7�07

telephone: (9�9) 8��-007�

Our Skin needs

Loving Care

Dr. Briley points out the facial muscles that are involved when Botox is used to reduce facial wrinkles.

“We are especially aware that our patients Who smoke are, with rare exception,

terrible WoUnd healers.”

Originally published in Health & Healing in the Triangle, Vol. 18, no. 1, health & healing, inc., Chapel hill, nC, publishers. Reprinted with permission.