The Physical, Economic and Emotional Benefits of Healthy Skin

Skin is the frontline of the body’s immune defenses. Simply put, if skin is breached—through a cut, sore or change in its protective barrier—bacteria, fungi, viruses and allergens can get in, which can affect your overall health.
Maintaining the strength of the top layer of skin is vital. This strength relies in part on lipids that are made by the skin and also on perspiration and water from deeper layers that help to keep skin moist, prevent the growth of fungi and bacteria, and maintain the protective barrier. However, this barrier is quite fragile and factors large and small—from ultraviolet light exposure to sweating and harsh skin products—may pose potential harm.
Healthy skin is moist, clear and glowing. Maintaining skin health requires a healthy diet, regular exercise, adequate sleep and stress management. Smoking and sunlight are two of the most damaging elements, resulting in poor circulation, brown spots and wrinkles, and significantly increasing the risk of skin cancer.
At any given time, one out of every three people in the United States is suffering from a skin disease. Unhealthy skin not only poses a threat to one’s physical health, but can also affect mental health and self esteem, and costs more than $60 billion in direct healthcare expenses, lost productivity and intangible effects on quality of life.

The Physical, Economic and Emotional Benefits of Healthy Skin

PART I: YOUR SKIN – THE FRONTLINE TO GOOD HEALTH
You may not think about your skin as an organ but in fact it’s the body’s largest, accounting for about one-sixth of your total weight. Taken off your body and stretched out on the floor, it would measure approximately 18 square feet, about the size of a dining room table.1, 2
Unlike other organs, your skin has direct contact with the outside world and its primary function is to protect the internal body organs from injurious external elements. It’s exposed to more potentially life-threatening infectious agents, toxins, environmental factors like pollution and temperature change and gene-damaging radiation than any other organ. Because of its protective barrier properties, your skin serves as the first line of defense for your systemic immune system.

In addition, your skin has its own fairly complex immune system, providing a defense against the outside world.3 Your skin also helps to regulate body temperature, provides insulation, stores energy and lets you perceive the outside world through touch and sensation.
Before you can understand what’s required for healthy skin, you have to understand the structure of skin itself.
Digging Into Skin’s Structure
Skin is composed of two main layers, the epidermis and the dermis, with an insulating layer of fat below, called the subcutis (subcutaneous fatty tissue):
3
1 Epidermis
2 Dermis
3 Subcutis
4 Hair follicle
5 Sebaceous gland
6 Sweat gland

Epidermis. The epidermis has several layers. The outermost part is the protective horny layer, or stratum corneum. This is the part of the skin we lavish with lotions and creams, paint with cosmetics and slather with sunscreen. Composed of dead cells that have migrated from lower levels, this layer is filled with the protein keratin and valuable lipids, forming a barrier against the external environment and internal water loss.
The dead cells are constantly being sloughed off in a process called desquamation, with about 10 grams of skin—about four teaspoons—lost each day. In this way, you create a new epidermis, or top layer of skin, about every month.

Dermis. The dermis is about three times thicker than the epidermis. This layer provides a network of collagen and other connective tissue elements that act like a scaffold that helps to maintain firm, flexible skin. The collagen and its surrounding matrix form a gel-like sponge, able to soak up or release water. The younger and more extensive the collagen network, the more water it can bind, providing the firm skin of youth. As you age, the collagen network is diminished and your dermis holds less water, causing sagging and wrinkles.

The dermis is also where the sweat glands, lymph and blood vessels, smooth muscle and hair follicles reside, as well as nerve endings and cells that transmit sensations of pressure and touch to your brain. 1
Subcutaneous tissue (hypodermis) This underlying layer is composed primarily of fat. It also contains the base of the hair follicles, sweat glands, blood and lymph vessels, as well as sebaceous glands which produce oily sebum that helps maintain moist skin and hair.

The Skin as Immune System
Now that you understand the skin’s structure, let’s focus on its immune-protecting functions. It begins with the stratum corneum—that top layer of dead cells that is constantly being renewed. Think of it as a kind of biological “Saran Wrap,”3 providing a defensive shield that is a major part of the innate immune system.5
Critical to the barrier function of the stratum corneum is the layer of fatty acids, lipids and cholesterol on the skin surface. Combined with sweat and secretions from sebaceous glands, this hydrolipid film inhibits the growth of fungi and bacteria.

This defensive hydrolipid film is slightly acidic with a normal pH between 4.0 and 5.5 (water is neutral, neither acidic nor alkaline, with a pH of 7). The acidity of the barrier is important in inhibiting the growth of alkaline-loving bacteria.5, 6
However, this first line of defense is fairly fragile. Strip away or weaken the protective covering, and the body may be subject to infection.3 Environmental factors like pollution and temperature change, exposure to ultraviolet light, as well as sweating and skin products, can all change your skin’s pH, increasing the risk of damage. That’s why it is so important to keep skin moist and to cleanse and treat it with products designed to maintain an ideal pH.

Water, Water, Everywhere
Water is critical to keeping skin supple. The stratum corneum is about 30 percent water, with younger skin containing 10 to 20 percent more. Without the balance of lipids (fats) and natural moisturizing factors that make up the biofilm, the water bound in the skin would soon evaporate leading to dry and cracked skin, a breach of its natural defenses.
Now that you understand the structure, it’s time to take a look at just what makes—and keeps—skin healthy.
PART II: KEEPING SKIN HEALTHY
Healthy skin is required for a healthy body, yet we tend to think of skin in terms of beauty and appearance. It’s important to realize the very things that work to keep skin beautiful also help maintain its health.
5
The three words that best describe healthy skin are moist, clear and glowing. Moist, well-hydrated skin means the hydrolipid film is doing its job of maintaining the right moisture balance. Clear skin is free of blemishes, clogged pores, sun damage, discolorations and broken blood vessels. Glowing skin has a healthy blood supply carrying lots of oxygen and other nutrients to skin cells.

Healthy skin looks beautiful, no matter what your age. Most wrinkles are caused by sun exposure and smoking. By avoiding both, your skin will appear much younger and healthier than a smoker or sun-worshipper 10 or more years your junior.

Smoking and Your Skin
Next time you’re around a smoker, take a good look at their skin. Note the excessive wrinkles, dryness and sallow complexion. Heavy smokers are nearly five times more likely to have wrinkles on their face than nonsmokers, no matter how much sun they were exposed to. Combine smoking and sun exposure, and the net result is much worse than either alone. Smoking attacks skin in several ways: Constricting blood vessels, limiting the amount of oxygen and other nutrients skin receives. Dehydrating the stratum corneum, leading to dry skin. Depleting levels of antioxidants, which are necessary to neutralize skin-damaging free radicals. Decreasing skin firmness and increasing skin sagging. Interfering with the ability of cells called fibroblasts to manufacture collagen and the extracellular matrix, the structural framework for your skin’s tissue that is vital for repairing skin injuries. Interfering with your immune system, one reason that smokers are 50 percent more likely to develop squamous cell skin cancer than nonsmokers, regardless of sun exposure.

When your skin is healthy, you are unaware of its existence. It doesn’t itch, break out or get irritated, and you don’t need to cover up its flaws with heavy makeup.
Healthy Skin from the Inside Out
Consumers today spend approximately $8 billion a year on over-the-counter skin products.8 However, the most important components of healthy skin come from within. How you eat, how much you exercise, how much ultraviolet light you’re exposed to and your level of stress can all affect your skin’s health.

Eating Right for Healthy Skin
Your diet directly affects your skin’s ability to bounce back from environmental insults such as ultraviolet light. Such exposures trigger the production of free radicals, rogue molecules that seek to steal electrons from healthy molecules, damaging cellular DNA. This is called oxidative damage, and it’s the same process that results in a cut apple turning brown when exposed to air, or a piece of metal rusting when left outside.

To protect cells, your body produces antioxidants designed to neutralize these free radicals. You can increase this supply by following a diet high in antioxidants.
Limit your consumption of low-fiber, high-sugar carbohydrates. They lead to spikes in blood glucose, which can, over time, contribute to the formation of advanced glycosylation end-products, or AGEs. These free radicals can damage collagen and elastin, proteins that help maintain skin’s elasticity and tone.9 AGEs are also more likely to develop (and in greater amounts) in people who are overweight and/or have diabetes, metabolic syndrome or other glucose/insulin related dysfunction.
A diet composed of fruits and vegetables, lean protein, high-fiber grains, low-fat dairy and poly- and monounsaturated fats that is low in saturated fats, red meat and sugar, will help maintain your skin’s health.

Exercise and Skin Health
If you needed another reason to hit the gym, here it is: your skin. Physical activity maintains the health of tiny blood vessels in the skin so they can supply adequate blood and oxygen. This helps provide skin with a healthy glow and also aids in the production of collagen.
Exercise helps you maintain a healthy weight and normal insulin/glucose metabolism, reducing the production of damaging AGE molecules. Exercise also reduces your risk of atherosclerosis, in which cholesterol, calcium and other substances build up on the walls of blood vessels, impeding blood flow.

Exercise helps balance out hormones like testosterone that contribute to acne. In fact, the stress-reducing benefit of exercise is beneficial to maintaining and improving skin health.

Stress and Your Skin
If you’ve ever awakened the morning of an exam, your wedding or the first day of work/school, then you know the effects of stress on your skin. If you have rosacea, psoriasis, eczema or acne, then you know that even the most benign stressful condition can trigger a flare.14 There’s even a new area of medicine focused on this phenomenon: psychodermatology, the study of the interaction between mind and skin.

Stress is more than simply feeling overwhelmed. It’s a biochemical reaction involving the release of numerous hormones, particularly cortisol, which increase inflammation and oil production. One study in graduate school students found that those under stress took longer to recover from a minor skin injury than those who weren’t stressed.16 Other studies found that one-third of psoriasis flares are stress related. Stress-relieving approaches like hypnosis, meditation and therapy improved healing and reduced flares.

Light and Your Skin
The most crucial factor in healthy skin is avoiding the sun’s rays. These rays (or ultraviolet light from tanning booths) are as toxic to your skin as cigarette smoke is to your lungs. This kind of light increases production of free radicals and spurs oxidative damage, triggering cellular changes that can lead to wrinkles, brown spots, sunburn and dryness, or serious diseases like cancer.
There are two types of damaging ultraviolet light:

UVA rays, which can penetrate into the dermis of the skin. These rays are the primary cause of immunosuppression and chronic sun-induced damage (such as premature skin aging). UVB rays, which can reach as far as the deepest layers of the epidermis. These rays are the main cause of sunburn, DNA damage and skin cancer.
Given how damaging sunlight is, it is imperative that you protect your skin through daily use of sunscreen. Unfortunately, just one-third of Americans regularly apply sunscreen.20
Keep in mind that a higher sun protection factor isn’t necessarily better. The American Academy of Dermatology notes that while an SPF of 30 screens 97 percent of UVB rays, an SPF of 15 still screens 93 percent of UVB rays (Figure 2).21 Most dermatologists recommend using an SPF of 30 for the face. Also keep in mind that the SPF only measures UVB protection, not UVA protection.

MAINTAINING HEALTHY SKIN
Clean Skin = Healthy Skin
The first step to healthy skin is keeping it clean. Choose the wrong products and you risk stripping away protective lipids and moisture. In fact, improper skin washing is the most common cause of skin disease!6
Water removes only water-soluble dirt, not the oily residue that clogs pores. Surfactants like sodium laureth sulfate and potassium cocoate dissolve fat-soluble dirt and oils so they can be washed away. However, they also remove important skin-protecting lipids or fats and your natural moisturizing factors, leaving your skin feeling tight and dry. Over time, harsh surfactants can damage the skin barrier itself.1, 24
Certain products can also change the skin’s pH, destroying the barrier function of the epidermis. This can lead to irritation and contact sensitivity, also called contact dermatitis.1
Since most skin cleansers contain surfactants, it’s important to choose products with lipid-replenishing ingredients such as vegetable and fruit oils. Also look for products that use less irritating surfactants such as cocamidopropyl (coconut oil), amphoteric surfactants , alkyl ether sulfates and alkyl glyceryl ether sulfonate.

Choosing the Right Cleanser
Soap Most soaps are alkaline, which can be irritating to unhealthy skin and lead to a condition called alkali eczema, resulting in itching, redness, small bumps and flaking.26 If you wash with
hard water, soap can leave calcium deposits that prevent oil replenishment, causing roughness. To reduce their drying properties, many soaps contain added fats like lanolin and paraffin and/or lactic or citric acid.6
Oil-free liquid cleansers leave a thin, moisturizing film. While often recommended for people with sensitive skin, many still contain propylene glycol and sodium laurel sulfate, both of which can irritate the skin’s top layer.
Cleansing creams simultaneously clean and moisturize. In lieu of surfactants, they use ingredients like beeswax and mineral oil to dissolve oily dirt.

Body washes contain cleansing agents or surfactants. Some may contain a significant amount of petrolatum (better known as petroleum jelly or paraffin), or other lipids which provide moisture.
What Do You Wash With?
Since the top layer of skin is composed of dead cells, it makes sense to think the harder you scrub, the clearer and younger your skin will appear. Such scrubbing can occur with washcloths or through the use of products that contain aluminum oxide particles or ground fruit pits, so-called exfoliants.6
These products can irritate sensitive skin. In most instances, warm water, cleanser and your fingers are all that’s needed. (Stay away from very hot water: it makes your skin absorb cleanser and lose lipids). Or use a soft, disposable cloth with your preferred cleanser. Since you throw it out after each use, it won’t develop bacterial growth.

Don’t over clean your skin! Too much contact with water can make even healthy skin more permeable, weakening its barrier function and leading to transepidermal water loss (TEWL), in which water from deeper layers of the skin is lost to evaporation. This, in turn, can increase your exposure to irritants, pathogens and allergens.

Moisturizing Your Skin
Moisturizers bind water to the skin so it doesn’t evaporate as quickly.1 Think of them as the lid topping a pot of simmering water. The result: a softer and more elastic stratum corneum with optimal protective properties.

There are several types of moisturizing ingredients:
Occlusives such as petrolatum, beeswax, lanolin and oils (think olive oil) form a protective barrier between your skin and the outside environment, keeping moisture in. Humectants such as amino acids, lactic acids, alpha hydroxy acids, propylene glycol, glycerine and urea draw water from the dermis into the stratum corneum, increasing skin’s resistance to drying elements. Emollients fill in the spaces between the cells in the stratum corneum, smoothing the skin like a skim coat of plaster smoothes a wall before paint is applied. Thicker emollients such
as castor oil and almond oil are found in night, eye and facial creams. Those that spread most easily (isopropyl stearate, isopropyl palmitate, isopropyl myristates, hexyl laureate, and dioctyl cyclohexane) are found in body lotions, hand creams and lotions and bath additives. Natural moisturizing factors include citrate, various minerals, urea, lactate and amino acids. When used properly, these factors can help heal the stratum corneum. Many have other health benefits and are used in topical products. However, an overload of these ingredients can cause irritation.

Cosmeceuticals

Designed to improve both skin appearance and health, cosmeceuticals contain commonly used ingredients ranging from natural botanicals (chamomile, curcumin, aloe, green and black tea) to synthetic compounds (ceramide, fluocinonide, retinoids and hydroxy acids). Some examples follow:
Retinoids. One of the most commonly used cosmeceuticals, retinoids are vitamin A derivatives with strong antioxidant and skin-repair properties. Even those found in non-prescription products can improve sun damage.
Hydroxy acids. The second most-common cosmeceutical, hydroxy acids include glycolic acid, lactic acid, citric acid, mandelic acid, malic acid and tartaric acid. They exfoliate dead skin cells to improve the appearance and texture of the skin.

Antioxidants. These include vitamins C and E, panthenol (a B vitamin), lipoic acid, ubiquinone (coenzyme Q10), niacinamide (another B vitamin), dimethylaminoethanol (DMAE), glutathione, superoxide, glucopyranosides, polyphenols and cysteine.
Depigmenting agents. These compounds help lighten skin and brown patches related to sun damage. They include hydroquinone, kojic acid, glycyrrhetinic acid, and N-acetylcysteine. Some products also contain glycolic acid, resorcinol or salicylic acid to induce chemical peeling, which can assist in depigmentation.

PART III: SKIN CONDITIONS AND DISEASES
At any given time, one out of every three people in the United States is suffering from a skin disease.29 In this section, we examine a few of the more common diseases, their underlying causes and treatments.

Dry Skin
Affecting up to 20 percent of the population, dry skin is a major risk factor for bacterial, viral and fungal infections.

Dry skin can occur when your skin is exposed to temperature changes like dry, cold or windy weather, ultraviolet (UV) light, or harsh skin products or chemicals. Many people have chronically dry skin because their skin isn’t “binding” water. This can be related to deficiencies in levels of the skin’s natural moisturizing factors.
Other causes of dry skin include genetics, aging, hormonal influences and skin diseases. One type of dry skin is called atopic dry skin, thought by some to be related to altered ceramide metabolism.
Signs of dry skin problems include mild scaling, roughness, tightness and itching. Signs of extremely dry skin include frequent itching and the formation of calluses, scaling and chapping.
Extremely dry skin needs skin care products designed to supply natural moisturizing factors, like urea and amino acids, to increase your skin’s water-binding capacity and prevent the loss of moisture from the deeper skin layers.

Don’t Forget Your Hands
Many of us focus only on the skin of our face and neck. But your hands deserve just as much, if not more, attention. Your hands get into everything, from scalding hot water in the kitchen sink to freezing cold water in the ocean. Overburden your hands and you can quickly “overtax” your skin’s protection and repair systems. Damaged, cracked and dry hands are more likely to develop dermatitis, or eczema, a condition marked by red, itchy rashes. An estimated 5 to 10 percent of the total population has hand eczema, 15 to 30 percent of working adults. In fact, hand eczema is the most commonly reported occupational disease.
Protect your hands by:
• Choosing washes and moisturizers designed to replace lost lipids, maintain the physiological
pH of your hands’ stratum corneum and promote skin cell regeneration1
• Wearing gloves when outside in cold weather
• Using protective gloves when washing dishes and using cleaning products
• Avoiding excessive exposure to water and liquids

Diabetes and Your Skin
More than 23.6 million children and adults in the United States - nearly eight percent of the population, have diabetes, according to the American Diabetes Association (ADA). Most have type 2 diabetes, in which cells become resistant to insulin, resulting in high blood glucose levels. People with diabetes are much more likely to develop fungal and bacterial infections, as well as dry, itchy skin.31 In fact, the ADA estimates that up to a third of all people with diabetes may develop a skin disorder caused or affected by their disease.31
Even dry skin can be dangerous for someone with diabetes, since scratching can increase the risk of infections. Many people with long-term diabetes have nerve damage in their legs and feet, and a simple cut or foot ulcer may go unnoticed until it becomes infected. Sadly, infections in the extremities can lead to ulcerations that are difficult to heal, which sometimes lead to amputation of the affected limb.
It is imperative that people with diabetes check for skin breaks and maintain the protective barrier of their skin with moisture-rich cleansers and lotions.
Atopic and Contact Dermatitis (Eczema)
Atopic dermatitis is a form of eczema, a chronic inflammatory skin disease marked by excessive dryness, lesions and severe itching. Those with the condition often have other allergy-related disorders such as asthma and hay fever. Atopic dermatitis also increases the risk of contact dermatitis, in which the skin becomes irritated from contact with fabrics, chemicals or clothes washed in certain laundry detergents.32
One reason for atopic dermatitis is low levels of ceramides, a component of the skin barrier lipids. These barrier lipids are found in the spaces between cells on the stratum corneum, and help to prevent water loss. Without their protection, the skin becomes more susceptible to infiltration by pathogens and allergens which, in turn, stimulate an immune response and inflammation.

Various studies have demonstrated urea-containing moisturizers can help with dry skin conditions such as contact and atopic dermatitis. They can reduce the risk of relapse and transepidermal water loss, protect against irritation, and strengthen overall skin barrier protection.What is Sensitive Skin?
Sensitive skin is skin with a lower resistance to irritants. Today, about 50 to 60 percent of the population reports having sensitive skin, compared to about a third in the 1980s. Although the causes of sensitive skin are not completely understood, both internal hereditary factors as well as external factors such as climate, UV exposure, frequent contact with water, alkalis or solvents, and skin peels can make skin more sensitive. Medical conditions such as diabetes or chronic kidney disease can also make skin more sensitive.
Sensitive skin tends to show redness, swelling and scaling when irritated. It may also prickle or burn, feel tight or itch. However, using mild cleansers and moisturizers formulated for sensitive skin—as well as sunscreen—can significantly improve overall skin health.
Rosacea
Rosacea is a condition marked by flushing, persistent redness, dilated blood vessels and/or papules and pustules on the face. In the late stages of the disease, an overgrowth of the sebaceous glands can occur, resulting in thick, horny skin on the nose or other parts of the face. Roseacea occurs more often in women but is more severe in men, generally occurring in middle age.

There is no cure for rosacea, although proper skin care can help reduce flares. That includes the use of mild cleansers and moisturizers, protecting the skin from the sun as well as avoiding extreme weather, alcohol, spicy foods and hot drinks. There are several prescription medications available to treat rosacea, although some can have serious side effects.

Psoriasis
Psoriasis is a chronic skin disease that affects other parts of the body, including the eyes and nails. It is an autoimmune disease, meaning that the immune system attacks a person’s own skin cells. This triggers a rapid proliferation of skin cells that collect at the skin surface, leading to the characteristic thick, scaly patches that develop on various parts of their body.

Psoriasis affects between 2-5 percent of the US population and its prevalence, like that of many autoimmune conditions, may be increasing.45, 46 While it has a strong genetic component, with up to 40 percent of people reporting a family history of the disease, environmental factors such as stress, sunlight, alcohol consumption, certain medications and infections also trigger outbreaks.

The disease is typically treated with prescription medications—oral or topical—and/or light therapy. Daily moisturizing is an important part of skin care for people with psoriasis. Studies have shown that some urea-containing moisturizers can improve the moisture barrier of the stratum corneum twice as much as treatment with a non-urea moisturizer, reducing epidermal overgrowth by a third and epidermal thickness by 50 percent.

Acne
An overproduction of lipids in the skin can promote the growth of P. acnes, a bacterium that causes acne.1 Acne is characterized by pustules and pimples on the face, chest, shoulders and back. Other factors that promote acne include hormonal changes, clogged hair follicles and bacterial infection. Processed foods and certain dairy products may lead to and/or exacerbate acne, as can stress.Although most people develop acne as teenagers, the number of people experiencing adult acne is on the rise. One survey found that between 30 and 35 percent of adults in their thirties said they had acne, with 12 to 26 percent of those in their forties reporting the condition.Treatments for acne include over-the-counter products containing salicylic acid and benzoyl peroxide. Oral or topical antibiotics such as tetracycline or erythromycin and vitamin A derivatives (retinoids) may also be prescribed.
Clean acne-prone skin with liquid cleansers instead of soap, and use skin care products that contain antibacterial additives. An anti-acne regimen should include a salicylic acid-containing cleanser, and a benzoyl peroxide topical product. When you use moisturizer, make sure it’s noncomedogenic, meaning it won’t block your pores.

PART IV: PHARMACOECONOMIC BENEFITS OF PUTTING YOUR SKIN HEALTH FIRST
The costs of skin diseases—in direct medical costs and lost productivity—are staggering, reaching nearly $40 billion a year.29 Another $20 billion is estimated to be lost in intangible costs, such as the effect on quality of life. In fact, skin disease is one of the top 15 medical conditions in the US in which prevalence and spending increased between 1987 and 2000. Both rose more for skin disease than for diabetes, stroke or cancer.51
A 2004 report from the American Academy of Dermatology and the Society for Investigative Dermatology found that the 22 most common skin diseases cost the country $29.1 billion in direct medical costs (including $2.2 billion spent on over-the-counter skin products) and $10.2 billion in indirect costs such as lost productivity. Consider that Americans spent about $1.2 billion on medical treatments for psoriasis in 2004, 40 percent of which were spent on over-the-counter products,29 and you can get an idea of the huge economic problem of skin conditions.

Direct and Indirect Medical Costs for Common Skin Conditions (2004)
Skin Disease
Direct Medical Costs (millions)
Prescription Drugs (millions)
Over-the-counter products (millions)
Indirect costs (lost productivity) (millions)
Intangible cost because of quality of life impact (millions)

One of the most commonly treated skin conditions—and most expensive—is actinic keratosis, i.e., sun spots. A precursor of skin cancer, actinic keratosis is common across the globe, particularly in fair-skinned people and those with suppressed immune systems. Overall, direct medical costs for topical medications, cryotherapy, photodynamic therapy, excision and a combination of treatment modalities used to manage this condition are $1.2 billion a year. Another $295 million is spent on indirect costs, such as lost productivity. However, if we can prevent actinic keratosis by limiting exposure to UV light, using sunscreen and wearing protective clothing, we can dramatically reduce the costs associated with skin cancer.52
Protecting the skin of people with diabetes could also save billions, since skin-related infections and ulcers are a major contributor to limb amputation. Each foot ulcer costs between $7,400 and $20,000 to treat, with many people ending up in the hospital as a result. Overall, diabetes-related amputations cost the US about $3 billion a year in direct medical costs.

Skin and Quality of Life
Unhealthy skin can play havoc with more than your physical health. It can devastate you emotionally. When researchers ask people what part of their body is most important to their body image, skin comes in third behind hair and nose. When something’s not right with skin, it shows!
That’s one reason researchers find that people with bad acne, psoriasis and other skin diseases often experience depression, anxiety and lowered self esteem, as well as overall poorer quality of life and even increased thoughts of suicide.

Studies find that people with skin itching, rashes or pimples were significantly more likely to have “mental distress” and to have experienced negative life events, such as illness or injury to themselves or a close relative, the death of a close relative, separation or a major financial crisis.57 One study found that atopic dermatitis, acne and psoriasis each had a greater negative impact on quality of life than chronic asthma, angina or high blood pressure.

Skin problems, such as psoriasis, are particularly devastating. One study found that psoriasis affects physical and emotional function as much as cancer, arthritis, hypertension, heart disease, diabetes or depression.59 Skin conditions can even negatively impact the quality of life of the family members of those with the condition, causing emotional distress, increasing the burden of care and affecting social life, finances and sleep.The condition of your skin affects every aspect of your life, from how good you feel about yourself to your physical and mental health.

Part V: COSMETIC PROCEDURES AS SKIN SOLUTIONS
Medical procedures are no substitute for maintaining healthy skin, yet they are one of the top solutions for skin problems. The number of cosmetic procedures has increased 162 percent since the collection of plastic surgery statistics began in 1997, according to the American Society for Aesthetic Plastic Surgery. The use of wrinkle fillers such as Restylane and Juvederm, the injectable botulinum toxin (Botox), chemical peels and laser skin resurfacing have become the top nonsurgical skin procedures, with Botox being the most frequently performed nonsurgical procedure. Botox is also the top nonsurgical procedure for patients ages 35 and up. Taking care of your skin with daily use of moisturizers, non-abrasive cleansers and sunscreen can help you delay or avoid these expensive cosmetic interventions.