Climate change and pediatric skin health

The Burden of Air Pollution on Skin Health: a Brief Report and Call to Action

INTRODUCTION

Air pollution in North America has intensified due to wildfires in recent years. In 2023, the wildfires in the Canadian province of Quebec caused a southward spread of pollutants, negatively affecting air quality and thereby aggravating certain health conditions in northeastern USA. This study examines the impact of air pollution on atopic dermatitis (AD) and skin health and how wildfires can exacerbate the burden of disease.

METHODS

Carbon monoxide levels measured by the U.S. Environmental Protection Agency (EPA) in the Boston region during the months following the Canadian wildfires of 2023 were collected from the U.S. EPA Outdoor Air Quality webpage. Patient records on dermatology clinic visits for dermatitis and eczema at the Mass General Brigham (MGB) hospital system, 300 miles from the wildfires, were examined, and the data compared with data from the corresponding months in 2019-2022 for historical control. No individual patient data were collected.

RESULTS

A notable rise and atypical summer peak in carbon monoxide (CO) levels in the Boston region during 2023 correlated with a spike in AD, dermatitis, and eczema-related dermatology clinic visits within the MGB hospital system, as compared with the prior 4 years.

CONCLUSION

The synchronized atypical peaks of CO levels and AD-related visits during the summer of 2023 highlight the potential impact of acute air pollution events such as wildfires on air quality and the consequences for skin health. Air pollution, exacerbated by wildfires, can damage the skin through the smoke and chemicals utilized for extinguishing fires, which contain multiple potential allergens and irritants to the skin, such as CO, particulate matter (PM2.5), and ammonium phosphates, triggering airway and skin inflammation and flares of AD. This issue disproportionately affects vulnerable populations, including low-income communities and the geriatric and pediatric populations. Healthcare professionals and government agencies must work together to improve air quality and purification policies and initiatives to lower the burden of skin disease, especially for vulnerable communities.

The impact of temperature on the skin barrier and atopic dermatitis

Climate change is a global threat to public health and causes or worsens various diseases including atopic dermatitis (AD), allergic, infectious, cardiovascular diseases, physical injuries, and mental disorders. The incidence of allergy, such as AD, has increased over the past several decades, and environmental factors such as climate change have been implicated as a potential mechanism. A substantial amount of literature has been published on the impact of climate factors, including cold and hot temperatures, on the skin barrier and AD. Studies in several countries have found a greater incidence of AD in children born in the colder seasons of fall and winter. The effect of cold and warm temperatures on itch, skin flares, increased outpatient visits, skin barrier dysfunction, development of AD, and asthma exacerbations have been reported. Understanding mechanisms by which changes in temperature influence allergies is critical to the development of measures for the prevention and treatment of allergic disorders, such as AD and asthma. Low and high temperatures induce the production of proinflammatory cytokines and lipid mediators such as interleukin-1β, thymic stromal lymphopoietin, and prostaglandin E2, and cause itch and flares by activation of TRPVs such as TRPV1, TRPV3, and TRPV4. TRPV antagonists may attenuate temperature-mediated itch, skin barrier dysfunction, and exacerbation of AD.

The Science of Selecting Excipients for Dermal Self-Emulsifying Drug Delivery Systems

Self-emulsification is considered a formulation technique that has proven capacity to improve oral drug delivery of poorly soluble drugs by advancing both solubility and bioavailability. The capacity of these formulations to produce emulsions after moderate agitation and dilution by means of water phase addition provides a simplified method to improve delivery of lipophilic drugs, where prolonged drug dissolution in the aqueous environment of the gastro-intestinal (GI) tract is known as the rate-limiting step rendering decreased drug absorption. Additionally, spontaneous emulsification has been reported as an innovative topical drug delivery system that enables successful crossing of mucus membranes as well as skin. The ease of formulation generated by the spontaneous emulsification technique itself is intriguing due to the simplified production procedure and unlimited upscaling possibilities. However, spontaneous emulsification depends solely on selecting excipients that complement each other in order to create a vehicle aimed at optimizing drug delivery. If excipients are not compatible or unable to spontaneously transpire into emulsions once exposed to mild agitation, no self-emulsification will be achieved. Therefore, the generalized view of excipients as inert bystanders facilitating delivery of an active compound cannot be accepted when selecting excipients needed to produce self-emulsifying drug delivery systems (SEDDSs). Hence, this review describes the excipients needed to generate dermal SEDDSs as well as self-double-emulsifying drug delivery systems (SDEDDSs); how to consider combinations that complement the incorporated drug(s); and an overview of using natural excipients as thickening agents and skin penetration enhancers.

The impact of climate change on atopic dermatitis and mental health comorbidities: a review of the literature and examination of intersectionality

Climate change, fueled by increasing concentrations of greenhouse gases, is associated with rising temperatures, extreme weather events, increased aeroallergen production, and air pollution. Our understanding that many inflammatory cutaneous diseases carry important mental health comorbidities is expanding. Simultaneously, the detrimental impacts of climate change on human health are now widely recognized as a global public health crisis. Importantly, these climate-associated phenomena exacerbate the environmental triggers of atopic dermatitis (AD) and are also associated with amplification of comorbid mental health conditions in AD including depression, anxiety, trauma-related disorders, and psychotic spectrum disorders. This review is the first to examine the nexus of climate change, atopic dermatitis, and mental health comorbidities and emphasizes the disproportionate impacts of climate change in vulnerable and marginalized populations.

Climate change and the displaced person: how vectors and climate are changing the landscape of infectious diseases among displaced and migrant populations

BACKGROUND

As the climate crisis grows, so does the global burden of displacement. Displacement, whether a direct or indirect consequence of natural disaster, can lead to dire health sequelae. Skin health is no exception to this, with dermatologic disease being a leading concern reported by those who care for displaced persons. Health professionals who provide dermatologic care for displaced persons benefit from understanding how climate change impacts the global profile of infectious agents.

METHODS

This review was performed using PubMed and Google Scholar. Search terms included climate change, displaced person, internally displaced person, and refugee, as well as searches of infectious disease dermatology and the specific diseases of interest. Case reports, case series, reviews, and original research articles were included in this review. Non-English studies were not included.

RESULTS

In this manuscript several key infectious agents were identified, and we discuss the skin manifestations and impact of climate change on cutaneous leishmaniasis, dengue, chikungunya, zika, malaria, pediculosis, cutaneous larva migrans, cholera, and varicella zoster.

CONCLUSIONS

Climate change plays a significant role in the challenges faced by displaced persons, including their skin health. Among the many consequences of climate change is its altering of the ecological profile of infectious agents and vectors that impact displaced persons. Being familiar with this impact can improve dermatologic care for this vulnerable population.

Climate change, the cutaneous microbiome and skin disease: implications for a warming world

The skin plays an important role in human health by providing barrier protection against environmental stressors. In addition to human skin cells, the cutaneous barrier is also home to a network of organisms that have co-evolved with humans, referred to as the cutaneous microbiome. This network has been demonstrated to play an active role in skin health and the manifestation of cutaneous disease. Here, we review how a warming world and its attendant changes in climatic variables, including temperature, humidity, ultraviolet radiation, and air pollution, influence the cutaneous microbiome and, in turn, skin health. Studies indicate that the cutaneous microbiome is affected by these factors, and these changes may influence the epidemiology and severity of cutaneous disorders including atopic dermatitis, acne vulgaris, psoriasis, and skin cancer. Further investigation into how the cutaneous microbiome changes in response to climate change and subsequently influences skin disease is needed to better anticipate future dermatologic needs and potentially generate novel therapeutic solutions in response.

Climate and health education: A critical review at one medical school

Introduction

As medical schools continue to improve and refine their undergraduate curricula, they are also redefining the roadmap for preparing future generations of physicians. Climate change is a critical topic to integrate into medical education. This period of change for undergraduate medical education coincides with a surge in interest and design efforts for climate and health curricula in health professional education, but this nascent field has yet to be solidly institutionalized. To continue to grow the number of medical students who achieve competency in the effects of climate change on individual health and the health of the planet during their training, we must examine what has worked to date and continue to shift our approach as curricular changes are implemented for feasibility and relevancy.

Objective and methods

In the present study, we assessed the "climate and health" content at one northeastern U.S. medical school that is undergoing an overhaul of their entire curriculum to explore strategies to deliver more robust climate health education in the context of the educational redesign. We conducted 1) a retrospective review of the now four-year-old initiative to investigate the sustainability of the original content, and 2) semi-structured interviews with lecturers, course directors, and medical education coordinators involved in implementation, and with faculty tasked with developing the upcoming curricular redesign.

Results and discussion

Of the original implementation plan, the content was still present in nine of the 14 lectures. Themes determined from our conversations with involved faculty included the need for 1) a shared vision throughout the content arc, 2) further professional development for faculty, and 3) involvement of summative assessment for students and the content itself to ensure longevity. The interviews also highlighted the importance of developing climate-specific resources that fit within the school's new curricular priorities. This critical review can serve as a case study in curriculum to inform other schools undergoing similar changes.

Progress in understanding climate change's effects on children and youth

PURPOSE OF REVIEW

Climate change remains a major threat to the health and well-being of children globally. This article reviews the myriad health effects of climate change on children throughout their lives and discusses ways in which the general pediatrician can be an advocate for climate solutions.

RECENT FINDINGS

Rising atmospheric temperatures, increased air pollution, and destabilized weather patterns all lead to adverse health outcomes for children and adverse obstetric outcomes. However, the impact of climate change is not evenly distributed. Children living in poverty are more likely to be adversely impacted by the changing climate.

SUMMARY

Ongoing and emerging research suggests that children are particularly vulnerable to the effects of climate change. The primary care pediatrician is encouraged to see this irrefutable evidence as a call to action for advocacy on behalf of our patients and the planet.

Climate change and dermatology: An introduction to a special topic, for this special issue

Anthropogenic global climate change is a well-documented phenomenon that has led to average global temperatures climbing to approximately 1 °C above preindustrial (1850-1900) levels, with even higher regional deviations in some areas and significantly increased average warming in densely populated urban centers. In 2018, the United Nations Intergovernmental Panel on Climate Change set a threshold of 1.5 °C of average warming (above the preindustrial baseline), beyond which our planet will become significantly less hospitable to human life. However, adverse human health impacts are already occurring due to current levels of global climate change, as summarized by publications such as The Lancet's annual "Countdown on Health and Climate Change," initiated in 2016. The human health impacts of climate change are truly cross-disciplinary, with nearly every medical specialty either already facing or set to face effects. The field of dermatology is not immune to these risks. This special issue of the International Journal of Women's Dermatology is dedicated to the cross section of dermatology and climate change. This initial article will serve as an overview to introduce readers to the topic and to lay the groundwork for the rest of the issue. We are delighted to work with the Women's Dermatological Society and welcome their support for this dedicated issue. Herein, you will read from up-and-coming stars in the field and established experts, including articles on the following key areas: infectious diseases, environmentally friendly office practices, sunscreens and the environment, refugee health, heat-related illness, the effect of air pollution on the skin, the impact of climate change on pediatric dermatology, implications for skin cancer, and skin issues related to flooding and extreme weather events.