Volume 218 - Issue 9
The impact of climate change on skin health
Authors: Austen Anderson, Fiona Bruce, H Peter Soyer, Crystal Williams and Rebecca B Saunderson
Med J Aust 2023; 218 (9): 388-390. || doi: 10.5694/mja2.51931
Published online: 15 May 2023
Published online: 15 May 2023
Climate change affects skin health and skin diseases; mitigation and adaptation strategies are required and are time-critical
Climate change affects skin health and skin diseases; mitigation and adaptation strategies are required and are time‐critical
The latest contribution to the sixth assessment report of the Intergovernmental Panel on Climate Change explained that the earth has continued to experience a net increase in anthropogenic greenhouse gas emissions since 2010.1 Australia has very high per capita greenhouse gas emissions.1
Australia has warmed on average by 1.47°C since national records began in 1910.2 Even if the minimum global agreements made at the COP26 (26th Conference of Parties to the United Nations Framework Convention on Climate Change) summit are achieved by 2030, it is likely that global warming will exceed 1.5°C during this century.1 To limit the health and ecological impacts of global warming, significantly more ambitious action on climate change is required now.
The impact of climate change on skin health
The skin is the human body's first line of defence to irritants, allergens and pathogens from the external world. Exposure to environmental conditions, such as extreme heat and cold, ultraviolet (UV) radiation, and pollution, has significant impacts on skin health and disease (Box).3 The importance of skin disease, including the potential severe systemic and psychological sequelae of undertreated disease, is often overlooked, particularly in priority populations.
Severe weather events such as bushfires and floods are occurring with increasing frequency, severity and scale across the globe, leading to devastation of ecosystems and health consequences.6,15 Both floods and bushfires lead to injuries, such as burns and traumatic wounds, which are a source of initial cutaneous morbidity and mortality. Floods lead to the development of immersive foot syndrome, contact dermatitis, and miliaria, and increase rates of bacterial, mycobacterial, fungal and parasitic infections.6
A more nuanced understanding of extreme weather events and how they affect skin health and skin disease is becoming apparent. Bushfires increase air pollution, especially particulate matter less than 2.5μm in diameter (PM2.5). Air pollution is linked to flares in psoriasis.16 Increased PM2.5 resulting from bushfires is associated with flares in atopic dermatitis and itch in both adult and paediatric populations.7 Air pollution generated from industry and traffic increases oxidative stress on the skin, ultimately exacerbating extrinsic skin ageing.11
Contact dermatitis presentations are likely to be affected by rising atmospheric carbon dioxide (CO2) levels. With increased atmospheric levels of CO2, poison ivy becomes more allergenic, ragweed plants produce more pollen, and the ragweed pollen season increases in length.8,10 Changes in the distribution of allergens will result in populations being exposed to allergens they may not have encountered previously.9
Skin cancer rates are rising and are a major burden of disease globally. Because of the partial recovery seen in the ozone layer as a result of the Montreal Protocol, the avoidance of large increases in UVB radiation reaching the earth's surface has been achieved.14 UV radiation levels at the earth's surface are determined by the complex interplay of ozone levels, aerosols, clouds, and surface reflectivity.14 These factors are influenced by levels of greenhouse gas emissions and are latitude‐ and season‐sensitive. Human behaviour also determines individual UV radiation exposure. Temperature and weather changes related to climate change will affect human behaviour. These behavioural changes, in addition to changing environmental factors, are likely to be variable across the globe, and the overall impact on skin cancer incidence is difficult to predict.14
There is evidence that many skin conditions, including atopic dermatitis, psoriasis, alopecia areata, vitiligo, and cutaneous infections such as herpes labialis, are exacerbated by acute and chronic psychosocial stressors.17 Dermatological presentations including trichotillomania, nodular prurigo (skin picking), and delusional infestation are manifestations of psychological distress.18 Climate change will affect mental health through increased exposures to acute stressors such as floods and fires, medium term stressors such as drought and heat, and longer term impacts such as economic hardship, displacement and forced migration, civil conflict, and isolation from a degraded environment.19
Climate change will continue to disproportionately affect Aboriginal and Torres Strait Islander Australians.20 Skin infestations, including scabies and head lice, and skin infections, including tinea and streptococcal impetigo, present commonly in Australian Aboriginal children.21
There is a correlation between impetigo frequency and hot and humid climatic conditions observed globally.5 The prevalence of scabies is also linked to hot and humid climatic conditions. Northern Australia has one of the highest prevalence rates of childhood scabies worldwide.22 Scabies infestation affects skin barrier function, predisposing affected individuals to bacterial skin infections. Cutaneous skin infections may lead to devastating systemic sequelae, including post‐streptococcal glomerulonephritis and rheumatic heart disease.22 As global temperatures rise, rates of impetigo are expected to increase alongside with associated sequelae.
The impact of these conditions is compounded by reduced access to general and specialist care as well as socio‐economic disadvantage as a legacy of discriminatory health access. A novel approach to this unequal access is the development of a clinic run by a Wiradjuri dermatologist who uses the low carbon footprint of telehealth to provide specialist dermatology care to Aboriginal and Torres Strait Islander patients through the Royal Melbourne Hospital.23
The Torres Strait is already experiencing significant environmental impacts as a result of climate change.12 Climate change‐related severe weather events in this region, including increased temperatures and prolonged warm periods, increased intensity in rainfall events, rising sea levels, and more intense tropical storm activity, are predicted to worsen.12 Ross River virus, dengue virus, tuberculous and non‐tuberculous mycobacteria infections and melioidosis are infectious diseases with potential cutaneous manifestations and are of local importance to the population of the Torres Strait. These infectious diseases are likely to be exacerbated by the effects of climate change.12
Mitigating the impact of climate change on skin health
The health impacts of climate change are far‐reaching. Like many other aspects of human health and disease, skin health will be significantly affected by the environmental, social and psychological consequences of climate change. Health care providers need to understand the effects of climate change on health and disease in their field and use this knowledge as a tool to encourage action on climate change in and beyond the health care sector, and to prepare to adapt to the new challenges we will all face.
Current models of health care provision in Australia contribute significantly to the country's carbon footprint.24 Dermatologists, like all specialty groups, need to critically examine the way health care services are delivered and make urgent changes to achieve zero carbon emission health care as rapidly as possible. Important actions include using only renewable sources of energy, reducing supply chain emissions, and reducing waste.
Teledermatology provides the opportunity to address chronic shortages of dermatology services, particularly in rural and remote areas, which are priority areas likely to be increasingly affected by the health impacts of climate change. Teledermatology has been shown to be an effective method of providing dermatological care with the additional benefits of training local practitioners in management of dermatological disease and reducing the carbon footprint associated with patient and clinician travel.25 In addition, teledermatology services provide the social, cultural and economic benefits of allowing patients to remain on country.
The coronavirus disease 2019 (COVID‐19) pandemic has shown us that rapid global action and cooperation can be achieved when the level of motivation is high. Similarly, with urgent and cooperative action locally, nationally and globally, we may be able to reduce the detrimental effects that climate change will have on health and disease. A zero‐carbon world will improve health outcomes through a healthier environment and more accessible service delivery methods.
Box – Dermatological diseases, infectious diseases, and injuries predicted to be affected by climate change
|
|
Diseases and injuries |
||||||||||||||
|
|
|||||||||||||||
|
Diseases exacerbated by heat4 |
|
||||||||||||||
|
Diseases exacerbated by flooding events6 |
|
||||||||||||||
|
Diseases exacerbated by bushfires and associated smoke |
|
||||||||||||||
|
Diseases exacerbated by increased atmospheric carbon dioxide |
|||||||||||||||
|
Diseases exacerbated by air pollution*11 |
|
||||||||||||||
|
Diseases affected by a changing climate |
|||||||||||||||
|
Notable uncertain impact†14 |
|
||||||||||||||
|
|
|||||||||||||||
|
* The impact of air pollution as an exacerbating factor on these diseases as a result of climate change is uncertain. The transition to renewable energy sources for transport and industry will likely reduce fossil fuel‐related air pollution; however, air pollution related to bushfire smoke, for example, is likely to increase. † Complex interactions between ultraviolet exposure, ambient heat, human behaviour, ozone and locoregional factors such as air pollution make the effect of climate change on skin cancer incidence difficult to predict. |
|||||||||||||||
Competing interests
H Peter Soyer is a shareholder of MoleMap NZ and E‐Derm Consult and undertakes regular teledermatological reporting for both companies. He is a medical consultant for Canfield Scientific, MoleMap Australia, Blaze Bioscience, and a medical advisor for First Derm.
Acknowledgements
H Peter Soyer holds a National Health and Medical Research Council Medical Research Future Fund Next Generation Clinical Researchers Program Practitioner Fellowship (APP1137127), which is unrelated to the submitted publication.
References
- Intergovernmental Panel on Climate Change. Summary for policymakers. In: Shukla PR, Skea J, Reisinger A, et al; editors. Climate change 2022: mitigation of climate change — Working Group III contribution to the Sixth Assessment Report of the Intergovernmental Panel on Climate Change. Cambridge, UK, and New York, USA: Cambridge University Press, 2022. https://www.ipcc.ch/report/ar6/wg3/downloads/report/IPCC_AR6_WGIII_SummaryForPolicymakers.pdf (viewed Mar 2023).
- Bureau of Meteorology. State of the Climate 2022: Australia's changing climate [website]. Canberra: Commonwealth of Australia, 2022. http://www.bom.gov.au/state‐of‐the‐climate/australias‐changing‐climate.shtml (viewed Sept 2022).
- Williams ML. Global warming, heat‐related illnesses, and the dermatologist. Int J Womens Dermatol 2021; 7: 70‐84.
- Burns T, Breathnach S, Cox N, Griffiths C; editors. Rook's textbook of dermatology, 8th ed. Wiley, 2010.
- Loffeld A, Davies P, Lewis A, Moss C. Seasonal occurrence of impetigo: a retrospective 8‐year review (1996–2003). Clin Exp Dermatol 2005; 30: 512‐514.
- Bandino JP, Hang A, Norton SA. The infectious and noninfectious dermatological consequences of flooding: a field manual for the responding provider. Am J Clin Dermatol 2015; 16: 399‐424.
- Fadadu RP, Grimes B, Jewell NP, et al. Association of wildfire air pollution and health care use for atopic dermatitis and itch. JAMA Dermatol 2021; 157: 658‐666.
- Wayne P, Foster S, Connolly J, et al. Production of allergenic pollen by ragweed (Ambrosia artemisiifolia L.) is increased in CO2‐enriched atmospheres. Ann Allergy Asthma Immunol 2002; 88: 279‐282.
- Case MJ, Stinson KA. Climate change impacts on the distribution of the allergenic plant, common ragweed (Ambrosia artemisiifolia) in the eastern United States. PLoS One 2018; 13: e0205677.
- Mohan JE, Ziska LH, Schlesinger WH, et al. Biomass and toxicity responses of poison ivy (Toxicodendron radicans) to elevated atmospheric CO2. Proc Natl Acad Sci USA 2006; 103: 9086‐9089.
- Krutmann J, Bouloc A, Sore G, et al. The skin aging exposome. J Dermatol Sci 2017; 85: 152‐161.
- Hall NL, Barnes S, Canuto C, et al. Climate change and infectious diseases in Australia's Torres Strait Islands. Aust N Z J Public Health 2021; 45: 122‐128.
- Coates SJ, Davis MDP, Andersen LK. Temperature and humidity affect the incidence of hand, foot, and mouth disease: a systematic review of the literature — a report from the International Society of Dermatology Climate Change Committee. Int J Dermatol 2019; 58: 388‐399.
- Neale RE, Barnes PW, Robson TM, et al. Environmental effects of stratospheric ozone depletion, UV radiation, and interactions with climate change: UNEP Environmental Effects Assessment Panel, update 2020. Photochem Photobiol Sci 2021; 20: 1‐67.
- Xu R, Yu P, Abramson MJ, et al. Wildfires, global climate change, and human health. N Engl J Med 2020; 383: 2173‐2181.
- Bellinato F, Adami G, Vaienti S, et al. Association between short‐term exposure to environmental air pollution and psoriasis flare. JAMA Dermatol 2022; 158: 375‐381.
- Passeron T, Zouboulis CC, Tan J, et al. Adult skin acute stress responses to short‐term environmental and internal aggression from exposome factors. J Eur Acad Dermatol Venereol 2021; 35: 1963‐1975.
- Kuhn H, Mennella C, Magid M, et al. Psychocutaneous disease: clinical perspectives. J Am Acad Dermatol 2017; 76: 779‐791.
- Palinkas LA, Wong M. Global climate change and mental health. Curr Opin Psychol 2020; 32: 12‐16.
- Hall NL, Crosby L. Climate change impacts on health in remote Indigenous communities in Australia. Int J Environ Health Res 2020; 32: 487‐502.
- Davidson L, Knight J, Bowen AC. Skin infections in Australian Aboriginal children: a narrative review. Med J Aust 2020; 212: 231‐237. https://www.mja.com.au/journal/2020/212/5/skin‐infections‐australian‐aboriginal‐children‐narrative‐review
- Engelman D, Cantey PT, Marks M, et al. The public health control of scabies: priorities for research and action. Lancet 2019; 394: 81‐92.
- Australian Indigenous Doctors’ Association. AIDA 25th anniversary member stories: Dr Crystal Williams [website]. AIDA, 2022. https://aida.org.au/member‐story/aida‐25th‐anniversary‐member‐stories‐dr‐crystal‐williams/ (viewed Apr 2023).
- Malik A, Lenzen M, McAlister S, McGain F. The carbon footprint of Australian health care. Lancet Planet Health 2018; 2: e27‐e35
- Ahuja S, Briggs SM, Collier SM. Teledermatology in rural, underserved, and isolated environments: a review. Curr Dermatol Rep 2022; 11: 328‐335.
Provenance: Not commissioned; externally peer reviewed.