Mass migration and climate change: Dermatologic manifestations

Climate Change, Skin Health, and Dermatologic Disease: A Guide for the Dermatologist

Climate change has a pervasive impact on health and is of clinical relevance to every organ system. Climate change-related factors impact the skin's capacity to maintain homeostasis, leading to a variety of cutaneous diseases. Stratospheric ozone depletion has led to increased risk of melanoma and keratinocyte carcinomas due to ultraviolet radiation exposure. Atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoaging are all associated with rising levels of air pollution. Elevated temperatures due to global warming induce disruption of the skin microbiome, thereby impacting atopic dermatitis, acne vulgaris, and psoriasis, and high temperatures are associated with exacerbation of skin disease and increased risk of heat stroke. Extreme weather events due to climate change, including floods and wildfires, are of relevance to the dermatologist as these events are implicated in cutaneous injuries, skin infections, and acute worsening of inflammatory skin disorders. The health consequences as well as the economic and social burden of climate change fall most heavily on vulnerable and marginalized populations due to structural disparities. As dermatologists, understanding the interaction of climate change and skin health is essential to appropriately manage dermatologic disease and advocate for our patients.

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.

Dermatologic conditions of adult refugees following resettlement in the United States, 2015 to 2018

Background

There is a paucity of literature regarding dermatologic conditions in migrant and refugee populations.

Methods

We conducted a cross-sectional study of all adult refugees resettling in a region of Connecticut, U.S. from 7 January 2015 to 20 November 2018. We conducted a manual chart review to determine dermatologic conditions diagnosed during and within one year of resettlement. We used multivariable logistic regression to determine demographic and clinical factors associated with having any dermatologic condition.

Results

We included 545 refugees primarily from Afghanistan (40.6%), Syria (24.6%) and Iraq (10.5%), with a median (interquartile range) age of 33 (28-40) years. Of the 545 participants, 213 (39.1%) had dermatologic conditions. Fifty-four participants (25%) had more than one dermatologic condition and 114 (53.5%) were diagnosed within the first month of resettlement. The most common categories of conditions were cutaneous infections (24.9%), inflammatory conditions (11.1%), and scar or burn (10.7%). Tobacco use was associated with having a cutaneous infection (OR 2.37, 95%CI:1.09-4.95), and younger age was associated with having a scar or burn (for each year increase in age, OR 0.95, 95%CI:0.91-0.99).

Conclusion

Dermatologic conditions are common among adult refugees. The majority of conditions were diagnosed in the first month following resettlement suggesting that a high number of dermatologic conditions arise or go undetected and untreated during the migration process.

Climate change and human health in the Eastern Mediterranean and Middle East: Literature review, research priorities and policy suggestions

Human health is linked to climatic factors in complex ways, and climate change can have profound direct and indirect impacts on the health status of any given region. Susceptibility to climate change is modulated by biological, ecological and socio-political factors such as age, gender, geographic location, socio-economic status, occupation, health status and housing conditions, among other. In the Eastern Mediterranean and Middle East (EMME), climatic factors known to affect human health include extreme heat, water shortages and air pollution. Furthermore, the epidemiology of vector-borne diseases (VBDs) and the health consequences of population displacement are also influenced by climate change in this region. To inform future policies for adaptation and mitigation measures, and based on an extensive review of the available knowledge, we recommend several research priorities for the region. These include the generation of more empirical evidence on exposure-response functions involving climate change and specific health outcomes, the development of appropriate methodologies to evaluate the physical and psychological effects of climate change on vulnerable populations, determining how climate change alters the ecological determinants of human health, improving our understanding of the effects of long-term exposure to heat stress and air pollution, and evaluating the interactions between adaptation and mitigation strategies. Because national boundaries do not limit most climate-related factors expected to impact human health, we propose that adaptation/mitigation policies must have a regional scope, and therefore require collaborative efforts among EMME nations. Policy suggestions include a decisive region-wide decarbonisation, the integration of environmentally driven morbidity and mortality data throughout the region, advancing the development and widespread use of affordable technologies for the production and management of drinking water by non-traditional means, the development of comprehensive strategies to improve the health status of displaced populations, and fostering regional networks for monitoring and controlling the spread of infectious diseases and disease vectors.

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.