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Wang SP, Stefanovic N, Orfali RL, Aoki V, Brown SJ, Dhar S, Eichenfield LF, Flohr C, Ha A, Mora C, Murase JE, Rosenbach M, Srinivas SM, Thyssen JP, Wei ML, Irvine AD, Abuabara K. Impact of climate change on atopic dermatitis: A review by the International Eczema Council. Allergy 2024; 79:1455-1469. [PMID: 38265114 DOI: 10.1111/all.16007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 12/04/2023] [Accepted: 12/19/2023] [Indexed: 01/25/2024]
Abstract
Atopic dermatitis (AD), the most burdensome skin condition worldwide, is influenced by climatic factors and air pollution; however, the impact of increasing climatic hazards on AD remains poorly characterized. Leveraging an existing framework for 10 climatic hazards related to greenhouse gas emissions, we identified 18 studies with evidence for an impact on AD through a systematic search. Most climatic hazards had evidence for aggravation of AD the impact ranged from direct effects like particulate matter-induced AD exacerbations from wildfires to the potential for indirect effects like drought-induced food insecurity and migration. We then created maps comparing the past, present, and future projected burden of climatic hazards to global AD prevalence data. Data are lacking, especially from those regions most likely to experience more climatic hazards. We highlight gaps important for future research: understanding the synergistic impacts of climatic hazards on AD, long-term disease activity, the differential impact on vulnerable populations, and how basic mechanisms explain population-level trends.
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Affiliation(s)
- Sheng-Pei Wang
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | | | - Raquel L Orfali
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Valeria Aoki
- Department of Dermatology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Sara J Brown
- Centre for Genomic & Experimental Medicine, Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, UK
| | - Sandipan Dhar
- Department of Pediatric Dermatology, Institute of Child Health, Kolkata, India
| | - Lawrence F Eichenfield
- Departments of Dermatology and Pediatrics, University of California San Diego, San Diego, California, USA
| | - Carsten Flohr
- Unit for Population-Based Dermatology Research, St John's Institute of Dermatology, Guy's & St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Alex Ha
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
| | - Camilo Mora
- Department of Geography and Environment, University of Hawai'i at Mānoa, Honolulu, Hawai'i, USA
| | - Jenny E Murase
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
- Department of Dermatology, Palo Alto Foundation Medical Group, Mountain View, California, USA
| | - Misha Rosenbach
- Department of Dermatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Sahana M Srinivas
- Department of Dermatology, Indira Gandhi Institute of Child Health, Bengaluru, India
| | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Copenhagen, Denmark
| | - Maria L Wei
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, Dublin, Ireland
| | - Katrina Abuabara
- Department of Dermatology, University of California San Francisco, San Francisco, California, USA
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Hui-Beckman JW, Leung DYM. Physical influences on the skin barrier and pathogenesis of allergy. Curr Opin Pediatr 2023; 35:656-662. [PMID: 37650580 DOI: 10.1097/mop.0000000000001289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/01/2023]
Abstract
PURPOSE OF REVIEW As the incidence of allergic conditions has increased in recent decades, the effects of climate change have been implicated. There is also increased knowledge on the effects of other physical influences, such as scratching and Staphylococcus aureus . The skin barrier is the first line of defense to the external environment, so understanding the ways that these factors influence skin barrier dysfunction is important. RECENT FINDINGS Although the impact on environmental exposures has been well studied in asthma and other allergic disorders, there is now more literature on the effects of temperature, air pollution, and detergents on the skin barrier. Factors that cause skin barrier dysfunction include extreme temperatures, air pollution (including greenhouse gases and particulate matter), wildfire smoke, pollen, scratching, S. aureus, and detergents. SUMMARY Understanding the ways that external insults affect the skin barrier is important to further understand the mechanisms in order to inform the medical community on treatment and prevention measures for atopic conditions.
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Fadadu RP, Chee E, Jung A, Chen JY, Abuabara K, Wei ML. Air pollution and global healthcare use for atopic dermatitis: A systematic review. J Eur Acad Dermatol Venereol 2023; 37:1958-1970. [PMID: 37184289 DOI: 10.1111/jdv.19193] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Accepted: 05/03/2023] [Indexed: 05/16/2023]
Abstract
Increasing air pollution is common around the world, but the impacts of outdoor air pollution exposure on atopic dermatitis (AD) are unclear. We synthesized the current global epidemiologic evidence for air pollution exposure and associated medical visits for AD among adults and children. This review followed PRISMA guidelines, and searches were conducted on PubMed, MEDLINE, Web of Science and EMBASE databases. The searches yielded 390 studies, and after screening, 18 studies around the world assessing at least 5,197,643 medical visits for AD in total were included for the final analysis. We found that exposure to particulate matter ≤2.5 μm in diameter (PM2.5 ) [(10/11) of studies], particulate matter ≤10 μm in diameter (PM10 ) (11/13), nitrogen dioxide (NO2 ) (12/14) and sulfur dioxide (SO2 ) (10/13) was positively associated with AD visits. Results were equivocal for ozone [(4/8) of studies reported positive association] and limited for carbon monoxide [(1/4) of studies reported positive association]. When stratifying results by patient age, patient sex and season, we found that the associations with particulate matter, NO2 and O3 may be affected by temperature. Exposure to selected air pollutants is associated with AD visits, and increasingly poor worldwide air quality may increase global healthcare use for AD.
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Affiliation(s)
- R P Fadadu
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - E Chee
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
| | - A Jung
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- School of Information, University of California, Berkeley, Berkeley, California, USA
| | - J Y Chen
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
| | - K Abuabara
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- School of Public Health, University of California, Berkeley, Berkeley, California, USA
| | - M L Wei
- Department of Dermatology, University of California, San Francisco, San Francisco, California, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, California, USA
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Fadadu RP, Abuabara K, Balmes JR, Hanifin JM, Wei ML. Air Pollution and Atopic Dermatitis, from Molecular Mechanisms to Population-Level Evidence: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2526. [PMID: 36767891 PMCID: PMC9916398 DOI: 10.3390/ijerph20032526] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/19/2023] [Accepted: 01/26/2023] [Indexed: 06/18/2023]
Abstract
Atopic dermatitis (AD) has increased in prevalence to become the most common inflammatory skin condition globally, and geographic variation and migration studies suggest an important role for environmental triggers. Air pollution, especially due to industrialization and wildfires, may contribute to the development and exacerbation of AD. We provide a comprehensive, multidisciplinary review of existing molecular and epidemiologic studies on the associations of air pollutants and AD symptoms, prevalence, incidence, severity, and clinic visits. Cell and animal studies demonstrated that air pollutants contribute to AD symptoms and disease by activating the aryl hydrocarbon receptor pathway, promoting oxidative stress, initiating a proinflammatory response, and disrupting the skin barrier function. Epidemiologic studies overall report that air pollution is associated with AD among both children and adults, though the results are not consistent among cross-sectional studies. Studies on healthcare use for AD found positive correlations between medical visits for AD and air pollutants. As the air quality worsens in many areas globally, it is important to recognize how this can increase the risk for AD, to be aware of the increased demand for AD-related medical care, and to understand how to counsel patients regarding their skin health. Further research is needed to develop treatments that prevent or mitigate air pollution-related AD symptoms.
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Affiliation(s)
- Raj P. Fadadu
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - Katrina Abuabara
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- School of Public Health, University of California, Berkeley, CA 94720, USA
| | - John R. Balmes
- School of Public Health, University of California, Berkeley, CA 94720, USA
- Division of Occupational and Environmental Medicine, University of California, San Francisco, CA 94143, USA
| | - Jon M. Hanifin
- Department of Dermatology, Oregon Health & Science University, Portland, OR 97239, USA
| | - Maria L. Wei
- Department of Dermatology, University of California, San Francisco, CA 94115, USA
- Dermatology Service, San Francisco VA Health Care System, San Francisco, CA 94121, USA
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Fadadu RP, Green M, Grimes B, Jewell NP, Seth D, Vargo J, Wei ML. Association of Wildfire Air Pollution With Clinic Visits for Psoriasis. JAMA Netw Open 2023; 6:e2251553. [PMID: 36637821 PMCID: PMC9857436 DOI: 10.1001/jamanetworkopen.2022.51553] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
This cross-sectional study examines whether clinic visits and online search interest for psoriasis were associated with wildfire air pollution after a delayed lag period.
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Affiliation(s)
- Raj P. Fadadu
- Department of Dermatology, University of California, San Francisco
- Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
| | - Marcus Green
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Barbara Grimes
- Department of Epidemiology and Biostatistics, University of California, San Francisco
| | - Nicholas P. Jewell
- Department of Medical Statistics, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Divya Seth
- Department of Dermatology, University of California, San Francisco
| | - Jason Vargo
- Office of Health Equity, California Department of Public Health, Richmond
- Now with Federal Reserve Bank of San Francisco, San Francisco, California
| | - Maria L. Wei
- Department of Dermatology, University of California, San Francisco
- Dermatology Service, San Francisco Veterans Affairs Health Care System, San Francisco, California
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