OZONE GLOW

NYC plastic surgeon Nina Naidu considers the effects of climate change on skin health

The interaction between climate and health is both complex and intertwined. Climate change can affect not just the health of the planet, but also that of every organ system in the body. There is increasing evidence to suggest that climate-related events including air pollution, depletion of the ozone layer, global warming, wildfires, extreme weather, and loss of biodiversity can disturb the normal functioning of the immune system. As a result of these events, our bodies are exposed to antigens, allergens, heat stress, pollutants, and changes in the microbiome. These stressors can also hyperstimulate the immune system to influence the body’s immune tolerance, which in turn can produce an array of conditions including autoimmune disease and allergies.

It is perhaps not surprising that because of exposure to the external environment, the skin tends to be one of the most affected organ systems when faced with climate change. Factors related to climate change affect the skin’s ability to maintain homeostasis, precipitating the onset of several cutaneous diseases. Depletion of the ozone layer with elevated exposure to ultraviolet radiation (UVR) has been associated with a higher incidence of skin cancers. Elevated levels of air pollution contribute to increased rates of atopic dermatitis, psoriasis, pemphigus, acne vulgaris, melasma, and photoageing. Higher temperatures because of global warming disrupt the skin’s microbiome and exacerbate skin diseases, including atopic dermatitis, acne vulgaris, and psoriasis.

NINA NAIDU

Nina Naidu MD FACS is a board-certified plastic surgeon practicing in New York City. Her areas of expertise include aesthetic surgery of the breast and body, and non-surgical facial rejuvenation. She is the founder of Anokha, a luxury skincare brand based on active botanicals. For more information, please visit https://naiduplasticsurgery.com and https://anokhaskincare.com 

Specific areas of concern related to climate change and their effects on skin health include the following:

1. Depletion of the ozone layer: As a component of the upper atmosphere, the ozone layer protects the earth’s surface from UVR by absorbing all ultraviolet C and most of the ultraviolet B radiation. As a natural filter, the ozone layer protects us from a known carcinogen. When the ozone layer is reduced, higher levels of UVR can reach the earth’s surface, resulting in increased cases of skin cancer, including melanoma, and premature ageing of the skin.

2. Air pollution: By protecting the body from external factors, the skin also helps to maintain internal homeostasis. Exposure to urban insults, including air pollution, damages the epithelium of the skin and mucosal surfaces, increasing the incidence of allergic and inflammatory diseases. Specific pollutants such as ozone, particulate matter (PM), volatile organic compounds, and nitrous dioxide have been shown to increase both the risk of developing allergic diseases such as atopic dermatitis (AD) as well as their exacerbation. Air pollutants are lipophilic, which allows their direct penetration through the top layer (stratum corneum) of the epidermis. The result is oxidative stress which dysregulates both the immune system and the skin barrier. Clinical studies confirm these effects, with a well-documented association between air pollutants and the development of AD. Studies have also shown that exposure to air pollution during pregnancy predisposes to the development of AD after birth. Air pollution also triggers oxidative stress with the release of inflammatory mediators within the skin, which in turn exacerbates autoinflammatory diseases including acne vulgaris, pemphigus, and psoriasis. Air pollution increases oxidative stress on the skin, which exacerbates extrinsic skin ageing.

3. Global warming: The skin’s microbiome acts as a part of the immune system to protect from pathogenic microbes. Although the microbiome typically remains stable over time, the changing climate may disrupt it. Elevated temperatures and humidity have been associated with the increased growth of skin bacteria. Some skin diseases known to be associated with alteration of the skin microbiome include AD, acne vulgaris, and psoriasis.

4. Wildfires: Wildfires lead to elevated levels of PM, with a demonstrated correlation between wildfires and AD. Wildfires have also been associated with elevated levels of carbon dioxide, which appears to elevate levels of allergic contact dermatitis.

CONCLUSIONS

The effects of climate change on the human body are varied and manifold, with some of the most obvious changes occurring on our most exposed organ, the skin. As the effects of this shift continue to manifest, physicians will undoubtedly see increased levels of photoageing and skin disease in addition to exacerbation of chronic diseases of the pulmonary, gastrointestinal, and nervous systems. This will require increased vigilance for diagnosis, as well as novel methods of treatment.

DEFINITIONS

Acne vulgaris: Acommon cutaneous disorder of the pilosebaceous unit. Atopic dermatitis: A type of eczema remarkable for red, flaky, itchy skin, typically affecting the inner elbows and behind the knees. It’s often seen with allergic rhinitis, hay fever, and asthma. Contact dermatitis: A skin rash caused by contact with a specific substance. Avoiding the trigger typically allows the rash to clear in two to four weeks.

Epithelium: A type of body tissue which forms the covering on internal and external surfaces of the body.

Homeostasis: The process by which an organism maintains a state of balance and stability in its internal environment.

Lipophilic: Technically, “fat loving”; also indicates that an ingredient is oil-soluble.

Melasma: A symmetric brown hyperpigmentation of the face and neck, typically seen in women.

Microbiome: All of the genetic material of a microbial community sequenced together.

Particulate matter: A mixture of solid particles and liquid droplets in the air with various components, dust, dirt, soot, smoke, acids, organic chemicals, metal, and allergens.

Pemphigus: A rare group of blistering autoimmune diseases affecting the skin and mucous membranes.

Photoageing: Premature ageing of the skin by the sun.

Psoriasis: Psoriasis is a skin disease characterised by a rash with itchy and scaly patches, typically found on the knees, elbows, trunk, and scalp.

Skin barrier: The skin barrier protects against external agents including mechanical and chemical insults, heat, pathogens, water, and radiation.