The Impact Of Climate Change On Skin Health

Behind The Business Woman

Tell us about your career path…

My undergraduate degree in Environmental Science has fueled my interest in how environmental impacts and climate alterations affect health. I initially intended to become an attorney in Environmental Law but because I am a people person and naturally empathetic, I decided to apply to medical school. Choosing Dermatology was largely driven by the fact that I have had Psoriasis my entire life and understand what it’s like to live with an inflammatory skin disease.

I love Dermatology because my clinical practice is so diverse. From infectious diseases, inflammatory skin conditions, and drug-related eruptions to treating diagnoses that are underpinned by mental health issues… Dermatology includes surgery, cosmetics, pathology… It checks off a lot of boxes.

Who has inspired you along the way?

The list is long! I’m proud to have followed in the footsteps of many trailblazers and feel fortunate to have the success that I have in medicine because of these strong women. One, in particular, was my chair when I was in residency at Northwestern, Dr Amy Paller. She was a force of nature — so inspiring. 

My medical school mentor Dr. Robert Dellavalle taught me a lot about research and epidemiology. He remains a supportive friend all these years later. 

Today, at Vanderbilt, my mentor is the current chair of radiology, Dr. Reed Omary. An amazing person who is extremely passionate about climate change and health, he inspires me to think outside the box in terms of identifying solutions.

INDUSTRY ZOOM

The Impact Of Climate Change On Skin Health

In March 2023 at the annual meeting of the AAD American Academy of Dermatology, you chaired a session on “The Impact of Climate Change on Skin Health.” How did you put together such a unique and fascinating program?

I have to credit Misha Rosenbach for starting the forum a few years ago. Last year, he asked me to co-chair it with him, and this year I took over. Climate change is the biggest health crisis we face this century, and many skin diseases are climate-sensitive.

Furthermore, climate change will impact how we practice due to changing patterns of disease and increased medical demand, but also because climate change will affect the way the health sector functions as a whole.

Extreme weather occurrences damage infrastructure, devalue real estate and disrupt supply chains. These institutional threats are going to affect how we’re able to deliver care in the future.

These are real issues that Dermatologists need to understand. So, the impetus for the session was to synthesize this complex topic and try to present it in a way that’s approachable and hopefully inspires advocacy and action.

What are the effects of climate change on skin health?

This is a big topic, but it can be broken down into a few categories:

First, I think we’ll see a tremendous impact on inflammatory skin disease. There is plenty of data already showing that air pollution, wildfire smoke and extreme temperatures are flaring atopic dermatitis, psoriasis, and acne. Some data suggests blistering diseases like pemphigus and autoimmune diseases like lupus may also be on the rise.

Secondly, there are numerous infectious diseases that we have to be worried about — the biggest category being vector-borne diseases, with the range of ticks, mosquitoes and sandflies broadening because of warmer temperatures. The growing season is longer, and winters are shorter and less cold. As a result, these insects can thrive in areas where they weren’t before and bring diseases with them. Flooding also increases the risk of cutaneous infections, including common infections like staph and strep, but also atypical pathogens like Aeromonas and non-tuberculous mycobacterial infections.

In addition, I suspect that we will see more systemic manifestations reflected on the skin as climate change worsens cardiovascular disease, diabetes, renal disease etc.
Mental health comorbidities are connected to many diseases, including psoriasis and atopic dermatitis, and acute climate events are likely to create stress and anxiety that exacerbate underlying inflammatory diseases or induce psychodermatological disorders like skin picking.

Tell us more about the concept of environmental justice.

There are two ways to think about environmental justice: locally or sub-nationally and globally. Unfortunately, in the United States, we have a long history of systemic racist practices. In the 1930s, the government sanctioned maps to be drawn that categorised neighbourhoods based on lending risk for mortgages. Black neighbourhoods were outlined in red and deemed hazardous, devaluing real estate. This became known as redlining, and this discriminatory practice meant that residents in those communities were unable to obtain mortgages and businesses were discouraged from establishing in these neighbourhoods.

As a result, 90 years later, those same redlined neighbourhoods remain minoritized and have a lower socio-economic status. There is a strong correlation with environmental health as many toxic waste dumps, industries, chemical manufacturing companies, and main roads are located in formerly redlined communities. These same neighbourhoods in the US are also urban heat islands. They have an abundance of concrete and very few trees. Consequently, these communities are often many degrees warmer. In my hometown of Nashville, Tennessee, previously redlined neighbourhoods are about 8.5 degrees Fahrenheit warmer than areas that are wealthy and white. The impacts of heat on health — both during heat waves and chronic exposure — are tremendous. Heat is the biggest weather killer in the US. As such, it is really important to recognize that while climate change impacts all of us, it does not impact us equally. Because of structural racism, there are many populations in the US that are disproportionately impacted and at the same time have fewer resources and less access to care.

Since were are at the AAD meeting in Louisiana, a prime example is the geographic region stretching between New Orleans and Baton Rouge that is called Cancer Alley — an area lined with factories and chemical manufacturing plants that produce many toxic chemicals. The residents who live in that corridor are largely Black with lower socioeconomic status. Historically, many of these communities were originally established by freed slaves. Residents living in these communities near sources of toxic pollution have many documented health effects, including higher cancer rates. Unfortunately, because of redlining and other forms of longstanding institutional racism, people of colour in the US remain marginalized. Environmental justice focuses on this concept and how these injustices are reflected in the health of these communities.

What are the effects of climate change on skin health?

This is a big topic, but it can be broken down into a few categories:

• First, I think we’ll see a tremendous impact on inflammatory skin disease. There is plenty of data already showing that air pollution, wildfire smoke and extreme temperatures are flaring atopic dermatitis, psoriasis, and acne. Some data suggests blistering diseases like pemphigus and autoimmune diseases like lupus may also be on the rise.

• Secondly, there are numerous infectious diseases that we have to be worried about — the biggest category being vector-borne diseases, with the range of ticks, mosquitoes and sandflies broadening because of warmer temperatures. The growing season is longer, and winters are shorter and less cold. As a result, these insects can thrive in areas where they weren’t before and bring diseases with them. Flooding also increases the risk of cutaneous infections, including common infections like staph and strep, but also atypical pathogens like Aeromonas and non-tuberculous mycobacterial infections.
• In addition, I suspect that we will see more systemic manifestations reflected on the skin as climate change worsens cardiovascular disease, diabetes, renal disease etc.

• Mental health comorbidities are connected to many diseases, including psoriasis and atopic dermatitis, and acute climate events are likely to create stress and anxiety that exacerbate underlying inflammatory diseases or induce psychodermatological disorders like skin picking.

Tell us more about the concept of environmental justice.

There are two ways to think about environmental justice: locally or sub-nationally and globally. Unfortunately, in the United States, we have a long history of systemic racist practices. In the 1930s, the government sanctioned maps to be drawn that categorised neighbourhoods based on lending risk for mortgages. Black neighbourhoods were outlined in red and deemed hazardous, devaluing real estate. This became known as redlining, and this discriminatory practice meant that residents in those communities were unable to obtain mortgages and businesses were discouraged from establishing in these neighbourhoods.

As a result, 90 years later, those same redlined neighbourhoods remain minoritized and have a lower socio-economic status. There is a strong correlation with environmental health as many toxic waste dumps, industries, chemical manufacturing companies, and main roads are located in formerly redlined communities. These same neighbourhoods in the US are also urban heat islands. They have an abundance of concrete and very few trees. Consequently, these communities are often many degrees warmer. In my hometown of Nashville, Tennessee, previously redlined neighbourhoods are about 8.5 degrees Fahrenheit warmer than areas that are wealthy and white. The impacts of heat on health — both during heat waves and chronic exposure — are tremendous. Heat is the biggest weather killer in the US. As such, it is really important to recognize that while climate change impacts all of us, it does not impact us equally. Because of structural racism, there are many populations in the US that are disproportionately impacted and at the same time have fewer resources and less access to care.

Since were are at the AAD meeting in Louisiana, a prime example is the geographic region stretching between New Orleans and Baton Rouge that is called Cancer Alley — an area lined with factories and chemical manufacturing plants that produce many toxic chemicals. The residents who live in that corridor are largely Black with lower socioeconomic status. Historically, many of these communities were originally established by freed slaves. Residents living in these communities near sources of toxic pollution have many documented health effects, including higher cancer rates. Unfortunately, because of redlining and other forms of longstanding institutional racism, people of colour in the US remain marginalized. Environmental justice focuses on this concept and how these injustices are reflected in the health of these communities.

We see the same situation worldwide in the divisions between the Global North and the Global South, where wealthy countries such as the United States, United Kingdom, and those in the EU have historically been the largest emitters of greenhouse gases. However, in the last 25 years, China has eclipsed all nations with respect to current emissions.

Historically, imperial conquests by the Global North extracted valuable resources from nations in the Global South and oppressed their citizens, leaving colonised nations with far fewer resources, greater financial and political instability, and less resiliency. In particular, low- and middle-income countries have less established healthcare systems to meet the health burdens of climate change and fewer economic resources for adaptation and recovery from climate-induced effects. Many of these nations also rely on agriculture and fishing as primary means of generating income — sectors that are heavily impacted by climate change. In addition, extreme weather events impact these countries to devastating effect, like the famine in Somalia or severe flooding in Pakistan. The legacy of colonialism has resulted in the ongoing disproportionate impact of climate change on nations in the Global South.

Climate change is an immensely complex problem with many interlinkages to consider when examining impacts on health and well-being. This is why we call climate change a force multiplier.

What would you like the physicians to have taken away from your session?

My main objective was to convey that the science of climate change is clear. There’s no debate there.

The second is that climate change is impacting health now. It has been for a number of years, and the effects are only going to increase in the future, especially if we don’t limit global warming to 1.5 degrees celsius.

The third is that many skin diseases are climate sensitive. It’s important for us to recognize that because the skin is the largest organ and the primary interface with our environment, we as Dermatologists should be at the forefront of advocating for reducing climate impacts on health.

The fourth is that it’s not just health that’s impacted; it’s health equity and justice, the health sector, and potentially, our ability to practice in the future.

Finally, there are so many opportunities for action and advocacy. Two recent surveys — one in the British Journal of Dermatology and one in the International Journal of Dermatology, exploring Dermatologists’ attitudes on climate change — demonstrate that Dermatologists are invested in this cause. They are seeing the effects in their practice, and the majority feel like we should be advocates on this issue. I encourage Dermatologists to take action!

What’s coming next for you?

I just had a scientific paper published on the intersectionality of atopic dermatitis, mental health comorbidities and climate change in the International Journal of Dermatology. It is available online and coming out in print soon.

I am excited to attend the 25th World Congress of Dermatology in Singapore this July, where I have two poster presentations and two oral presentations, and I will be speaking in the Hot Topics session on Global Warming and Skin Disease.

And, of course, I’ll continue to promote a broader education on the health impacts caused by climate change!

Read our Women in Cosmetology series here