Climate Change, Pollution’s Growing Impact on Dermatology

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Experts highlighted climate change and pollution's increasing impact on dermatology, emphasizing the need for climate advocacy and sustainable practices during a Sunday afternoon session at the 2025 American Academy of Dermatology Annual Meeting in Orlando, Florida.

Experts stressed the importance of dermatologists engaging in climate advocacy and adopting sustainable practices, as their actions may inspire others to follow suit. | Image Credit: hramovnick - stock.adobe.com

The Intersection of Climate Change, Health Equity, and Dermatology

Eva R. Parker, MD, FAAD, of Vanderbilt University Medical Center, began the session, “Skin-Environmental Interface: Dermatologic Challenges of Our Changing Climate and Environment,” by providing an overview of climate change and how it impacts health care. She emphasized the dramatic increase in fossil fuel combustion since the 1950s, which has caused the concentration of heat-trapping greenhouse gases to increase dramatically.

As carbon levels have risen, so has the temperature, with a global increase of 1.15 degrees since the 1880s. Parker highlighted that the hottest years on record occurred in the last decade, with 2024 being the hottest year yet.

Additionally, she noted that the melting polar ice accelerates sea level rise, with the oceans absorbing 90% of heat-trapping greenhouse gases. Parker explained that warm ocean water has greater evaporation rates, which increases the frequency and intensity of storms; this results in the growing global threat of extreme weather events.

Also, she emphasized that most of the world experiences unhealthy air pollution levels, accounting for 8 million premature deaths annually. In particular, chlorofluorocarbons worsen climate change as they act as potent greenhouse gases and destroy the stratospheric ozone layer, allowing increased UV radiation to reach the Earth’s surface.

Parker explained that climate change acts as a “force multiplier” for health disparities as it affects all communities. However, vulnerable and marginalized populations in the US and low- and middle-income nations experience disproportionate effects from related events.

She acknowledged health care’s contribution to climate change, noting it accounts for 5% of total greenhouse gas emissions. In particular, dermatology generates significant procedural waste and has a high energy consumption.

Parker concluded with a call to action, emphasizing the moral imperative to decarbonize health care delivery. She urged dermatologists to prioritize climate and health research, advocate for sustainable policies, support resilience in vulnerable populations, and engage in a multidisciplinary approach to climate solutions.

“We have a moral imperative to decarbonize our delivery of dermatologic care and to prioritize climate and health in our research, advocacy, and policies,” she said. “We must include the impact of climate change on social determinants of health and support, resiliency, and social justice in vulnerable and marginalized populations.”

The Dermatologic Impact of Environmental Pollutants

Additional presentations explored the relationships further between pollutants, climate change, and dermatology. Annika Belzer, MD, MHS, a dermatology resident at the University of California, San Francisco, focused on the impact of forever chemicals on dermatology.

Forever chemicals, also known as per- and polyfluoroalkyl substances (PFAS), consist of over 15,000 known synthetic compounds. Classified into legacy and emerging PFAS, they are a group of man-made chemicals that are persistent in the environment and human body; PFAS are used in various consumer products, like cookware and clothing.

PFAS were discovered in the 1930s, but the Environmental Protection Agency did not establish legally enforceable maximum contaminant levels on legacy PFAS until 2023. Less is known about emerging PFAS, resulting in less regulation.

Potential PFAS exposure routes include inhalation, ingestion, maternal-fetal transfer, and dermal absorption. Belzer noted they are associated with various health impacts, including thyroid disease, liver damage, kidney cancer, and immune dysregulation.

As for their dermatological impact, PFAS upregulate inflammatory cytokines, induce lipid peroxidation, cause oxidative DNA damage, and disrupt the skin barrier and vitamin D endocrine system. Also, Belzer said studies found that PFAS are potentially linked with atopic dermatitis (AD), psoriasis, and melanoma.

Among patients with AD, some studies associated PFAS with dose-dependent interleukin-4 increases and a higher risk of elevated fetal cord blood PFAS levels. Additionally, evidence suggests increased psoriasis and melanoma risk with PFAS exposure. A retrospective cohort study also found increased mitosis in histology among PFAS-exposed groups; however, no significant difference was observed in long-term clinical outcomes.

Belzer acknowledged several research limitations, including the lack of toxicity data on the approximately 10,000 emerging PFAS. Overall, she urged dermatologists to increase their awareness of potential PFAS exposure, consider counseling patients about potential risks, and support further research.

“Although we have more comprehensive data on the 4 most common legacy PFAS, there are approximately 10,000 PFAS compounds, specifically those classified as emerging, with little to no data on toxicity to humans and ecosystems,” she concluded. “Forums such as this will hopefully inspire further work into the cutaneous repercussions of PFAS exposure.”

Similarly, Dennis Niebel, MD, of University Hospital in Regensburg, Germany, discussed the impact of microplastics on dermatological conditions. He began by explaining that plastic is made up of mostly fossil fuel–driven synthetic or semisynthetic polymers. He claimed that over 50% of all plastic was produced after 2000, with current production at 550 megatons annually amid minimal recycling.

Niebel defined microplastics as plastic particles smaller than 5 mm that are a “very heterogenous group,” as they can be different shapes, sizes, polymer types, and beyond. He explained that microplastics contain chemical additives that can bind environmental toxins, meaning they can be present in water and soil; microplastics have the potential for long-term ecosystem disruption.

Individuals can be exposed to microplastics through sources like personal care products, textile microfibers, and unintentional environmental releases. Niebel noted that microplastics have the potential to penetrate the skin and interact with cells, but there is limited clinical research on the subject; this is an emerging area of investigation.

To avoid the potential effects of microplastics, Niebel recommended that dermatologists reduce single-use plastics, avoid microplastics in personal care products, promote sustainable practices, and support research initiatives.

“While plastics are crucial, both in dermatology and health care, their environmental health risks cannot be ignored,” he concluded. “We, as dermatologists, should actively reduce plastic where possible by choosing sustainable products, educating our patients, influencing industry practices, and reducing plastic pollution to mitigate health risks.”

How Dermatologists Can Lead Climate Advocacy

Amid the escalating effects of climate change, David P. Fivenson, MD, FAAD, of Trinity Health Michigan, suggested ways that dermatologists can be climate advocates. He emphasized that they should start small as every simple action, like turning off exam room lights when it is not in use, can make a difference.

Also, Fivenson noted that health care professionals are highly respected in society and can have significant community impact. Consequently, if patients learn that their dermatologists are climate activists, they may feel inspired to take action, as well.

He explained that climate advocacy can be as simple as participating in sustainability initiatives, putting up informative signs in exam rooms, and filling out online legislative support forms. For those looking to become more sustainable, he suggested exploring My Green Doctor, a platform for environmentally-conscious medical practices.

Lastly, he recommended that dermatologists interested in climate advocacy get involved with organizational groups, like Doctors for Climate, Medical Society Consortium for Climate Health, Practice Green Health, and Citizens’ Climate Lobby.

“Lead by example, do something, do anything, because once you start doing, people will see it, and either they're going to ignore you because they don't agree with it, or else they're going to say, 'Hey, that guy’s doing it, maybe I can do something,’” he concluded.

Reference

Parker ER, Belzer A, Niebal D, Fivenson DP. Skin-environmental interface: dermatologic challenges of our changing climate and environment., Presented at: 2025 American Academy of Dermatology Annual Meeting; March 7-11, 2025; Orlando, FL.