From health.yahoo.com
Climate change is making its effects felt in increasingly visible ways around the United States - and the world. Temperatures are rising, heavy rainfall and flooding are becoming more common in some areas, drought is intensifying in others, and hotter, drier conditions are increasing the risk of wildfires.
Climate change has been tied to heatstroke, dehydration, mental health issues, worsening chronic disease symptoms, and pressure on healthcare systems. But what does climate change have to do with psoriasis?
Researchers suggest climate change and air pollution may aggravate skin conditions, including psoriasis, acne, rosacea, and atopic dermatitis. A systematic review of 26 studies found that environmental exposures, including air pollution, wildfires and specific weather conditions, were linked to worsening of psoriasis, and increased use of healthcare services.
That doesn't mean climate change is causing psoriasis - or that every person with psoriasis will notice their skin changing along with the weather. But it suggests that psoriasis isn't just about genetics and immune dysfunction.
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Air Pollution
Air pollution is emerging as one of the better-studied environmental factors associated with psoriasis - along with other inflammatory skin conditions like atopic dermatitis and alopecia areata, says Lauren Fine, MD, a Chicago-based dermatologist specializing in medical and aesthetic dermatology.
A review of research listed nitrogen dioxide, sulphur dioxide, and carbon monoxide as key pollutants linked to psoriasis incidence and severity, along with particulate pollutants, which are a mix of tiny solid particles in the air like dust, dirt, soot, and smoke. Researchers think that air pollution could affect psoriasis by increasing oxidative stress and inflammation and disrupting normal skin barrier function.
Beyond irritating psoriasis-prone skin, air pollution may also affect the whole body, Dr. Fine says. "The skin is our largest organ ... so there's the interaction with these pollutants having direct contact with the skin," she says. "But what's probably more important is the systemic effects. It's triggering those inflammatory cascades, increasing reactive oxidant species, which is directly damaging and pro-inflammatory. It's basically shifting the body into a more pro-inflammatory state."
That could matter with psoriasis because the condition already involves immune dysregulation, Fine says. "If you're adding another stressor on top of an existing immune dysregulation, it will likely make it worse."
She says there is an important caveat, though: Researchers don't yet know how much pollution exposure it takes to affect psoriasis, why one person may notice a change while another doesn't, and how other factors are interlinked.
Humidity
Climate change is altering rainfall and humidity patterns, and research notes these fluctuations may "worsen" conditions like psoriasis and atopic dermatitis.
It's low humidity that's especially irritating for people with psoriasis, says Lawrence Green, MD, a clinical professor of dermatology at the George Washington University School of Medicine in Washington, DC.
It can lead to transepidermal water loss - essentially, the amount of water that escapes through the skin - leading to skin dryness, tightness, and a disrupted skin barrier.
"It's very tough on the skin," Dr. Green says. He says he remembers the difference in humidity when he was completing his dermatology training at the University of California in Irvine compared with his practice in DC.
"Being in the dry California conditions, with the Santa Ana winds kicking in, that was really tough on both my allergies and my psoriasis. My psoriasis was flaring up," Green says.
The effect of weather isn't universal, though. Many people with psoriasis report improvement during warmer, sunnier months. Temperature, humidity, sunlight exposure, infections, stress, and other seasonal factors can all interact to have different effects, Green says.
Flooding
Floodwater can contain sewage, chemicals, debris, and other contaminants that can cause skin irritation, rashes, and wound infections.
Green says contaminated floodwater may be more concerning to people with atopic dermatitis, but that flooding comes with another aspect that can potentially trigger a flare in people with psoriasis: stress.
It's considered a "pivotal" contributor to disease onset and exacerbation.
"If you're in a flood, or when a hurricane hits, you're under major stress on the body, and the mental stress of that could theoretically worsen psoriasis," Green says. "But it all goes back to the sudden stress on the body, whatever is triggering it."
Evacuations, disrupted sleep, displaced homes, or difficulty accessing your normal skin-care routine could lead to a flare-up, he says.
Contaminated water may be a problem for another reason: There is risk of the Koebner phenomenon, in which if you scratch irritated skin, psoriasis plaques develop at the site of the injury.
"If there's an irritant chemical [and] you scratch your skin, it can give rise to more psoriasis," Green says.
Wildfires
Wildfire smoke is another area where psoriasis-specific evidence is starting to emerge.
Researchers reported an increase in visits to dermatologists for psoriasis in the weeks following the California fires in 2018. Another study of more than 5,000 adults with psoriasis in the San Francisco Bay Area found that greater exposure to wildfire-related fine particulate matter, or PM2.5, was associated with increased prescriptions for systemic psoriasis treatments in subsequent weeks.
The research doesn't prove that wildfire smoke directly caused psoriasis flares. Instead, Fine says it makes biological sense that wildfire pollutants could act as another inflammatory stressor on the body.
"All pollutants, whether it's from wildfires, from decreased ozone, from worsening heat - I'm thinking of them all similarly," she says. They may have direct effects on exposed skin, but the larger concern may be what happens after pollutants enter the body.
And smoke may not be the only issue during a wildfire. Green points out that the same conditions that allow many wildfires to spread - hot, extremely dry air - can also be hard on psoriatic skin.
How to Cope With Environmental Factors
When it comes to managing your psoriasis, there are steps you can take to adjust to shifts in the environment and the effect those changes might have on your skin.
Protect Yourself Against Air Pollution
You can't control outdoor air quality, but you can reduce your exposure when smoke or pollution levels climb, Fine says.
Now more than ever before, Fine recommends paying closer attention to local air-quality alerts, especially because smoke can affect air quality far away from the fire.
"Anyone with inflammatory disease, like psoriasis, has to think about the analogy that no parts of your body exist in a vacuum. Everything's interconnected," she says.
On poor air-quality days, Fine recommends limiting time outdoors. If you do need to go outside, she advises wearing a mask and wearing long sleeves, pants, and eye protection to reduce exposure. "It's really the best we can do," Fine says.
Indoors, keeping windows closed when practical and using an air purifier may also help reduce exposure to outdoor particulate matter, she says.
Navigate Humidity Swings
If low humidity tends to worsen your psoriasis, a humidifier can help add moisture to dry indoor air. Fine says she commonly recommends indoor humidifiers during Chicago's cold, dry winters.
But a humidifier isn't a substitute for directly moisturizing the skin, especially in arid climates, Green says. In low-humidity parts of the country, Green recommends creams and ointments rather than lighter lotions.
"The real answer is heavily, heavily moisturizing the skin consistently," Green says. "You want to keep your skin barrier intact and moisturize with heavy moisturizers, not lotions, or even thicker petroleum jelly-based products."
High humidity doesn't present the same problem, Green says. But heat and humidity may increase sweating, which can irritate the skin.
"You don't want to sweat too much. That can be an irritant on the skin, so certainly you want to make sure you wash the sweat off as much as you can," Green says.
Wear loose, breathable clothes and change out of sweaty clothing promptly to help reduce irritation.
Floods and Water Contamination
If flooding occurs where you live, the safest choice is to avoid direct contact with floodwater. If your skin does come into contact with contaminated water, wash with soap and clean water as soon as possible, and seek medical care for signs of infection such as increasing redness, swelling, pain, warmth, or draining.
It's worth keeping a travel-friendly skin-care kit, including a thick moisturizer, sunscreen, and gentle cleanser, along with prescribed psoriasis medications, Green says.
"Patients that have chronic disease should always have a backup prescription," Fine says.
If one of your medications requires refrigeration or has other specific storage requirements, ask your pharmacist about what to do during a power outage or evacuation.
Talk to Your Dermatologist About a Rescue Plan
It's also worth knowing what to do before a psoriasis flare-up becomes severe.
Talk to your dermatologist about which treatments you should use if symptoms begin worsening, when you should contact their office, and how you should manage your medications if an evacuation or other emergency interrupts your normal routine.
If psoriasis does begin to flare, Green recommends continuing to moisturize and using prescribed treatments as directed. But don't let a persistent or worsening flare go untreated.
His advice is simple: "Moisturize and call your dermatologist so they can figure out what treatment you need," Green says. "Don't wait. The sooner you go in, the better off you'll be, and the easier the treatment will be."
The Takeaway
The effects of climate change, such as air pollution, wildfires, or fluctuating humidity, may worsen psoriasis by increasing inflammation in the body, adding stress to an already dysregulated immune system, and irritating the skin barrier.
Floods, wildfires, and other natural disasters can also cause potential psoriasis triggers, including psychological stress and uncertainty, skin irritation, disrupted sleep, and difficulty maintaining skin-care routines.
By monitoring air quality alerts, limiting exposure to pollution during poor conditions, and keeping psoriasis medications and moisturizers readily accessible, you can be better prepared to manage symptoms if environmental conditions trigger a flare.
