Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin condition influenced by genetic, immunologic, and environmental factors. While dermatologists have long considered irritants and allergens in disease management, a growing body of evidence now points to a more complex environmental driver: climate change.
A new systematic review and meta-analysis published in JAMA Dermatology confirms what many clinicians have observed anecdotally, air pollutants and climate stressors are significantly associated with disease flares in adult patients with AD. As heatwaves intensify, air quality declines, and weather patterns shift, the dermatology community must prepare for a future in which environmental exposures are central to managing inflammatory skin disease.
Air Pollutants and Atopic Dermatitis Activity
The meta-analysis, which included 42 studies and over 11,000 observations across four continents, found that common air pollutants, notably particulate matter, sulfur dioxide, and nitrogen dioxide, were consistently linked to increases in AD-related healthcare utilization.
Each increase in these pollutants was associated with a 1–3% rise in outpatient visits, emergency room admissions, or disease flare-ups in adults with AD. These findings underscore the inflammatory role of airborne chemicals, which penetrate the skin barrier and activate immune responses, worsening pruritus, erythema, and lichenification.
Extreme Weather and Environmental Instability
It’s not just air quality – temperature extremes, humidity fluctuations, and precipitation patterns were also tied to AD exacerbations. Both very cold and very hot weather were associated with increased disease activity, likely due to impaired skin barrier function and disruption of epidermal lipid regulation under thermal stress.
Interestingly, the study found that climate volatility – rapid weather changes and longer-than-average dry seasons – appears to play as much of a role as chronic pollution. This has significant implications for dermatologists in both urban and rural settings, especially when counseling patients about seasonal triggers.
A Shift in Clinical Practice
For clinicians, these findings reinforce the need to expand environmental screening in patient assessments. Asking about exposure to secondhand smoke, traffic-related pollution, and occupational irritants is no longer optional in managing AD, it’s becoming essential. In parallel, dermatologists should consider working with patients to:
- Track flare-ups in relation to local air quality indices
- Adjust topical regimens seasonally to account for barrier disruption
- Recommend protective clothing and humidifiers for extreme conditions
- Incorporate anticipatory guidance into long-term disease management
The study also suggests the potential for future integration of climate-responsive care models, particularly for patients living in pollution-dense or climate-unstable regions.
Looking Ahead: Advocacy and Research
As environmental health becomes more deeply integrated with dermatologic care, advocacy for cleaner air and more equitable access to skin care resources will become increasingly relevant. Dermatologists can also play a key role in advancing research into barrier-supportive therapies that mitigate environmental stress.
The dermatologic burden of climate change is no longer theoretical, it’s quantifiable. And it’s growing. By taking a proactive stance, the specialty can position itself at the forefront of both treatment and prevention.
