Well, the rapid test says that I am now COVID-free, which is nice. My nose and sinuses aren’t back to normal yet – still some congestion and my voice resonates in my head as if I’ve got a cold. I also seem to just have less energy, which is annoying. All in all, it was unpleasant but far from unbearable, and I’m sure the vaccine helped with that.

When it comes to climate change and health, my focus has mostly been on stuff like the ways in which air pollution affects the cardiovascular system, with occasional mentions of how ecosystem collapse will likely lead to more zoonotic disease outbreaks. What I hadn’t really considered was how climate change looks to a dermatologist. Honestly, I don’t think about how the environment affects skin health in general, beyond solar radiation and things like poison ivy. I have encountered it when looking into the health impacts of flooding, but for some reason I haven’t felt a need to write about it, and that ends today. Sort of. It ends today because I came across some research on the ways in which extreme weather affects skin health:

The skin is a large, complex organ, and it serves as the body’s primary interface with the environment, playing key roles in sensory, thermoregulatory, barrier, and immunological functioning. As floods, wildfires, and extreme heat events increase in frequency and severity, they pose a significant threat to global dermatological health, as many skin diseases are climate sensitive. Investigators draw on an extensive review of published research to highlight the key dermatological manifestations initiated or exacerbated by these climatic events and also highlight the disproportionate impacts on marginalized and vulnerable populations. Their findings appear in The Journal of Climate Change and Health, published by Elsevier

“We wanted to provide dermatologists and other practitioners with a comprehensive overview of extreme weather-related skin disease as a foundation for patient education, implementation of early treatment interventions, and improved disease outcomes,” explained lead author Eva Rawlings Parker, MD, Department of Dermatology and the Center for Biomedical Ethics and Society, Vanderbilt University Medical Center, Nashville, TN, USA. “We were astounded by the shear breadth of impacts that extreme weather events have on skin disease and how profoundly climate change exacerbates inequality.”

In their review, Dr. Parker and her colleagues cite nearly 200 articles documenting the myriad impacts of extreme weather events on skin. Marcalee Alexander, MD, Editor-in-Chief of The Journal of Climate Change and Health, noted, “This information is especially timely in light of traumatic events such as Hurricane Ian, which has led to increased infections due to flood and standing water exposures.”

Flooding, one of the most common natural disasters, is linked to traumatic wounds and bacterial and fungal infections of the skin. Contact dermatitis is another common consequence of flooding since flood water is often contaminated with pesticides, sewage, fertilizers, and chemicals. Exposure to wildfire smoke can trigger atopic dermatitis (eczema) in adults with no prior diagnosis, and it can trigger or exacerbate acne.

Because the skin plays a critical role in the regulation of body temperature, the effects of extended heat waves can be severe. The inability to properly cool during high heat events can lead to heat stroke and death, for example. Many chronic inflammatory dermatoses are exacerbated by heat as well. Infectious diseases can be seasonal, with heat and humidity increasing the risk of common cutaneous infections caused by bacterial, fungal, and viral pathogens. Less obvious, extreme heat events influence behavior. When temperatures are high, people may spend more time outdoors, increasing exposure to air pollution, UV radiation, and insects.

I think I’ve been ignoring skin problems partly because I’ve been fairly lucky in the kinds of skin ailments I’ve had, and partly because of the ways in which our culture has affected my brain (more on that later). Injuries don’t seem to count, in my head. As a kid I had an unpleasant encounter with a bunch of boiling water, and learned that burning large portions of your skin can be deadly. It’s clearly a vital organ, but it’s one that’s designed to handle treatment that would destroy any other organ in our body, so I think I take it for granted sometimes. I suppose the same can be said of other organs as well, but generally if there’s something detectable wrong with an internal organ, that’s a much worse sign than being able to detect a problem that’s only skin-deep.

But, of course, skin health is damned important. Leaving aside the way the skin itself can give us indications of more internal health problems, it’s also where we’re most exposed to external harm, we rely on our skin to keep the good stuff in, and the bad stuff out.

Skin ailments come with unique forms of misery. It’s difficult to not be aware of something wrong with your skin, and the mental toll of pain, itching, and dysmorphia that tends to come along with skin problems – especially chronic ones – is something that I think we should not underestimate. More than that, skin problems are visible. They’re there for other people to see, and so they can be harder to ignore. You can sometimes cover them up, but if there’s something wrong with your skin, having it in constant contact with cloth can be a problem all by itself.

There’s also a degree to which actively taking care of one’s skin is seen as an act of vanity. Certainly, most products surrounding skin care are aimed at appearance, and while a desire to be seen as attractive is an entirely valid part of the human experience, I think the Puritanical disdain for seeming like you care about your appearance is still running strong in our society, as is the misogynistic denigration of “feminine” activities like skin care.

I’m mentioning the social stuff because beyond the direct impact of any given health problem, I think it’s important to remember that stress – in addition to being an effect of all sorts of illness, also is a cause of ill health.

The news on climate change tends to be bad. The planet is going to keep getting more hostile and dangerous as the temperature rises, and so if we want life to get better for everyone – mere survival is not enough for me – then developing a more caring society is a key public health measure. Climate change is happening, and happening fast, but a lot of the pain and death we’re seeing because of it is still mostly because of social, political, and economic factors that make life unnecessarily hard for a large majority of humanity. I think that systemic cruelty is going to get worse as the temperature rises, unless we make some pretty big changes.

Thankfully, this report does not shy away from the ways in which societal conditions interact with skin health:

Dr. Parker and her colleagues observed that extreme weather events disproportionately affect marginalized and vulnerable populations and widen existing health disparities. Children, pregnant women, the elderly, people with mental health illness, racial/ethnic minorities, low-income individuals, and migrants are especially vulnerable to climate-related effects.

Black and Hispanic populations and lower income populations are more likely to live in areas at higher risk for flooding. These populations also have a greater incidence of skin disease and less access to care. Extreme heat is a frontline occupational hazard for manual laborers and migrant workers. Extreme weather events contribute to large-scale migration. Skin diseases are among the most commonly reported health concerns observed in migrants. Of particular concern is the spread of communicable and infectious diseases and vector-borne viruses. People experiencing homelessness are plagued by higher rates of highly morbid, climate-sensitive skin diseases.

As a reminder – there are more vacant houses and apartments than there are unhoused people, and the money most societies spend on “policing” houseless folks (also known as punishing them for being poor) far exceeds what it would cost to just guarantee safe housing for all. The same is true for the cost of privatized vs. universal healthcare. Things are likely to get worse as the temperature rises, but it’s important to remember that they don’t necessarily have to get worse. Climate change is increasing all sorts of health problems, but the degree to which people suffer because of those problems is almost always going to be determined by their place in the economic and political systems in which they live.

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