How to prevent skin damage from air pollution part 2: Current treatment options

Abstract

In the first part of this review, we have summarized the methods used to examine skin exposure to air pollution and the fundamental concept of skin-exposome interactions. Part 2 of this review focuses on dermatoses, whose aggravation or initiation by air pollution has been confirmed in evidence based medicine manner. Based on the model of photodermatology and photodermatoses, we propose a new concept of "polludermatoses." A key feature of this concept is identifying patients at risk, which will reveal the noxious effects of air pollutants on skin health. Identifying clinical signs of pollution-damaged skin could be beneficial in categorizing conditions caused or exacerbated by exposure to air pollution. Finally, we discuss the current treatment options and the pathogenetic processes targeted by these therapeutics or the development of novel treatment modalities.

Exposome and Skin: Part 1. Bibliometric Analysis and Review of the Impact of Exposome Approaches on Dermatology

“…The implementation of the exposome concept in dermatology started about 5 years ago and is growing rapidly (Table 1 ) [ 22 – 47 ]. The overall aim of most studies has been to evaluate the combined and cumulative effects of the exposome factors on skin health.…”

“…Two meteorotropic studies assessed the real-life exposure conditions during routine daily activities on hair fibres and skin, carried out in Rio de Janeiro, by using multiple sensors to capture UVR, temperature, relative humidity, air pollution and ground level ozone levels [ 24 , 40 ]. Damevska et al reviewed qualitative and quantitative skin exposure assessment methodologies to air pollution [ 39 ], and subsequently published a second review focusing on how air pollution triggers or aggravates dermatoses [ 22 ]. Apenzeller et al proposed hair biomonitoring as an alternative to biological fluids for assessing chronic exposure to environmental factors since hair analysis gives access to information covering a much wider temporal window than urine and blood [ 32 ].…”

“…In addition to the environmental interactions, exposome approaches should be studied and interpreted against the genetic background of the population to create the most accurate disease prediction model as possible, thereby enabling the design of tailor-made prevention strategies. Most of the skin exposome studies published to date (Table 1 ) [ 22 – 47 ] are reviews that examine studies evaluating the effect of exposome factors individually; consequently, interaction effects are probably missed and not taken into consideration. There has been no environment-wide association study (EWAS) published to date that evaluates the link between environmental variables and skin disorders in a high-throughput and unbiased manner, which would help to elucidate how exposure modulates pleiotropy, as in the example of diabetes [ 48 ].…”

Effects of Air Pollution on Cellular Senescence and Skin Aging

“…Exposure of the skin to urban air pollution activates mechanisms of cell detoxification, which, if active over a longer period of time, can lead to DNA and protein damage, elevated ROS levels and lipid peroxidation, resulting in skin alterations, such as impaired barrier function, pigment spots, wrinkles, and decreased skin hydration [ 83 , 84 ]. Additionally, air pollution induces inflammation, activates the AhR pathway, and leads to alterations of the skin microbiome [ 85 , 86 ]. Given the strong link between low-grade systemic inflammation and biological aging, it is possible that exposition of the skin to air pollution leads to premature cellular senescence and, consequently, to skin aging [ 85 ].…”

“…Additionally, air pollution induces inflammation, activates the AhR pathway, and leads to alterations of the skin microbiome [ 85 , 86 ]. Given the strong link between low-grade systemic inflammation and biological aging, it is possible that exposition of the skin to air pollution leads to premature cellular senescence and, consequently, to skin aging [ 85 ]. The literature regarding the effects of air pollution on different ethnic skin types is still elusive.…”