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Dermatologists Have Bad News to Share About Climate Change
Your climate disaster zone is ruining your skin.
April 26, 2023
<p>Heatmap Illustration/Getty Images</p>
If you’ve been avoiding making your annual skin screening appointment for, like, years, rest assured that some things never change: Dermatologists are still obsessed with telling you to wear sunscreen, and your mole probably isn't cancerous (you should get it tested, anyway). But while paper robes with confusing openings aren’t going anywhere, conversations about climate change don’t typically make it into the examination room.
Some doctors think maybe they should. Our skin is our largest organ as well as the one that interacts most immediately with our environment, serving as the first line of defense against harmful microbes; a barrier against UV radiation and pollution; and a regulator of our body temperature via sweat glands. It is, as a result, on the frontline of how our bodies handle their increasingly extreme environments.
Though the International Journal of Women’s Dermatologydevoted an entire 2020 issue to climate change, which ran over 120 pages, looking at dermatology through a climate lens is still gaining traction in the medical community.
“When I lecture about climate change, I invariably get lower grades and more negative comments, including hate mail,” Dr. Misha Rosenbach, an associate professor of dermatology at the University of Pennsylvania, co-founder of the American Academy of Dermatology’s climate change and environmental issues expert resource group, and the co-author of the Women's Dermatology introduction told me, speaking in the capacity as an individual. “And every time I give a lecture, someone will stand up and say it’s a hoax from China — like literally, without fail, no matter what venue, some doctor says it’s a hoax.”
At the same time, the dermatologic response shouldn’t be limited to “wear more sunscreen” and “limit your time in wildfire smoke.” Since our skin is our primary defense against the external world, it is also being impacted in as many ways as there are expressions of climate change. Here are just a few, broken down loosely by American geography.
In the East
The northeastern United States is warming faster than the rest of the country, and unlike the southern U.S., where climbing temperatures will make regions far less habitable, winters and shoulder seasons in the East are becoming, well, pretty pleasant!
But the good weather also means people are spending more time outside. And remember the ozone layer? Though the Montreal Protocol in 1987 helped eliminate the chemicals that were causing its depletion and consequently exposing people to higher levels of UV radiation, its full recovery isn’t expected “until 2050,” the World Health Organization warns. Skin cancer rates, partially as a result, have been rising: Between 2000 and 2010, the overall rates of basal cell carcinoma rose 145 percent and squamous cell carcinoma rose 263 percent, the American Academy of Dermatology reports.
More time outside also means more exposure to pollutants generally. “I grew up in Harlem,” Dr. Lynn McKinley-Grant, the current president of the Skin of Color Society and an associate professor of dermatology at Howard University College of Medicine, told me. “The people who grew up there have a lot of these diseases that affect the skin like sarcoidosis and lupus” — an inflammatory disease that can cause small growths on the skin, and an autoimmune disease that can cause rashes — and “there are some people who have had mycosis fungoides,” a skin cancer that often begins its presentation with a rash.“It’s something we’ve seen for a while,” McKinley-Grant went on, “unrelated to the sun but related environmentally to things that affect us.”
“Urban air stagnation events” — four or more days of low wind speeds and little precipitation, when pollutants can settle — are also a risk, the International Journal of Women’s Dermatology’s introduction adds. Those pollutants can trigger autoimmune skin diseases like lupus, and a blistering disease called pemphigus vulgaris also has “increased hospitalizations if there’s high pollution in the environment,” Rosenbach told me.
There are small annoyances, too: Apparently more CO2 also means more poison ivy.
In the North
Pollen seasons across the country are getting worse due to climate change, but particularly so in places like Wisconsin, Minnesota, North Dakota, and parts of Canada — something any sufferer of seasonal hay fever will tell you can quickly develop into a nasty dermatology concern.
Speaking of nasty, research also shows that increased rainfall in the Great Lakes region due to climate change is resulting in a runoff of “metals, pesticides, pathogens, and fecal indicator bacteria” into recreational waters. “Summertime bacteria concentrations in an inland lake in Wisconsin,” for example, exhibited “positive, significant correlations” with the amount and duration of seasonal rainfall. Swimmer’s itch also appears to be on the rise due to warming temperatures. Fun!
Then there’s Lyme disease, which causes a rash that, if addressed quickly with antibiotics, can head off the development of more serious post-treatment Lyme disease syndrome. The concern is, ticks are now moving into areas where they haven’t been seen before — “dermatologists in Canada went their whole careers without ever encountering Lyme disease,” Rosenbach said — as well as emerging earlier in the season and hanging around through the late fall. “And that ... can mean that you’re not expecting Lyme disease [when] it walks in the door,” Rosenbach said. “And if you don’t recognize that, you can have severe consequences.”
Alaska, meanwhile, gets to enjoy thinking about a “worst-case scenario” of smallpox re-emerging from the melting permafrost.
In the West
When a fire burns through the West, it doesn’t just burn trees — there are cars, houses, and other not-great-to-breathe-in materials being incinerated and ending up in the air. Our skin doesn’t love that. Last year, a study that looked at the 2018 Camp Fire near San Francisco found that instances of eczema rose in local health clinics compared to 2015 and 2016. “Fully 89% of the patients that had itch during the time of the Camp Fire did not have a known diagnosis of [eczema], suggesting that folks with normal skin also experienced irritation and/or absorption of toxins within a very short period of time,” one of the authors said.
Skin is also affected by pollution, which disproportionately affects Black and Latino neighborhoods. Due to historic redlining, these areas are often “low-income, densely populated urban areas adjacent to industrial activities and lacking green spaces,” conditions that compound “health impacts such as chronic dermatitis exacerbations and carcinogenic skin damage,” the International Journal of Women’s Dermatology found. One study that looked at pemphigus flares — that’s the blistering autoimmune disease — “found an association between UV index and hospital admissions only in the subset of Hispanic/Latino patients,” despite using a representative U.S. sample.
The high heat in the West is also a concern since being unable to properly cool off via sweat can cause heat-related illnesses, currently the leading cause of death from extreme climate events in the United States. “The laborers who are out there working in the sun, not only do they get skin cancer, but they end up getting very dehydrated,” McKinley-Grant said, citing studies that have found high rates of kidney failure in agricultural workers and construction workers who labor in high heat conditions.
In the South
If you’re taking a dermatology board exam and the question mentions that a patient went camping in Costa Rica, “everyone knows the answer is leishmaniasis,” Rosenbach said. “The key word is ‘Costa Rica.’”
Leishmaniasis is a parasitic disease spread by sand flies that can cause skin sores and impact internal organs, but it’s taught to aspiring doctors as being a tropical and subtropical disease. Yet parts of the United States are now subtropical too, including Texas and Oklahoma — where, indeed, endemic leishmaniasis cases have begun to appear. But if dermatologists aren’t looking for leishmaniasis in patients with no travel history, they could miss a crucial diagnosis.
Speaking of new diseases, “chikungunya and dengue are now reported within the southern United States, with Zika on the horizon,” one of the papers in the Women’s Dermatology special issue found. And with more powerful storms and flooding slamming southern coasts, “there is terrible dermatitis,” said McKinley-Grant, who has seen firsthand how unidentified infections arose in patients in North Carolina after they waded through waters up to their waists. In extreme environmental conditions such as we live in now, infections of any kind “need to be addressed immediately,” McKinley-Grant went on to stress, even if they seem as innocuous as a bug bite.
Skin problems are actually the “most common issues” medics see after major storms, Rosenbach said. Part of the reason is simple things, “like laceration from flying debris,” he went on. Part of it is that when water rises, “humans and animals are in closer contact, you get animal bites and things like that.” And part of it is that when “you get standing water [...] it releases some of these vector-borne things.”
Oh yeah, and then there are jellyfish. Seabather eruption, an itchy skin reaction caused by jellyfish larvae, “has become increasingly common potentially because of increased ocean temperatures,” the Women’s Dermatology paper found. “This eruption can occur in up to 16% of patients swimming during peak seasons in southeast Florida.”
So where do we go from here?
If you go to the hospital for a broken hip, a doctor might suggest a home safety search. Someone will come to your house, tape down your carpets, and move low-hanging objects in order to prevent future trips and falls.
Rosenbach envisions a future where doctors would do the same for something like repeated childhood asthma hospitalizations. “What if someone at your house was like, ‘Hey, you have a gas-burning stove, and you have mold here, and you’re actually losing a lot of heat through these single pane windows and no insulation. And what we should do is, get rid of your gas stove, rip out this mold, and make your environment better and have some air filters, or whatever,” he mused. “Imagine you could go and make these changes, and suddenly this kid never had asthma anymore, never [needed to be] admitted to the hospital.”
Rather than play whack-a-mole with medical symptoms, then, Rosenbach is thinking like a dermatologist — that is, we ought to cut out the real cancer, which is our dependence on fossil fuels.
Admittedly, that’s daunting to tackle if you’re more immediately concerned with the weird rash you keep getting at the beach. But beyond “eating less meat, flying less, electrifying everything,” from a health-care standpoint, “I don’t think a lot of people think about talking about climate change with their medical team,” Rosenbach said. “And if they do, it pushes the medical team to educate themselves and educate the field.”
Good news for oversharers — talking about your weird rash with friends and acquaintances is also praxis. “No one should be afraid to say, ‘I saw my doctor and they said I got Lyme. I got bit by the tick in February, because of climate change! That’s kind of crazy!’” Rosenbach added. “Just having those conversations and showing people that these are real-time impacts that they’re experiencing I think is important.”
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Lifestyle
Pacific Crest Trail Hikers Are Dealing with the Unprecedented This Year
Hikers plan and climate change laughs.
April 25, 2023
<p>Heatmap Illustration/Getty Images</p>
Mini Chimi was taking a nero with her tramily when she replied to my email. “I believe there is a lot of fear out there associated with the high snow year on the [Pacific Crest Trail],” she told me. “I want to be a positive voice out here.”
Mini didn’t need to worry about coming across as anything else; her writing on The Trek, ablogging platform for long-distance, end-to-end “thru-hikers,” is punctuated by joyous clumps of exclamation points.
“WE ARE DOING IT!!!!” celebrates one post. “COWBOY CAMPING IS SO FUN!!!!!” she raves further on, about sleeping without a tent. Even “snow around mile 35!!!” — a section of high desert just north of the Mexican border — warrants Mini Chimi’s excitement, although it is snow that most hikers of the Pacific Crest Trail, or PCT, are dreading the sight of this year.
In the little more than a decade since Cheryl Strayed published her bestselling memoir about hiking the PCT, Wild (adapted into a movie starring Reese Witherspoon in 2014), interest in thru-hiking the 2,650-mile Mexico-to-Canada trail in a single season has skyrocketed. But in the same span of time, the Pacific Crest Trail Association (PCTA) — the nonprofit stewards of the trail — has grown increasingly worried that thru-hiking as we know it is on the verge of going extinct. Wildfires now regularly close vast sections of the trail in the late summer, and water sources in the desert and high Sierras are drying up, making remote regions virtually impassable. Hiking the trail end-to-end in one year, a bucket-list item for many long-distance backpackers, is now “almost impossible” due to climate change.
Though Mini Chimi is keeping her chin up, 2023 thru-hikers — who’ve quit jobs, bought one-way international flights, and sunk thousands of dollars into new gear — are already watching their odds of completing the trail this year evaporate, some before they’ve even begun (northbound hikers continue to start their trips through the end of May). But ironically, it isn’t extreme heat or wildfires that are scuttling plans. It’s the snow.
“This time of year, there is always snow on the trail,” Scott Wilkinson, the content development director of the PCTA, explained to me. “But this year, obviously, we’re talking about an order of magnitude much, much bigger.”
Due to the parade of atmospheric rivers that slammed the West Coast this winter, California remains buried under once-in-a-generation levels of snow. Ski areas are promising to stay open until “AT LEAST July,” and the Sierra Nevada might not melt out until well into August. This has caused a number of problems that aren’t typical of the trail, which has otherwise trended hotter and drier: A recent post in the Class of 2023 PCT Facebook group, which is administered by the PCTA, suggested that the precipitation this winter has resulted in a lush desert underbrush that is making it harder to spot rattlesnakes, increasing the likelihood of bites. The trail will likely get insufferably buggy this summer, and the West Coast superbloom is also expected to dry into fodder for wildfires.
But fires, one of the most foreboding late-season obstacles on the trail, still seem a world away. In parts of the southern Sierra Nevada, which hikers usually aim to hit around mid-June, the snowpack is still 300% above normal levels. “Right now, about 660 miles of the PCT in the Sierra Nevada are under snow,” Wilkinson told me last week. “That, at a normal trail hiking pace of 20 to 30 miles a day — I mean, that’s a month’s worth of hiking. In snow, it’s likely to be considerably slower than that.” He noted that while there are “a few people that are leading the pack” who have experience in snow conditions, for the most part, that level of snow is “pretty much a nonstarter.”
Firefly is one such hiker who is hoping to push through the Sierras (thru-hikers traditionally refer to each other by their trail names, which I’m honoring here). A retired San Diego Fire Department fire captain, Firefly left the trail in March at mile 151, just south of the San Jacintos, the first major mountain range that hikers encounter headed north. With a high point of over 9,000 feet (or 10,804 feet, if one detours off trail to bag Mt. San Jacinto), the San Jacintos will mark the highest elevation many of the less experienced thru-hikers will have ever stood at, and the steep, bare slopes are “nerve-racking under normal conditions, and downright treacherous if it’s icy,” as they are now, the Fatmap PCT guide cautions.
Part of the reason Firefly left trail was to take a snow travel class offered by the Sierra Mountain Center, which she'd signed up for in October 2022, before even knowing how bad this season was going to be. In the class, she learned how to use crampons, traverse steep snow slopes, and, critically, how to self-arrest using an ice ax. “It feels that a lot of hikers have already decided to skip the Sierra without even setting up to try it,” she wrote to me. “And that’s totally fine for them because it really looks overwhelming. It just feels like an opportunity for me to do something amazing, scary, challenging, and hard.”
Refill, a thru-hiker from northern Germany, managed to make it through the San Jacintos “as probably the third or fourth group,” by his estimate. He’s reflected in a Trek journal entry that “since the start of my planning, San Jac was the mountain range that scared me the most” — a sentiment that is common among PCT hikers, especially after a thru-hiker slipped on a patch of ice on Apache Peak and slid to his death in 2020. In the Class of 2023 PCT group, hikers have been busy exchanging beta about the conditions; one offered up a handy flowchart titled “So You’re Considering the Apache-Onward Section??” with the most common outcome being: Skip it! The local search-and-rescue group is getting to the point even quicker, urging hikers to entirely bypass the 60-odd miles through the San Jacintos, while the PCTA has posted sternly-worded reminders on Facebook that spots on the trail “will require mountaineering skills” and pose avalanche dangers: “Do not assume it will be okay or easy.”
Refill, for his part, is planning to take the skills he practiced with his tramily — that is, his “trail family” — in the San Jacintos and use them in the Sierra Nevada. “All in all, this sketchy and steep mountain range was very good training; we will probably start hiking at 3 a.m. every night in the Sierras,” he told me, describing a mountaineering technique that ensures traversing hard, firm, and more navigable snow during colder hours. “I WAS nervous about San Jacinto, as this range is known to be deadly and steep,” he went on. “I AM nervous about the river crossings in the Sierras.”
The water crossings are also what is keeping Firefly up at night. Outdoor educator Andrew Skurka lists over 30 PCT “High Sierra creek hazards” that still lay ahead of hikers on his website, some with ominous notes like “PCT hiker died here in 2017.” Already, a “critical backcountry bridge” in a section of trail about a month ahead of the lead thru-hikers “has been badly damaged [by snow] and will almost certainly mean long-distance hikers will have to reroute their trips around one of the most picturesque stretches of the High Sierra this summer,” the San Francisco Chronicle reports. The news isn’t encouraging from the PCTA, either: “Without a bridge, crossing the river is not possible anywhere in the general vicinity during high water,” a blog post from the organization warns. “The record-breaking snowpack this year essentially guarantees that high water conditions will exist into August, if not longer.” (White water rafters, meanwhile, are thrilled).
Serendipity is an experienced thru-hiker who completed the Appalachian Trail in 2022; her plans look more like the typical 2023 thru-hiker’s. “My tramily and I are planning to skip the Sierra and possibly come back later in the year, depending on conditions,” she wrote to me from a water cache on the trail just short of the 100-mile mark last week. “We are taking a cautious approach.” It’s not that she doesn’t want to thru-hike — “if the conditions were passable, we would have” — but “I am keeping a take-it-as-it-comes attitude, and [planning] accordingly as we get information,” she went on. “I don’t feel any pressure to attempt to take on unsafe conditions.”
Firefly was staying realistic too: “If there is significant warming or rain before the end of May or while I am in the Sierra, and the river crossings are gnarly or too difficult, then I will bail out, skip up to Northern California, and return in August to finish the Sierra,” she said, describing, like Serendipity, a strategy known as “flip-flopping” — skipping temporarily impassible or challenging trail conditions and returning to complete the sections when they’ve cleared up. Mini Chimi said she has already reworked her plans in this way: “We are ... having to skip around [in order to] avoid large amounts of dangerous snow,” she wrote to me during her “nero,” a “near-zero” mileage rest day. “We will be going back when the conditions are better to complete these sections.”
One day, even elaborate flip-flopping likely won’t allow hikers to complete all the PCT sections in a single season — such as if the Sierra has a snowless year, as is anticipated — but Wilkinson said the hikers I spoke to all have the right mindset. “A lot of hikers are rolling with it; they’re getting creative,” he told me. “They’re beginning to let go of this continuous journey concept in their minds.”
Among those who are on trail, though, letting go can still be easier said than done. “Last year on my [Appalachian Trail] thru-hike, I felt a certain ‘do it now!’ urgency, in part due to my age,” Serendipity said. “I feel a similar ‘do it now’ urgency on the PCT because of my age and also how the uncertainty of extreme weather conditions will affect the PCT.” Those not on trail feel this anxiety too: Thru-hiking the PCT has long been a dream of mine, one that I may now never realistically be able to complete — at least, not in the way I’d envisioned it. Losing that possibility is sad: I’ve alternated between denial (maybe I could still get lucky and pull it off?) and anger that this is our reality.
But like Mini Chimi, Wilkinson remains almost impossibly upbeat about the future of the PCT. “None of this spells the end of the trail,” he said. “This isn’t necessarily gloom-and-doom. It’s change, right? And change is never easy, especially when it’s as difficult to predict as what we’re experiencing now.”
The PCT is nothing if not a patient teacher of change: on the journey, spring turns to summer turns to fall; the trail weaves through six of the country’s seven eco-zones; and sometimes, years-in-the-making plans have to be reworked due to hydroclimatic events, a washed out bridge, or a dry lightning storm. The only way anyone ever gets from one border to the other is by surrendering to whatever the unknowable mile ahead may bring. Mini Chimi is right; you might as well be positive about each step, in that case. None of them can be taken for granted; every one of them, each year, becomes a more precious gift.
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