Dermatologists Call for Action in Commentary on Climate Change

Dr Markus D. Boos

A commentary published across four dermatology journals in September urges dermatologists and their medical societies to "engage more meaningfully" on climate change issues, "moving beyond merely discussing skin-related impacts" and toward prioritizing both patient and planetary health.

Dermatologists must make emissions-saving changes in everyday practice, for instance, and the specialty must enlist key stakeholders in public health, nonprofits, and industry – that is, pharmaceutical and medical supply companies – in finding solutions to help mitigate and adapt to climate change, wrote Eva Rawlings Parker, MD, and Markus D. Boos, MD, PhD.

"We have an ethical imperative to act," they wrote. "The time is now for dermatologists and our medical societies to collectively rise to meet this crisis."

Their commentary was published online in the International Journal of Dermatology, Journal of the European Academy of Dermatology and Venereology, British Journal of Dermatology, and Pediatric Dermatology.

Dr Eva Rawlings Parker

In an interview, Parker, assistant professor of dermatology at Vanderbilt University, Nashville, Tenn., said that she and Boos, associate professor in the division of dermatology and department of pediatrics at the University of Washington, Seattle, were motivated to write the editorial upon finding that dermatology was not represented among more than 230 medical journals that published an editorial in September 2021 calling for emergency action to limit global warming and protect health. In addition to the New England Journal of Medicine and The Lancet, the copublishing journals represented numerous specialties, from nursing and pediatrics, to cardiology, rheumatology, and gastroenterology.

The editorial was not published in any dermatology journals, Parker said. "It was incredibly disappointing for me along with many of my colleagues who advocate for climate action because we realized it was a missed opportunity for dermatology to align with other medical specialties and be on the forefront of leading climate action to protect health."

' A Threat Multiplier '

The impact of climate change on skin disease is "an incredibly important part of our conversation as dermatologists because many cutaneous diseases are climate sensitive and we're often seeing the effects of climate change every day in our clinical practices," Parker said.

In fact, the impact on skin disease needs to be explored much further through more robust research funding, so that dermatology can better understand not only the incidence and severity of climate-induced changes in skin diseases – including and beyond atopic dermatitis, acne, and psoriasis – but also the mechanisms and pathophysiology involved, she said.

However, the impacts are much broader, she and Boos, a pediatric dermatologist at Seattle Children's Hospital, maintain in their commentary. "An essential concept to broker among dermatologists is that the impacts of climate change extend well beyond skin disease by also placing broad pressure" on infrastructure, the economy, financial markets, global supply chains, food and water insecurity, and more, they wrote, noting the deep inequities of climate change.

Climate change is a "threat multiplier for public health, equity, and health systems," the commentary says. "The confluence of these climate-related pressures should sound alarm bells as they place enormous jeopardy on the practice of dermatology across all scales and regions."

Health care is among the most carbon-intensive service sectors worldwide, contributing to almost 5% of greenhouse gas emissions globally, the commentary says. And nationally, of the estimated greenhouse gas emissions from the United States, the health care sector contributes 10%, Parker said in the interview, referring to a 2016 report.

In addition, according to a 2019 report, the United States is the top contributor to health care's global climate footprint, contributing 27% of health care's global emissions, Parker noted.

In their commentary, she and Boos wrote that individually and practice wide, dermatologists can impact decarbonization through measures such as virtual attendance at medical meetings and greater utilization of telehealth services. Reductions in carbon emissions were demonstrated for virtual isotretinoin follow-up visits in a recent study, and these savings could be extrapolated to other routine follow-up visits for conditions such as rosacea, monitoring of biologics in patients with well-controlled disease, and postoperative wound checks, they said.

But when it comes to measures such as significantly reducing packaging and waste and "curating supply chains to make them more sustainable," it is medical societies that have the "larger voice and broader relationship with the pharmaceutical industry" and with medical supply manufacturers and distributors, Parker explained in the interview, noting the potential for reducing the extensive amount of packaging used for drug samples.

Parker cochairs the American Academy of Dermatology's Expert Resource Group for Climate Change and Environmental Issues, which was established several years ago, and Boos is a member of the group's executive committee.

AAD Actions

In its 2018 Position Statement on Climate and Health, the American Academy of Dermatology resolved to raise awareness of the effects of climate change on the skin and educate patients about this, and to "work with other medical societies in ongoing and future efforts to educate the public and mitigate the effects of climate change on global health."

Asked about the commentary's call for more collaboration with industry and other stakeholders – and the impact that organized dermatology can have on planetary health – Mark D. Kaufmann, MD, president of the AAD, said in an email that the AAD is "first and foremost an organization focused on providing gold-standard educational resources for dermatologists."

The academy recognizes that "there are many dermatologic consequences of climate change that will increasingly affect our patients and challenge our membership," and it has provided education on climate change in forums such as articles, podcasts, and sessions at AAD meetings, said Kaufmann, clinical professor in the department of dermatology, Icahn School of Medicine at Mount Sinai, New York.

Regarding collaboration with other societies, he said that the AAD's "focus to date has been on how to provide our members with educational resources to understand and prepare for how climate change may impact their practices and the dermatologic health of their patients," he said.

The AAD has also sought to address its own carbon footprint and improve sustainability of its operations, including taking steps to reduce plastic and paper waste at its educational events, and to eliminate plastic waste associated with mailing resources like its member magazine, Kaufmann noted.

And in keeping with the Academy pledge – also articulated in the 2018 position statement – to support and facilitate dermatologists' efforts to decrease their carbon footprint "in a cost effective (or cost-saving) manner," Kaufmann said that the AAD has been offering a program called My Green Doctor as a free benefit of membership.

'Be Part of the Solution '

In an interview, Mary E. Maloney, MD, professor of medicine and director of dermatologic surgery at the University of Massachusetts, Worcester, said her practice did an audit of their surgical area and found ways to increase the use of paper-packaged gauze – and decrease use of gauze in hard plastic containers – and otherwise decrease the amount of disposables, all of which take "huge amounts of resources" to create.

In the process, "we found significant savings," she said. "Little things can turn out, in the long run, to be big things."

Asked about the commentary, Maloney, who is involved in the AAD's climate change resource group, said "the message is that yes, we need to be aware of the diseases affected by climate change. But our greater imperative is to be part of the solution and not part of the problem as far as doing things that affect climate change."

Organized dermatology needs to broaden its advocacy, she said. "I don't want us to stop advocating for things for our patients, but I do want us to start advocating for the world ... If we don't try to [mitigate] climate change, we won't have patients to advocate for."

Parker, an associate editor of The Journal of Climate Change and Health, and Boos declared no conflicts of interest and no funding source for their commentary. Maloney said she has no conflicts of interest.

This article originally appeared on MDedge.com, part of the Medscape Professional Network.

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