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Cited by 101Air Quality and Health ImpactsPsoriasis: Treatment and PathogenesisDermatology and Skin Diseases

Association Between Short-term Exposure to Environmental Air Pollution and Psoriasis Flare

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Bellinato, Francesco, Adami, Giovanni, Vaienti, Silvia, Benini, Camilla, Gatti, Davide, Idolazzi, Luca, Fassio, Angelo, Rossini, Maurizio +2 more·2022·JAMA Dermatology
DOI 10.1001/jamadermatol.2021.6019PMC PMC8851365
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Abstract

IMPORTANCE: Psoriasis is a chronic inflammatory disease with a relapsing-remitting course. Selected environmental factors such as infections, stressful life events, or drugs may trigger disease flares. Whether air pollution could trigger psoriasis flares is still unknown. OBJECTIVE: To investigate whether short-term exposure to environmental air pollution is associated with psoriasis flares. DESIGN, SETTING, AND PARTICIPANTS: This observational study with both case-crossover and cross-sectional design retrospectively analyzed longitudinal data from September 2013 to January 2020 from patients with chronic plaque psoriasis consecutively attending the outpatient dermatologic clinic of the University Hospital of Verona. For the case-crossover analysis, patients were included who had at least 1 disease flare, defined as Psoriasis Area and Severity Index (PASI) increase of 5 or greater between 2 consecutive assessments in a time frame of 3 to 4 months. For the cross-sectional analysis, patients were included who received any systemic treatment for 6 or more months, with grade 2 or higher consecutive PASI assessment. MAIN OUTCOMES AND MEASURES: We compared the mean and cumulative (area under the curve) concentrations of several air pollutants (carbon monoxide, nitrogen dioxide, other nitrogen oxides, benzene, coarse particulate matter [PM; 2.5-10.0 μm in diameter, PM10] and fine PM [<2.5 μm in diameter, PM2.5]) in the 60 days preceding the psoriasis flare and the control visits. RESULTS: A total of 957 patients with plaque psoriasis with 4398 follow-up visits were included in the study. Patients had a mean (SD) age of 61 (15) years and 602 (62.9%) were men. More than 15 000 measurements of air pollutant concentration from the official, open-source bulletin of the Italian Institute for Environmental Protection and Research (ISPRA) were retrieved. Among the overall cohort, 369 (38.6%) patients with psoriasis flare were included in the case-crossover study. We found that concentrations of all pollutants were significantly higher in the 60 days before psoriasis flare (median PASI at the flare 12; IQR, 9-18) compared with the control visit (median PASI 1; IQR, 1-3, P < .001). In the cross-sectional analysis, exposure to mean PM10 over 20 μg/m3 and mean PM2.5 over 15 μg/m3 in the 60 days before assessment were associated with a higher risk of PASI 5 or greater point worsening (adjusted odds ratio [aOR], 1.55; 95% CI, 1.21-1.99; and aOR, 1.25; 95% CI, 1.0-1.57, respectively). Sensitivity analyses that stratified for trimester of evaluation, with various lag of exposure and adjusting for type of treatment, yielded similar results. CONCLUSIONS AND RELEVANCE: The findings of this case-crossover and cross-sectional study suggest that air pollution may be a trigger factor for psoriasis flare.

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Crossref · 10.1001/jamadermatol.2021.6019

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  • In studies analyzing multiple air pollutants, the short-term association between psoriasis and air pollution showed a strong relationship with gaseous pollutants such as NO2, SO2, and CO.

    “it was observed that a short-term association between psoriasis and AP showed a strong relationship with gaseous pollutants such as NO2, SO2, and CO [66, 68, 69]”

    From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [66]

    Table 2 (section labeled Conclusions; page unavailable) shows significantly higher CO and NO₂ concentrations in the 60 days before psoriasis flares than before control visits. The Study Participants and Definitions section lists the pollutants assessed, but not SO₂. The paper also does not establish that gaseous pollutants had a stronger relationship with flares than particulate pollutants. (LLM, conf=0.88)

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  • In most studies, high air pollution was shown to have a more immediate effect, lasting from 1 to 6 days, while some studies have even investigated longer lag effects.

    “Third, in most studies, high AP was shown to have a more immediate effect, lasting from 1 to 6 days, while some studies have even investigated longer lag effects [39, 64, 66].”

    From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [66]

    The Study Participants and Definitions section examines air-pollution exposure over the 60 days before psoriasis assessment, and the Case-Crossover Analysis also reports 15-, 30-, and 45-day exposure windows. This supports the statement that some studies investigated longer periods, but this paper does not establish that most studies found effects lasting 1 to 6 days. Page numbers were not available in our copy. (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • A study conducted in Verona, Italy found a correlation between air pollution exposure and increased psoriasis activity, along with a higher likelihood of flares.

    “A study conducted in Verona, Italy found a correlation between air pollution exposure and increased psoriasis activity, along with a higher likelihood of flares [69].”

    From The Environmental Determinants of Skin Health: Linking Climate Change, Air Pollution, and the Dermatologic Disease Burden (2025) · cites this paper as [69]

  • Few studies, all from Italy, reported a positive and significant association between PM (PM10, PM2.5), NOx (NO2, NOx), and exacerbation of psoriasis symptoms.

    “Few studies, all coming from Italy, analyzed the association between AP and disease severity for psoriasis and reported a positive and significant association between PM (PM10, PM2.5), NOx (NO2, NOx), and exacerbation of psoriasis symptoms [39, 65, 66].”

    From Air Pollution and Skin Diseases: A Systematic Review of Epidemiological Evidence (2026) · cites this paper as [66]

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Research works printed but not linked: 1

  1. [2]2. Araviiskaia E, Berardesca E, Bieber T, et al. The impact of airborne pollution on skin. J Eur Acad Dermatol Venereol. 2019;33(8):1496-1505. doi:10. 1111/jdv.15583

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Authors
Bellinato, F., Adami, G., Vaienti, S., Benini, C., Gatti, D., Idolazzi, L., Fassio, A., Rossini, M., Girolomoni, G., & Gisondi, P.
Affiliations
University of Verona (IT)
Corresponding author
Bellinato, Francesco
ORCID
Venue
JAMA Dermatology
Publisher
American Medical Association (AMA)
Published
2022-04-01
Volume
158
Issue
4
Pages
375
ISSN
2168-6068 (ISSN-L)
DOI
10.1001/jamadermatol.2021.6019
PMC
PMC8851365
OpenAlex
W4213023526
Cited by
101
References
35
Citations by year
2026: 14 · 2025: 28 · 2024: 25 · 2023: 20 · 2022: 14
FWCI
8.54
Type
journal article
Language
en
Open access
Locations
  • JAMA Dermatology (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Life Sciences › Immunology and Microbiology › Immunology › Psoriasis: Treatment and Pathogenesis
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
Keywords
psoriasis flare, plaque psoriasis, air pollution, short-term exposure, particulate matter, PM2.5, PM10, nitrogen dioxide, nitrogen oxides, carbon monoxide, benzene, environmental risk factors, PASI, systemic therapy, case-crossover, cross-sectional analysis, Italy
MeSH terms
Air Pollutants, Air Pollution, Cross-Sectional Studies, Environmental Exposure, Female, Humans, Male, Middle Aged, Psoriasis, Retrospective Studies, Cross-Over Studies, Particulate Matter

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