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Cited by 67Air Quality and Health ImpactsDermatology and Skin DiseasesSkin Protection and Aging

Bad air gets under your skin

Open access
Koohgoli, Roxanna, Hudson, Laura, Naidoo, Khimara, Wilkinson, Simon, Chavan, Bhaven, Birch‐Machin, Mark A.·2017·Experimental Dermatology
DOI 10.1111/exd.13257
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Abstract

Air pollution is increasing beyond previous estimates and is viewed as the world's largest environmental health risk factor. Numerous clinical and epidemiological studies have highlighted the adverse effects of environmental pollutants on health. Although there is comparatively less research investigating the cutaneous effects of ambient pollution, there is growing recognition of the adverse effects on skin. In this article, we provide an overview of the nature of environmental pollution and highlight the current evidence detailing the effects on cutaneous health. There is convincing evidence demonstrating that air pollution has a detrimental impact on skin and can exacerbate skin disease. Further epidemiological and experimental studies are required to assess the short‐ and long‐term deleterious effects of ambient pollutant exposure on skin. The future challenge would be to use this evidence to develop specific strategies to protect against pollution‐induced damage and prevent the effects of “bad air getting under our skin.”

AI snapshot

Written from the paper’s full text.

TL;DR

This narrative review/essay summarizes evidence that ambient air pollutants—including phthalates, particulate matter, PAHs, ozone, and nitrogen dioxide—can adversely affect skin integrity and contribute to inflammatory, ageing, and carcinogenic cutaneous outcomes. It argues that although research on outdoor pollution and skin is comparatively limited, the available evidence supports the need for further experimental studies on short- and long-term exposure.

Key findings

  • Phthalates can disrupt keratinocyte differentiation and proliferation and impair barrier function; in mouse or pig models, infants and children were high-risk populations, and HSP27 was overexpressed with cutaneous phthalate exposure, suggesting tumorigenesis of squamous cell carcinoma.
  • Particulate matter exposure was associated with increased atopic dermatitis symptom severity in children, and a Korean longitudinal study found a direct correlation between outdoor particulate concentration and AD symptoms.
  • Vierkötter and colleagues found that exposure to soot, a mixture of carbon particles covered with PAH, was associated with a 20% increase in pigmented spots on the forehead and cheeks; PAH studies in mouse skin produced papillomas, carcinoma in situ, and squamous cell carcinoma, with no tumors in AhR-deficient mice.
  • Ozone caused dose-dependent depletion of antioxidants vitamin C and E; increased ozone was linked to more skin complaints including urticaria, eczema, contact dermatitis, and skin infections in China, while nitrogen dioxide exposure was significantly associated with increased cheek lentigines in Caucasian and Asian women and with epidermal barrier disturbance in atopic eczema.

Methods

  • Narrative review/essay synthesizing published literature on ambient air pollution and cutaneous health; no primary data collection or systematic review methodology is described.
  • Evidence cited includes mouse and pig models, transgenic mice, and human studies such as Caucasian women in urban and rural Germany, a Korean longitudinal atopic dermatitis study, emergency department and general practitioner visit studies in China and France, and studies of lentigines and atopic eczema.
  • Main analysis is narrative synthesis of cited findings; no quantitative meta-analysis or pooled effect estimates are reported.

Limitations

  • The paper states that there is a paucity of research investigating the effects of ambient pollutants on human skin, that animal skin and localization of acute toxicity can be limiting factors for human translational studies, and that further experimental studies are required to assess short- and long-term ambient pollution exposure on skin.
  • Evident from the text: this is a narrative essay/review without a described systematic search strategy, risk-of-bias assessment, or meta-analysis, and its conclusions rely on selected cited studies rather than primary data.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1111/exd.13257

Cites

10 of 10 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 46 cited sources checked · 0 supported · 0 flagged

  • Premisecitation

    Certain countries, in particular China and India, have annual PM concentrations that far exceed the limits set by the WHO.

    “This has demonstrated that certain countries, in particular China and India, have annual PM concentrations that far exceed the limits set by the WHO.[2]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • Premisecitation

    Exposure to phthalates can disrupt the differentiation and proliferation of keratinocytes, impairing barrier function.

    “Exposure to phthalates can disrupt the differentiation and proliferation of keratinocytes, impairing barrier function.[4]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • Premisecitation

    The plastic industry continues to generate phthalates every year on a considerable scale.

    “It is known that phthalates are widespread contaminants in both indoor and outdoor environments, but the plastic industry continues to generate phthalates every year on a considerable scale.[4]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • Premisecitation

    In mice or pig models, infants and children were high-risk populations for xenobiotic toxicity on skin.

    “Using mice or pig models, they found that infants and children were high-risk populations for the xenobiotic toxicity on skin.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites Pan and colleagues

      Not checked in the free run.

  • Premisecitation

    Phthalate exposure has potential for tumorigenesis.

    “A further concern of phthalate exposure is potential for tumorigenesis.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] source

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  • Classified as probably not a substantial claim. 5
  • May combine two claims. 11

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Many studies have demonstrated acute and chronic effects of exposure to environmental pollutants on morbidity and mortality.

    “Many studies have demonstrated the acute and chronic effects of exposure to environmental pollutants on morbidity and mortality.[3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based).

    Interpretationnone given

    Animal skin and localization of acute toxicity can be limiting factors for human translational studies of phthalate skin effects.

    “animal skin and localization of acute toxicity can be limiting factors for human translational studies.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Major sources of PM include open fires, industrial facilities, power plants and vehicle exhausts.

    “Major sources of PM include open fires, industrial facilities, power plants and vehicle exhausts.[3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

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  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    Particulate matter is a complex mixture of particles suspended in air produced by a variety of natural and anthropogenic activities.

    “Particulate matter is a complex mixture of particles suspended in air which are produced by a variety of natural and anthropogenic activities.[3]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [3] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    HSP27 was overexpressed with cutaneous phthalate exposure, suggesting tumorigenesis of squamous cell carcinoma.

    “HSP27 was overexpressed with cutaneous phthalate exposure, suggesting tumorigenesis of squamous cell carcinoma.[4]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [4] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    NO2 causes oxidative damage, generating free radicals that can oxidize amino acids in tissue proteins, and initiates lipid peroxidation of polyunsaturated fatty acids in pulmonary cell membranes.

    “NO 2 causes oxidative damage, generating free radicals that can oxidize amino acids in tissue proteins, and initiates lipid peroxidation of polyunsaturated fatty acids in pulmonary cell membranes.[11]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Ambient air pollutants generate free radicals that also include the cutaneous inflammatory cascades, activating AhR-dependent mechanisms and altering cutaneous microflora.

    “Ambient air pollutants generate free radicals that also include the cutaneous inflammatory cascades, activating AhR-dependent mechanisms and altering cutaneous microflora.[6]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Activation of AhR plays a role in mediating the biochemical and toxic effects of air pollutants such as dioxins, ozone and PAHs and can influence cell biological endpoints such as growth and differentiation.

    “Activation of AhR plays a role in mediating the biochemical and toxic effects of air pollutants such as dioxins, ozone and PAHs and can influence cell biological endpoints such as growth and differentiation.[6]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [6] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The interaction between PAH and the AhR induces the production of highly carcinogenic metabolites and promotes tumorigenesis.

    “The interaction between PAH and the AhR induces the production of highly carcinogenic metabolites and promotes tumorigenesis.[2]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [2] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    PAHs are ubiquitous constituents of ambient pollution that have been shown to have serious carcinogenic effects.

    “Polycyclic aromatic hydrocarbons are ubiquitous constituents of ambient pollution that have been shown to have serious carcinogenic effects.[5]”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [5] source

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  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    ROS are free radicals that contribute to oxidative stress, a resultant damage that arises due to an increase in destructive free radicals and reduction in protection from antioxidants.

    “ROS are free radicals that contribute to oxidative stress, a resultant damage that arises due to an increase in destructive free radicals and reduction in protection from antioxidants.[5]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The toxic effects of O3 are mediated through free radical reactions that are achieved either directly by oxidation of biomolecules to generate ROS or by the radical-dependent production of cytotoxic, non-radical molecules (aldehydes).

    “The toxic effects of O 3 are mediated through free radical reactions that are achieved either directly by oxidation of biomolecules to generate ROS or by the radical-dependent production of cytotoxic, non-radical molecules (aldehydes).[8]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [8] source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    The ability of PAHs to increase ROS production is detrimental to skin and can result in adverse cosmetic effects.

    “The ability of PAHs to increase ROS production is detrimental to skin and can result in adverse cosmetic effects.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Premisecitation

    Exposure to PAH resulted in the development of squamous cell carcinomas in AhR-positive mice; no tumors were found on the skin of AhR-deficient mice.

    “They found that exposure to PAH resulted in the development of squamous cell carcinomas in AhR-positive mice; however, no tumors were found on the skin of AhR-deficient mice.[5]”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [5] source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Short-term exposure to nitrogen dioxide leads to skin surface changes and disturbance of epidermal barrier function.

    “The results showed that short-term exposure to nitrogen dioxide leads to skin surface changes and disturbance of epidermal barrier function.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] source

      Not checked in the free run.

15 of 15

  • The paper relies on this without support.

    There is a paucity of research investigating the effects of ambient pollutants on human skin.

    “By comparison, there is a paucity of research investigating the effects of ambient pollutants on human skin.”

  • The paper relies on this without support.

    The skin serves as an environmental interface and is a major target for toxic insult by ambient pollution capable of altering its structure and function.

    “The skin serves as an environmental interface, providing a protective envelope and as a result, is a major target for toxic insult by a broad spectrum of physical and chemical agents in ambient pollution that are capable of altering its structure and function.”

  • The paper relies on this without support.

    The size and composition of PM both influence their effects on health.

    “The size and composition of PM both influence their effects on health.”

  • The paper relies on this without support.

    AhR is a ligand-activated transcription factor found in various skin cells including keratinocytes, fibroblasts and melanocytes.

    “AhR is a ligand-activated transcription factor found in various skin cells including keratinocytes, fibroblasts and melanocytes.”

  • The paper relies on this without support.

    O3 targets the skin surface and does not directly exert an effect on skin cells.

    “O 3 targets the skin surface and does not directly exert an effect on skin cells.”

  • The paper relies on this without support.

    Phthalates can be delivered into the body via inhalation, dietary intake and skin absorption.

    “The toxicants can be delivered into the body via inhalation, dietary intake and skin absorption.”
6 of 6

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Increased levels of exposure to nitrogen dioxide contributes to oxidative stress and barrier dysfunction leading to skin surface changes such as the formation of lentigines.

    “Increased levels of exposure to nitrogen dioxide contributes to oxidative stress and barrier dysfunction leading to skin surface changes such as the formation of lentigines [20].”

    From The Environmental Determinants of Skin Health: Linking Climate Change, Air Pollution, and the Dermatologic Disease Burden (2025) · cites this paper as [20]

    Section 6 (Ozone and Nitrogen Dioxide; page not provided) reports an association between nitrogen dioxide exposure and increased cheek lentigines, and says short-term exposure disturbed epidermal barrier function in patients with atopic eczema. It describes oxidative damage from NO₂ but says a similar mechanism in skin only *may* account for its effects. The claimed causal chain from oxidative stress and barrier dysfunction to lentigines is therefore stronger than the source establishes. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Ambient air pollution negatively impacts skin health via four general mechanisms: generation of ROS; induction of inflammatory cascade and impairment of skin barrier; activation of AHR stimulating skin aging genes such as MMPs that degrade collagen; and alterations to skin microflora.

    “two recent reviews have summarized the recognized negative impact of ambient air pollution on skin health, which suggested four general mechanisms by which this occurs: (1) generation of ROS; (2) induction of the inflammatory cascade and subsequent impairment of the skin barrier; (3) activation of the AHR which stimulates the expression skin aging genes such as MMPs that degrade collagen; and (4)”

    From Equol’s Anti-Aging Effects Protect against Environmental Assaults by Increasing Skin Antioxidant Defense and ECM Proteins While Decreasing Oxidative Stress and Inflammation (2018) · cites this paper as [61]

  • Numerous studies have demonstrated that ambient pollutant exposure is linked with the development of the signs of extrinsic skin ageing.

    “Numerous studies have demonstrated that ambient pollutant exposure is linked with the development of the signs of extrinsic skin ageing [28].”

    From Oxidative Stress and Ageing: The Influence of Environmental Pollution, Sunlight and Diet on Skin (2017) · cites this paper as [28]

  • Environmental pollution has a detrimental impact on skin health and can lead to skin ageing.

    “These findings contribute to the growing evidence demonstrating that environmental pollution has a detrimental impact on skin health and can lead to skin ageing [28].”

    From Oxidative Stress and Ageing: The Influence of Environmental Pollution, Sunlight and Diet on Skin (2017) · cites this paper as [28]

Cites

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Related

Authors
Koohgoli, R., Hudson, L., Naidoo, K., Wilkinson, S., Chavan, B., & Birch‐Machin, M. A.
Affiliations
  • University of Guelph (CA)
  • Newcastle University (GB)
  • Croda (United Kingdom) (GB)
Corresponding author
Birch‐Machin, Mark A.
ORCID
Venue
Experimental Dermatology
Publisher
Wiley
Published
2017-02-20
Volume
26
Issue
5
Pages
384-387
ISSN
  • 0906-6705 (ISSN-L)
  • 1600-0625
DOI
10.1111/exd.13257
OpenAlex
W2559007831
Semantic Scholar
d86a80e4a618b9fc45590a9f91c0a42de7e66dab
Cited by
65
References
10
Citations by year
2026: 5 · 2025: 6 · 2024: 8 · 2023: 9 · 2022: 7 · 2021: 6 · 2020: 9 · 2019: 9 · 2018: 4 · 2017: 1 · 2016: 1
FWCI
3.14
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Experimental Dermatology (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • National Institute for Health Research
  • Newcastle University
  • Innovate UK
Topics
  • Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Air Quality and Health Impacts
  • Health Sciences › Medicine › Dermatology › Dermatology and Skin Diseases
  • Health Sciences › Medicine › Dermatology › Skin Protection and Aging
Keywords
air pollution, skin health, environmental pollutants, environmental health risk factors
MeSH terms
Air Pollutants, Air Pollution, Humans, Nitrogen Dioxide, Ozone, Phthalic Acids, Polycyclic Aromatic Hydrocarbons, Skin, Receptors, Aryl Hydrocarbon, Particulate Matter

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Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-10.

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