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From vector-borne illnesses to pavement burns, climate change poses wide-ranging threats to skin health, particularly in vulnerable populations, according to some of the authors of a clinical image series recently published in The New England Journal of Medicine’s Images in Clinical Medicine section.

The cases were accompanied by a note that said that the featured images “spotlight some of the effects of the climate crisis on clinical health.”

Vector Spread

One case was a 65-year-old man who presented with an itchy rash on his hip 1 week after removing an adult female Lone Star tick (Amblyomma americanum) from the area. The rash’s bull’s-eye appearance helped authors led by Eva R. Parker, MD, DTMH, assistant professor of dermatology at Vanderbilt University Medical Center, Nashville, Tennessee, diagnose southern tick-associated rash illness (STARI). There is no diagnostic test for STARI, since the causative organism remains unknown.

The Lone Star tick’s range has spread from the southern United States (including Tennessee, where this case was diagnosed) to the northeastern United States, Parker and her co-author, Misha Rosenbach, MD, professor of dermatology at the University of Pennsylvania, Philadelphia, wrote. “This change in distribution is attributable at least in part to climate change, and further geographic spread of the vector and a longer active season are anticipated as temperatures increase,” they noted.

In a separate case, a 3-year-old boy who had recently immigrated from Venezuela to the United States presented with a 6-week history of painless bumps and ulcers on his leg, which developed after he had insect bites on his foot. Histopathology showed severe lymphohistiocytic infiltration, but no organisms were identified by routine stains. Polymerase chain reaction testing identified Leishmania guyanensis, a parasite transmitted by phlebotomine sandfly bites, and he was diagnosed with cutaneous leishmaniasis.

“Climate change is affecting the spread of leishmaniasis by altering the geographic distribution and size of sandfly populations. People experiencing poverty and migration are at highest risk for acquiring the infection,” wrote the authors of this case, led by Umber Dube, MD, PhD, of the University of California, San Diego, and Dawn Eichenfield, MD, PhD, of Rady Children’s Hospital, San Diego.

Pavement Burns

The third case was a 56-year-old man with a history of alcohol use disorder, who was treated at a burn center for second-degree pavement burns. While intoxicated, he had walked barefoot on asphalt for 1 minute during a regional heat wave in the Pacific Northwest that created maximum air temperatures of 108°F, about 38°F higher than historical averages. “Extreme heat events increase the risk of contact burns from hot surfaces in the environment. Young children, older adults, unhoused persons, and persons with substance use disorder are at elevated risk for these types of burns,” wrote the author of this case, Jeremy J. Hess, MD, MPH, of the University of Washington, Seattle. 

At press time, all three featured cases had resolved or were resolving with standard treatment.

In an interview, Rosenbach said that clinicians should be talking about climate-related issues because these issues are changing when, where, and which patients present with skin diseases and other manifestations.

Having climate change impacts highlighted in The New England Journal of Medicine helps to emphasize that such issues can affect every organ and medical subspecialty, said Rosenbach. “If people aren’t staying up to date and informed, that can lead to missed or delayed diagnoses.”

Knowledge Gaps

“While many physicians are becoming more familiar with climate impacts on disease in general,” Parker told Medscape Dermatology, “there are still large gaps in our knowledge.” Many medical schools and residency programs fail to teach this curriculum, she explained, and practicing physicians have limited opportunities to learn it.

The American Academy of Dermatology (AAD) Annual Meeting included sessions that highlight the climate impact on skin disease. Additionally, a sustainability session at the upcoming AAD Innovation Academy meeting will address how dermatologists can limit the environmental impacts of care delivery. And for providers needing a basic understanding, the AAD basic dermatology curriculum includes free climate change modules. Dermatologists who wish to help raise awareness can join the AAD’s Climate Change and Environmental Affairs Expert Resource Group (ERG), Parker added. She and Rosenbach are co-chairs of the ERG.

Many international dermatology meetings also spotlight the issue — usually more so than domestic meetings, Parker said.

Special journal issues devoted to climate change include a January 2021 edition of the International Journal of Women’s Dermatology coedited by Rosenbach. Additionally, Parker and Rosenbach plan to coedit an early 2026 issue of Dermatologic Clinics.

Climate change alone causes no specific disease. “It’s all existing diseases that are exacerbated by climate change,” said Parker. “Or the epidemiology has changed because of climate change. So a heightened awareness among clinicians to consider climate impacts on skin disease when evaluating patients and to collect environmental histories and act on that information, is critical. It means a pivot in our way of thinking.”

Along with helping physicians recognize the shifting patterns, she said, “it’s an opportunity for us to educate our patients.” One of her recent patients could not believe she had a tick bite in April. “In Tennessee,” said Parker, “I sometimes pull ticks off in January and February now.” Accordingly, she said, people who do outdoor activities must protect themselves year-round.

The cases were published online in The New England Journal of Medicine on April 19 and 23.

Parker and Rosenbach reported no relevant financial relationships. Their comments reflected their own personal opinions, not the position of the AAD.

John Jesitus is a Denver-based freelance medical writer and editor.