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December 12, 2025“The skin is the body’s first line of defense against air pollution. Inevitably, it becomes a target for toxic particles and molecules, which can penetrate deeply, triggering a strong immune response,” says dermatologist and venereologist Dr. Markos Michelakis, from EDOEAP. “It has been found that people exposed to wildfire smoke are at increased risk of developing atopic dermatitis (eczema) and itching. Some of the toxic substances in the smoke appear to damage the skin barrier as well as the skin microbiome.”
The skin barrier is the outermost layer of the skin, composed of keratin, and serves two main functions. It protects the body from external pathogens, chemicals, toxins, and allergens, while also helping maintain internal fluid balance, preventing dehydration.
Similarly, the skin microbiome consists of colonies of beneficial microorganisms that play a crucial role in protecting against pathogens and ‘training’ the immune system.
Anything that damages the skin barrier or microbiome can lead to serious skin problems. In fact, toxic chemicals in wildfire smoke have been linked to flare-ups of inflammatory skin conditions such as atopic dermatitis and psoriasis. Additionally, smoke byproducts like carbon monoxide and sulfur dioxide have been associated with premature skin aging, leading to more wrinkles and discoloration.
A study published in 2021 in JAMA Dermatology showed that during the large California wildfire in November 2018, weekly dermatology visits by children with atopic dermatitis increased by 49% compared to weeks without fires. The corresponding increase in adults was 15%.
However, this study focused on medical visits in San Francisco, located 280 kilometers from the fire zones, meaning the increases in closer areas were likely much higher.
The wildfire lasted nearly two weeks. Of the adults seeking care for atopic dermatitis and itching, 89% had no previous diagnosis. Scientists are unsure whether these individuals had subclinical (symptom-free) eczema that was triggered by the smoke or if the smoke caused the condition directly. Either way, something in the wildfire smoke led to the onset of dermatitis.
The same research team published another study in 2022 in JAMA Network Open, showing that wildfire smoke exposure increases atopic dermatitis flare-ups, particularly in older adults (65+ years).
For patients with existing skin conditions, flare-ups may also appear later. According to a recent statement from the American Academy of Dermatology (AAD), patients with psoriasis are more likely to need medical care 5–9 weeks after the fire, whereas patients with atopic dermatitis are more likely to experience flare-ups during the fire itself.
“These differences likely reflect the distinct biological mechanisms behind atopic dermatitis and psoriasis,” explains Dr. Michelakis. “Eczema is primarily an allergic condition, while psoriasis is autoimmune. Both involve immune reactions, but the responses are entirely different.”
Studies also show that during wildfires, prescriptions for atopic dermatitis medications rise significantly, suggesting that smoke-induced flare-ups are more severe than usual.
Online searches for skin issues like atopic dermatitis, itching, and acne also increase during wildfires, according to a 2022 study published in the Journal of the American Academy of Dermatology.
The key question is what we can do to protect ourselves. “On days with poor air quality due to smoke, it is advisable to wear long-sleeved shirts, long pants, and, if necessary, a protective mask,” says Dr. Michelakis. “Even more effective may be avoiding travel unless absolutely necessary. No studies have yet shown whether additional measures, such as more intensive skin hydration, would help. What is certain is that the effects of climate change are already becoming apparent not only in the environment but also in our bodies, and this should strengthen everyone’s environmental awareness.”
https://www.aad.org/news/climate-change-wildfire-smoke-skin
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5967208/
https://www.nytimes.com/2021/08/26/style/skin-care-climate-change.html
https://jamanetwork.com/journals/jamadermatology/fullarticle/2778632
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2797721
