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from a lipid membrane to the DNA in a cell’s nucleus, in an
attempt to steal the last electron needed to stabilise themselves.
This process causes intracellular chaos. The damage causes
inflammation, led by cytokine generation, which not only affects the
cell itself, it over-spills into surrounding structures, causing collateral
damage of the tissue.3 Activation of matrix metalloproteinases
UV exposure also activates destructive intracellular enzymes,
known as matrix metalloproteinases (MMPs). This group of enzymes
includes collagenase, which cause the breakdown of collagen and
elastin. In a different context, the activation of MMPs is essential for
the remodelling of connective tissue and wound healing. However,
when UV radiation and toxic pollutants artificially trigger this process,
it causes premature collagen breakdown, which leads to accelerated
ageing of skin cells, and ultimately the visible signs of ageing, in
particular, wrinkle formation and volume loss.4
The Effects of
Pollution
on the Skin
Dr Jane Leonard discusses how
environmental factors such as UV
radiation and pollution can affect
the skin and details how to recognise
related skin conditions in patients
The primary purpose of the skin is protection; it provides a
physical barrier against radiation, toxic chemicals, and water
exposure to protect the internal organs. In carrying out this
function, the skin encounters inevitable harm which leads to the
signs of skin ageing that we are familiar with: wrinkles, fine lines,
altered pigmentation, loss of volume and skin tone. We know that
both internal and external factors lead to skin ageing; internal
factors include smoking and excess alcohol, and external factors
include sun exposure through UV radiation and environmental
pollution. I have come across many different theories of how
exposure to pollution can lead to skin ageing. The most widely
accepted is the theory of free radicals and oxidative stress. This
states that the accumulation of free radical damage and oxidative
stress creates a cascade of intracellular damage, which impairs
cellular processes that allow skin cells to divide in order to grow
and repair themselves.1,2
Oxidative stress and free radical theory
It is commonly accepted that UV radiation and photoageing cause
the majority of visible signs of ageing. When UV radiation comes
into contact with the skin surface it initiates the production of free
radicals and the formation of reactive oxidative species (ROS).3
Examples of these are oxygen ions, free radicals and peroxides.
ROS are highly reactive, unstable molecules due to the presence
of their unpaired electron. They will attach themselves to anything
Chemical pollutants
UV radiation is not the only environmental factor that causes
skin ageing. A landmark study in the Journal of Investigative
Dermatology compared women living in urban and rural
environments over 24 years and found that those living in the
urban area that had been exposed to increased pollution had more
dark spots and wrinkling.5
Microscopic particles are released into the atmosphere every
second from fires, power plants, construction sites and motor
vehicles. These tiny chemical particles create an invisible but toxic
film on the surface of the skin.6 The microscopic size of the particles
allows them to easily penetrate the skin pores, making their way
through the deeper layers of the skin to eventually target the
skin cell nucleus. They create a cascade of intracellular damage.
This process is driven by the activation of free radicals leading to
oxidative stress and the activation of MMP, both described above.5
It also triggers a phenomenon known as replicative senescence;
this is a process of cellular ageing, where the cell can no longer
replicate. This is a natural process but it can be triggered prematurely
by the effects of UV radiation and environmental toxins. The hallmark
of this process is the shortening of telomeres at the ends of DNA
strands, which help ensure chromosomal stability. Skin cells are some
of the most rapidly dividing cells in the body; when DNA is damaged,
it is susceptible to replicative senescence, which means they are no
longer able to divide, multiply and repair themselves.5
The additive effect of these processes leads to intracellular and
collateral inflammation and dehydration of skin cells and surrounding
structures. This causes collagen breakdown and damages the lipid
layer of the skin, thus impairing its barrier function, which manifests
itself in the loss of elasticity, firmness and volume.7
Ozone effects
The ozone also has an impact on skin ageing and can trigger
exacerbations of pre-existing skin conditions.8 The ozone exists
in the stratosphere and troposphere and is also found in low
concentrations at ground level as a by-product of human activities,
which release chemical pollutants into the atmosphere, such as
smog. The effects of the ozone are amplified by the presence of
other environmental factors such as UV radiation and other toxic
pollutants.8
Studies suggest that the ozone, like other chemical pollutants, first
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targets the stratum corneum and start to penetrate down to the
dermis. Their path of destruction is driven by oxidative stress, the
formation of free radicals and MMP activation.8
The presence of the ozone induces epidermal damage to the skin
through collagen breakdown and impairing the lipid membrane
of skin cells to inhibit their barrier function. In addition, the ozone
also inhibits the protecting effects of antioxidants, making harmful
damage inevitable and irreversible once the process has started.
The inflammatory aspect of ozone damage has been associated
with a flare-up in skin conditions including; urticaria, eczema,
contact dermatitis, and other nonspecific eruptions.9,10,11
with inflammatory changes in the skin, and the flare up in existing
or new skin conditions such as acne and dermatitis.
Skin conditions triggered by pollution
In addition to premature ageing, what ailments can pollution trigger in
the skin?
Examination
Carry out a full facial assessment, paying attention to patterns
of wrinkle formation and volume loss, and ask yourself: are
they localised or global? Are they associated with hyper/
hypopigmentation? How is the skin texture? Does this pattern
extend into the neck? Is the extent of the ageing consistent with
the age of the patient? It is also useful to examine the patient’s
hands too, rather than just focusing on the face, as hands and face
are often the main areas suffering repeated exposure to the effects
of the environmental pollutants.
Chloracne
Acne and the effects of acne are something that most practitioners
are familiar with. On rare occasions, environmental pollution can
result in an acne variant called chloracne, also known as halogen
acne. Chloracne results from environmental exposure to certain
halogenated aromatic hydrocarbons. The skin’s manifestations
of acne indicate systemic poisoning by these compounds.12 Von
Bettman first observed chloracne in 1897, followed by Herxheimer
in 1899.12 Today, chloracnegens are thought to include
polychlorinated compounds, such as herbicides. Chloracne is
caused by direct contact of the toxins with the skin, however some
cases have been documented which involve ingestion or inhalation
of toxins too.13 Although chloracne tends to slowly resolve upon
cessation of exposure to chloracnegenic compounds, the duration
of chloracne correlates with the severity of the disease.13 Like other
causes of acne, chloracne can be challenging to treat. The most
effective documented treatment is topical treatment with retinoids.14
Irritant contact dermatitis
The direct effect of toxic chemicals on the skin surface can lead to an
eczematous eruption. Commonly this condition is caused by cosmetic
products or a change in washing powder, for example, but it can also
be triggered by toxins and solvent in the atmosphere.15
Chemical depigmentation
Exposure to environmental chemicals can also have a destructive
effect on epidermal melanocytes, which can cause hyper or
hypopigmentation of the skin known as chemical depigmentation,
which resembles vitiligo. The most common causative agents
are derivatives of hydroquinone and related compounds.16
Occupational leukoderma is commonly observed, where chemicals
have a depigmenting effect on the skin, which is typical in workers
who have skin contact with them. This condition tends to have a
hypopigmenting effect on the skin called chemical leukoderma,
which unfortunately has no specific treatment.16
Recognising the signs
The signs of accelerated skin ageing caused by pollution
are similar to those we are all aware of. When caused by
environmental exposure to UV, in combination with toxic
chemicals, the skin signs tend to show changes in skin texture
and pigmentation, rather than the formation of lines, wrinkles and
volume loss alone. The signs of skin ageing, secondary to UV
radiation and environmental pollutants, are also often associated
History
When assessing patients it’s key to talk thorough their history, in
particular occupational history, their sun exposure and exposure to
chemicals or toxins. In patients with pre-existing skin conditions such
as eczema, acne or dermatitis, ask about triggering and relieving
factors, to see if a pattern emerges in association with environmental
changes, i.e. do symptoms only flare up at work? Are they seasonal?
Are they triggered by the use of particular cosmetic products?
Management
Antioxidants
Antioxidants prevent against free radical damage and oxidative
stress through stabilising the free radicals by donating one of their
own electrons to neutralise them and ending the ‘electron stealing’
reaction. This ends the path of destruction in the skin cell nucleus,
which can lead to inflammation and collagen damage.17
Antioxidants can be applied to the skin directly, in the form of
creams or serums, or can be obtained from dietary sources.
Vitamin E is the most abundant fat-soluble vitamin in the body and
defends against oxidation and lipid peroxidation.18
Vitamin C is a water-soluble antioxidant, which acts primarily
in cellular fluid. It also helps to return vitamin E to its natural
form. Topical preparations need to be able to penetrate the
outmost barriers of the skin’s surface in order to reach the
cell nucleus to have the desired effect.19 The dietary effects of
antioxidants are controversial; as little as 1% of antioxidants taken
orally reaches the surface skin where they are needed to carry
out their protective role.19 That said, a diet rich in antioxidants
should always be encouraged as their benefits are not exclusive
to skin; research shows antioxidants have other health benefits, in
particular protecting against cardiovascular disease and cancer.20 Cleanse
Thoroughly cleansing the skin surface to remove the invisible film of
toxic pollutants gathered over the day is the first step in protection.
Cleansing and exfoliating with products containing alpha hydroxy acids
(AHA) like glycolic acid, are excellent as they to help to chemically
exfoliate the skin and encourage new skin cells to the skin surface.
Protect
Sunscreen is fundamental to protecting the skin from harmful UV
rays. It provides a physical barrier to prevent UV radiation coming into
contact with the skin, which creates the harmful free radical cascade.
SPF 50 is recommended for complete protection. It should be used
separately as the final part of the skincare regime, and not combined
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with moisturisers and foundations, as they are less effective.
High factor sunscreen is especially important when using
products containing AHAs as they increase the photosensitivity
of the skin.
Summary
UV radiation, ozone and chemical pollutants can all cause
premature skin ageing by the activation of free radicals and
matrix metalloproteinases, and oxidative stress. This leads
to intracellular inflammation and the breakdown of collagen
and elastin. Damage can be minimised by effective cleansing,
application of antioxidants and, most importantly, application
of sunscreen.
Dr Jane Leonard is a GP and cosmetic doctor. She
specialises in skin conditions, antiageing medicine
and bio-identical hormones. Dr Leonard achieved a
first class honours degree in Anatomical Sciences,
specialising in head and neck. She has also
spent time in dermatology research and has had her worked
published in Australia.
Aesthetics
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Advances in Aging research, (2014), 3, 265-284, p.266
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S267-271
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