Air pollution and skin diseases: Adverse effects of airborne particulate matter on various skin diseases
Graphical abstract
Introduction
Particulate matter (PM), which includes the harmful suspended contaminants in the air, is generally encompassed in air pollution [65], [27]. The airborne PM is a complex mixture including particulate contaminants (smog, tobacco smoke, soot, etc.), various types of dust, biological contaminants (pollen, house dust mite allergens, etc.), and gaseous contaminants (exhaust gas from traffic or hood, etc.). It comprises sulfates, nitrates, and carbon compounds in the atmosphere [65], [27]. As a result of rapid industrialization and urbanization, environmental pollution is becoming a severe public problem worldwide. In particular, airborne PM in the ambient atmosphere is highly associated with the incidence of respiratory and cardiovascular diseases and with increased mortality [39], [10], [87]. The World Health Organization (WHO; Fact Sheet N 313, 2014) has established that premature death by air pollution occurs with cardiovascular diseases, respiratory diseases, and lung cancer at rates of 80%, 14%, and 6%, respectively. The ambient PM is the most intimate element of the human health impacts. Recent increased PM concentration in the air pollution is correlated with the increased mortality and morbidity. It affects human health even at low concentration. Due to the significant impacts of small PM, WHO has suggested a guideline for limited concentration of PM. PM10 must not exceed 20 μg/m3 (annual mean) and 50 μg/m3 (24-h mean). In the case of PM2.5, the mean of concentration must not exceed 10 μg/m3 per year and 25 μg/m3 for 24 h.
Airborne PM is classified as particulate matter, fine particulate matter, and ultrafine particles depending on the aerodynamic diameter of particles. Particles that are less than 10 μm are called the particulate matter (PM10) and are inhalable. PM10 is composed of inhalable particles from dusts, industrial emissions, and traffic emissions [27]. Inhalation of PM10 is highly related to various respiratory diseases. Infiltration of PM10 into the lungs results in systemic immune responses, including enhanced lung inflammation due to increasing various pro-inflammatory cytokines such as interleukin (IL)-1, IL-6, IL-8, and monocyte chemoattractant protein-1 (MCP-1) from lung epithelial cells and macrophages. The lung inflammations cause various diseases of the lung and other inflammation-related conditions [29], [27].
In the 1990s, a smaller PM particle size (less than 2.5 μm) was discovered and defined as fine PM (PM2.5). Fine PM is primarily comprised of organic carbon compounds, nitrates, and sulfates [17], [95]. Ambient PM2.5 is increasingly present in the surrounding air and is significantly associated with human health and especially respiratory tract diseases because PM2.5 can reach bronchial tubes and deep lung. In addition, PM2.5 is associated with the exacerbation of cardiovascular diseases and systemic inflammation [24], [16], [80]. A cohort study in which participants were followed for decades has discovered that compared with larger particles, smaller particles like PM2.5 have much more adverse effects on human health [23].
Recently, ultrafine particles (UFPs) have been found in abundance in urban air and defined as a new particle type. UFPs are less than 100 nm in diameter and have greater potential for adverse effects to human health than PM2.5, because UFPs can penetrate into the blood stream and accumulate in the lung and other organs of the body [23], [28]. As well as the size, the composition of UFPs is also important with regard to its impact on human health. Both indoor and outdoor UFPs are primarily from cigarette smoke, engines, cooking fumes, and industry. The most important sources of UFP are vehicular exhausts, especially diesel exhaust that includes black carbon, which contains large amounts of UFP [38] and is defined as a class one carcinogen by WHO. UFP, the smallest PM, result in chronic obstructive pulmonary disease (COPD) and asthma through their deposition in the lungs without the filtration through the nasal mucosa [3].
Although PM is divided into three different types based on the mean of aerodynamic diameter, PM10 generally includes all fractions of PM10, PM2.5, and UFPs [27]. Deposition by inhalation is primarily in the upper respiratory tract (head and comparatively large conducting airway), lower respiratory tract (larynx, small airway, and alveoli), and deep lung (alveoli) for PM10, PM2.5, and UFPs, respectively [27]. These three categorized particulate matters are globally implicated in severe environmental pollution due to significant increases in urbanization and industrialization processes. Given the growing concern about environmental pollution, we have chosen to discuss how PM air pollution affects various diseases, and especially skin diseases.
Section snippets
Review
Skin is the largest organ in body, and acts as the first and most important defense barrier against environmental contaminants. Skin is always exposed to the contaminants, and various industrial chemicals can be absorbed into the skin. These absorbed compounds can cause local toxicity in the skin and systemic toxicity in other organs, although it may enter by percutaneous penetration. The severity of these toxicities depends on the age and medical history of skin diseases. Percutaneous
Conclusion
PM, including PM10, PM2.5 and UFPs, has been adversely related to human health [39], [10]. Many epidemiological studies have shown that the increased ambient PM concentration is highly associated with premature deaths in individuals with cardiovascular and respiratory diseases [39], [10]. Based on the severity of PM-associated human health problems, WHO limits the mean concentration of PM in the air. Here, we focused on the human health impacts of PM, especially cutaneous impacts, such as
Conflict of interest
The authors declare that they have no conflict of interest.
Acknowledgements
This research was supported by Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Ministry of Education, Science and Technology (2012R1A2A2A02046972).
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Hyun Jeong Park and Daeho Cho contribute to this work equally.